being with people is the essence of psychiatry

March 24, 2007 § Leave a comment

"Being with people was all that kept you going this year… And ‘being with’ is the essence of psychiatry."

Berry to Roy, The House of God- Samuel Shem


Eric was an intern doing so well in his psychiatry theoretical exams and rotation. He has respect for the discipline an the patients. He thinks it’s difficult and too subjective. And to him, even the psychotic patients are humane, although not what the world would say sane. And it’s always with that respect, he approached psychiatry with confidence. He knew he had to study, to learn how to approach patients and respect them. Always respect them.

The respect could be traced to the fact that his uncle had been a successful psychiatrist, always encouraging him to do well in psychiatry. Or to the fact that he’s a fanatic reader of Paulo Coelho, once a patient of a psychiatric hospital, who wrote about spirituality inside the institution.

There were times when he came back from the ward excited to tell his friends and family about what delusional patients did. But there were times when he contemplated patients in silence, and admitted that amidst the lost sanity, their essence of being is undeniable.

And he sailed through psychiatry with grace: the grace of an intern who’s able to listen, acknowledge symptoms, diagnose and manage patients.

His mother said, "You have talent for this." For psychiatry. His uncle commented similarly. And he’s amused by their sayings. What talent? Which, if there’s any?

Psychiatry is not the perfect storm and high tide like obgyn, surgery, or internal medicine. It is a calm ocean with turbulence underneath the surface. Each patient pulls you in a strong current to the individual inner-working of their mind. To diagnose is to let yourself being pulled into a patient’s reality, sometimes too far away from ours. And after each working day with psychiatric patients, you try to swim against that current, fight your way to the shore, to the safety of the beach where then you lie exhausted. Tired. 

What’ s the talent? Or perhaps interest, in combination with facilitation by life circumstances, as geneticist would rather say.

And by the time he read "The House of God", page 349, the answer was there. Answer that couldn’t have been more precise. "Being with people was all that kept you going this year… And ‘being with’ is the essence of psychiatry." That’s it. Being with people. That’s his talent, his interest. That’s why he had gracefully sailed through psychiatry. Not because he was exceptionally intelligent, not because he liked psychiatry. It’s because he liked being with people. Thus he could stand the patients, the disorders, the pain of the patients family. He’d genuinely liked being with people.

He probably wouldn’t do psychiatry. The swimming to the shore exhausted him, and he wouldn’t want to spend his life being emotionally drained by efforts to get back to reality nor being too deep in the current that he’d lost himself in it. Being with people brings him joy, fullness, and love of life. Being with people is a way of life; and you choose how you want to do it.


Minervaplaats-Nijmegen, 23 March 2007



I have the chance to read The House of God myself. And having gone through internal medicine rotation in Kariadi Hospital, I know how dehumanizing the experience can be. It’s under the title "internal medicine", in December 2006 link. I couldn’t feel anything during my rotation there. I was lost in the exhaustion and constant pressure. This novel is a vivid documentation of an intern’s life in the hospital. Not just what he learnt, but also what he did, felt, and didn’t feel during the period.   


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