Category Archives: Psychiatry

Passing Time

It never feels like that much time has passed between posts..and then I look at the date. Despite being on a “year off,” times seems to pass by extremely quickly.  I suppose that is what happens when every weekend is excellent. A few months ago, I spent an awesome, sleep-less 3 days in NYC with some good friends from California. Not only did I spend time with amazing people, I also spent the weekend doing touristy things intermixed with things that could only happen in NYC.

While we were there, we had the opportunity to tour Donna Karan’s Urban Zen Foundation (THANKS DHRUMIL!). As I understand it, the Urban Zen Foundation is inspired by Donna Karan’s husband Stephen and his battle with lung cancer. Having first hand experience with patient care, Donna focuses on the fusion of western and eastern medicine. While we were touring the center, the foundation was hosting a large training session for yoga instructors involved in patient care. Because of Dhrumil’s natural charms, we had the opportunity to sit down with Rabbi  Stephen Robbins, a kabbalist and psychologist.

Sitting down with him, he recounted numerous encounters with patients dealing with emotional and psychological barriers. While medical school makes me very skeptical of non-traditional, little researched forms of “medicine,” I do believe attitude and mood play a significant role in patient outcomes. After all, we are often told about the importance of hope and having the will to live.

The half hour to forty-five minutes we spent with the Rabbi were incredibly interesting. While I am still skeptical at his ability to improve outcomes for concrete diseases with a known pathophysiology, I do see how his work could benefit people whose state of mind affects their disease. On my psychiatry rotation, it was pretty clear that there was a fine line between sane and crazy. In many cases, there was some significant trauma or a sustained external factor that would often push an individual in one direction versus another. As one of my preceptors would say, “we all have the potential for crazy, we just need the push.”

If I had one patient that I could send to the Rabbi for treatment, I would have to pick a patient that was on my service on medicine. Having to switch to a new team in the middle of a rotation was always difficult. New attending, new residents, new interns and new patients with their own set of problems. This particular patient on our service stuck out…in a good way. He was incredibly nice. He was understanding of delays. And, he was constantly showering our team with unnecessary praise.  As a recovering addict, he had been on long-term methadone treatment. He was admitted for palpitations and EKG changes that were side effects of his treatment. Our plan for him was to wean him off Methadone and switch him to another form of treatment. On his last day in the hospital, he thanked our entire team for our hard work. He even left with the name and business contact information for the intern taking care of him, vowing to return to clinic to see her.

A few days later, while rounding, we saw him again. He was in a hospital gown being followed by a nurse.  As he walked by us, he started at us as if he had never seen us before. It was almost eerie to see the lack of recognition in his eyes. While we wondered why he wasn’t bounced back to our team for treatment, an interesting story  emerged. He had been taken to the emergency room after dunking his head into a fish tank in an Asian restaurant and spitting water at the diners. Upon arriving at the hospital, he was admitted under a different name….one that was in the system….one that he had used in the past. He had no recollection of his previous hospital stay or even the person he was just a few days earlier. After several attempts to escape the 6th floor through a small open window, he was transferred to a psychiatric hospital.

It’s one thing to hear about “Multiple Personality Disorder” aka Dissociative Identity Disorder (DID) but another thing to meet someone who has it. To have no recollection of an alternate life you have created for yourself is really an amazing and scary thing. Genetic predisposition aside, I’ve often wondered how jarring the inciting event would have to be to result in the development of multiple personas.  Considering that DID is thought to be caused by physical/sexual abuse during childhood, it’s no surprise that this disorder predominately occurs in women. As you can imagine, therapy is critical in merging the different “alters” that are created to process the trauma.

So while I don’t ALWAYS see a place for “eastern medicine” in daily practice, meeting patients like this one is a reminder that western medicine doesn’t always offer concrete solutions for the complete spectrum of human disease. In many cases, alternative treatment strategies can complement traditional western medicine in providing patient care. Perhaps there is a greater place for those lessons in medicine that have been passed down from generation to generation (hardar nu dood anyone?).

On a side note, I’ve become obsessed with this song. Hope you enjoy it as well!