Talk Therapy

The June issue of JAMA Internal Medicine included a powerful Perspective piece from Dr. Colleen Farrell, an internal medicine resident, who reflected on her own mental illness in the wake of young physician’s suicide in her city. Physician suicide is a horrible, insidious issue, and it’s clear that more needs to be done to address the underlying environment in which a medical trainee feels like suicide is a reasonable option.
Dr. Farrell’s piece was remarkable not only for its mission to raise awareness about this important issue, but also for her candor and eloquence is describing her own experience on the other side of the doctor-patient relationship.
When she struggled with depression as a fourth-year medical student, Dr. Farrell was able to ask for and receive the help she needed. She writes,
“…in being forced to see that I too suffer and need care, I learned one of the most valuable lessons of my time in medical school: that I am not fundamentally different from my patients…When, in time, I began to unearth my pain, the people who helped me heal listened to me without flinching. They showed me how to have compassion for myself. They showed me what it means to be a healer.”*
This, to me, is one of the marvels of talk therapy, and indeed, one of the main draws of psychiatry as a field. A few months ago I worked as a sub-intern in a Partial Hospitalization Program — a voluntary 6-week day program for adults who had been recently discharged from the inpatient psychiatry ward. At PHP, the day consisted of a variety of group therapy offerings as well as the freedom to talk to the staff psychiatrist or social workers at any time. Or, should they feel like it, the sub-I — me.
I was surprised to find that after a few days, patients did indeed start to seek me out. They felt comfortable talking to me, and I was more than happy to sit and listen. It wasn’t the same as chatting with a friend, and both of us knew that, and were okay with it. I tried to mimic the active listening skills of residents and attendings I admired, with one important difference — I wasn’t a doctor. I wasn’t there to diagnose, and the patients knew that I couldn’t change their medications. I was just there to help, as much as I could on our acid-green plastic chairs within the confines of four walls.
Dr. Farrell remarks that her healers listened to her “without flinching,” and it was startling to realize how much I could help my patients in PHP by simply listening without judgment. Each “Hey Sara, do you have a second?” could turn into anywhere from twenty minutes to two hours of quasi-therapy, after which the patients almost always seemed a little livelier than when they came in. And that change wasn’t from a pill, it wasn’t from a procedure, it was from me — or rather, from us. It was intoxicating.
I don’t think I’m alone among medical students when I say that one of the strongest draws of becoming a surgeon is the satisfaction of a quick fix. The patient has a tumor, and then they don’t. An inflamed appendix is making a patient miserable, and then it isn’t. All because of you (and the anesthesiologist, the scrub tech, the circulating nurse, the first assist, and the medical student retracting for four hours, but mostly you). Psychiatry and surgery are very different fields, but there’s a reason why I did back-to-back sub-internships in both. They share a gravity and a satisfaction. In both fields a patient entrusts you with their deepest self, either mental or physical. And sometimes, you can offer them a life-changing intervention. I think there’s less of a difference between cutting to bone and cutting to the soul than we realize.
*Farrell CM. A Physician’s Suffering — Facing Depression as a Trainee. JAMA Intern Med. 2018;178(6):749–750. doi:10.1001/jamainternmed.2018.1520
