- Can you quickly introduce yourself: who are you, what has been your career path and where are you today?
Hello ! My name is Maria Alice and I am currently finishing my psychiatric internship. I studied medicine and then chose to specialize in mental health. The psychiatry residency lasts four years and consists of eight six-month rotations.
- Why did you choose psychiatry?
There were several reasons why I chose to become a psychiatrist. First of all, I find that it is an extremely rich and diverse specialty. All ages can be concerned, from babies to the elderly, as well as all social classes. In psychiatry, we cannot limit ourselves to the symptoms presented by the patient. We must look at the individual as a whole, taking into account his or her family, social and professional development, for example. Internal and external factors, specific to each individual, are involved in the psychopathology of disorders, which makes each clinical picture unique. Moreover, several approaches are possible. From neurobiology to psychoanalysis, the practice of psychiatry is vast. However, the relational aspect remains at the heart of the treatment. Although the mechanisms of psychiatric disorders remain poorly understood, several explanatory hypotheses have been formulated. This is an area of medicine where knowledge is still being developed. Numerous research projects in genetics, brain imaging, neuroscience, and many other fields are underway in order to clarify the physiopathological mechanisms. It is therefore a dynamic specialty that is continually evolving. In addition, I find it interesting to work with the notion of stigma that psychiatric patients suffer. Society has many false prejudices about mental disorders. However, psychiatric pathologies are not rare, for example, one French person out of five suffers or will suffer from depression in his life. Generally speaking, it is easier to understand and accept an illness when a diagnostic test exists, or when a lesion is visible (on the skin, on an imaging test or even on a blood test). In psychiatry, this is not really the case yet and this is why research is developing a lot. Finally, this is a very transversal specialty. It implies an openness to ethical, social and transcultural issues that I find really fascinating!
- Do you have one (or more) speciality(ies)? If so, why did you choose this one in particular ?
During my internship, I had the opportunity to discover different services. I worked in addictology, child psychiatry, medical and legal emergencies, a unit for resistant pathologies and a crisis unit. Each service brings a specificity in the care of the patient and several therapeutic tools can be used at the same time. Personally, I intend to work in a general psychiatry service later on, as the general adult clinic is what I am most passionate about.
- How do you think care, especially in CH/HP or in medical-psychological centers, can be improved?
I think that the dissemination of mental health information to the general population would help fight against misconceptions. There might be a little less reticence among some patients and possibly less delay in diagnosis among some young subjects. Moreover, the French health system is very well recognized, but it is not perfect. Psychiatry remains the poor relation of medicine and more means would be necessary for a better organization of psychiatric care. In the hospital, the lack of beds is felt in certain departments. Caregivers are sometimes forced to maximize the capacity of their beds or to rush the end of certain stays in order to free up space. It is not always comfortable to work in this way, both for the carers and for the patients. In the outpatient department, the lack of resources is also felt. The waiting time for consultations is sometimes too long and places for therapeutic activities are scarce in certain medical-psychological centers, particularly in child psychiatry. However, improving the quality of care outside of the hospital can reduce the number of hospitalizations. I think that these elements would make it possible to improve care in psychiatry.
- What were your first experiences in psychiatry like? If there were any, how did you handle the difficulty? Do you have a funny anecdote to tell us?
I don’t think I’ll ever forget my first experiences in psychiatry. I was lucky enough to do an internship in a Parisian hospital ward at the beginning of my medical studies. I was a very young student at the time and so was very much supervised by my seniors. I was immediately intrigued by the clinical pictures that were presented to us, and above all, by the clinical evolutions that I was able to follow at that time. I found, and still do today, the psychiatric symptoms fascinating and my curiosity was quickly aroused. One question kept circling in my head: how could someone develop such symptoms? I still don’t have the answer to this question, but I think these early experiences played a big role in my choice of specialty.
- Do you think that psychiatrists have something to gain by working with health professionals of different backgrounds? (psychologists, psychotherapists, sophrologists, nurses…)
Of course! I think that this is essential. I think that the term to use here is complementarity. Ideally, we should look for the most appropriate treatment for the patient’s problem. The intervention of different professionals allows for a broader approach to the difficulties encountered by the patient, which greatly optimizes his or her care. Nurses, psychologists, occupational therapists, speech therapists and others all contribute to the good of the patient and this only improves the care.
- What advice would you give to a young person between 18 and 25 who is suffering from mental illness? How do you distinguish between normal and pathological difficulties in the adolescent’s passage to adulthood?
First of all, I would tell him that it is already a big step to have recognized that he is suffering. Then, I would try to identify with him the nature and the severity of his suffering in order to be able to propose the most adapted solution. The functional impact is a criterion to be systematically taken into account in psychiatry: do the symptoms imply a dysfunction in the different spheres (personal, family, social, school, etc.) of the individual’s life? Adolescence is a period of transition with a lot of physical, psychic, identity and relational modifications. Faced with a symptom, it is sometimes difficult to distinguish the pathological from the non-pathological, especially during adolescence. It is therefore necessary to proceed with a meticulous interview in order to collect fine clinical elements allowing to decide what could be potentially pathological or not. However, it is important to know that the symptoms are not fixed. They also evolve with the individual. In general, the earlier the symptoms are treated, the better the prognosis. The help of a professional is sometimes necessary, even if only temporarily, to prevent the symptoms from getting worse and a pathology from developing.