Emotions are intriguing and mysterious. And they are open to interpretation – depending on whose point of view is taken into consideration – the emoter or the interpreter. When you are the emoter then you are said to be in an emotional state. When you are the interpreter you are said to be empathic. When you are the emoter and the interpreter then you are said to be self evolved. Can’t pretend emotions can always be understood or expressed adequately or as intended but they do add little something to our lives which we all seem to value incredibly.
During my days as wide eyed undergraduate I found my psychiatry lessons interesting but I somehow imagined that the subject will always remain in the sidelines as I manage the other real stuff like diabetes, heart disease, kidney problems, and all such pizzazz. Not saying that I didn’t appreciate the significance of mental health but I imagined that knowing my depressions from my anxieties and knowing my psychosis from neurosis will equip me well enough to deal with all that my patients will need from me.
But I have learnt slowly that the psychiatry lessons never stop for a general practitioner and the greatest teachers are the patients. They are way more complex… or perhaps far simpler… than I initially thought, all depending on how I choose to look at them or relate to them.
They have taught me that it’s not possible to put every mental health problem in a few well labelled boxes I brought to the table. In fact I’m finding out that these neat boxes are only the tip of the iceberg in a far more scattered and confusing sea of dysthymias, adjustment disorders, interpersonal issues, personality problems, anger and emotion dysregulation, substance use which are present everywhere around us, sometimes glaring and commanding attention but generally much meeker and quieter and hiding under the layers of physical health issues which don’t seem to shy away from attention as much as the mental health ones.
Over the years my patients have gently but firmly guided me to strive to gain better understanding of their emotions, making quite clear that unless I understand their emotions I am going to struggle to get best outcomes in managing their health. It’s driven home the fact that I’d read hundreds of times before – chronic and longitudinal care. The relevance of what a GP does for a patient in comparison to 10 other health care professionals involved in their care makes sense now. Every health care worker’s contribution is significant and irreplaceable but it takes the bond of the patient with the GP to keep it all tied together.
I’ve learnt this from the silence I have heard from my diabetic patient who just never seemed to be able to regulate his sugar levels, no matter how hard his GP, endocrinologist, diabetic educator tried. I heard about his non verbally communicated struggles of not being able to control his emotions and the related comfort eating and the seeming non caring for his own health. In the noise of his behavioural problems, I also heard the silent plight of his feelings of guilt and inadequacy in relation to the impact of his poor health on his family and his worry about his ability to continue providing for them. I was at the receiving end of his external frustration which seemed to be directed at everything and everyone but himself. But because he didn’t press all the keys needed to unlock the codes of various mental health boxes I had lined up on consulting table, he kind of just hovered over the boxes, not getting the permission to enter any but refusing to let go either.
This situation seemed to repeat itself with all the health care professionals he came in contact with in his pursuit to achieve better health. It sometimes made him short tempered and angry, acquiring him the label of rude and aggressive patient. This also frustrated his health care professionals as despite their best efforts he just seemed to be help seeking with poor self motivation.
So what’s not working out in this situation? Is it the patient who has been equipped with all the help he needs in managing his health but doesn’t seem to be able to do so? Or is it the health care professionals who can perhaps sense that this is not a happy individual who is not being able to exercise enough will power or restrain in helping himself and there’s little they can do as on more occasions than not they have waiting rooms full of similar patients demanding their time and attention, leaving them under serious time constraints and then they just deal with the superficial layers of physical health issues, hoping that the person will sort out their emotions in due course. Or if they get worse enough then they can be put into a mental health box which then makes it bit less chaotic to deal with the problem.
The patient can generally sense when his health care professionals are getting tired of his confusing and disorganised emotions and behavioural problems with constant and recurring inability to help himself. I regularly come across a number of patients who report judgement from their health care professionals when it comes to confrontation with their out of the box mental health issues.
As time is going by, the only constant I am learning is that emotions are complex, they are individual and hard to be understood in their entirety. But there’s also another constant truth that generally people just want to feel happy and normal, howsoever they interpret normal to be. They don’t want to self harm, take drugs, treat their bodies badly by abusing them with unhealthy diet, lack of exercise and relaxation and general loss of purpose and motivation in their life. If they are doing all these things then they need a friend and guide and not judgement.
And health care professionals are in a fortunate and privileged position to be able to be there for them. People generally figure things out themselves, all they need is some validation and guidance.
The day I stopped telling my patient what to do to manage his health better and started listening without judgement I learnt about the difficult childhood he had growing up in the shadow of a dominant and alcoholic father. As he spoke some more, I quietly put the mental health boxes away and stopped worrying about which one to put him into. We then spoke some more and discussed about how does he ever see himself moving forward, towards better health and he told me that he’d already done this. He’s opened up to his GP about issues that he’d bottled up for 45 years. He had finally accepted what he couldn’t change and decided to change what he could, one small step at a time. He wanted to do this for his children so they don’t go through the same cycle that he did. He reported that he was ready to take some control back.