From the Editor
This week’s Reading: an excerpt from the new Goldbloom-Bryden book.
Get this book. Read it. Share it with your friends.
It’s beautifully written and important.
New Psychiatry Book
How Can I Help? A Week in My Life as a Psychiatrist
David Goldbloom and Pier Bryden, Simon & Schuster Canada, 2016
Almost thirty years ago, a patient on the psychiatry inpatient unit where I had just started working approached me as if we were lifelong friends. He was tall, skinny, unshaven, dressed in threadbare jeans and a pale blue hospital pajama shirt. His hair was long and matted, and it was clearly some time since he had bathed. I assumed my best psychiatrist manner – unthreatening, warm but not familiar, and firm – and prepared to tell him that I was not actually his doctor, that we had never met, and that my colleague Dr. Buckingham would be looking after him.
He started speaking before I could deliver my blurb.
“David Goldbloom! I heard you had gone to medical school. How amazing to see you here. Do you remember me?”
There was something about the man’s deep, slow voice, with an Ottawa valley drawl, that was familiar. But I couldn’t recognize or place him.
“It’s Andrew. Andrew Balkos. We played squash together at university.”
His voice, height, and smile coalesced immediately into an older, gaunt phantom of the muscular twenty-something squash player who had won a healthy number of games off me during round-robins in university. We had been part of a group of young men who played sports and socialized before we all headed off to further education or our first serious jobs.
We were a confident bunch in those days, encouraged by our education, our youth, and our health to think we would attain whatever life goals we set ourselves. I hadn’t known him particularly well, but I now recalled that he had dropped out of school – no one said why – and that I was short a squash partner as a result.
Usually when I run into old school friends, we discuss work, family, travel. Andrew told me that he had been admitted from the emergency room the previous night. He explained that he had been struggling with mental illness for years, and this was not the first time he had been hospitalized.
So opens a new book written by psychiatrists Drs. David Goldbloom and Pier Bryden. Though this volume has two authors, the book follows Dr. Goldbloom as he sees patients and grapples with the illness of his own mother. It’s a book about a week in the life of a psychiatrist. It’s a book about illness and recovery, about life and death, about love and loss.
I’ll disclose that the Toronto community is small and that I’ve met Dr. Bryden on a handful of occasions. And I’ll disclose that, like many who have trained in psychiatry at the University of Toronto, I worked directly with Dr. Goldbloom in residency. I consider him a friend and a mentor. We have also co-written a paper together.
With this background, I wondered: would the book live up to my high expectations? It does.
What makes this book entertaining: the somewhat larger-than-life professionals who are described, drawing from Dr. Goldbloom’s own life and from the history of psychiatry. We meet, for example, his father-in-law, the founding chair of McMaster University’s Department of Psychiatry, with his fondness for Porsches, and his aversion to psychoanalysis.
But the real stars of this show are the patients that Drs. Goldbloom and Bryden write about. They are sharply described, complex, and interesting. We see the young woman with depression, the physician with anxiety, the woman in her 50s with refractory anorexia. The book describes them and their struggles.
In recent years, doctors’ books have become somewhat fashionable. The local bookstore is lined with books written by ER physicians. (Search “ER doctors” books on amazon.com and there are over 7,200 hits.) Few of these books work because of the basic human instinct to colour our stories. And so, in many of these books, the doctor is all-knowing; the patients get better; and the outcomes are wins.
How Can I Help? describes patient success stories, yes, but it describes failures, too. It doesn’t hide the fact that many psychiatric patients are ill, and some don’t get better. And so, we hear about the lawyer who gains stability over his bipolar illness but we also read about the ultimate failure: a patient who suicides.
This book sparkles with insights. No wonder. Dr. Goldbloom has held some of the biggest psychiatry jobs in the country, including chair of the Mental Health Commission of Canada. Dr. Bryden, an accomplished clinician and educator, knows much about medical history. While collective efforts can bring out the worst in authors, this collaboration benefits from their deep knowledge.
One goal of How Can I Help? is to demystify psychiatry. Ours is a field that is difficult to explain, even to people in health care. We don’t cut people like surgeons; we don’t diagnose like internists. Complicating matters is the portrayal of psychiatry in the popular culture. This book follows the life of a psychiatrist for a week, shining light on our work and the thinking behind it. After a conversation with my older daughter about what I do, I picked up this book and read her the first few pages. She liked it. For the record, me too.
But my reasons are different than hers. For my older daughter, the book offers a glimpse into the world of psychiatry. It’s the world I work in, live in – and often – dream about. For me, what stands out is the honesty of the book.
Near the end:
I think back to the mistakes I have made in my career: missed opportunities to act as well as rushes to judgment; consultations provided to other physicians where I did not follow up assiduously enough with helpful telephone calls or offers to check in the patients at a future date; Code Whites that potentially could have been avoided by more strategic use of verbal deescalation or medication; not following up on Daryl’s final words to me: It’s hard. There are too many.
But perhaps in dwelling on my perceived mistakes, I am guilty of therapeutic omnipotence, believing I have far more influence on my patients’ decisions and outcomes than is the case. And arrogance, in believing that I could make it through thirty years of practice without error and reasons for self-recrimination.
Psychiatry has few easy answers for either its patients or its doctors… What it does have is the potential for connections between two people built on trust…
How Can I Help? reminds us of the limitations and the blemishes of psychiatry. It also serves to remind us of the importance of our work.
As I have agreed with Simon & Schuster Canada, I note:
From HOW CAN I HELP?: A Week in My Life as a Psychiatrist by David Goldbloom, M.D. and Pier Bryden, M.D. Copyright © 2016 by David Goldbloom, M.D. and Pier Bryden, M.D. Reprinted by permission of Simon & Schuster Canada, a Division of Simon & Schuster, Inc.
Reading of the Week. Every week I pick articles and papers from the world of Psychiatry.