From the Editor
“‘I think your brother has schizophrenia,’ she said.
“I was entering my third year of medical school when I received a phone call from my brother’s friend.”
So begins a perspective paper published in today’s issue of The New England Journal of Medicine. The essay is deeply moving. Written by Dr. Saadia Sediqzadah, a fifth year psychiatry resident at the University of Toronto, the author discusses her brother’s schizophrenia and her family’s efforts to get him care – for Dr. Sediqzadah, dealing with mental illness is not just part of her training.
This week, we consider Dr. Sediqzadah’s paper.
Note that for some of our younger colleagues who have just finished their medical training and begun their specialty training in psychiatry, this week will be your first Reading. Welcome to the conversation.
Illness and Family
“Sister First, Doctor Second”
The New England Journal of Medicine, 11 July 2019
‘I think your brother has schizophrenia,’ she said.
I was entering my third year of medical school when I received a phone call from my brother’s friend. She shared enough detail to suggest that he had a brewing psychotic illness, whose signs were so insidious that we hadn’t initially noticed them. In retrospect, his was a textbook case of schizophrenia: a 21-year-old man in his first year of university, slightly paranoid but holding it together enough to get by — until he couldn’t anymore. He believed that he was being followed on campus and called his friend terrified, and then his friend called me. I decided I needed to do something; I had to save my brother. I packed my suitcase and headed home. The plan was to get him a psychiatry referral and start him on medications. Easy, right?
But it wasn’t.
So begins a short, personal piece by Dr. Sediqzadah.
As her brother’s symptoms grow worse, he becomes harder and harder to engage in care. Finally, frustrated, they have a fight.
One evening, I cornered my brother and informed him that I was going to refer him to a local mental health program that permitted family referral. I told him I couldn’t wait around for him to get the help he needed. We ended up having a big argument that night; he said ‘You aren’t my sister anymore. You’re a psychiatrist,’ which was his way of saying, ‘You see me as a patient, not your brother.’ I had no idea of the impact this fight would have on our relationship.
A period of estrangement ensues that stretches for years.
The next morning, he moved out of our family home. Over the next 2 years, he did not respond to our phone calls, texts, or emails. Thanks to my parents’ investigative work, we knew where he lived, and some of his acquaintances would provide us with updates. We did our best to maintain an empathic distance, ready to swoop in if he ever needed help.
She notes: “Those were the darkest years of our lives.”
Fortunately, he eventually reconnects with his family, an occurrence she describes as a miracle.
She discusses the need to adjust her role. Ultimately, she isn’t her brother’s physician; she is his sister.
We have since rebuilt our relationship with him, and my priorities in caring for him have shifted significantly. My focus has evolved from ‘How can I get him to see a psychiatrist?’ to ‘How can I ensure that he is housed, has financial support, and is willing talk to us?
What my brother needs, I now understand, is for me to be his sister, not his doctor. Every day, I am learning to be a better sister for him. In the process, I believe I have also become a better doctor.
A few thoughts:
- This is a beautiful and raw essay.
- Dr. Sediqzadah lucidly discusses the challenges of being a family member of someone with mental illness and also being a physician – a medical degree doesn’t always bestow an advantage on us.
- Statistics Canada reports that approximately 38% of Canadians have at least one family member with a mental health problem (defined as problems with their emotions, mental health, or use of alcohol or drugs); about 1 in 5 Canadians has more than one family member with a mental health problem. This essay reminds us of the people behind those statistics, and the toll that mental illness takes not only on our patients but also on their families.
- A quick word of congratulations to Dr. Sediqzadah on completing her Master of Science in Health Policy Management from the Harvard T.H. Chan School of Public Health.
Reading of the Week. Every week I pick articles and papers from the world of Psychiatry.