when things start to sink in

I finished the hospital consult service of my psychiatry rotation last week and have now begun a month-long rotation in child/adolescent psychiatry. I spend half the day at an inpatient hospital for kids that are so mentally ill that they have to be locked up in a hospital for a few days (yes, we cure them in a few days and they live happily ever after - or at least that is what the government/insurance budgets call for). My afternoons are spent with the Minor Emergency Response Team (MERT), a drop-off mental health facility where those kids usually end up before a doctor decides that they need to go into a psychiatric hospital.

My experiences in psychiatry have been interesting and mind opening. I have always thought myself to be fairly educated in mental illness, but the immersion in this world continues to give me new perspectives every day.

I have a teenage patient in the psychiatric hospital, who is currently experiencing an intense manic episode of his bipolar disorder. Though I know people who are bipolar, it is quite different to really witness these symptoms, in their full intensity, especially now that I understand the disease a lot better.

During a manic episode, everything about a person is reved up. My patient talks fast and his thoughts are racing so quickly that he can hardly stick to a topic. For this same reason, he is actually incapable of listening to what you say, and he'll often pick up on a word and go with it because his mind has already raced ahead to all the things that he wants to say about that topic. He says he feels like his mind is going so fast sometimes that it feels like it's melting or bleeding. He tries to slow it down by smoking pot, drinking, smoking or taking high doses of Benadryl. And because he is constantly struggling to slow down his thoughts and energy, he is tense and always feels like he's on the edge of exploding. His thought process and coordination is increased, but his perception of the increase is also reved up, which makes him strongly believe that he is a genius. At full mania, these feelings of grandiosity are so intesne that he becomes convinced that he has super powers or is a Jesus-like figure -- a special being with a destiny he has not found yet. It is amazing to see his conviction, even as he struggles to gain insight into his illness, and it is scary to imagine what it would be like to go through such euphoria, only to be told that it is just a life-long and potentially debilitating mental illness.