More psychiatry

When my public health studies in Sydney ended in early December 1960, we piled our belongings and ourselves into our Holden station wagon and drove back to Adelaide. I must mention that during our year in Sydney I spent one late afternoon every week at an acute psychiatric hospital, observing through a one-way window group psychotherapy sessions in which 10 emotionally disturbed patients engaged in dialogue with David Madison, associate professor of psychiatry. The group psychotherapy session was followed by 1-2 hours of discussion between David, several trainee psychiatrists, and me. By the end of the year, I knew David Madison, and most of these patients, really well. More important, I was beginning to understand a little about how the mind works. I had about 6 months before my traveling fellowship began. There was a vacant position for a senior resident physician at the acute psychiatric receiving hospital in Adelaide, so I took this, and spent 6 months on full-time care of acute mental and emotional disorders. I was caring for patients with acute mania, profound depression, early stages of schizophrenia, alcohol-induced delirium tremens, and several with the comparatively rare disorder of acute paranoia. I learned a great deal about the diagnosis, and a little about the prognosis and treatment of acute psychiatric disorders during that 6 month period. It was no comfort to me that the most senior and experienced psychiatrist on the staff misjudged the mental and emotional state of a middle-aged woman, whom he allowed to go home on weekend leave. She used the opportunity to critically injure her husband, and to kill herself in dramatic fashion. I learned from this that even a richly experienced psychiatrist can't always tell when a patient presents high risk of harm to self or others. This did not assuage my feeling of guilt for failing to recognize the distress signals that my nice young Czech patient had tried in vain to transmit to me.