Q: Hello Dr Neuman ,I am a 34 year old female doctor .All my life,I suffered feelings of worthlessness and inadequacy, and I am becoming more and more withdrawn as years pass by.I was an ambitious student in school,I tried to compensate through studies. I usually made friends with girls (I studied in a girls-only school) who were less scholarly than I was. Studious girls made me feel more insecure than I was already.As a young child, I remember having suffered severe separation anxiety at 2-3 years of age.I had suffered from severe loneliness,home sickness,loss of interest ,sadness and anxiety during my MedSchool days.I had very few friends,never dated anyone.I didn’t realize that I could be depressed ,I thought it was my nature .I was kind of disillusioned by medicine and decided that I would go for nonclinical residency. I never failed my classes, though I was not a top student I wanted to be.I found no specialty appealing ,during my internship. Strangely, I considered psychiatry but my friends discouraged me. Finally I decided to go for Pathology .But after starting pathology residency,I suffered severe anxiety.I did not like the kind of work they did and didn’t find the subject interesting enough to put up with the rigorous training and long hours.I was having difficulty adjusting and went for psychotherapy,but found it ineffective .After 3 months of suffering , I dropped out of Pathology. I then decided that a less challenging more peaceful environment of research and teaching would be ideal for me.I went for Pharmacology only to be bored to tears too soon. But felt better than Pathology. I was single,had not many friends and felt redundant. So during the next session, I tried again and qualified for psychiatry as well as radiology .Though my heart was after psychiatry, I decided to play safe and put up radiology as my first option .A senior psychiatrist I had seen for advice, told me that I would be an asset in psychiatry after an hour long conversation. I felt exhilarated and apprehensive at the same time.But by the time of starting the new residency program, I could not switch my options and I had to go for radiology. Though I don’t have a true passion for radiology, I am able to manage my small town scan centre job now for the last 5 years.I don’t feel very fulfilled or happy and my level of enjoyment of my work is going downhill over the years.I like some aspects of the job like security, good remuneration and office hours, I don’t feel confident to pursue higher studies or any career advancements in it, as I don’t feel much interest or passion. I am becoming more and more withdrawn. I recently dropped out of a fellowship program due to stress and lack of true interest. As for my personal life, for the kind of introvert and not-so –attractive person I am, I never had any lovers, though I had always wanted to be in love. I had had an arranged marriage, which is common in my cultute .I had never been happy or attracted to my spouse and we tried long enough. We have filed for a divorce recently.We have no children. .I was put on antidepressants every now and then, but I did not like them.I didn’t feel better too.Now at 34 years, I find myself alone ,not much happy with career and miserable in personal life. I realize that I don’t know what I want. . I had gone to a number of psychiatrists ,psychologists but not much difference was felt ,despite getting many diagnoses from them. I have a weird question : I had a secret wish to take up psychiatry .I have a vague hope that it would help me understand myself better. What’s your opinion?
– Rachel D
A: If you have an interest in psychiatry, I think you should pursue it. For many years I shared an office with a man I knew in medical school who had been a pediatrician. He was in an accident, he told me, and regained consciousness with the thought that he did not want to be a pediatrician the rest of his life. He entered a psychiatric residency and became a psychiatrist. He seemed happy to me, but I think he would have been happy also if he remained a pediatrician.
You are not happy, and, frankly, it does not seem to me that simply changing your profession would make a big difference. Not that you shouldn’t try. You mention a few other medical subspecialities that always seemed interesting to me. I liked the idea of being a radiologist since it seemed to me a little like being a detective. Staring at a film and reaching a tentative diagnosis. The same applied to pathology, where you would have the last word in diagnosis. I recognize that these are specialties without a lot of interpersonal contact, but that does not make them uninteresting–to me, at least. Despite the fact that I always wanted to be a psychiatrist.
Certainly, I did not become a psychiatrist in order to understand myself. Like every other profession, it is largely technical and presents no magical insight while providing technical services. More than that, I don’t think patients come to therapy with the idea of understanding themselves. They come in order to feel better; and they will put up with an examination of themselves if it promises to help them.
I recognize that you have tried the usual remedies for being chronically depressed and withdrawn. You have not said anything that makes me think that you would respond to anti-depressant drugs, although if I knew you, I might change my mind. If I had to sum up the way you speak about yourself, I would say you are demoralized. Others might say you have a social phobia.
Two thoughts:
1. You have been unhappy for a long time. Most happy people have a number of things going for them: a lover or spouse, children, an interesting job, friends and sometimes an overriding interest, such as art or religion. The fewer of these supports you have, the more difficult it is to be happy. Without any, it is not possible to be happy. I have known one or two professionals who have been so dedicated and engrossed in their profession, that that suffices; but there are few of these. Still, If you think you would be interested in becoming a psychiatrist, certainly you should give it a try. None of your problems would interfere with your pursuing that kind of work. Psychiatrist in general are no happier than anyone else, though.
2. Nothing you have said makes me think you would not respond to psychotherapy, despite your previous failure. It is a matter of timing, and sometime a matter of a proper fit with the therapist. Frankly, I don’t see an alternative. You have to understand that simply exploring your past will not make a significant difference. You will have to undertake doing things that make you uncomfortable and that you have shied away from in the past. These include making friends. Therapy is a help.
You hint at cultural differences aggravating your problems. That may be so, but, still, I have known many psychiatric residents, in particular, who come from India or China. Arranged marriages do not work in cultures where they are not supported. I don’t think you give up on the possibility of finding someone you can love. Certainly, being bright and capable is an advantage.
– Dr. Neuman