Seeing the season's hidden sadness
Posted on 27 December 2012 by Rory Conn
Being perhaps the only NHS junior doctor qualified for four-and-a-bit years lucky enough never to have worked a bank holiday, I couldn’t grumble much about being asked to work this Christmas night. My only complaints were that I was needed unexpectedly, to cover a sick colleague, and had to travel 60 miles from my family home, leaving behind a seven-week-old baby.
Night shifts in psychiatry are extremely variable, from the eerily quiet to the hair-raising, and I wondered en route what might lie in store on such an unusual shift.
‘Tis the season to be jolly. But this night was to serve as a reminder that for many, Christmas can be a time of desperate sadness. Loneliness and social isolation at any time of year can precipitate crises in mental health, but a time traditionally considered to be about family and friends can be harder than any to spend alone.
This was to be a night with a man of mild learning difficulties, bullied at his hostel accommodation, intoxicated with alcohol and desperate to end his life. Another in his 70s, considering travelling to Beachy Head to finally end the depression that had gripped him for years. One of a young lady with known personality difficulties, self-presenting, reportedly suicidal, then absconding before being seen. And a Somalian refugee, withdrawing from the alcohol he had considered his only solace.
All of them living alone, all with no one to hear their stories.
All doctors will be asked to treat patients who have intentionally put themselves at risk. Not all doctors will appreciate why people turn to drugs or alcohol: often unconsciously this is to numb an unbearable emotional experience. In contrast, the very need to feel something — anything — might explain the use of self-harm in those for whom chronic emptiness pervades.
City centre emergency departments are often hotbeds of interesting psychopathology, including complex delusions, hallucinations, and disorders of thought process. But they can also be places of emotional refuge, where the skills of a psychiatrist are bound less to textbook diagnosis or psychotropic prescription, more to a holistic appreciation of the social and emotional environment which we all inhabit.
On this particular Christmas night, the majority of my patients were people for whom Christmas had not been a time of happiness. My role was to offer hope, in the prospect of services for the future which might ease the distress of the present.
Rory Conn is a CT3 psychiatry trainee and the Royal College of Psychiatrist’s Core Trainee of the Year 2012
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