Monday, August 15, 2005

Counterproductive Countertransference

I haven't written much over the last two weeks, i.e. ever since I started psychiatry. Strangely, I have had far more sleep (avg 7 hrs from avg 5) and free time (avg 5 hrs/day from avg 2) than I had on ob/gyn; yet I've been feeling less happy, less energetic, and less motivated to write or do other things that I enjoy. It's not so severe that I can't laugh and have fun with friends, but the key for me is that my default mood and default thoughts--the state I fall back into in those in between moments--seems more sluggish than the usual Me. Also, my appetite's been a bit less than normal (in itself a *very* abnormal event, though not entirely unwanted), and I've had some difficulty staying focused on completing the items on my non-hospital to-do list.

In short, I think I've come down with an acute case of dysthymia, or mild depression.

Although I'm not happy about this recent bout of generalized not-as-happy-ness, I am--like a good doctor-in-training--determined to explore other differential diagnoses as well as possible etiologies (causes) of my current state. So here goes:

DDx (Differential Diagnosis):
1. Mild Depressive Disorder With Seasonal Pattern: there's something about the imminence of autumn that wraps me in a blanket of back-to-school dread. Even though I've been working through the entire summer, the thought of September still gives me olfactory hallucinations of rubber erasers and freshly copied worksheets; tactile hallucinations of gusty leaf-laden winds whipping through the space between my back and my backpack, and auditory hallucinations of the teacher saying "close your books--pop quiz".

2. Cyclothymic Disorder: This is where you get numerous periods of hypmanic symptoms (increased energy, excitement, racing thoughts and speech) with depressive symptoms over a few years. I did have a two week period back last September when I was on hyper-overdrive and needed less sleep than usual, so if I were to seriously self-diagnose, this would probably be my best guess.

3. Countertransference: The pace of psychiatry--a slow amble through the day, with multiple stops to smell the roses and analyze our emotional response to them--is quite different from the sprints, hurdles, and night float marathon of ob/gyn. And I already know from exercise experience that I get far more endorphin release from a hard run than a quiet stroll. Moreover, like the phenomenon of countertransference (the subjective responses of a physician to particular patient personality traits or behaviors) I tend to subconsciously mirror/absorb the environment or people around me. So it's no wonder that while on the high energy surgical floors, I was diagnostically hypomanic (less than 4 hours of sleep a night, talking/writing more effusively than usual, excessive involvement in pleasurable activities like delivering babies and risk-taking activities like doing surgery); and now on psych consult I've developed many of the depressive symptoms of the depressed patients I spend time talking to every day. Hopefully for my own sanity, I won't get assigned too many floridly psychotic patients...

And last but *certainly* not least...

4. Hypochondriasis: "Preoccupation with fears of having, or the idea that one has, a serious disease based on the person's misinterpretation of bodily symptoms". The most likely diagnosis of them all. I probably just liked the feeling of making a difference so prominant in ob/gyn, so I'm less excited about just sitting and talking to my psychiatric patients, and thereby have less to look forward to each day; and now that I can get in later I stay up later for no good reason, so I'm more tired in the morning; and now that I have more free time, I go out more in the evenings and therefore make less time for writing or other work tasks; and given that I haven't lost any weight, the reduced appetite is probably just wishful thinking. Sigh.

We really need a separate section in the DSM-IV (the official psychiatric diagnostic manual) for conditions specific to medical students.


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