Psychiatry is rapidly advancing, but a few years ago, I didn’t exactly know what this meant. I am still only beginning to understand what the field has left to learn, how existing gaps in knowledge are affecting vulnerable populations, and the hopeful progress that has been made in recent years towards filling these gaps. Quite quickly, however, I did realize that the thought of playing a role in this progress excites me more than anything else has in my academic career.
My exposure to the field of psychiatry began in research, specifically in the Carolina Center for Neurostimulation in UNC School of Medicine’s Department of Psychiatry. The first study that I worked on during my freshman year was more neurology-focused as I was exploring the potential role of neuroinflammation in mild cognitive impairment, a precursor to Alzheimer’s Disease. This was my first time working directly with a vulnerable patient population in the capacity of both a research assistant and phlebotomist, and I began to gain a better understanding of the clinical relevance of observational patient studies such as these. One of my favorite parts of working on this study was the in-clinic recruitment of patients, as I got to see the multitude of factors that determine diagnostic criteria for these illnesses, as well the clear overlap between neurological and psychiatric pathologies. Brain-related illnesses have an inherent complexity that intrigued me and made me excited to learn more.
More recently, I worked on a just-completed study exploring optimistic biases in belief-updating in healthy individuals, employing measures such as EEG and pupillometry. This was used to inform our current study—and the focus of my senior honors thesis—investigating these same measures in patients with treatment-resistant Major Depressive Disorder (MDD) receiving intranasal Esketamine treatment. Our goal is to better understand both the neurophysiological and behavioral mechanisms of this drug. As a peer mentor for Neuropsychopharmacology the past two semesters, I knew that this focus area would pique my interest, but seeing these concepts applied in practice has fascinated me even more than I would have expected. I began to see the field of psychiatry as a way to take these pharmacology-related interests a step further, seeking an understanding of not only how psychotropic drugs work, but how they can be leveraged in unique ways and practically improve patients’ lives.
While my research experiences have played a pivotal role in shaping my career aspirations, my interactions with psychiatric patient populations in more clinical settings have been equally meaningful. Volunteering as a Behavioral Health Companion at UNC Hospitals, for example, has allowed me to build relationships with both pediatric and adult patients with a broad range of psychiatric illnesses, and in doing so, better understand the unique struggles and needs of this population. This also brings me to discussing my current role as a Gil Intern at Threshold Clubhouse in Durham, NC, where I have been able to build upon these past experiences in a unique setting. Threshold offers a rehabilitative program to individuals with Severe & Persistent Mental Illness (Bipolar Disorder I, Schizophrenia, Schizoaffective Disorder, Major Depression with Psychosis, or Psychosis NOS). The key component of this rehabilitation program is the opportunity for members to participate in what is called the “Work Ordered Day,” where they can volunteer in one or more prevocational work units which are essential to the overall functioning of the clubhouse. The members meet into various groups at the start of the day, such as the kitchen and vocational groups, among others, and then delegate tasks amongst each other. This process allows members to gain a sense of independence and structure, while making tangible contributions to the clubhouse community.
The Clubhouse Model, a well-established paradigm in the field of mental health, completely deconstructs traditional clinical roles in a beautiful way: by allowing members and staff to work directly alongside one another as equals, embracing the inherent strengths and capabilities of each individual regardless of mental health diagnosis. As an intern, much of my role consists of doing just that: accompanying members as they complete their day’s tasks, and following their guidance and instruction just as closely as they follow mine. Some members have been part of Threshold for years if not decades, and I have learned a great deal from hearing them recount how the community and stability provided by the clubhouse has served them. Whether attending the member-led journal club, serving coffee alongside them in the morning, or getting a member’s help in watering the garden, I always feel immense privilege in the opportunity to gain insight into their lived experiences outside of the clinic or hospital. Diagnosing and treating psychiatric illness is one thing, but empathizing with the unique aspects of their daily life is another entirely. If I do end up in a career in psychiatry, my hope is that this type of exposure to mental health care will add another important dimension to my perspective, and allow me to approach treatment with a strong sense of regard for each patient’s distinct needs.
As far as psychiatry has come, there is still a long way to go before existing approaches are refined, essential knowledge is uncovered, and the patient care process is improved. But if I have learned anything from the experiences I’ve described, it is that these goals are within reach when there are people that care about them. Although I anticipate my career aspirations to evolve and change from here forward, right now, I can sum them up as a desire to be one of these people.