Jason Gencher is a medical student in the Class of 2018 at the University of Toronto
Today is the day. I have waited six months for today. I’m so tired, I can barely get myself out of bed. What time is it? I’m so hungry. Those Timbits look old, but I’m too hungry to care about that. I’m so tired — maybe I’ll go back to sleep? Don’t I have something to do today? Why is there this weird taste in my mouth? What she’s saying is all lies. There’s no truth in it all. They say things about me, but it’s all a big lie. One giant lie. When did I get this fat? It’s because of the medication. I used to be slim and athletic. But now I have circulation problems. It’s the medications they give me. Every day they come. They ask me questions. I can’t remember what they ask. It’s always the same questions. I’m fine. I just need to get out of bed for my hearing. Then I can tell the judge about the truth. First, I need a smoke. Here we go — one, two… and out of bed. I need to take some deep breaths. It’s my circulation system. It’s not working like it used to. Probably because of the medications they give me. Ring ring ring. That’s my phone. I shouldn’t answer it. It’s probably someone that wants to hurt me. Ring ring ring. Where are my cigarettes? Ring ring — it’s going to voicemail. “Hello, Mr. ___. This is Mr. ___, your lawyer. I wanted to remind you of your upcoming capacity and consent board meeting this afternoon. I’ll be by your house in about thirty minutes to drive you over to the hearing. Take care.” I just need a smoke first. This is my last pack, and I don’t have money for another until I meet with the Public Guardian. The meeting will be downtown. Do I have to take the bus? Last time they came they gave me tokens. A good smoke to start the day. It will help my circulation problems. I take medicine for my blood circulation so that it doesn’t slow down in my brain. That’s why I gained so much weight. The medicine they force me to take — it’s not like the medicine the real doctor gives me for my blood, or for my sugar. They inject me. I can’t remember how often they come to inject me. They force a needle into my ass, but I don’t say no because the police will come. Today I will tell the judge I am healthy. I don’t need any needles because what they said last time is all lies. I don’t have any problems in my head. A knock at the door. His lawyer is here to take him to the Capacity and Consent Board hearing. Hours have passed since he first woke. My clothes? What is wrong with my clothes? I changed them last week. Why does he keep on asking me about my clothes? Maybe he wants to hurt me like the others. Yes, it’s very warm outside. That’s because it’s the summer. He has a nice car though. It’s hard for me to get in. Why did he put a towel down on my seat? We’re driving to see the judge so I can tell him that I’m healthy in my head. Is this Toronto? It looks different from yesterday. There are so many tall buildings. People are staring at me. They’re all talking about me. They know about my meeting. Do they know about all her lies? We are outside the judge’s office. She’s here. The one who likes to lie. I’m not going to talk to her. I need to sit down. I’ll sit by the T.V. until the judge is ready for me. The CCB hearing begins. She’s talking about me — it’s all lies! Now the lawyer is telling me to be quiet. He wants to hurt me. How do I even know these people judging me aren’t also against me? She says it’s called schizophrenia. That means fucked in the head. I already told you it’s a lie! They’re all looking at me. Now I get to speak. There’s nothing wrong with my thinking. The medication they give me is for no reason. It slows my blood circulation to my brain and freezes my head. It makes me fat, too. Now they’re asking us all to leave the room. They say they will let me know in 24 hours about their decision. The next morning. I win. I proved that there’s nothing wrong with my brain. I need a cigarette and I’m so hungry. A knock at the door. What is she doing here? The judge called me and said I won. I don’t need shots anymore! I refuse! You’re a liar!
Author’s note: I found the process of reflecting and trying to place myself in the mind of someone with schizophrenia challenging for two reasons: 1) altering my language to better reflect the patient’s cognitive and intellectual abilities, and 2) disorganizing my thoughts to attempt to portray the disorganized process pathognomonic of schizophrenia. This reflection was an excellent exercise in trying to better understand the psychosocial elements that people with schizophrenia face throughout their lives. Issues of trust, understanding, and reality constantly pervade their consciousness. This reflection has helped me better appreciate the disease and the role that we, as physicians, can play in treating it.
As a healthcare provider working within the inner-city, I think that this is an extremely unique exercise that I think could be beneficial.
Often, we deal with patients struggling with mental health and addiction-related issues. Unfortunately, for many, stepping into this environment can prove to be extremely challenging – especially for students and interns who have not yet been exposed to this sort of practice site.
Perhaps one may even consider comparing and contrasting their own reflection with the reflection of someone struggling with the mental illness in order to gain even more insight.
This piece was clearly written as a self-reflection exercise, and meant to be a tool to promote empathy and respect. Learning to see beyond our own experience is such a valuable tool, but probably better developed through first listening to others (as already pointed out), and then self-reflection on our own identities and experiences as individuals. I have learned the hard way, as I have progressed in my medical career, that we must be very careful to never speak on behalf of those who can speak for themselves, nor presume that we can ever understand another’s perspective or experience beyond what they themselves explain.
That said, the author clearly values this important process of empathy, and I commend him for that. I would encourage him to continue using narrative as a medium to explore and self-reflect on both his own experiences and the conveyed experiences of others (was this piece purely speculative, for example, or was it based on a real story? Perhaps your own reflections to having witnessed such an event, or having heard it from a patient would be more powerful for your own journey as a professional…). I have found this process very helpful, and one that certainly promotes empathy for myself and my patients.
I feel it’s incredibly gross, unnecessary and unethical to have a neurotypical doctor pretend for the sake of education and entertainment that they live with schizophrenia. There are many people living with schizophrenia that could have told their own story and given us a more accurate picture. I thought cutting edge medicine and research was starting to prioritize and amplify people with lived or first voice experience? As someone that has worked for mental health organizations and done research with universities I’m heartbroken that another generation of medical students think it’s ok to speak for those living with mental illness. I truly hope cmaj takes this critique to heart and uses this opportunity to educate students about the ethics of speaking for a group of people they do no belong to as opposed to getting defensive about my comment.