This question sounds abstract and naïve. Yet it was one that brought me all the way from Kathmandu to Boston. Medical school is usually a place of abundant exuberance and inquisitiveness. Every medical question seems to have an answer and there is always a little more to know than we can read. It was the same for me until that quaint experience. As a third year student smitten with psychiatry and behavioral sciences I was delighted to take up an opportunity to work with an NGO which rehabilitated women (often teenagers) rescued from human trafficking and forced prostitution.
Being the most junior member of the team meant a lot of observing and very little of doing. Yet, the most disappointing thing was that even the team as a whole could do so little. These women who had been through such grave psychological trauma were quite contrary to what we imagined. They had learnt to shut off the world around them. It proved to be an impossible task to elicit their stories which was the first step in being able to heal. A lot of these women had developed unexplained somatic symptoms and medical diseases, yet upfront they looked far from what we might expect of a depressed patient.
This came as a huge burden on my curious mind which could not accept the severe limitations of medical science. Looking over Medical Literature I found extensive material on Post-Traumatic Stress Disorder, Anxiety Disorders and their management. Yet the way to elicit stories from such victims of grave psychological trauma had very little coverage in published literature.
Over the next years my love for mental health issues grew and it brought me to the United States and Canada for clinical electives in psychiatry. I was exposed to some path breaking research in psycho pharmacology and brain imaging as I spent time at Yale and Harvard. Yet my questions from two years back remained unanswered and I raised this point with a certain person whom I had looked up on the internet. I was hopeful of answers.
Dr. Richard Mollica, a professor in psychiatry at Harvard who had dedicated his life working for victims of mass violence and refugees from Haiti , Cambodia, Congo and Iran etc. Thirty minutes with the man mesmerized me and enlightened me.His work attracted little funding and unlike his colleagues who were leading more glamorous lives this doctor had chosen to serve this marginalized group of people.
A couple of stories stood out. A man who spent his teenage years working as a slave in Cambodia lifting weights heavier than a human should lift. Thirty years down the line the pain reappeared at the same sites and brought with it the memories and thus immense psychological pain. A woman at 14 in Iran saw her father being assassinated, his body mutilated, liver taken out and barbequed and eaten by the killers in the living room of their own house. She spent the next two decades with an average of two hours of sleep a night and multiple medical illnesses. This story was never known until the team at the refugee clinic used their experience to facilitate sharing of stories from her. Dr. Mollica’s team while working with limited resources has dedicated itself to find tools to elicit their horror stories and use medical, spiritual, and religious tools collectively to help create a healing atmosphere for the patient.
The one lesson I took home from the interaction was that as I get on my way to become a psycho-pharmacologist I must look to treat the patient holistically giving due respect to his spiritual and religious beliefs. Healing a patient goes way beyond the rapidly evolving DSM-IV and V’s and prescribing medications.