Puzzles and Pieces
Guest Post: Michael Smith, M.D. is a practicing Psychiatrist and Medical Director for TLC. We’re always pleased to learn from “Doctor Mike.”
I often find myself with a patient who wonders why they aren't all the way better. Often they had made some improvement and are doing better than when they started, but they still haven't arrived at that state of optimal functioning - where all 8 cylinders are firing smoothly and effectively. Working together we may have picked out a course of treatment that makes sense, but now they are feeling some frustration, as am I.
Often in such a situation, I remind my patient (and myself) that there are many parts of "life fitness." And (please excuse me for switching metaphors) I talk about life being like a puzzle, where maybe most of the parts are in place, but if one or two parts are missing then the puzzle doesn't fit together very well, and the result is less than satisfying.
The puzzle includes things like nutrition, exercise, relationships, financial stability, work, sleep, recreation, meaning, and many other things. Sometimes I have patients who are disappointed that the medication they are taking hasn't solved all their problems. I point out that the medication is only one piece of the puzzle, and that other things need to be addressed as well. Other patients may be doing a good job of taking care of things generally, but still, are not doing well or feeling well (and they may avoid using medications).
In some cases, the right medication is the missing piece of the puzzle, and when it is put in place then other things come together, and the patient does fine. Just to be clear, I don't believe that medications are necessary or appropriate for all people who walk into my office. But just like insulin may be a necessary part of the puzzle when managing diabetes, psychiatric meds can be a very important part of the puzzle when helping people who struggle with psychiatric illness. I also consider counseling to often be an important part of the puzzle for many people.
In psychiatry training, the "bio-psycho-social" mantra is heavily emphasized. Each of these broad domains may be considered a different puzzle, with many different pieces. We must consider each of these broad domains in our own lives as we try to make our puzzle fit together.