The Mental-Physical Tango
I sometimes forget how influential a person’s mental state is on their physical appearance. Two of our young schizophrenics have really come around this past week, and it feels so great to see them functioning at much higher levels. Steve has laid in bed most of the week, with a pretty flat affect (this means he interacts with very little emotion). And almost miraculously (the miracle being an anti-psychotic medication called clozapine), Steve started smiling on Friday. I was walking by him in the hallway, and he was on the phone. Smiling and laughing.
Joe, who hasn’t showered in about a week, and he lays in bed all day. When he actually does get up to eat or go smoke, his hair stands straight up, something we’ve affectionately been referring to as the “Joe-hawk.” For him, a shower went a long way to making him look better.
Another patient maybe illustrates the more subtle; she came in extremely delusional and just didn’t look well. It’s kind of how doctors can tell when someone is concerningly-sick; Jenny didn’t look so great. But there’s also something else–I don’t know if it’s a glimmer in the eye, or just a more interactive set of facial movements–or just basic body language during conversation–but when you really get these patients doing better, they look better. Healthier, more attractive. It’s an incredible change, and really feels rewarding.
It’s both fun and educational for me to read your current posts because it helps me get all fired up for *my* medical students. Thanks!
One thought: Remember to *tell* the patients that they’re looking better! It’s not just a matter of compliments or “strokes” — in many cases, people will *look* better well before they actually *feel* better, and it’s helpful to give them a bit of “notice” that they’re on the upswing.
It is a wonderful thing of beauty to see someone who suffers from a major mental illness become connected to this world again. I applaud your work! As a medical student I realize medication is the primary treatment modality practiced and extremely effective. Some of the research suggest that family psychoeducation can help to keep a patient healthly (Best-practice guidelines for schizophrenia). “The randomized clinical trials have reported one-year relapse rates for patients receiving these family “psychoeducation” programs in combination with medication that are more than 50 percent lower than for patients receiving medication alone.” http://www.milbank.org/reports/2004lehman/2004lehman.html Love your blog…Keep up the good work.
“I sometimes forget how influential a person’s mental state is on their physical appearance.” I wonder how you could forget! I’m not being rude, I promise. I just can’t help but think you need to come back to high school for a few days.
People are more than just bodies, that is for sure, and I think that is what we are forgeting in this world! What it is that motivates us needs to be re-though out – and thank you for the fun blogg Dr.Walker, it is a great thought starter.
this brought back a memory of when i was an inpatient. i was sitting across from the nursing station when my psychiatrist and the attending physician stopped by to check in with me. the attending physician commented that the medications seemed to have worked because i looked good compared to when i first came in.
Just curious,
wondering how young the youngest schizophrenics are?
In your experience (or readings?) have you heard of seven year old schizophrenics?
A worried but doubtful mom…
When I was in college, I was in trouble and in need of therapy. I had a history of attachment disorder and panic attacks as a child that were now in the forefront in college. I had a family history of agoraphobia, depression and borderline personality disorder, and I was drowning for a variety of school and life related reasons.
I was basically unable to attend classes I was so unwell. I was also being stalked by an ex boyfriend who lived in my dorm, I was suffering PTSD and hanging around a bunch of maladjusted other kids with various psych disorders.
I was being treated in private therapy by a psychiatrist who worked at Mclean Hospital in Belmont, MA. Her office was in a group home on site.
Whenever I drove up to that place, or walked into her building, the patients there mistook me for a NEW PATIENT–one who was STAYING with them. They could look at me and see how broken I was–even though I had on normal college kid clothes, even though I was making an effort to shower/brush hair/put on makeup every day, etc.
People walking down the street didn’t see it, but the homeless people always did. I was incapable of walking around Harvard Square without being approached by someone schizophrenic or manic or otherwise altered. This was not standard “spare some change” accosting that happened to others–this was an attempt to initiate a conversation as if I could see what they saw.
To this day, you can see that I’m having a panic attack by watching my eyes. They stop tracking correctly. They don’t both maintain focus and vector. I’m sure there are dozens of other cues as well. I assume the best shrinks are consciously aware of these cues. I wonder how many of them are only subconsciously aware, though?