Dr. Hamilton Interview Part Two
In this second part of a two-part interview series, Dr. Hamilton speaks on the nature of psychiatry, and the importance of restoring agency in the treatment of mental illness. Dr. Hamilton is a psychiatrist and assistant professor at the University of Virginia’s School of Medicine.
What difficulties do you personally face in encountering people in varying mental states on a daily basis?
An attending once told me: surgeons have their scalpels, psychiatrists have their feelings. I’m a pretty centered person, so when I walk into a room and suddenly feel anxious, that’s an empathic experience. Your experience, or countertransference, towards a patient is just another form of information. That being said, we’re all people too. Just like patients don’t get better in a vacuum, we can’t practice in a vacuum because if you’re not checking yourself with a supervisor or colleague, things can get crazy. Part of this kind of work is practicing good professional self-care. Not doing that has ethical implications, because you lose perspective.
Does psychiatry as a practice differ fundamentally from any other medical specialty?
If you decide to become a psychiatrist, you’re deciding to study not only the most complicated organ, but the most complicated object in the universe. We study and treat diseases we don’t fully understand with medications whose actions we don’t fully understand - and somehow, people get better. So there has to be a certain amount of comfort with uncertainty. Because of that, one of the wonderful things about psychiatry is that it changes all the time. Not a month or two goes by that new literature doesn’t come up that completely changes the way we think about things. So this field is different because in psychiatry, a lot of fundamental things can change very quickly.
To what extent do you see mental illnesses as fitting into well-defined categories, versus extensions of people’s natural tendency to have certain exaggerated qualities that may become problematic?
What I tell residents and patients is that it’s only a problem if it’s a problem. It’s not a mental disorder if it doesn’t cause functional impairment. People are allowed to be as kooky as they want - and that’s great! We need all different kinds of people. But if people are suffering in a way that’s preventing them from living the life they want to live, or other people around them need them to live, then that’s a problem.
To what degree do you see mental well being as something that we can promote through our own actions?
No matter the epistemological path you choose to take, we experience ourselves as having choices. And like I was saying before, most mental illnesses involve some degree of problem with agency. A lot of working with people is getting them to understand what they have control over, and what they don’t have control over. The stuff they have control over is really up to them, and the stuff that isn’t, isn’t. No one chooses to have a mental illness, but the way through it does involve restoring a feeling of agency.
Finally, what is the most gratifying part of your career?
I work with people who are pretty treatment resistant; they’ve tried all the medicines and treatments. Then, we’ll try TMS or different treatment options, and they get better. A lot of these people have built a life around being patients, or being depressed, so watching them build a new life and seeing what they’re going to do with that is extraordinary. A close second is watching an intern come in, and seeing over the course of five years, the doctor they’re going to be and how they’re going to help people. So the problem that I started with, 25 year-old me in philosophy school concerned about not having an impact - that’s solved.
This interview has been lightly edited for length and clarity.