When I was a medical student, I spent two months of my clerkship at a psychiatric hospital that sits atop a small mountain, rising up from the rocks, a place that to this day sends shivers down my spine.  It may not sound like a place one would enjoy, but the time I spent there was in fact both interesting and alluring.  Encountering patients in the midst of their struggles with mental illness opened my eyes to another existence; one that I did not recognize from having lived it, but that I understood somehow deep within my soul.

The Hospital is a behemoth, a nightmare come to life, the monster under the bed.  Within its’ walls stories are told verbally, emotionally and physically.  I remember sitting in group sessions with senior psychiatrists and a room full of patients in the throes of psychosis, depression, mania, all interacting or withdrawing at their own level of comfort or ability.  We would listen attentively to complex, colourful and vibrant delusions; these tales woven by the psyche of a patient were tangible to them and as a clinician it was often hard to tell reality from confabulation.  Some believed the radio or television spoke to them directly; others believed magically that the world turned just for them or that a higher power spoke through them.  Others were dark, and told frightening accounts of what they had perceived had happened to them that night or early morning when supposedly alone in their beds.

I was assigned patients throughout the two months, and during my time on the inpatient unit I remember very specifically one young woman whose illness terrified me.  Interviews with patients were done privately, either in clinical, white walled spaces, or in a patient’s own room.  I entered her room; she was eighteen, tall, thin and devastatingly beautiful.

But her eyes were wild, if you looked carefully.

At first, she sat, calmly, on her bed.  She spoke with me, like any young woman would with a person of around the same age.  Not much older than her, I related to her situation. Here she was, in a stark cage meant to keep her safe, to help her heal; trapped in her own mind she had multiple locks to shatter before she could fly out.  Suddenly in the midst of normalcy she threw her head back and shrieked at the ceiling; she hurled her lean body down on the bed and suddenly I was in The Exorcist.  Speaking in tongues she had become a demon; no longer but yet still the girl who had sat softly on clean sheets.  Arching her back, fighting with someone inside her mind she sent ice through my veins as she tried to pull me into her encounter; as I struggled to guide her back to me she yanked my mind just as thoroughly towards a place I did not want to go.  We separated as I backed quietly out of her space and fled slowly down the hallway to find my attending staff.

First episode psychosis, was the official term for this presentation.  She had never had any psychiatric issues before, and over the last few months had been withdrawing from her family.  She had isolated herself in her room at home, refusing to go to school, talking to herself, at times frightening her family in the same way she scared me.  Prognosis?  Unclear.  I left her to her possession and spent the years since meeting her still unsettled.

Another sparkling memory that pokes it’s sharp teeth to the forefront of recollection is perhaps the most physically disturbing of all.  On call in a psychiatric institution at night is not a place one particularly relishes being.  At least not I.  In the basement of the Haunted House we had a call room, with lockers, a land line phone that sometimes worked, a couch, a washroom.  It was locked with a key.  Down those stairs my heart fell like stone, eyes always searching, feet quiet, in the cavern of that deep dark space.

Reaching the door and closing it quickly behind was always a relief.

One night, the hairs on my neck tingled and suddenly I saw a man looming out of the darkness.  Not far from the call room door I froze, unsure, whether to run for it and lock myself in or turn back and try to make it to the stairs.  This man was not a physician, not an orderly, not a nurse; he was not even a harmless patient who had gotten lost.  This was a 6”4 criminally insane, violent, rapist.  He was supposed to be in the locked inpatient unit upstairs, and in and out of an institution where criminals with mental health issues are sent.  Instead, here he was, and I can still see the shadows on his face as he perceived my fear.  Lunging for the room I flung myself inside after fiddling with the key, slammed the door, and called upstairs to notify security that there was a very dangerous patient lurking in the basement.  His quiet, calm, fearsome demeanour still haunts my nightmares to this day, as I feel him stalking the dusky corners of my thoughts.

And yet, this Hospital taught me so much about medicine, my patients, and the mind.  It was a fertile ground for growing the crops of my learning.  When I work, I carry the nuggets of insanity in the back pocket of my scrubs and draw on all that those patients taught me by allowing me into their intellects.  Sure, cavorting in the unstable psyche of the human brain is a startling experience; but it expands one’s own understanding of the way we all think.  Comprehending abnormal allows me to better recognize normal, and to better identify with my patients who are caught in a world we cannot see.