The Impossible Job: It is so much more than helping someone feel better.

I have been wrestling with my relationship to my work for quite some time now. I have sought out therapy, mentorship and peer support for what it is that I do and I am so grateful for this support. I was hoping, with all the resources I have poured into this over the past few years, that I would have figured it out, and that I would be able to write something clean and concise about the journey; That it would conclude with, "I've made it! I have a healthy and sustainable relationship with work, and a clear vision for what it is that I do! I am confident in all aspects of the care I provide!"

Unfortunately, this is not the case, and rather than pretend or wait for the "happy ending", I thought it would be more honest and helpful, quite frankly, to write about where I am right now. And where I am is that this job feels impossible.

Off the top of my head, it did not help I found most of my psychiatry supervisors during my training, to be models of what NOT to be. You can't know what you want and how to get there only guided by what you don't want. It is like describing an elephant only to say it is not a hippo, giraffe or snake...helpful much?

This goal of knowing exactly what I am doing and why I am doing it, for every patient I see, every day on the job initially felt obvious and intuitive, like it was not a goal at all, but something I had attained already by graduating from residency training. This is not the case and I admit, I feel angry and disappointed in my training for this. Further compounding my frustrations is that I do not have a clear, coherent explanation for why this job feels so utterly impossible a lot of the time. But on particularly bad days, these thoughts offer me some clues:

• Medications do not work a lot more than I realized. I do not know how to predict when they will work, and what to do when they do not.
• I do not know when therapy will work. It also does not work all of the time. When it does not, I do not know why. Is it me? The patient? My expectations? The technique? So far, as a psychiatrist who tries to do it all (therapy and medications), I fear I have ended up doing it all but poorly. And with the demands on psychiatry at this time, I also do not have the time or resources to do things right. And what is right? When I have not been shown or taught this?
• I can no longer deny the toll patient suffering has on me, and how my empathy is less renewable than it once was.
• I can also no longer deny the toll of difficult patient interactions, where a patient may not want what is my professional duty to provide, or where a patient may use their suffering to try to convince me to act against my clinical judgement. Trying to be true to myself while feeling responsible for the patient's symptoms can be an impossible position.
• I form hypotheses for the origin of a patient's pathology. It is part of my assessment and expertise. But because there are no tests like there are in other fields of medicine, I feel under enormous pressure when suggesting a treatment on something that can not be objectively confirmed, and will have significant implications.
• I feel invisible in my job a lot of the time. That my patient's suffering always dwarfs my own and that many of my mental health colleagues do not do both therapy and medications makes me feel more alone.
• Is the job only to remove symptoms? even if the patient continues to suffer? At one time I was so certain that I was not only removing symptoms but trying to help patients attain their emotional and mental optimum. But this ideal may be killing me slowly because of its impossibility. What is someone's optimum, when patients often do not know for themselves?