Cathy Liebowitz '15
Student Director of CCESP Nicaragua
Major: Environmental Studies
Hometown: Plainfield, NHRead the full interview
Since my first year at Dartmouth College, I had worked in many sectors of community service, ranging from tutoring elementary school students in America Reads to building a house in Habitat for Humanity. As I perused the service opportunities available through the Tucker Foundation, I stumbled upon a new and exciting experience. This opportunity would allow me to work closely with patients afflicted with severe mental health illnesses. As a psychology major and pre-medical student, interning at Dartmouth-Hitchcock Medical Center (DHMC) in Inpatient Psychiatry was the perfect match for my interests.
This curiosity in psychology and medicine first arose when a close family member was diagnosed with a psychological illness. Throughout her struggle toward recovery, I recognized the difficulties in treating the illness and the extreme stigma surrounding mental health patients. As a concerned member of the family, I sought to educate myself about the symptoms of mental health disorders, their choice of treatment and societal attitudes toward them. I, as a Chinese-American, became particularly interested in cross-cultural assessment and treatment because I learned that much of the stigma in minority groups' perceptions of psychological disorders may be attributed to longstanding cultural customs.
Despite the amount of research and the number of classes I had taken to learn more about this field, I needed some practical experience to supplement my discoveries. First-hand experience with psychiatric patients would better support my hopes of dispelling invalid stereotypes about mental health issues, compared to rote textbook recitation. In addition to the personal goals I sought in an internship, I also wished to lend my help to the mental health community. Being the DHMC Activities Therapy intern was the ideal way for me to learn more that which I was interested in and to serve a community need.
The Activities Therapy department, which fell under the wing of Inpatient Psychiatry, was where I was placed. The group therapists in activities therapy worked with the nursing staff, the attending physicians, the resident physicians, the medical students, the patient care mangers and countless other personnel as a team. The team stabilized patients in a critical psychiatric crisis when the patients arrived in the emergency room or were referred to by outpatient health care professionals. Together, they comprehensively diagnosed and assessed the patient. They also involved the patient in planning a treatment with a strong support system outside the hospital.
An integral part of the patients' treatment included participation in the volunteer-run Leisure Program, which worked to bolster self-esteem and self-confidence while stressing social interaction, communication, relaxation, and enjoyment. Volunteers encouraged patients to chat, play cards or board games, do small crafts, or go for walks. Furthermore, they facilitated conversation in a group setting, reinforcing positive social interaction, while focusing on non-illness-related issues. Thus, the volunteers assisted staff in charting a patient's level of interaction and functioning at activities, which would be eventually added to the patients' permanent records.
As a small, understaffed department that additionally ran group therapy sessions and art workshops, Activities Therapy benefited from the help of an intern in coordinating the Leisure Program. Under the supervision of assistant activities therapist Linda Steele, I intensely recruited, trained and followed-up with twenty volunteers during the winter term. The volunteer positions were normally limited to students of Abnormal Psychology, but the class was not offered in the winter. Fortunately, my advertising of the program to various student organizations (i.e. community service groups, pre-medical societies, introductory psychology classes) drew a diverse group of excited student volunteers, some without prior knowledge of psychology or medicine. This made the orientation of these volunteers more challenging. My first few tasks (i.e. holding orientation meetings, arranging TB skin tests, checking for completed volunteer applications, scheduling volunteer slots) tested my organizational skills. Once the recruitment and orientation process ended, however, the internship became challenging in another way.
Familiarizing the volunteers with patient interaction was a difficult task for me because I, myself, had not had previous exposure to mental health patients. As I trained others with the help of the Activities Therapy staff, I learned the complexities of patient interaction through first hand experience. One should be engaging patients but at a distance. One must distract patients from ruminating about their outside stressors, while also objectively make observations about their behavior during the activity. In other words, maintenance of boundaries and confidentiality was a constant concern. One must learn how to make patients feel comfortable, sharing just enough for a good conversation while holding back from any personal details. One must constantly be reminded of his or her position as a volunteer in the hospital and not let patients think otherwise. Borders and confidentiality prevent patients from becoming dependent on and attached to the volunteer or the hospital.
When I entered the psychiatric units as an intern, I knew that I would be interacting with those afflicted with terminal psychiatric illnesses, many times more severe than that observed in my family member. I tried my best to not go in with a negative preconception, but I was aware of the stigma present in psychiatry. One of the biggest eye-openers I have experienced working at DHMC is truly understanding that one should interact with each psychiatric patient without preconceived notions and should treat each patient as an individual. When the other volunteers came to this realization as well, I felt rewarded because I had helped to educate and to change other's perspective toward psychiatric patients.
Activities Therapy provided the intern with additional educational opportunities. I experienced life as part of a hospital staff and learned the inner workings of an inpatient psychiatry department. During weekly grand rounds, I sat in on lectures of various topics, such as "Toward Conducting Culturally Competent Research on Trauma and PTSD (Post-Traumatic Stress Disorder)." I observed team meetings and patient rounds, where I watched physicians discuss and interact with patients. Other patient activities I observed included group therapy sessions, which ranged from "Therapeutic Adventure Change" to "Medicine Education." I have seen electro-convulsive therapy, a successful treatment which involves inducing seizures in patients diagnosed with depression. As an intern, I had access to the patients' charts, the biomedical library in the hospital and the plethora of literature and videos in the psychiatry department.
My internship taught me more about the realities of psychiatric treatment in hospitals. The comorbidity of psychological disorders was a common challenge for the psychiatric treatment team. Consider a patient who was doubly diagnosed with depression and substance abuse. He or she would not be able to receive treatment for depression until he or she is detoxified in another clinic. Since the depression is the underlying cause of the substance abuse, this makes the treatment of substance abuse extremely difficult. This reoccurring scenario prevented many patients from receiving effective treatment. Another distressing reality I witnessed was the high readmission rate of psychiatric patients. Although DHMC psychiatric patients recover due to the wealth of resources available during their stay, some patients relapse when placed back into their own world filled with stressors. It felt disappointed to see a patient whose recovery progressed so well return to the hospital in a regressed state.
To provide assistance for the difficulties I encountered and to aid my reflection on the service experience and its meaning, the Tucker Foundation provided me with a Dartmouth Partners in Community Service (DPCS) mentor. My DPCS mentor, Nancy Adams, worked with the National Alliance for Mental Illness and had vast experience in mental health issues. She supplemented what was lacking in my knowledge on mental health, which was extensive experience in patient interaction. Nancy understood how it felt to have mental illness afflict a close family member and shared her stories with me. She explained more to me about the matter of readmission and urged me to observe more on post-discharge follow-up. My curiosity led me to analyze the patients' wellness recovery plans and observe outpatient psychiatry.
An appropriate end to my internship was spending a day in Partial Patient Hospital Program (PPHP), the outpatient psychiatry treatment program at DHMC. It showed me the resources available to patients after their discharge from the hospital. Group therapy sessions are more direct and concentrated because outpatients have higher functioning cognitive abilities. The staff is not allowed to socialize with patients in outpatient as much as in inpatient psychiatry. This keeps the patients focused on their treatment plan and also prevents them from being dependent on the hospital. During my short stay at PPHP, I observed the intensified progression of patient treatment. Unfortunately, wellness regression may also occur in patients. Since PPHP is a voluntary program, patient progress is dependent on the patient's willingness to return to the program. I discovered that a psychiatric professional tries his or her best before reaching a certain point where the patient's recovery is out of his or her hands. Sometimes the outcome is fruitful but other times it is not. That is what makes psychiatry very emotionally taxing for the staff involved.
In addition to learning the realities of psychiatry, I got a taste of the reality of post-graduation employment. This was the first time I held a fulltime job away from home. Besides arranging for room and board on campus, there were many miscellaneous "real world" lessons which I learned. Transportation to work was one factor which increased the amount of time I dedicated to this internship. Reliance on public transportation also decreased the availability of work hours for me. Paying for meals at DHMC with my own earnings was a change from swiping a card with a meal plan which my parents paid for. The most difficult adjustment to make was experiencing the "full-time" aspect of my internship. This meant early sleeping hours and early waking hours. The "real world" stressors are very different from those which one received from the academic world.
Transition back into a life of studying and classes and application of what I have learned through this internship to the academic world will be a fascinating challenge. I have certainly gained a greater appreciation for my psychology major. The experience has supplemented the knowledge I gained from my previous psychology courses, such as Abnormal Psychology, and will continue to supplement all that I learn from future psychology classes, such as Forensics Psychology. My future course selections will be greatly affected by this new interest which I developed as the Activities Therapy intern.
My positive experience with DHMC Activities Therapy has given me a reason to pursue a career in psychiatry. However, my experience at DHMC is not a perfect reflection of the role of a mental health professional. I discovered that patients do not view a volunteer intern as one who imposes rules and regulations on their treatment; thus, they do treat me with as much difficulty as they treat the hospital staff. Nevertheless, I still feel confident that I will be a motivated, capable psychiatrist. Although I understand a profession in this field may be emotionally trying at times, I no longer doubt that I have the potential to interact well with mental health patients and to successfully treat them.
Hearing veteran psychiatry personnel speak of the frustrating changes managed care has brought to the department, I learned that psychiatry, as one of the biggest money losers in the hospital, is often an easy target for budget cuts. This, nonetheless, is not a deterrent in my determination to enter the field. As the stigma surrounding mental health continues to break down, there will be a great need for additional resources and a great need for additional people to enter this profession. Prior to this experience, I was simply a premedical student with a focus on psychology because I found the subject interesting. Now, however, what I have learned from my internship has solidified my commitment to the field.
What I have gained from my DPCS internship is similar to the goal of the program, which is to inspire Dartmouth students to address problems facing society. In high school, I told others my reason for volunteering was it felt good to brighten another's day. Although community service was an activity I derived simple pleasure from, the Tucker Foundation has helped me to realize that it means much more. "Educating Dartmouth students to think and act as ethical leaders and responsible citizens in the global community" is highlighted on the homepage of the Tucker foundation website. It shows Tucker's complex goal of serving the community need while educating student volunteers. Though the impact of the service I provide may be minimal compared to the impact that this learning experience has had on me, I am encouraged by the thought that even the smallest good deed will make a difference. My experience at DHMC Inpatient Psychiatry, in combination with my family situation, has become the motivational factors for me to go into cross-cultural psychiatry. Involvement in Tucker has made me aware of societal needs which require the assistance of ethical and responsible people and has empowered me to understand that willing individuals are capable of enacting change.
Last Updated: 9/29/11