Challenging patients: Human misery

Abstract

IntroductionPsychiatry has seen significant progress in recent decades due to scientific advances. However, beyond genes, neurotransmitters and neurocircuits, there is a truly human dimension that escapes all the science. The choices each one makes, even if biologically mediated, and the consequences, even if mediated through individual vulnerabilities, dictate an outcome. That outcome may be a biopsychosocially ill individual. Health professionals trained and up-to-date on the latest research are confronted with challenges that far outweigh what they expected and know what to do with, defying the humanity of even the most humane.ObjectiveTo reflect upon a clinical case of human misery.AimsTo promote growth at a professional and personal level through the process of treating challenging patients.MethodsPresentation of a clinical case.ResultsA homeless person with a history of and current drug use, prostitution, untreated HIV-AIDS, hepatitis B and C, untreated Mycobacterium lentiflavum pulmonary infection, bleeding rectal prolapse, prolonged psychotic manic episode and a very difficult personality has trouble finding and ultimately rejects help from medical professionals and ends up involuntarily admitted to a psychiatric inpatient unit.ConclusionsMany unsolvable or only partially solvable puzzles end up under psychiatric care. The complexity of human nature escapes all scientific advances. We can put many pieces together but the whole often remains a challenge, a challenge of our values, our motivation, creativity and resilience.Disclosure of interestThe authors have not supplied their declaration of competing interest.