The following feature story was written for Vanderbilt Medicine, a semiannual magazine mailed to alumni of the Vanderbilt University School of Medicine. View the original version here.
Reid Finlayson, MD, MMHC, was nine months into his first year of psychiatric residency training when he awoke on the seventh floor of a psychiatric hospital in downtown Toronto, Ontario.
It was Easter morning in 1974, and hazy memories of being “wrestled to the floor by a sea of faces dressed in white” injecting him with sedatives flooded his mind.
Finlayson, who was 29 at the time, had recently relocated his family to Hamilton, Ontario, to study psychiatry at McMaster University after practicing for three years as a family physician in Owen Sound. His family was unhappy with the move, and the draining work required by his training program led to a lingering feeling that things weren’t going well. He had trouble sleeping, a decreased appetite and an overall sense of hopelessness.
The week before Easter in 1974, he decided to see a psychoanalyst, who prescribed him an antidepressant.
“Although I felt despondent, it was not easy to accept that I might be clinically depressed. I thought of my symptoms as the result of events outside myself. Even years later it has been difficult to accept that the changes in mood might originate from within myself,” said Finlayson, now an associate professor of Clinical Psychiatry and Behavioral Sciences at Vanderbilt University Medical Center. “I remember thinking (rather grandiosely for my first year of residency training) that I was already as capable as any psychoanalyst.”
Within days of beginning the antidepressant, Finlayson became dissociated, confused and restless with behavior changes that concerned his family. On the morning of Good Friday, he showed up at his program director’s office door unannounced while his director was in the middle of an interview.
“I don’t remember what was said, but he was kind, recognized my distress and arranged for me to receive an injection of a major tranquilizer and be transported by ambulance to a psychiatric hospital in Toronto. He must have reasoned it would be wiser to not admit me to one of the Hamilton-area hospitals where I might work again someday,” said Finlayson. “It was my formal induction into the shame, guilt and stigma of mental illness.”
An unwelcome initiation
Upon his arrival to the hospital, Finlayson believed he’d meet with the clinical director and be sent on his way. Instead, a certificate of involuntary committal was signed, requiring him to remain on the unit for two weeks despite his personal wishes.
Angry and impatient, Finlayson’s attempts to leave the hospital anyway resulted in sedation, and he spent the next few weeks lying in his hospital bed, trying to make sense of the situation and afraid of being labeled with a mental illness.
Much of his treatment was medication based, and the doses he was prescribed only angered him further.
“I felt I was better qualified to decide how much medication I should take,” said Finlayson. “Maybe it was denial, or the grandiosity of the illness, or maybe it was the only thing I felt I could control in the hospital, imprisoned against my will.”
When the nursing staff was distracted, he hid the pills in his hand, under his tongue or in his cheek before flushing them down the toilet.
Seeing that his family was nervous to take him home upon discharge, he began taking small quantities of his medication to calm their nerves and in hopes his symptoms might improve. Instead, he felt lethargic and more depressed. He was stressed about how the events of the previous weeks might impact his career and was uncertain about continuing his education in psychiatry.
After a few weeks of misery at home, Finlayson’s family doctor referred him to a psychiatrist, who diagnosed him with clinical depression and recommended replacing the high-dose antipsychotics he had been prescribed at the hospital with another antidepressant. Within days, he returned to a state of confusion and fear and experienced sudden bursts of high energy.
Without an appointment, he walked several miles back to his family doctor’s office, who recognized his psychotic symptoms and arranged for admittance to a nearby psychiatric hospital. He was involuntarily committed for a second time, just a few weeks after his first hospitalization.
“I became extremely frightened and endeavored to escape. After the first attempt my clothing was removed, but I eloped once more and this time made it to a nearby busy highway. I tried to hitchhike, but dressed only in an open hospital gown with no shoes, I failed to hitch a ride,” said Finlayson. “It was like something you’d see in a movie.”
When the nurses got him back onto the unit, they tried placing him in a seclusion room, where he used a bed on wheels as a battering ram to force the door back open. He was injected with sedatives and woke up a full day later naked on the linoleum floor of an empty room.
“That was a pretty low point in my life,” said Finlayson. “I never had the nerve to ask to see my records from that hospital stay.”
The next day, he received a visit from a psychiatrist and faculty member at McMaster University whom he’d met during an early rotation in his residency. The psychiatrist diagnosed Finlayson with bipolar affective disorder, also known as manic depression, which is associated with mood swings involving emotional highs and lows.
He advised Finlayson to begin taking lithium, a medication that was still being investigated at the time to treat the highs and lows of mania but is now one of the most common treatments for bipolar disorder. Within days of his first dose, his behavior became more rational, and he could think more clearly. His condition improved as he returned to life at home, where he took some time away from his training to reassess his ambitions.
“At the time, I wondered if I’d ever be able to practice again and if I’d ever go back to psychiatry. I ultimately decided I felt I had made the correct choice to train in psychiatry and that I did not wish to start over in another specialty or return to family medicine. If anything, my experience as a patient only heightened my desire to learn more about psychiatry,” said Finlayson.
Despite his hospitalizations, he was welcomed back into his residency program with understanding and acceptance. Three years later, he finished his training and was invited to join the faculty at McMaster University as a lecturer in the Department of Psychiatry.
An unexpected passion
When Finlayson graduated from medical school in 1969, he originally dreamed of becoming a surgeon. After learning he only required one year of internship to become a fully licensed family physician, he took an internship in Toronto, where he met another young internist. Together, they established a family practice in the more remote area of Owen Sound, where Finlayson also served as a coroner and jail surgeon.
“At that time, I was the youngest county coroner ever appointed,” said Finlayson, who was 27. “I found that work very challenging. I saw a lot of things I wasn’t trained to manage, especially some of the grief and concern of friends and families about the sudden, unexplained or unexpected deaths I was called to investigate.
“When a 2-year-old child drowns, what do you say to the distressed mother? I had little experience. I sometimes didn’t know what to do.”
His lack of training in the emotional side of medicine piqued his interest in returning to study and train in psychiatry, a path his father had also taken.
“I tried to figure out what I could do to make more of a difference,” said Finlayson. “What could I do to help before these terrible things happened rather than making recommendations after someone had already died? How could I learn how to intervene with patients’ families to make a difference?”
Although his training taught him the ins and outs of family therapy, Finlayson believes he learned just as much from his experiences as a psychiatric patient.
“I know what it’s like to be nervous, unsure whether you can trust somebody, frightened about your situation and career, and worried about a mistake you may or may not make. Going through it yourself makes it a lot easier to understand the person in front of you,” said Finlayson. “It would take years, including many hours in therapy and years of recovery, before I was able to more completely accept and even enjoy the harmless ‘demons’ within myself that I was so terrified to face back then.”
Finlayson was hospitalized three more times after his stays in 1974 — once briefly in 1985 after reacting to chemical fumes while fixing a wind surfing board and twice in 1994 when he tried stopping his lithium prescription amid family troubles.
To his surprise, following each time he was hospitalized, he was warmly welcomed back to work.
“By and large, the psychiatrists I’ve worked with have all been very understanding. I’ve never interacted with a patient when I’ve been incompetent to do so. I’ve always been honest about when something is wrong or when others think something may be wrong,” said Finlayson.
The most effective treatment
In 2001, he moved to Nashville after many years working in psychiatry and addiction medicine to begin his career at Vanderbilt, where he had already been involved in research projects. Currently, he sees patients in both the inpatient and outpatient settings at Vanderbilt Psychiatric Hospital (VPH), teaches and supervises trainees and medical students and serves as medical director for the Faculty and Physician Wellness Program, where he provides psychological support to Vanderbilt faculty and house staff facing their own mental health concerns.
He also evaluates physicians through the Vanderbilt Comprehensive Assessment Program, which is designed for adult professionals experiencing emotional or behavioral concerns that affect their work behavior or quality.
He continues to take lithium, seeks therapy regularly as needed, even from his colleagues at VPH, and has attended countless Alcoholics Anonymous meetings to help him manage habitual drinking, another “demon” — as he calls it — he has faced. He has now been sober 26 years.
To Finlayson, these personal experiences are nothing to be ashamed of, and he often shares them with patients who are struggling with their own mood disorders and addiction to help build trust and hope.
“I sometimes get a patient who is hospitalized and is really disgruntled about it. Sometimes they’ll say, ‘You’re a doctor — you have no idea what it’s like.’ And I’ll say, ‘Wait a minute, you don’t know anything about me,’” said Finlayson.
“It was novel to experience being a patient and to learn the rituals associated with mealtimes, medications, meetings and spending long hours interacting with other patients. I know psychiatric illness inside and out, and in some ways, that’s an advantage when I’m treating patients.”
One of the biggest takeaways Finlayson applies from his own experiences when treating patients is that just because he prescribes a medication doesn’t mean the patient will take it. He understands why some patients may be reluctant, and he often prescribes liquid medications when he feels drugs are necessary since liquids are more difficult to avoid taking than pills.
He has also learned the importance of forming a relationship with each patient and getting to know what’s important to them. He believes listening without judgment or rejection builds trust and opens his patients up to more recommended treatments.
Above all else, he has learned that acceptance of oneself and of others, despite the powerful stigma that still exists around mental illness, is the most powerful tool that exists.
“I know what it’s like to be without judgment, reason and emotional control, but I did not lose my mind, my spirit or my soul,” said Finlayson. “Experience has repeatedly taught me that the most powerful enemy is my own fear. But most importantly, I realize that love and understanding are the most powerful treatments available. Without them, nothing else really works.”