Rites of Passage: Initiation into the Culture of Psychiatry

Puneet Chawla Sahota, MD, PhD

“Over many generations, healers have learned from one another, passing down wisdom gained in their lifetimes of clinical practice. Internship was my chance to be part this legacy…”

I’m so happy to share this blog post by medical anthropologist and Penn psychiatry resident Puneet Chawla Sahota, MD, PhD.

Physician burnout is increasingly discussed in popular media, and of course, residency programs.

I am now over a year into my psychiatry residency, and have found perspectives from the field of anthropology most helpful in moments where I feel close to burnout.

Medical anthropology is a subfield of anthropology (broadly defined as the study of humankind). In medical anthropology, there is an emphasis on culture, that is, a community’s way of life. Healing systems are also viewed as having a culture of their own, and conversely, culture itself is an instrument of healing – for example, ceremonies and rituals have long been used by societies to help individuals heal from trauma.

Understanding psychiatry as a cultural healing system has helped me during my early years of residency. One tool of anthropology is participant-observation. In this research method, an anthropologist seeks an insider’s view of the culture through participating in community life while simultaneously maintaining distance as a scientific observer.

The intern year of residency is a rite of passage for all physicians.  At moments in my internship, the learning curve felt unbearably steep. When close to exhaustion, I found that assuming the position of a participant-observer provided a much needed meta perspective, and helped me to cope.

I began to think of psychiatry as a culture into which I was being initiated.  As a participant-observer, I tried to distance myself from the moment-to-moment difficulties of residency.  I realized I was an initiate, still a novice, in this new cultural healing system. A steep learning curve was part of the process, and I needed to be patient with myself.

Rather than worry about how I was performing as an intern, in my best participant-observer moments, I would stop to curiously observe, without judgment, the clinical circumstances before me.  I would ask, “What did I learn from that patient interaction? How does the feedback from my attending enrich the broader cultural schema I am building as a junior psychiatry resident entering the profession/community?”

Taking this participant-observer role also gave me an appreciation for all the gifts of internship. In cultural anthropology, mundane, daily experiences of community life are understood to be a rich source of data. As an anthropologist, then, I appreciate and seek meaning in everyday clinical experiences. In stepping back as a participant-observer in my residency, I realize that everyone I interact with is a teacher, a key informant in the culture I am studying. Every single patient care experience is an opportunity to grow as a clinician. Each time I reflectively observe myself as a new participant within the culture of psychiatry, I realize I am growing and changing. And it is the close mentoring I receive from senior residents and attendings that is responsible for my growth.

Many books have been written in anthropology about how healing systems are learned and taught in different cultures. A common thread is that of apprenticeship. Over many generations, healers have learned from one another, passing down wisdom gained in their lifetimes of clinical practice. Internship was my chance to be part this legacy, to be trained as an apprentice the way doctors have learned their trade for eons. I was an apprentice to many fellows, senior residents, and attendings. Understanding residency as apprenticeship, as a way to become acculturated and proficient in a healing system, gave me a deep sense of gratitude for my teachers. I felt like a small link in this vast chain of healers over time.

As an intern, I often stopped in the middle of a day thinking, “How lucky am I to be training as a healer?” I was grateful to receive the everyday gifts of knowledge from experienced doctors who took me under their wings.

Mentoring from senior physicians was what I treasured most about my internship. Although my internal medicine and neurology rotations also operated on an apprenticeship model, it was in my psychiatry months that I worked most closely with attendings, one on one, to learn their approach to caring for patients. It was during those rotations that I remembered why I had chosen to specialize in psychiatry.

Many aspects of residency are challenging for young physicians. Insights from anthropology about biomedicine as a cultural healing system, and residency as a time of acculturation, rite of passage, and apprenticeship, may help young physicians to keep a broader picture in mind and to appreciate the everyday experiences of clinical training. I remain grateful for both my anthropological and medical perspectives, and feel these two different ways of looking at the world have enriched my learning experience as a new psychiatrist.

Puneet Chawla Sahota is a medical anthropologist and psychiatry resident at the Hospital of the University of Pennsylvania.

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