"Sometimes I have to face patients as myself, not as a doctor."
Patients and doctors, priorities and victims, minds and illness…
A story about the contradictions encountered in psychiatric practice.

"Ethical Psychopaths - Reflections of a Psychiatrist" is a clinical essay written by psychiatrist and poet Kamiyu Oh, recording his experiences and reflections from ten years of clinical practice.
It humorously and honestly captures the moments when I had to constantly think about the balance between my role as a doctor and my role as a human being while facing the lives of patients closely.

Psychiatrists cannot shoulder all of their patients' suffering, nor can they completely ignore it.
So the author confesses, “I would rather be an ethical psychopath.”
Rather than embracing all the patients' wounds and breaking down, it is a pledge to maintain an 'attitude of returning and reflecting' even if it inevitably means putting someone's pain at the back of the priority list.

"The Ethical Psychopath" is not simply a psychiatrist's record.
The author's constant questioning behind the cool judgment of "Triage (emergency patient triage system for priority)" ultimately connects with the moments of choice that everyone faces in life.
In our relationships, at work, or within our families, we face ethical dilemmas, big and small, every day.
This book gently asks us what attitude we should have in those moments.

His writing, brimming with sharp insights and poetic prose, goes beyond mere clinical documentation to show how a human being can live while embracing self-contradiction.
It will provide a time of deep resonance and reflection not only for patients, but also for doctors, counselors, and 'all those who cannot turn a blind eye to someone's suffering.'

So I decided at this moment.
I won't become a simple 'psychopath'.
This moment refers to the moment when you realize the problem with psychopathic thinking.
In other words, while it is certainly necessary to have a psychopathic mindset at work, I have decided to become an "ethical psychopath" who reexamines and examines whether there are any areas that have been missed because of this.
--- p.24

While doctors naturally tend to focus on those who stand out when providing medical care, I also try to pay attention to the "victims" hidden among seemingly innocent people whenever possible.
It is about listening to the voices of victims who are not even aware of it.
Of course, sometimes that voice is a signal to leave it alone, but I also want to sense it and determine what it means.
--- p.34

But our words are like a scalpel, and speaking without thinking is no different from swinging a scalpel carelessly in a doctor's office.
The tip of the knife grazes the patient's cheek or, unfortunately, sometimes even stabs the chest.
“I still sometimes think about what you first said to me three years ago.”
--- p.58

The fact is that people simply call people who don't talk back, who don't get in trouble for something they deserve, and who don't show their dislike for something a 'good person.'
In other words, we judge whether a person is a good person or not by looking at his actions, not his heart.
--- p.105

When dealing with patients, there is a natural human relationship where they stand in the position of brothers and sisters (or older and younger brothers).
This seems to be caused by a combination of the patient's desire to find someone more mature than them and the doctor's desire to give advice like an elder.
However, if I act like my brother, as is inherent in human nature, I may end up repeating the negative relationship the patient has had with his brother-like person.
--- p.173

People who criticize others on social media or leave comments that border on malicious are usually people whose realistic judgment is clouded.
Because there is no distinction between this and that, anger builds up and arrows of criticism are fired directly.
Still, whenever I receive such criticism, my heart strangely aches.
In some ways, it's not a wrong statement, and I feel like it's understandable to hear such words.
I think there may be a strong feeling within me that a doctor must be a doctor 24 hours a day.
--- p.183

Moreover, online treatment, which can be accessed anytime and anywhere, lowers the threshold for treatment, so the meaning hidden in 'when and where' will be hidden.
In other words, the method of getting to the heart of the problem through information like, "You're an office worker, but you came here on a weekday afternoon?" or "You came all the way here to our hospital?" can naturally disappear.
Additionally, all the nonverbal information that can only be obtained when meeting someone face-to-face, such as the appearance in the waiting room, the atmosphere when entering the room, the gait when approaching and sitting in the chair, and the behavior displayed when facing another person, will be greatly reduced.
--- p.257

We have some idea of ​​what might happen tomorrow, but it's still a premature judgment.
Your condition could suddenly worsen, or something unimaginable, like war or an epidemic, could happen and completely change your situation.
That is 'reality'.
The basic rule is to first accept the situation and then decide how to act.
But at some point, when something bad happens, we tend to deny that 'reality' and believe it is fake, and we often mistakenly believe that only the scenario we imagined is real.
--- p.263

This is because patients sometimes believe simple, definitive statements floating around on social media and give up on complex, persistent face-to-face treatment.
Just like people who believe in conspiracy theories, some patients hear information on social media that they can instantly escape all the pain that has been tormenting them, and they believe that the reason their reality has been so complex and difficult is because they did not know this one method.
This way, no matter how hard I explain, the logic becomes that the authoritative teacher on social media knows everything, while I, an ordinary psychiatrist I met at this hospital by chance, doesn't know anything.
--- p.282

Of course, you can act like a doctor to a certain extent.
Prescribing medication and performing tests are the things that connect me and my patients.
There are many cases where things end well if you just act calmly and play the role of a doctor.
But at some point, I have to face the patient as myself, not as a doctor.
When I have to answer a patient's question, the reaction that comes out unconsciously is actually my own, rather than my own, 'as a doctor'.

--- p.329