Brandon Unruh, MD

Since leaving my home in Fresno, California, I’ve alternated between the west and east coasts every four years.   After graduating from Harvard College, I worked for a year at McLean Hospital as a mental health worker.  I was struck by the MGH/McLean residents and faculty I met then, and by the history and character of the MGH and McLean campuses.  I moved back west for medical school at UCLA with hope that I would someday return.

As a PGY-3 resident, I can happily report that my resident experience is surpassing my favorable early impressions of the MGH/McLean program.  One of the most enjoyable aspects is my ongoing connection to the psychiatric communities at both MGH and McLean.  I’ve spent most of the past year on the MGH-based core rotations, but have consistently spent on average one day per week in my outpatient clinic at McLean.  So I’m able to take advantage of the case conferences, faculty, research, and scenery uniquely available at each campus.

As psychiatry becomes increasingly specialized, the separate but related traditions at MGH and McLean inspire me to think broadly and to draw understanding from multiple modes of thought within psychiatry, as well as from other fields.  I am particularly interested in applying insights from philosophy to a phenomenological understanding of patients’ experience and to our own experience as psychiatrists.  I’m interested in the source of philosophical judgments we form about persons with psychiatric disorders, and in how we engage with them around questions of agency and moral responsibility.

My current four-month rotation on the consultation/liason psychiatry service at MGH stimulates this mode of interdisciplinary thought every day.   Twice weekly service-wide rounds and weekly resident-led Psychosomatics conferences are geared to examine patients and their problems from multiple perspectives.  In rounds, we ponder difficult cases alongside attendings who bring a depth and breadth of experience (from psychoanalytic to neurobiological), as well as a humor that is characteristic of the C/L service.  We consider the boundaries of diagnostic categories, the process of interacting with difficult patients, and the meaning the experience has for us – much more than just what to do with any given patient.  Over the four months, every resident works with every attending, ensuring that we learn a variety of potential approaches.

The C/L rotation also brings opportunities to practice presenting case-based and topical material in a formalized way.  Each week at Psychosomatics conference, one resident selects a topic to present and a local expert to provide discussion.  So far, I’ve presented on conceptual problems with characterizing dissociation and dissociative disorders, and on philosophical problems related to the notion of psychopathy.  While preparing and giving each talk, I’ve developed lines of thought I’m now turning into full-blooded manuscripts.  In the fall, I’ll be taking an elective writing seminar (led by the chief of the C/L service) in which residents and faculty exchange manuscripts in progress with the intent of revising and finalizing projects that otherwise might remain in limbo.  My coauthors on each paper will probably be those who served as discussants during my Psychosomatics presentations, as they were both eager to offer ongoing mentorship.

So, what’s true on the C/L rotation has been true elsewhere in the program so far – the daily work I do, the mentors I do it with, and the campuses and settings where the work happens all play a role in helping me build a more comprehensive understanding of patients’ problems and potential solutions.