When I was in medical school, I was torn between going into infectious diseases – I had loved Rats, Lice, and History (Boston: Little, Brown & Co., 1935) – and psychiatry. I spent a month at the former Army facility, Gorgas Hospital, in Panama City, studying tropical diseases. I found that looking at slides under a microscope gave me headaches and ended up studying psychiatry at Walter Reed, which was in Washington at the time.*
But I remained fascinated by the intersection between tropical disease and their psychiatric manifestations. These included the neuropsychiatric manifestations of schistosomiasis – cysts in the brain – and the neurologic effects of Lyme disease and tetanus. But this was a relatively arcane area in the United States.
Dr. Elspeth Cameron Ritchie
Then came the AIDS epidemic. AIDS showed both the connections between reckless behavior – casual sex, intravenous drug use – and the drastic effects of the virus on the brain. There was also the fear factor. Back when AIDS was new, medical students and doctors entered the hospital rooms in gowns, masks, and gloves. We feared the infected needle stick.
Now AIDS is a chronic disease, not a death sentence. If we are exposed, there are prophylactic medications.
Then there were the anthrax letters. Five died. Fear gripped the East Coast, as we wore gloves to open the mail.
But mundane antibiotics stopped the deaths. Our collective anxiety eased.
So enters Ebola virus in the news. Obviously, the spread of the disease in West Africa is very scary, especially with reports of doctors and other health care workers getting infected and dying.
NPR and other media outlets have interviewed Dr. Tom Frieden of the Centers for Disease Control and Prevention. He says the risk of transmission and infection in the United States is low. Still, there is the fear factor for both health care workers and the general public. Do we believe him or the other experts from CDC?
Some of the basic principles of health risk communication are: 1) do not just dismiss concerns; 2) convey what you know and don’t know; and 3) listen to the concerns of the audience.
Doctors, including psychiatrists, are an essential part of that risk communication. Thus the information in these articles on Ebola and HIV is critical for psychiatrists to know, so that we can be a soothing voice to treat the anxiety of the public.
Dr. Ritchie is former chief of psychiatry for the U.S. Army and the current chief clinical officer in the department of behavioral health for the District of Columbia.
*Correction, 8/7/2014: An earlier version of this story misstated the location of the institution.