Birit Broekman (49), daughter of a general practitioner, knew from an early age that she wanted to become a doctor. The first time she registered for medicine she was rejected. And again the next year. And again. And again. After four years she was able to start in Amsterdam. In the meantime, she had trained as a psychologist in Groningen. She is now a hospital psychiatrist and, recently, a professor at Amsterdam UMC. In September she gave her inaugural lecture, Interplay of body and mind in context. She does her clinical work at the OLVG in Amsterdam and this is also where this conversation takes place.
You did psychology because you wanted to become a psychiatrist?
“No, I was thinking about neurology. That’s where I found the conversion disorders most interesting, the paralysis without demonstrable physical cause, and that’s how I became interested in psychiatry. I did another year of general medicine, which was a lot of fun, but I missed the in-depth knowledge. What interested me then was the connection between physical and mental disorders.”
Half of the patients in the hospital, she said in her inaugural lecture, also have psychological complaints. And 60 to 70 percent of psychiatric patients have a physical condition. Wiepke Cahn, psychiatrist and professor at UMC Utrecht, previously explained NRC that psychoses are often associated with diabetes, and bipolar disorders with eczema, asthma and allergies.
Also read this article: ‘Body and mind are often ill together’
After your training as a psychiatrist, you started doing research in Singapore.
“My husband was able to get a nice job there in the semiconductor industry and I came along. It was a difficult decision, because I had just started my PhD, but in the end it turned out very well for me. In Amsterdam I looked at hereditary and environmental factors that influence the development of stress-related disorders. In Singapore I was able to join research by Michael Meaney from McGill University in Montreal, a big name in biological psychiatry. We used MRI scans to look at the brains of newborn children and saw subtle changes when their mother had severe depressive symptoms. These changes were mainly in the brain areas involved in processing stress and emotion. After six months we looked again and saw again that those brain areas developed differently when mothers were less sensitive due to depression and could not properly regulate their child’s stress. These children have a greater risk of anxiety and depression later.”
And also on cardiovascular diseases and diabetes.
“What stress-related disorders are. We often see people with cardiovascular disease, diabetes or obesity in the hospital and they often suffer from depression. You see comorbidity so often that you think: there has to be one common pathways are. Very logical, actually. If your system is disrupted, your stress system or your immune system, your metabolism or your hormone balance, it affects your entire body, including your brain. And the functioning of your brain determines your thoughts, your behavior and your feelings.”
Does it matter which system is disrupted?
“I think so and that is what I find very interesting now. There are many types of depression and some will have more to do with the immune system or hormones than others. And that offers starting points for treatment. Some women are more sensitive to hormonal changes than other women – around menstruation, during pregnancy and later in menopause – and here at OLVG, thanks to gynecologist Dorenda van Dijken, we now have a clinic where we treat women with serious menopausal complaints and treating psychiatric problems together with antidepressants and hormones. We also look at lifestyle and sleep. Poor sleep and insomnia are a known risk factor for depression and physical complaints.”
Do you see more depression in women than in men?
“Depression is more common in women, yes. But you can also think: maybe women present themselves differently. They are more likely to say they feel sad, they cry more. Men start drinking and put it away. In the hospital, the difference between women and men becomes smaller.”
And especially in the cardiovascular department?
“Also in orthopedics, after knee or hip surgery. Also in nephrology, kidney diseases. A very large percentage of patients have psychological complaints, even psychiatric disorders. I was recently talking to an ophthalmologist and I said: maybe not for you? He said: you should know. Pain in the eye, blurred vision, seeing spots, seeing nothing. A very large part, he said, I cannot sufficiently explain.”
If so many people are depressed, is it still a disorder?
“Feelings of depression are part of life, absolutely. And you can easily become depressed due to illness or treatment in the hospital. But serious depressive complaints do have to be dealt with, especially if they influence the treatment. Operation went well, patient is not recovering. Do you have to operate again? And stick to your diet if you feel sluggish and think there is no point anymore. I’m not saying everyone should go to a psychiatrist. However, we need to look more closely at the serious psychological factors that have an effect on the disease process and recovery.”
At the OLVG you also have a clinic for pregnant women with psychiatric disorders.
“Depression, anxiety, autism, addictions. One in five pregnant women has a psychiatric diagnosis and sometimes there is also obesity, diabetes or high blood pressure. Psychiatrists see many women of childbearing age and, strangely enough, they rarely talk to them about wanting to have children and becoming pregnant. While it is an important topic for many women. We see that quite a few women are willing to change their behavior before pregnancy. Quit smoking, quitting drugs. Now I’m going to do it, now I finally have a reason. The chance of success is many times higher for women who want to become pregnant, or who already are.”
And this is how you try to prevent harm to the children?
“Even after birth. At the OLVG, with money from the municipality, we have brought in care providers who, if they want, help mothers to have a good relationship with their child. What do you do when it cries? How do you comfort it? The first years are, unfortunately, very decisive for the development and risk of disorders later, but you can do something to make the start as good as possible.”
Career Hospital Psychiatrist
Birit Broekman (The Hague, 1974) is a hospital psychiatrist and professor at Amsterdam UMC.
She studied medicine in Amsterdam and worked at the National University Hospital in Singapore
She has with her husband three children and lives in Aerdenhout.
A version of this article also appeared in the October 9, 2023 newspaper.
2023-10-08 20:00:01
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