Letter to a Young Psychiatrist

It’s easy to give advice, hard to receive it, harder still to live it. The privilege of youth is action; of age, experience. Nature resists combining both. Experience is a comb you get when you’re bald.

I teach ignorance. Four years of medical school; and 4 more years of residency. Tens of thousands of dollars of debt, and years of minimum wage labor. You must think you have bought something with those funds and that toil; you must finally know something special. You graduate, and you get to work in this bewildering business. People pay you—and so you must know something. If decades pass and you keep getting paid and you don’t pause to reflect, you may end your life thinking that you know much. In fact, as newer generations come up, they see what you don’t.

I teach we don’t know; I teach that knowledge only increases our ignorance. This is what knowledge is: knowing what we know and, just as importantly, knowing what we don’t know.

Knowledge is 2-edged: it illuminates a fact or a part of experience. Usually, in so doing, it shows that what previously seemed sunlit truth is now utter darkness. As you learn something, you realize that much of what you “knew” was actually false. You become more ignorant as you become more wise.

Young psychiatrists need to learn, foremost, that they are ignorant. And they need to learn that their elders are even more ignorant, sometimes because they are wise—because the more you know, the more ignorant you are—sometimes because they are blind.

There is a beneficial and a baleful ignorance. The harmful kind is the ignorance of he who thinks he knows—end of story. This fellow doesn’t know and is simply “mind-blind.”² He is not wisely ignorant: he doesn’t know that what seemed “true” is false; he just thinks it’s true. Most of your teachers are of this variety, and most of your patients, and most of your colleagues—and, most likely, you.

Look for the dogma. Whatever is believed by most, is likely to be untrue. The truth is not a matter of popular vote; it tends to prefer solitary homes.

Live on the sunny side of doubt. Some doubt darkly: they disbelieve everything and everyone; the truth saunters in front of them and is treated like a vagrant. Take a naive, childlike attitude toward ideas: accept everything—initially, then think on it and reject what seems wrong. Most of your colleagues do the reverse: they reject everything immediately, so as not to disrupt the feeble furniture of their minds; rarely, and with great languidity, do they ever come to accept a new idea.

Reject a superficial worldly skepticism: don’t read The New York Times as your main supply of psychiatric discourse. Read the old books and the journals—not the new books² and the newspapers. Why do we all wrangle about the disputations in The New York Times and ignore the quiet facts of Acta Psychiatrica Scandinavica? One article in the Times is sent to an entire department e-mail list; the poor Acta meta-analysis sits ignored, except by an occasional half-dozen–member journal club.