I realize that I cannot simply wax philosophic and expect to be accorded any credibility—the young psychiatrists of today have taught me this, as well as several dozen trial attorneys. I could cite for you, at length, evidence that supports why and how older physicians add significant value to the profession. I could go on long-windedly about how they may be less narcissistic and have greater wisdom.8 How they tend to have a greater capacity for emotional regulation and are better at ignoring irrelevant stimuli.9,10 Apropos of their role as workhorses, I could discuss how they are more resistant to the cognitive effects of sleep deprivation, restriction, and fragmentation.11 Finally, I might finish up with an exploration of how they tend to have lower psychological distress and burnout, which they attribute to lessons learned over their years of training and practice.12 Yes, I could go that sterile, evidenced-based route, but then I would miss the opportunity to discuss two things I find infinitely more interesting: Our fetishization of change and 1970s science fiction movies.
The fetishization of change and Logan’s Run
By the time most persons have neared or passed the half-century mark, they will have witnessed a fascinating, if not sanctimonious, expression of the eternal recurrence—each new generation “imagines that they face an unprecedented period of perpetual . . . transformation.”3 We are in an age of unprecedented change! It is an era of such exceptional modernization and acceleration that any attachment to the past condemns us to an embarrassingly antediluvian failure to reach a glorious future. The path to progress lies before us—clear out all traditional and thus antiquated dead wood, for the superior ambition of modernization “demands that society break with the old ideas that are holding it back.”3
It is not until one has lived enough life, and witnessed enough repetitions, that the perpetual restating of the proclamation of unprecedented change eventually leads one to consider “just how novel is the latest version of the ‘new age’”?3 On finally recognizing this phenomenon, one begins to see how “the ceaseless repetition of the proposition that the past is irrelevant serves to desensitize people from understanding the legacy of human development on their lives.”3 The ceaseless change takes on a life of its own and becomes “an omnipotent, autonomous force that subjects human beings to its will.”3 Yet we all eventually bow down to the imagined ultimate supremacy of novelty, innovation, and upgrades. This has been referred to as the fetishization of change, which distances society from its past and undermines “the foundation on which a forward-looking intellectual life can be constructed.”3
The turning of our collective backs on the past brings to mind the classic 1970s sci-fi movie (and novel) Logan’s Run.13 If you are a “psychiatrist under a certain age,” you may not have heard of this movie. Not to worry—it is about due to be remade with Hollywood’s latest 20-something stars. The movie takes place in a dystopic, ageist future in which everyone who reaches age 30 must submit to an unquestioning, voluntary death. This is signaled when a colored crystal in one’s palm turns a certain color. Before that, life is a carefree stroll through the pleasures of youth.
The protagonist, Logan, is a policeman of sorts (called a Sandman) whose job it is to track down and kill citizens who “run” from society’s lethal demand. Then one day Logan becomes a runner himself. I’ll not spoil it for you, but will tell you that one of the premises is that society cannot sustain a culture without wisdom, experience, and tradition. I do realize this is a hard message to swallow in an age when youth is so highly prized that it is practically stolen from the souls of our children.
Dr Ghaemi wisely notes “there are always exceptions” to the problem of generations, and he gives several honorable examples of his own. By way of my own experiences, hard-won and patiently discovered, I cannot escape the notion that the exceptions we speak of are worthy of careful, thoughtful concentration, which coincidentally happens to be “an art of slow acquisition.”2 Osler might agree with me that a student of medicine may become “mind blind” at any age. Therefore, what we are left with, once we exclude biological and constitutional factors beyond our control is our capacity to remain lifelong students and adapt to change without rejecting our hard-won historical knowledge. To do so sentences us, paradoxically, to the opposite of true progress—a fate no different from that of Sisyphus: we are condemned to ceaselessly reinvent the wheel, never building on the sweat and toil of efforts past.
According to Heraclitus, change is the only constant in life. Yet embracing this maxim blindly runs the risk of “pedagogical chaos,”3 in terms of ensuring that future generations of psychiatrists have a solid foundation on which to develop and improve the profession in a meaningful way. The concept of lifelong learning is directed at precisely this dilemma of ceaseless change. Thus, the challenge becomes this: how long can one maintain lifelong learning, whilst also remembering the lessons of history? Mental rigidity can occur at any age, while wisdom and experience are hard-won—over time. Or as Osler2 put it: “The way of life that I preach is a habit to be acquired gradually by long and steady repetition.”
We desperately need competent psychiatrists of all ages—young, middle-aged, and old—to fill our waning ranks and relieve the suffering of patients who need us. As long as one accepts the role of eternal student, always learning, always questioning, mentally flexible, the age of the psychiatrist seems irrelevant. How do the young and old compare in their approach to knowledge? They don’t. They complement each other.
A postscript: My beloved Firebird broke down completely about 5 months after I bought it. Years later, I asked my father how he could have allowed me to buy such an obvious lemon. He told me that he knew he could not have convinced me otherwise, and that it was a lesson I had to learn for myself.
There is one transcending level. . . . This person is aware of the endlessness of entering deeply into a certain Way and never thinks of himself as having finished. He truly knows his own insufficiencies. . . . Throughout your life advance daily, becoming more skillful than yesterday, more skillful than today. This is never-ending.1