During my time as a columnist at Psychiatric Times, I have received many thoughtful e-mails and letters in response to my columns, most often when the topics related to ethical or humanistic themes. Frequently, these missives contained requests for additional resources or a sharing of experience, or they included questions about the subject. While it was my privilege to send a response to each reader who had taken the effort to write me, I often wished I could continue the conversation and connect the community of our readers in a wider circle of mutual edification.
Thanks to Ronald Pies, MD, editor in chief of Psychiatric Times, and to Susan Kweskin, editorial director, I now have the opportunity to fulfill that wish. This year as one aspect of the remodeling of our PT Web site, we will feature a new electronic feature called Living the Questions. The title is taken from a poem:
. . . I would like to beg you dear Sir, as well as I can, to have patience with everything unresolved in your heart and to try to love the questions themselves as if they were locked rooms or books written in a very foreign language. Don’t search for the answers, which could not be given to you now, because you would not be able to live them. And the point is to live everything. Live the questions now. Perhaps then, someday far in the future, you will gradually, without even noticing it, live your way into the answer.
—Rainer Maria Rilke, in Letters to a Young Poet
The title is chosen to convey several messages about the intention of the feature: to provide a forum in which readers can submit ethical and humanistic questions they are living everyday. Should you pray with a patient who asks you to do so? What do you do if a patient comes to your clinic intoxicated and insists on driving home? Should you discharge a patient who is not acutely suicidal but who is still very depressed at the behest of utilization review?
The feature will live the questions in the sense that it will not provide pat or ready answers like an ethical cookbook with a stock of recipes. Instead it will explore the variety of reasonable resolutions and will offer a semi-structured process of thinking through contemporary professional problems that confront us all. In addressing readers’ queries, I will draw on clinical research and empirical ethics as I have always done in my columns and also on a broader array of philosophical, religious, and literary sources. The aim of the responses will not be so much to transmit knowledge as to convey wisdom.4 When inquiries lie outside my area of expertise, masters of those fields will be invited to offer their insights. To further animate this Socratic dialogue in cyberspace, brief commentaries on current or common ethical or humanistic concerns will be posted on www.psychiatrictimes.com. These will also be available as podcasts for readers who enjoy walking or driving meditations.
Recently, Academic Medicine published an article on the primacy of neuroscience for the educational horizon of psychiatry.5 Several accompanying commentaries underscore the need for the teaching of psychiatry to encompass not just the disciplines of the brain but also those of the mind.6 My colleague, Ron Pies, MD, would also add to this disciplines of the soul. It is my hope that Living the Questions will be such an inclusive arena and will advance the cause of the integrative specialty of “Encephiatrics” he pioneered.7