Boston medicine in the early 1950s was more favorably inclined toward psychoanalysis and psychiatry than my medical school in Dallas and the physicians I knew in practice were. A career in psychiatry came to be seen by me as not necessarily a second-rate option, but rather a specialty that attracted some of the best and brightest. I am certain that the intellectual ambiance of academic medicine in Boston con tributed to my growing conflict.
Not surprisingly, however, my relationship with another powerful man during medical school was involved. Tinsley R. Harrison (of Harrison's Principles of Internal Medicine) was at the Dallas medical school while I was a student there. He selected one or two medical students each year to take a year out of school and become his personal research fellows. I became a fellow and my experience with him changed my life in many ways. He was a remarkable teacher—one of the last bedside clinicians of prominence in academic medicine—as well as a learned, charismatic mentor. There was no question in my mind that I wanted to follow his example, and he was un stinting in his warm support of those plans. I was to train in Boston and then return to work with him.
It was, once again, in the context of the strong need to please an older, powerful, and charismatic man who had given so much to me that my calling to psychiatry began to grow. Again, it was experienced as a growing inner conviction that this career path was right for me. I reminded myself that literature and the humanities always had more appeal than chemistry and biology did. Family and friends in Texas were polite but clearly unenthusiastic when I began to talk about going into psychiatry. My wife supported my decision, although much later she revealed that it involved some discomfort for her. Harrison offered only a type of ambivalent support when I finally told him. "Wonderful," he said. "Get your psychiatric training, then a year or so in the cath lab here with me, and then we’ll talk about a division of psychosomatic medicine." He wasn’t going to let go.
These reflections about my sense of being called to medicine, then to psychiatry, suggest that the psychology of a calling may, for some, include a de velopmental challenge involving the conflict between establishing an au tonomous identity and pleasing important others. The calling itself can be understood psychologically as a resolution of this conflict and the initiation of a period of growth. My experiences (and those of the Episcopal candidates I have interviewed) also suggest that external support from important others may be a crucial component of responding to the calling.
There are jobs, careers, and callings. We know much more about jobs and careers than we do about callings. Bellah and colleagues,2 however, have suggested that callings (more than careers or jobs) are much more likely to be incorporated into the basic sense of self. If this is so, callings present an unusual opportunity for personality growth. Therefore, we need to better understand callings, and perhaps our personal experiences may be one starting point.
Dr Lewis is chairman emeritus of the Timber lawn Psychiatric Research Foundation and clinical professor of psychiatry at the University of Texas Southwestern Medical School in Dallas. He is also in private practice of individual, marital, and family therapies in Dallas.