Donald C. Fidler, MD, FRCP-I

When the pandemic hit in 2020, individuals disappeared into isolation. And so did I.

I got through by returning to my childhood of 60 years ago. Someone once told me that what makes us happy as adults is what made us happy at age 7. At that age, I loved my Lionel train, movies, making up stories, and plays.

I grew up in the North Carolina mountains. My father was a high school principal, World War II medic, basketball star, and a summer outdoor theater manager. When I was 9 years old, he dragged me to

, a play that dramatized the settlement of High County. He thought it would teach me business principles. During breaks from business lectures, I sneaked into summer stock theatre rehearsals. I was stunned by the truths declaimed in Tennessee Williams and Eugene O’Neill plays. Certainly not the truths I heard and saw at our family’s dinner table. Tennessee? Eugene? You guys hooked me.

One day I announced to my father, “I want to audition for a role in 

” Dad wanted to shield me, concerned I would be devastated if I lost competing against New York actors. After weeks of the air being sucked from me, Dad gave in. I landed a role. When I jogged to him and announced out of breath that I was cast, he said he looked at my face and knew I was lost to the business world forever.

Outdoor drama led to summer stock theater. Before long, I organized neighborhood children and my cousins to perform in plays that I wrote. My parents’ garage was our theatre and the garage door our curtain.

At age 9, I learned I was legally blind and required glasses. No wonder I could not catch Dad’s pitches. I could not even see the ball. Blindness was a good reason to spend afternoons in my grandfather’s movie theater, sitting in the front row. I could see people’s gigantic faces and expressions. Childhood blindness was a gift that led me to music, theater, writing, and eventually medicine.

Mom and Dad were not parents who read to their children. My teachers and librarians did. After I got home from school, I read to my little brother. Dad said I used to grab napkins, paper bags, anything I could write on, and sit at the end of the hall and write. He liked showing his basketball friends that if I was writing he could not distract me. Writing was necessary to me, like breathing.

All the while, I loved my chemistry set, math, and physics. (To this day I still read 

 cover to cover.) In fifth grade, I learned to play the clarinet and joined the marching and symphonic bands.

At the University of North Carolina at Chapel Hill, although I majored in chemistry and played in the symphony, I took theatre courses, acting and directing. I also took electives in creative writing, novel writing, short story writing, feature story writing, and playwriting. What skills the university could not fit into my schedule, I studied in art schools, from ballet, stage dance, choreography, stage and television light design, and editing to screenplay writing.

In medical school, I composed music and gathered classmates who also adored writing. We put on a full-blown musical: an allegory of Merlin the Magician apprenticing to become a Medicine Man in days of old. Students in our class joined in acting, singing, dancing, playing instruments in the pit orchestra, building sets, making costumes, running sound and lights. It was a smash hit.

During psychiatry residency, professors asked if I could combine show business with teaching. What a terrible idea, I thought. They dragged me into it. Using drama to teach landed me on the UNC-Chapel Hill psychiatry faculty. Following passions opens unexpected doors.

And so, in Chapel Hill; Morgantown, West Virginia; Australia; and New Zealand, I spent over 30 years teaching psychiatry while a half day a week I taught theatre. I recruited drama students to play patients for my medical student classes. One hundred-ten medical students gathered, eager to raise hands and each pose a single question to the patient—they often forgot “the patient” was an actor.

If medical students messed up, they got to do something they could not do on the wards: have second and third chances to rephrase questions. And those classes were favorite activities for my West Virginia University theatre students.

, friends, and theatre students portraying patients and used those videos to teach. That led to cofounding a company in San Diego where we produced over 400 videos of simulated patients using New York and Los Angeles actors. Those videos teach in classrooms across the country. Meanwhile, I continued writing plays for local community theatres, occasionally acting and directing.

Then in the blink of an eye, I got old. Amazing how fast that happens when you are having fun. I decided to narrow my focus. No more doctoring. No more acting or directing. No more producing plays or videos. Just write. Just breathe. Get better at it. Eight hours, 9 hours a day. Expose myself to others’ works. Learn.

 hours to become an expert. Working 8 hours a day, except for an annual 2-week vacation, means 3 and a half to 4 years to become an expert. I think—no, I know—it takes longer for writers.

Every day I improve. And thank gosh for collaborations. My multitalented friends and colleagues at the 

 are producing a video series on the history of psychiatry. During the pandemic, by using 

, we were able to continue producing videos.

During a decade of so-called retirement, I have had plays performed nationwide in universities, community theatres, and professional theatres. 

is the story of a young United States soldier with Afghanistan nightmares being treated by a military psychiatrist still suffering from traumas in Vietnam. Tons of conflicts in that therapy.

 garnered the Cleveland Critics Circle Theatre Award and moved onto Chicago and New York. It was made into a video by a theatre company in Carlisle, Pennsylvania. It was the first serious drama to be performed in an Alaskan indigenous village where during a performance, children crawled onto the set to examine props. At least they were well behaved.

Far more important than awards, audiences cry. Audience members hug and thank the cast. They say they feel understood. Talk about their own heartbreaks. Or their sons and daughters’ heartbreaks. Or fathers and mothers’ tribulations.

I write more—lots more. I breathe. My mind aches to fill blank pages. My characters act up while I am still lying in bed. They scream at me to vault out of bed, to scribble and then type. They surprise me. They enchant me. They teach me truths I do not even know I know.

Maybe they spring to life because I am old, old enough to have lived adventures with individuals from varied cultures. Australian Outback tribes, Persian Gulf mountain Bedouins, Kodiak Alutiiqs, New Zealand Maori, Appalachian rural folks—and of course: the college students, adolescents, adults, and elderly blessing my psychiatry office. Truth poured out from those people. I was a collection vessel. I tap into that fullness, shape bits of lives into plays, novels, stories, into daydreaming.

And what about memories of life journeys with family and friends? They are the glue that holds my center together.

Time flies. And what about this pandemic? It is becoming more fodder in my rearview mirror.

was an endowed chair of education psychiatry at West Virginia University. He is also a decorated playwright and founder and senior clinical consultant at Symptom Media.

Do you have a passion you would like to share with your colleagues? Please contact us at 

Articles

The pandemic has driven a psychiatrist into isolation, but his long history in the arts helps him reconnect. 

Calling on the Arts to Thrive During a Pandemic

This is the first article in a series focused on reintroducing the arts into psychiatry. The articles are written and collected by psychiatrists who are members of the Committee on Arts and Humanities, one of thirty-three committees in the 

We will share clinical vignettes, hoping to stimulate thinking about the indispensability of human connections in psychiatry. In the months to come, we will present examples of how art, music, performance, and writing enhance both patient care and medical education.

For three years, I was medical director of a specialized adolescent inpatient unit at 

 (WVU). All patients were court-ordered for 12-month stays. Three admission criteria were required: (1) criminal charges, (2) substance use disorder, and (3) one or more additional psychiatric diagnoses.

Approximately 90% of our patient population had witnessed people being shot and killed. The majority had been sexually abused. None were known sexual offenders since those adolescents were assigned to a different specialized unit. The majority had experienced people trying to kill them. Approximately 50% reported experiences of being gang members. A minority lived in homes with one or both biological parents.

Some were incapable of withstanding strong and painful emotions launched by self-reflection and requested to be returned to juvenile criminal offense programs. For those who remained, we offered numerous psychotherapies and prescribed medications. These included individual cognitive, behavioral, and insight-oriented psychotherapies, as well as traditional group, family, art, recreation, and physical exercise therapies. In addition, I directed adolescents in psychodrama groups. I trained in psychodrama courses taught at American Psychiatric Association meetings and was an adjunct professor in the WVU School of Theatre, teaching and co-teaching psychiatry for actors, studio acting, and working with playwrights.

In psychodrama sessions, I began by leading patients in simple warm-up exercises such as repeating telephone numbers while displaying varying emotions and making constant eye contact at close proximity while making faces and trying not to laugh. We progressed to complex, traditional exercises of having patients direct other patients and staff members in acting out stories from their own lives. As they became skilled in acting, they elected to perform scenes from Shakespeare’s works (drama therapy) and were especially drawn to Hamlet, finding parallels between Shakespeare’s characters and their own lives.

Adolescents gained trust during simple psychodrama exercises, realizing we did not judge their “pretend” characters, and that the stage was a place where they could experiment. If they didn’t like how they performed, they were free to change what they said and did.

Once the program had been in place for several months, new patients had advantages of observing experienced patient performers, which increased their courage and helped them participate.

The majority of participants were candid and truthful in their responses. Some used humor, helping them to avoid demonstrating strong emotions they did not want to exhibit in front of groups, often revealing even more with their humorous truths.

An advanced technique was interviewing them twice while they imagined and acted out themselves at age eighty. In the first scenario, I asked them to imagine that as teenagers, after being in our program, they never made changes in their lives. I did not specify what “changes” meant, allowing them to use their imaginations as guides.

While interviewing my pretend 80-year-old patients, I prompted them with open-ended, generalized statements and questions, such as the following:

• Tell us about the role of alcohol and drugs in your life

• Tell us about the role of school and out-of-school education

• Tell us about members of your family, including any children and grandchildren; how much contact if any do you have with relatives; how well do you get along?

• Tell us about moments you regret in your life

• Tell us about moments you treasure in your life

• Tell us about the worst action you took that made the world a worse place

• Tell us about the best action you took that made the world a better place

• Tell us about anything that stood in your way of being a better person

• Tell us about your important life lessons

• Tell us what you would like your epitaph to read

While portraying 80-year-old people, these adolescents were accurate in describing elderly views of failing to achieve 

 of “integrity,” instead, being immersed and stuck in “despair.”

 They discussed marked regret and heavy hearts of living lives of little accomplishment, of ruining lives of others, and of feeling empty and depressed. Their affects matched their pretend lives’ stories.

On occasion, when they became tearful and began to withdraw, as is done in theatre, I remained in character as an interviewer of 80-year-old people and made comments such as, “It must be difficult being 80, close enough to death to be running out of time, looking back and realizing life did not always go well.” Such reminders that we were “pretending,” predictably enabled them to continue.

In the second scenario, I asked them to imagine that as teenagers, after being in our program, they made significant changes in their lives. Again, I did not specify what “changes” meant, allowing them to use their imaginations as guides. Again, while interviewing these pretend 80-year-olds, I prompted them with similar open-ended, generalized statements and questions.

Portraying 80-year-olds, adolescents were accurate in describing elderly views of succeeding in achieving Eriksen’s developmental stage of “integrity.” They discussed marked pride and full hearts of living lives of accomplishment, of improving the lives of others, and of feeling joyful and grateful. And again, their affects matched their pretend lives’ stories.

Staff members and I were struck by the amazing health that resided within all of them, despite the severity of psychiatric presenting symptoms. These adolescent patients had never experienced lectures on human development, and yet, with very little prodding, they were markedly capable of telling riveting, detailed stories of successes and failures for all of the various stages of development.

Important in therapy, were the discussions that compared and contrasted the two varying outcomes they created from their fertile imaginations. The brain maps of development were clearly present in their minds. Their performances revealed dreams and aspirations hidden from consciousness.

During subsequent weeks and months, staff members and I reinforced the adolescents’ exposed self-knowledge. We encouraged them to own the capacities for change they had found within themselves. Their smiles and positive energy contagiously spread to the staff. We had connected, and the connections energized us and led to our eagerness to continue to help them.

By conducting psychodrama sessions, building emotional and understanding connections, I was able to more accurately evaluate my patients’ mood patterns, cognitions, attentions spans, recall, and their abilities to deal with challenges and adversity. My diagnoses were more accurate. I was able to more accurately target symptoms for indicated medications and/or indicated psychotherapies. My sense of contentment and effectiveness skyrocketed.

Let’s reintroduce the arts into psychiatry.

Group for the Advancement of Psychiatry Committee on Art & Humanities: David Sasso, MD, MPH (Committee Chair), Assistant Clinical Professor in the Child Study Center, Yale University School of Medicine; Anish Ranjan Dube, MD, MPH, Volunteer Clinical Faculty, University of California, Irvine; Donald Fidler, MD, FRCP-I, Professor Emeritus, West Virginia University; Alan M. Gruenberg, MD, Professor, Department of Psychiatry and Human Behavior, Sidney Kimmel Medical College at Thomas Jefferson University; Andrew Lustbader, MD, Associate Clinical Professor in the Child Study Center, Yale University School of Medicine; Allan Peterkin, MD, Professor of Psychiatry and Family Medicine, University of Toronto; Anna Skorzewska, MA, MD, Staff Psychiatrist University Health Network, Assistant Professor, Faculty of Medicine, University of Toronto; Chris Snowdy, MD, Associate Program Director, USC Psychiatry Residency and Child Psychiatry Fellowship; John Tamerin, MD, Greenwich, CT; Kenneth J. Weiss, MD, Robert L. Sadoff Clinical Professor of Psychiatry, Perelman School of Medicine, University of Pennsylvania; Alexander Westphal, MD, Assistant Professor of Psychiatry and in the Child Study Center, Yale University School of Medicine.

Dr Fidler is retired from psychiatry in Morgantown, WV; he is also an actor, a playwright, lecturer, and Professor Emeritus, Department of Behavioral Medicine and Psychiatry, West Virginia University, Morgantown, WV.

 McLeod S. Erik Erikson’s Stages of Psychosocial Development. 2018. 

https://www.simplypsychology.org/Erik-Erikson.html

This is the first article in a series focused on reintroducing the arts into psychiatry.

Donald C. Fidler, MD, FRCP-I

Articles

Calling on the Arts to Thrive During a Pandemic

Use of Psychodrama With Adolescents