Callings

November 1, 2006
Jerry M. Lewis, MD
Volume 23, Issue 13

In this essay, however, I wish to use another source of data about callings my personal experience of a calling to medicine and, later, to psychiatry.

"Tell me about your calling."

"It's not easy to describe. Some years ago my wife divorced me-said I was a workaholic, never truly there for her. I got very depressed and was miserable-could hardly get out of bed, and my productivity as a broker fell drastically. I saw a therapist, took an antidepressant-and that helped-but I still wasn't myself. Gradually, I began to feel that God wanted something else from me, and the idea of becoming a priest came to occupy more and more of my thoughts. It seemed that, for all of my economic success, I had been terribly self-centered and needed to redirect my life. I began to visit with my priest, and, after a while, he suggested I consider studying for the deaconate. I started then and here I am 6 years later a candidate for ordination for the priesthood. I feel like a different person, like God has called me to do what I've been meant to do."

"So, in your early forties, you were very successful as a broker, but after your wife divorced you, you got really depressed, and coming out of that crisis has changed the whole direction of your life. And, although the therapy and medication helped, it was the experience of being 'called' that really turned things around."

"Yes, those are the bare bones of it. Another important part of it, though, is several years ago I met a woman, and she and I love each other and share a deep spirituality."

The middle-aged man went on to describe his severely dysfunctional family of origin, which involved abuse from his alcoholic father, and a history of failed relationships throughout his adult years. Although economically successful, he was without a coherent system of meaning until his emergence from depression appeared to initiate a process of personality reorganization and apparent growth.

As this article is being written I am reviewing the evaluation interviews with 88 candidates for ordination in the Episcopal denomination. One aspect of my semistructured interview format involves exploring each candidate's experience of a calling. At its most in clusive level, a "calling" has been defined as a strong inner impulse toward a particular course of action or duty.1 From this perspective, a calling does not always involve religious vocations; one can be called to other occupations, including medicine. A literature review has revealed that, despite the huge amount of research on science and religion-with significant attention paid to the psychology of conversion-there has been practically nothing published on the psychology of callings.

Thus, there is much to learn. For example, are persons with certain personality characteristics more apt to experience a calling? What is the natural history of a calling? Is a calling a rel atively brief experience or a lifelong part of the self? What experiences over time influence the processes involved in the course of a calling? Questions like these only begin to probe the unknowns about the psychology of callings.

There appear to be multiple experiences in adulthood that may initiate psychological growth. "Healing" marriages, psychotherapy, religious conversions, dealing with adversity, and meditation are some examples. A calling itself may also be an experience that initiates or reflects psychological growth. Interview studies-such as my evaluation interviews with the 88 candidates-can be seen as qualitative re search and a necessary beginning that may yield hypotheses to be tested by more rigorous quantitative studies.

In this essay, however, I wish to use another source of data about callings-my personal experience of a calling to medicine and, later, to psychiatry. Understanding such personal experiences may also lead to useful hypotheses about the psychology of callings. The specific nature of my experience is not what I believe to be generalizable; rather, it is that the callings occurred in a particular developmental context, involved the resolution of conflict, and were aided by support from an important other.

It was during adolescence that I began to feel the strong inner impulse to become a doctor. The impulse was actually more like a conviction of what I wanted my life to involve. It was as if I had come upon an important self-observation, and it was an exciting and positive experience. As I began to let people know my decision, the feedback was almost always positive. The one important exception was my father--a powerful, charismatic man who had achieved much with just a high school education. And he had other plans for me.

A major turning point in my father's young adult life was a World War I commission that led to a decorated battle career and brought about the social acceptance he had not found as a poor farm boy. The worst experience of his life was being discharged after that war-much against his wishes-because only West Point graduates were retained. It came, then, as no surprise that he wanted me to go to West Point to fulfill his dream.

I was ambivalent; I wanted to please him but was not at all sure that a military career was right for me. He obtained an appointment for me, but I flunked the then-rigorous visual examination. My calling to medicine thus occurred during the familiar adolescent developmental challenge of establishing an identity, one that was centered on my wishes rather than on pleasing a powerful parent. Put in a different way, I needed a calling to resolve an underlying conflict with my father and to fortify my emerging autonomy.

Support for my calling came mostly from my mother. She idealized doctors and was thrilled with my choice. I believe her feelings of approval were genuine but probably also influenced by her use of indirect oppositionalism with her powerful spouse.

My sense of calling to psychiatry had some similarities. It began when I was an intern at the Brigham in Boston. I did well, and my professors outlined the steps leading to a possible academic career there. At the time, I was a young adult, husband, and father-to-be, so my ultimate career decision needed to be made. Many of my house-staff colleagues planned academic careers, but when asked which field they wished to pursue, they re sponded with what seemed like narrow interests. One mentioned amino acids, another the pancreas.

In contrast, I found myself in creasingly interested in patients' stories-what are now called illness narratives. Psychiatrists were assigned to each of the medical wards and were freely avail able to discuss such matters, as well as one's responses to patients and their stories. Although I did not experience a calling to psychiatry then (that took several years), I did become aware of the conflict between my basic interests and where I thought academic internal medicine was going.

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.

References:

References1. Webster's Third New International Dictionary. Springfield, Mass: Merriam-Webster; 1964.
2. Bellah RN, Madsen R, Sullivan WM, et al. Habits of the Heart: Individualism as Commitment in American Life. Berkeley, Calif: University of California Press; 1996.