Giving Witness: Current Social Psychiatric Concerns of the Yale Medical School Class of 1971

PSYCHIATRIC VIEWS ON THE DAILY NEWS

Introduction by H. Steven Moffic, MD

When I was in medical school almost 60 years ago, I was fortunate to be in one that had expressed and acted upon concerns in regard to what we now call the social determinants of health (SDofH). The social upheaval and protests of the late 1960s remind many my age of what we are currently experiencing. Many of my class, of course, now and then, were not so interested in these determinants, just pure biological medicine that was enough to help patients. Over the years, significant numbers of classmates attended periodic reunions, including a very well-attended Zoom one for our 50th during the pandemic. So, it was no surprise that we resumed our conversations online during the current medical and health changes that are so rapidly occurring during the new federal administration.

Barry Perlman got us started. Perhaps you have heard his name here. I reviewed his memoir “Rearview” on April 21, 2021, and he wrote a fascinating and unusual article about “Here Comes Jimmy Hendrix”: A Psychiatrist and Patient Reconnect” on April 14, 2023.

After some back and forth, another classmate, the family physician William Toms, MD, produced what seemed to me to be a potential column. From his required thesis on “An analysis of the effect of the loss of a primary physician upon a patient population,” Bill surely had the psychiatric sensitivity that the best family physicians do. Some of that has been reflected over the years in his poetry and teaching about poetry to medical students.¹ One example called “Hot Ticket” about a patient with dementia closes with:

“And her paranoid dementia

Didn’t harm the truth when she said,

‘I love you.’

More can be found in his book of prose and poetry.²

He agreed that I could use his reflection in any way I chose, and so I will just paraphrase it a bit and condense it, keeping in mind our Goldwater Rule. I think it conveys the wisdom of the elders that the psychiatrist Dilip V. Jeste, MD, has researched and written about so much.

Barry, friends, and classmates,

All your words and thoughts are inspiring, motivating and striking a good balance, oscillating between anger/fury and reassuring/calming resolve. Thank you for your therapy. I need it.

Getting back to the awful mess that has befallen our country and the creeping feeling that we are not making a difference despite our protesting, donating, organizing, etc, I must say that just hearing what you all are doing is inspiring in itself. We are informed by reliable media that there is great dissatisfaction, but most people are just trying to get through their life, working harder than they want to be, unable to pay their bills, and generally desperate, yet still quiet about it. For our part, recognizing this mélange of inertia and sense of powerlessness, it is beyond discouraging. I was wallowing around in this swampy feeling the other day as my wife and I were walking through our beautiful New Hampshire woods. I realized that lately, I have never appreciated what our country affords us as much as I do now. And, since I had just come back from my third doctor appointment of the week, I even appreciated the far from perfect health care system we have, including the National Institute of Health, the Centers for Disease Control and Prevention, and even the Food and Drug Administration.

But as Joni Mitchell taught us, maybe we “don’t know what we’ve got til it’s gone.” This recognition of our true values is our best armament and the underpinning of all of our overt efforts. And this led to me another “So what are you going to do about it, Bill?” moment. I stumbled on a timid epiphany, namely, that we have been witness to a remarkable 250-year history of a people seeking fairness and justice, a history of developing a government that was designed to deliver the voice of the people.

How do you, my classmates, feel about giving witness? Would you be willing to add your personal ideas on what makes up the framework, perhaps not very exciting at all, that allows you to feel safe, secure, and, hopefully, productive? And when I verbalize this recognition and appreciation out loud, when I give witness, it makes me feel better.

Dr Toms is a family medicine physician in Keene, New Hampshire, and has over 50 years of experience in the medical field.

Dr Moffic is an award-winning psychiatrist who specialized in the cultural and ethical aspects of psychiatry and is now in retirement and retirement as a private pro bono community psychiatrist. A prolific writer and speaker, he has done a weekday column titled “Psychiatric Views on the Daily News” and a weekly video, “Psychiatry & Society,” since the COVID-19 pandemic emerged. He was chosen to receive the 2024 Abraham Halpern Humanitarian Award from the American Association for Social Psychiatry. Previously, he received the Administrative Award in 2016 from the American Psychiatric Association, the one-time designation of being a Hero of Public Psychiatry from the Speaker of the Assembly of the APA in 2002, and the Exemplary Psychiatrist Award from the National Alliance for the Mentally Ill in 1991. He presented the third Rabbi Jeffrey B. Stiffman lecture at Congregation Shaare Emeth in St. Louis on Sunday, May 19, 2024. He is an advocate and activist for mental health issues related to climate instability, physician burnout, and xenophobia. He is now editing the final book in a 4-volume series on religions and psychiatry for Springer: Islamophobia, anti-Semitism, Christianity, and now The Eastern Religions, and Spirituality. He serves on the Editorial Board of Psychiatric Times.

References

1. Toms W. So can you. Dartmouth Medicine Magazine. 2008:38-41.

2. Toms W. Quiet Lives: Stories from Beyond the Stethoscope. BookBaby; 2021.