Reporting from Canada, #13: Elbows Up and Eyes Wide Open

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PSYCHIATRIC VIEWS ON THE DAILY NEWS

If you have been following my recent columns, you will know that my wife and I have been in Canada, focusing as we do annually on the Stratford Shakespeare Festival. The plays that we saw seemed terribly prophetic, chosen well before the emergence of our current presidential administration and reduction of psychiatric services. Multiple social psychiatric issues became readily apparent in the plays and elsewhere, seeming to require multiple columns to discuss them. This one is slated to be our last in the series.

Due to the threats from the United States for Canada to become our 51st state and the initiation of higher tariffs, we had concerns about how we would be welcomed. We debated even coming, but that concern turned out to be an erroneous fantasy. We could not have been more welcomed, and then immediately helped when we had car trouble twice. I just put up our hood, and like magic, Canadians came to our aid.

We also found out how the threats to their political independence was rallying Canadian citizens towards greater unity and a Canadian identity of working multiculturalism. Whether Canada should become capable of nuclear weapons has even emerged. As applicable to other belief systems and countries, external threats often increase internal unity.

One of the Canadian responses was the rallying cry “elbows up.” I had a vague memory that it related to their love of hockey. Elbows up referred to a way to both protect oneself and also be aggressive at times, both defensive and offensive. Hence, the phrase now reflects Canada’s political response to being threatened and absorbed by the United Stares.

It also seemed to me that the rallying cry could reflect our internal political conflict in the United States and the potential response of psychiatry. We both need to defend against the reduction of federal support of our institutions’ services, as well as to be more proactive in creating alternatives. Once again, the Canadian single payer system and lack of business control has produced a system of greater and enviable clinical satisfaction.

Come to think of it, we do the same in clinical practice when the outcomes of clinical care are threatened in any way. We are ethically required to fight back and find alternatives, even as we experience burnout at epidemic rates.

Sometimes, elbows up is done with eyes closed in fear. That can lead to even more risk. So I would add approaching our current politically-based present psychiatric challenges with eyes wide open in order to best recognize our obstacles and dangers.

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.