Thanks to Psychiatry!

December 4, 2010
H. Steven Moffic, MD

We've just had Thanksgiving and I have been in a most thankful mood. I'm still feeling that way after returning to work--and even after an email from a colleague reminded me of one of the many problems facing our field.

We've just had Thanksgiving and I have been in a most thankful mood. I'm still feeling that way after returning to work--and even after an email from a colleague reminded me of one of the many problems facing our field. The colleague marveled that a plumber called by her daughter over the weekend charged $175 an hour.

I think it's interesting that society will pay as much or more for plumbing of our waste than for plumbing the depths of our minds. Regardless of this reimbursement issue and the many other problems in our field, I give much thanks for my career in psychiatry. Here's why.

When I was in high school, I read Freud's Interpretation of Dreams and was fascinated. Combined with my mother's desire for me to be a physician, what better career choice than a psychiatrist?

Of course, being so interested in Freud as an adolescent implied that I was curious about myself, and maybe even needed psychiatric help. And I did. I was voted "Most Accident Prone" in High School as confirmation of that.

Actually, the most help for myself came from my wife, but psychiatry did its part. I was trained in the era when personal treatment was expected, and I did receive some psychotherapy during my residency. It also helped.

And, in turn, psychiatry has allowed me to feel that I've helped others . . . to play my part in Tikkun Olam, in healing the world. Not that this is ever easy. Psychiatry is a relatively young profession and the brain is well-protected and not easily assessable to study or remedy.

On Thanksgiving Day, I heard a radio interview with the jazz great Dave Brubeck. About the same time I was learning psychiatry, I began a lifelong fascination with jazz and Brubeck was an early favorite. On the show, Brubeck discussed how sometimes he has felt like a psychiatrist in managing and interacting with his musical group. In addition, he discussed how one's profession would influence what one paid attention to in the world. For him, his love of music led him to pay particular attention to the rustling of the wind, the burbling of the streams, and the clanging rhythm of a car going over bumps in the road (which helped lead to his innovations in jazz rhythms).

In a similar way, psychiatry has helped me to see the world with more depth by sharpening and strengthening my senses. This includes hearing and listening, but in a different way than Brubeck. We were taught to listen to patients with a "third ear" for unspoken messages. I think we also can learn to see with "3-D vision" for the hidden messages of appearance. When shaking hands, the nature of the touch may be revealing. We can also learn how to "smell a rat," though unfortunately, that took me a long time.

A psychiatrist-at least one with some psychodynamic training-can't help apply this way of looking at the world to everyday life. That's why I might quickly think that Colonel Sanders of Kentucky Fried Chicken fame might be of special meaning to the Chinese if they associated his appearance to the revered Confucius and their emperors of the past. (See last month's blog). Sure, one has to learn to keep this kind of reaction in check for fear of inappropriately applying it to one's children, friends, acquaintances, and colleagues. Those who are not our patients don't appreciate that we are trying to read their minds or analyze them, as the public commonly assumes anyway.

Psychiatry has exposed me to people and populations in ways that would have been unlikely or impossible in any other way. Every patient has a deep and unique story if you allow enough time and trust to hear. In what other field would I have had the chance to work with the transgendered, with refugees from so many countries, and with prison inmates, often all in the same week? One can see not only their weaknesses, fears, and problems, but also their strengths, courage, and potential contributions to society-and to me. The psychiatrist is often privileged to encounter the heights of service and the depths of evil; courage and/or cowardice; morality and/or corruption.

I feel psychiatry has helped me to fulfill my destiny in this life. I've come to believe that each of us is challenged to find the best way to use our unique psychology and skills. Psychiatry has been that for me.

There may be one more reason to feel grateful about feeling gratitude. As I was finishing this blog, I ran across new research that suggests that feeling gratitude can improve one's mental and physical health. If so, I hope I have expressed enough gratitude to psychiatry!

Feel free to express yourselves in your comments.