A colleague recently asked me why I was not still in practice. I felt awkward, because if I kept up with the news, I could be just as good a clinician as I ever was\u2014and my wife said she thought I was pretty good\u2014as have some colleagues, etc. But the field has changed! <\/p>\n
In the olden days I wasn\u2019t so paranoid about making a possible mistake. A few brushes with predatory malpractice lawyers who involved me in ambiguous distant fault-finding\u2014I was in no way accountable for the final dismal outcome\u2014reminded me how much medical practice has become uncomfortably defensive. We can no longer afford to take any chances, rely on the healing potential in each soul. While a more positive attitude might operate to the benefit of 9 of 10 clients, the 1 out of 10 who denied drug use, suicidal thoughts, or in other ways understated the true fragility of his condition\u2014and then committed suicide\u2014would end up leading to the psychiatrist or treating clinician being sued. It seems to me and many others that this has become an entitled and litigious culture. So that in part accounts for the overuse of medicines, etc. The physician is consciously or unconsciously responding to the probing of a lawyer in court saying, \u201cSo you didn\u2019t think this patient needed medicine, eh?\u201d <\/p>\n
My own career emerged between the decline of psychoanalysis and the growing dominance of \u201cbiological\u201d psychiatry. I was more action oriented, more of a humanistic psychiatrist, more eclectic than others who were more tied into psychoanalysis\u2014which I thought had become too rigid. On the other hand, in the mid-late 1970s psychiatry swung from its having been dominated by psychoanalysis to the other extreme, which is a domination by neuro-science, psycho-pharmacology, and the like. This trend has some genuine value, but it has also been over-played. (We should recognize that 90% of the psychotropic drugs\u2014for depression or anxiety, etc.\u2014are being prescribed by non-specialty physicians, family practitioners, internists, etc.\u2014 and they are not infrequently prescribed in doses that are greater than what the client needs, or less, or not adequately adjusted.) So being \u201cin between\u201d is an awkward role.<\/p>\n
Also, as one who is still identified as a psychiatrist (even though I\u2019ve been retired from practice for over a decade), people stereotype me: I\u2019m either associated with unpleasant experiences (by them directly or through the reports of relatives and friends) for what seemed like non-compassionate drug-pushers; or with the old cartoon caricature of psychoanalysis. Admitting my professional background evokes prejudice in either or both directions. <\/p>\n
Admittedly, this prejudice in part is fueled not only by excesses in practice and distortions of cultural caricatures, but also the fear that people\u2019s diverse nature will be labeled as abnormal. I recently met a charming and playful woman (probably in her 60s) who was a bit defensive on hearing I was a psychiatrist. She had some relatives who unfortunately didn\u2019t know how to take her playfulness, and so was a little afraid that I (as a psychiatrist) would think she was abnormal<\/em>. (I didn\u2019t\u2014I thought she was great.)<\/p>\n It seems that the clinical fields (many cannot differentiate a psychiatrist—who is a physician, an M.D.) from a psychologist) during the 20th century have not made a clear place for a wide variety of quirks that, from a wiser perspective, are really interesting qualities. Some folks dream with extraordinary vividness, some have psychic experiences, some have mystical spiritual experiences, some are playful, etc. But the 20th century didn\u2019t recognize these mental states as valid, and people felt they might be thought of as peculiar if not slightly insane. This woman had heard in her circle of an over-diagnosis of \u201cbipolar disorder,\u201d as if that had become almost fashionable. She was worried that her really rather delightful mood swings from ordinary to enthusiastic might be viewed as a \u201cdisease.\u201d She enjoyed herself. I reassured her, but privately, I contemplated the prevalence of subtle anxiety when people are in the presence of those whose job it is to help others. <\/p>\n So psychiatry has been in transition, and I am not happy with many of the changes. I have extra concerns about this because I think that on the positive side, psychiatry and depth psychology have brought to our attention a wealth of ideas about how people fool themselves, and this and other insights need to be brought into the mainstream in this century as much as basic science became a mainstream cultural development in the last century. My solution is to promote this idea in spite of not actually being \u201cin practice\u201d any more.<\/p>\n","protected":false},"excerpt":{"rendered":" A colleague recently asked me why I was not still in practice. I felt awkward, because if I kept up with the news, I could be just as good a clinician as I ever was\u2014and my wife said she thought I was pretty good\u2014as have some colleagues, etc. But the field has changed! In the […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[24,11,12],"tags":[],"class_list":["post-260","post","type-post","status-publish","format-standard","hentry","category-autobiographical","category-literacy","category-psychotherapy"],"_links":{"self":[{"href":"https:\/\/blatner.com\/adam\/blog\/index.php?rest_route=\/wp\/v2\/posts\/260"}],"collection":[{"href":"https:\/\/blatner.com\/adam\/blog\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blatner.com\/adam\/blog\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blatner.com\/adam\/blog\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/blatner.com\/adam\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=260"}],"version-history":[{"count":0,"href":"https:\/\/blatner.com\/adam\/blog\/index.php?rest_route=\/wp\/v2\/posts\/260\/revisions"}],"wp:attachment":[{"href":"https:\/\/blatner.com\/adam\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=260"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blatner.com\/adam\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=260"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blatner.com\/adam\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=260"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}