Shirah Vollmer MD

The Musings of Dr. Vollmer

Fear Becomes Reality: Psychiatry in Transition

Posted by Dr. Vollmer on May 9, 2016

 

Fewer psychiatrists are entering psychoanalytic training. Of these few, few are graduating to teach psychiatric residents about psychoanalytic thinking. Meanwhile, psychiatric residencies are strongly emphasizing the biological aspects of psychiatry to the exclusion of acknowledging unconscious motivation and self-sabotaging behavior as a result of developmental trauma. The respect, for what some academics, jokingly, or not so jokingly, for the “rent-a-friend” treatment is seriously lacking. Hence, although UCLA has a sizable clinical faculty association, comprised of volunteer faculty generously available to teach about psychodynamic psychotherapy, the opportunities for teaching are minimal, in that the residents have a full schedule without us. Moreover, the demographics of the psychiatric clinical faculty who are able to teach psychodynamic concepts are skewed towards those over 50, most of whom are close to retirement. I have been aware of the fact that I do not have younger psychiatrists following in my footsteps, which means that my skill set could soon be put out to pasture. Yet, I was still shocked when I received an email from a psychiatric resident asking me for supervision. When I told her I was booked up, she asked me to refer her to “someone like you.” I was at a complete loss. Am I so arrogant to think there is no one like me, or is this the reality? I wonder. I have pounded the payment and alas, it is not my arrogance, but the sad reality of the changing nature of psychiatry. There are very few psychiatrists who trained after I did who are comfortable in both worlds; the world of neural networks and neurochemicals and the world of the unconscious conductor making life go in unnecessary twists and turns. Now, I am reminded of my favorite book in college,

  • The Two Cultures and the Scientific Revolution, 1959 by C. P. Snow.
“A good many times I have been present at gatherings of people who, by the standards of the traditional culture, are thought highly educated and who have with considerable gusto been expressing their incredulity at the illiteracy of scientists. Once or twice I have been provoked and have asked the company how many of them could describe the Second Law of Thermodynamics. The response was cold: it was also negative. Yet I was asking something which is about the scientific equivalent of: ‘Have you read a work of Shakespeare‘s?’
I now believe that if I had asked an even simpler question – such as, What do you mean by mass, or acceleration, which is the scientific equivalent of saying, ‘Can you read?’ – not more than one in ten of the highly educated would have felt that I was speaking the same language. So the great edifice of modern physics goes up, and the majority of the cleverest people in the western world have about as much insight into it as theirNeolithic ancestors would have had.”

And so, despite my many rants on this blog, I am shocked that I am shocked about the lack of referrals I could give this eager resident. I know and I don’t know the pain of thinking that I am the last generation to embrace the mind and the brain.

2 Responses to “Fear Becomes Reality: Psychiatry in Transition”

  1. Shelly said

    Are you really the last of your generation? What will the next crop of psychiatrists do, be supervised by family doctors? Because PCPs are prescribing mood stabilizers but don’t do therapy, which is firefighting without rooting out the burning embers. What will happen to all the passion you have regarding your field and it’s future once you retire?

    • Unfortunately, with few exceptions, it is looking that way. The next crop will work like neurologists, with relatively short appointments, at relatively lengthy intervals, diminishing the opportunity to explore the nuances of human communication and thereby explore the nuances of psychological functioning. As you say “firefighting without rooting out the burning embers.” The torch might be taken by non-MD therapists, and although this could work well, there are complicated patients in which this is not appropriate. For those patients, there will be very few providers. I can only hope the tides will turn, but so far, I have not seen it.

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