What does it mean to be a psychiatrist in 2016? As I teach many UCLA Psychiatry Residents, this question comes up on a weekly basis. My identity, feeling not much older, but in fact being twenty years older, is vastly different from their budding professionalism. I see myself as someone who listens, someone who privileges past experience as causing current symptoms, as someone who deeply feels that developing in-depth narratives is a healing process. I see myself as someone who has a toolbox which includes medication, but I do not privilege that over my other tools. They see themselves as someone skilled at “psychopharmacology,” a word I have come to despise, as that word has justified the development of pill-mills, doctors who have an assembly-line of patients, lined up to get a prescription, as if it is some sort of food line. I see myself as developing long-term relationships with patients, not that patients will see me for their whole lives, but rather patients will see me as a resource for their whole lives. They see themselves as not knowing their patients, not recognizing them on the street, or knowing their major milestones. Their identity makes me wonder two things. First, how do they not burn out? If they don’t develop relationships with their patients, how do they get up every morning and do their job? Where is the passion, the life-force, which makes them feel fulfilled? “It is not enough to help someone,” I say, “but it is important, for your own satisfaction, to know who you helped.” Second, and similar to my first question, how do they feel stimulation? Our medications have stagnated since the 90s. Our new treatments are expensive, and not necessarily robust. Understanding and listening is a stimulating and constantly changing experience. There is novelty on an hourly basis, and yet, prescribing medication can become painfully routine.
One resident, quoting another resident, said that they did not want to learn psychotherapy because it is “boring”. I was quite shocked by the comment, but my response was “of course it is boring, if you don’t have the skills to know how to listen, then it is boring.” Mastery is very important to self-esteem. Learning a new skill is both humiliating and time-consuming. “Psychopharmacology” is a relatively quick learning-curve, leading to a short-time to mastery, which I understand is seductive. Yet, what about the long haul? How do these residents do in twenty, thirty years? My hunch is that their passion goes elsewhere. They develop intense hobbies, and have intense relationships outside of work, while being a psychiatrist is their “day job”. I can see how this gives them a nice life, a comfortable salary, and time to themselves and to their families. At the same time, I am overwhelmed with sadness that the passion in psychiatry seems to be dying. Whereas when I trained, my colleagues and I spent countless hours trying to understand a patient’s dynamics, while we were doing patient care, the younger residents, by and large, are more eager to “get out of the hospital” so that they can have “a life”. For us, our profession, caring for patients, was our “life”. It is not that we did not have other relationships, but it was that the priorities were closely aligned, meaning that professional and personal work mattered, if not equally, close to equally. One could argue the value of that lifestyle, but from my point of view, my generation, and those that came before me, were blessed with the privilege of work that felt passionate. My students, although, for the most part, are not interested in that “passion,” they remain curious, as those who are curious about history, as to how I think, and at least in that way, I still have a place in their education.
Shirah Vollmer MD 