My hiatus is officially over and now I am returning to my blog, perhaps with less intensity in terms of the number of posts, but not with less intensity in terms of my deep concerns for the movement of psychiatry towards quick assessments and hence hasty diagnosis and treatments.
One might wonder why I was on hiatus, and why I am back. One might also wonder what I have been up to professionally. Let me begin there. I was honored to speak at the UCLA Child Psychiatry graduation. This was a special honor as it was my students who wanted me to wish them on their way to what I hope to be a very rewarding career. So, here is my speech…
Thank you- the graduates if 2014- for asking me to speak at this- momentous occasion- marking you as newly minted child psychiatrists. Your class is very important to me as you provided me the opportunity to teach the clinical practicum- the class that formally introduces you to child psychotherapy . It was an honor and a privilege to teach you – as it is an honor to stand here tonight.
As I think about you- the graduates-I am reminded of my mentors who very sadly are no longer here- Denny Cantwell, Chris Heinicke and Ken Silvers- three UCLA professors who each gave me the courage to launch a very rewarding career.
I would like to speak to you about those rewards- as you are about to embark in the next chapter of your life!
The parent calls confused and bewildered as to how to help their child. We listen to their confusion and we think about the neurobiology, the possible psychopharmacology and the issues of child development. Through these multiple lenses we can analyze the situation with empathy and compassion to help this family get back on track .
That first call may be because someone told them their child might need medication, but the family stays in treatment- not just for their prescription- but also to help their child grow up and navigate their worlds through the foibles of their parents and the challenges of their own biology.
Nature and nurture come alive for a child psychiatrist. Like no other specialty in medicine, we have the privilege of a cradle to grave specialty because our toolbox is wider and deeper than our colleagues! We can see how their birth and subsequent development landed them in our offices and then we can help them understand how to cope with their circumstances.
As Denny said you have to pick your parents carefully if you want to do well in the world and this motto has helped me help my patients understand that there is not just a brain lottery but there is a parent lottery as well.
To be a child psychiatrist- as you- the 2014 graduates will learn more and more- is to feel the heartbreak of both children and parents. The art in this field is to walk a fine line between empathizing with the child and the parent at the same time. It is both sad to watch a child be abused by his parent and it is also sad to watch a parent being tortured by a difficult child. This ability to see multiple points of view is the excitement of this field.
To be a child psychiatrist also means feeling the reward of helping kids mature. I am reminded of
of male teenager I see who is now 18 but I have worked with him since he was 12. I will call him Tom. Tom came to me against his will. He was having severe substance abuse issues and conduct problems. He was failing at school and was disrespectful to his parents. I worked with him and his parents over the years . I gave him an SSRI briefly but it did not have a big impact on his mood so we decided to do intensive psychotherapy to help him through his issues. He reluctantly agreed. Now he is off to an Ivy League college, he has nice friends and he enjoys his life . This past week in one of our sessions-he completely surprised me as he reflected on our work. “You know,” Tom said sweetly, ” I think we have a good relationship and I think you have really helped me grow up and see the world in a very different way then I did a few years ago.” I could feel my ego swell as those words came out of his mouth. The gratitude from a g adolescent is a particularly special experience.
Being a child psychiatrist is in one way like going to the movies every day- seeing a tale unfold in unique ways – but- perhaps more like a videogame- we get to attempt to change the ending. I just cannot imagine a more rewarding career. Good luck to all of you and most importantly-stay in touch!
Another important professional development is that I am now on faculty at LMU. I will be teaching psychopharmacology to first year art therapy students.
Meanwhile, I continue to teach at Los Angeles Institute for Psychoanalytic Studies, where I am now teaching the first year class about basic psychoanalytic concepts.
In November, I will begin teaching Psychoanalytic Understanding of Mood Disorders at the New Center for Psychoanalysis and in January, I will teach basic clinical concepts to their evening psychodyanmic psychotherapy program.
I continue to teach at UCLA where I supervise both an adult psychiatry resident and a child psychiatry fellow. I also remain active there on the board of the Volunteer Clinical Faculty Association.
Finally, I continue to teach and serve on the board at the Venice Family Clinic.
In returning to my blog, I plan on posting about psychiatry, psychoanalysis, child psychiatry and the changing of the profession, given the presence of electronic medical records. I want this blog to be a place where ideas are shared with thoughtfulness and consideration for the writer (me) and the audience. Of utmost importance to me is maintaining the privacy of my patients. Keeping this in the front of my mind, I want to use small moments, without identifying information, to illustrate important clinical concepts. I am happy to receive comments, either personally or publicly.
Thank you readers who have waited patiently for me to return. I appreciate all of your support during my hiatus.