JANUARY 6 • 2022 | 9
essay
40 Years of Psychiatry: What Have I Learned?
A
good friend of mine
suggested that I
write about what
I recall most vividly from
my 40 years of practicing
psychiatry. (Please notice
that I said practicing and
not mastering.) I decided
to retire two years ago, just
before COVID
hit. It seemed
like the right
time for me to
retire while I
still was enjoy-
ing my interac-
tions with my
patients and
their families. I
suggested to a colleague that
I was trying to go out like
Barry Sanders, at the top of
my game. He laughed and
suggested that if that were
my plan, perhaps I should
have hung up my cleats 10
years ago! (I think he was
kidding.)
Over the years, my prac-
tice evolved to focus on
evaluation and medication
management, mostly with
children and adolescents.
I saw many patients from
childhood into adulthood.
Some I only saw once
because they or their parents
didn’t choose to return. The
recent events in Oxford are a
sobering reminder, however,
of how important even one
contact with a mental health
professional can be.
LOOKING BACK
What do I miss the most? I
miss the warm feeling that
comes from helping people.
Making my living trying to
improve the lives of others
was a blessing. I also miss
meeting new people and
hearing their stories. I miss
the challenge of figuring
out what was important and
developing a treatment plan
with my patients and their
families. I miss my relation-
ships with my colleagues,
psychiatrists, therapists and
secretaries.
What do I not miss?
Paperwork … fighting with
insurance companies …
conflicts with patients …
missed appointments …
calling in prescriptions …
problems that seemed insolv-
able (although I was often
surprised by how much peo-
ple benefitted from having
someone hear them out and
validate their feelings, even if
I didn’t have an easy answer!)
I developed my own style,
what I called my “Socratic
method.” Why are you real-
ly here? Why now? What
help do you think you need?
What do you think that I
have on my metaphorical
shelf that may be helpful to
you? Can we work together
to find out what you really
need?
I borrowed from Socrates’
famous “Know thyself” and
the Serenity Prayer: You may
not always be able to change
yourself or accept yourself,
but you can always try to
know yourself better. And if
I encourage your attempt to
deepen your self-awareness,
it usually makes it easier to
change what you can and to
accept what you can’t.
I learned a lot from coping
with my own problems. I saw
a few therapists from time
to time, some who helped
and some who didn’t, and I
learned from those experi-
ences.
LEARNING FROM
PATIENTS
When I think about it, I did
an awful lot of borrowing
from others. Psychiatry is
a lot like writing; stealing
ideas from others is often the
best way to find your own
style. And I not only learned
from national experts, I
learned from my colleagues
and, most of all, from my
patients. A few examples
come to mind. (Names and
details have been altered.)
Kathy presented with
severe IBS (irritable bowel
syndrome) and intense anx-
iety. Her anxiety lessened,
helped by cognitive therapy
and Zoloft, but she con-
tinued to feel ruled by her
bowel symptoms. Eventually,
with a lot of help, she was
brave enough to say to me
and herself: “I’m tired of
missing out on trips and
family outings; even if I have
to make three bathroom
stops along the way, it’s bet-
ter than sitting at home feel-
ing sorry for myself.”
Jake was a kid who never
quite fit in at school. I treat-
ed him for ADHD with clear
improvement, but he was
still struggling academically
and socially, despite counsel-
ing and medication. He was
well-intentioned, but contin-
ued to get in trouble for his
impulsive behavior. I worried
about what would happen to
Jake as he got older.
I followed him through
his high school years and
once he started working at a
local pizza place, I began to
see a different side of him.
Unlike at school, he showed
a real aptitude for learning
at work and was game to try
everything from cleaning the
floors to serving and even
cooking.
Once he graduated from
high school (by the skin of
his teeth), he briefly tried
community college without
much success. Instead, he
began to work in the kitch-
en at the schools he had
previously attended. Once
again, his work ethic and
positive attitude led to suc-
cess and advancement. He
continued to take his ADHD
meds, which helped with his
attention span and, when I
retired, he had advanced to
Dr. Jeff
London
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