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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