Where the Real Doctors Live

Those who are aware of my C-V know that I left Emory for two years of private oncology practice as one of the founding members of the Georgia Oncology Group. While at Emory I became unable bear the large load of clinical care and also faced some conflicts of interest with masters demanding to be served. The burden of high volume of clinical care and no back up coverage was the primary cause of my the decision to leave the splendid group of physicians and staff of the Georgia Oncology Group. Wishing to remain in the Atlanta area I decided to move into another medical specialty and soon entered specialty training in psychiatry at Emory. 

My choice to pursue training in psychiatry and child psychiatry owes full credit to the many competent and courageous families with whom I had become associated and for whom I developed great admiration. My presence among them led to my developing a thirst to know more of the functioning of the family unit.  Great awe for the marital bond and those trusting and loving families endures to today; some 40 years of practice later.

Entering psychiatric training as a task oriented linear thinking researcher I was confronted with the necessity to develop the skill to follow the circuitous pathways of symbolic and emotional associations to often deeply veiled fact. Had I not had the maturity and confidence that twenty years of medical practice brings plus some two years of personal psychoanalysis I might well have never mastered the techniques. Psychiatry is the most humbling and complicated of the medical sciences.

The physician who deals with the mortal coil is dreaded for the news of illness he may bring. The physician who deals with the soul, "das ich," is even more dreaded. His advocacy is for the reality that one himself must discover.

A source of some pride, I believe I eventually became very successful in integrating and incorporating the two bodies of knowledge from my two previous specialties into my private practice of adult and child psychiatry. It is to my regret that a number of factors, prominently age and finances prevented me from actualizing that in academia.

The degree of attention that I give to what doing psychiatry is like, the techniques and the settings, may at first be perplexing and then boring. The reasons are twofold. The first is from an acknowledged longing for those I love to know my reality. The larger reason is to lay the foundation for some of my other writing and clarification for our understanding various human institutions. I hope my faith in the wisdom of this is born out.

The emotional exploration of a segment of an individual's life gives the power of understanding toward free choice, motivation to change and the capacity to address future challenges.

A therapeutic alliance is the patient/therapist bond which is first employed in the setting of conscious and unconscious aims as well as mundane parameters. These include fees, frequency of visits and also the absolute prohibition of physical acting out in and out of the consulting room. Operating throughout a course of treatment the alliance is the reliable core that engages the objective mind to join in the therapy, interpretation of events, feelings, memories etc. In psychoanalysis or psychoanalytic psychotherapy the development of a transference relationship is encouraged to form, in part through the parameters.

Necessarily there is constant awareness that the patient while in the consulting room, especially during the working through phase of therapy, may believe he is to a greater or lesser extent dependent on the analyst/therapist. Feelings and events, past and present, are explored not to excuse or encourage childish behavior but to support desirable change for the future. It is what is not consciously recalled that is memorialized in actions or affective states.  

One is encouraged to "remember in order to forget." --- Freud 

Healing involves more than decrease or suppression of symptoms. It must include encouraging the attainment of realistic perceptions of the external world, self and physician and ultimately the ending of therapy. Though the therapist must take a stance favoring reality he must be sensitive to the capacity of truth to traumatize. Just as with surgery, tissues will heal best if handled gently and truths teased out with the sharp scalpel of the intellect, not the bludgeon of raw emotional confrontation.

The strengths of the patient are recruited to the task of healing while flaws are viewed with nonjudgmental respect and never exploited. As a wounded ego gains strength so does the capacity for empathy. Communications are made in light of those facts, never counseling any particular course of action and in all matters trusting his patient to know his own mind. Excluding risk of abuse, intervention on behalf of some perceived good is rarely appropriate, even with relatively young children.

Man encouraged to use his own capacities will become empathic and respectful of others and their rights and place in the world and as well of himself and his place.

It goes without saying, it is imperative that the therapist have also a realistic image of himself and be conscious of his own anxieties, emotional strivings and vulnerabilities; this so that he may satisfy or otherwise deal with them, always, outside the consulting room. I could never have been an effective analyst and therapist had I not acquired those understandings. Much, if not all, is instructional for any physician or counselor in whom trust is placed. Indeed in many arenas of ordinary human life. In my view, the good psychiatrist is the ultimate example of the good physician. As I said when I received my specialty certificate;

"It is where the real doctors live."

I am reminded that there are today serious inhibitions to access by other medical disciplines to the body of knowledge encompassed in the psychiatric literature and experience. The causes are many. One is the unique way the information must necessarily be organized. However causes sadly include mistrust and lack of respect between the medical and psychiatric communities. Introduction of  third and fourth parties (employers, managed care, big pharma promotion etc.) have seemed to be the coup de grace'. Not limited to psychiatry, demands for simple solutions through pharmacology have further supported loss of respect for the necessity of the therapeutic alliance in genuine healing.

However on this day of revision I learn the Congress has passed a bill mandating parity of insurance coverage for mental illness. Ironically it has come from a re-discovery of the impact of trauma on the mental processes, stemming from the long wars this nation is presses.  Only an old historian such as I will make note that the first theories of the seminal role of trauma in creating mental illness were developed by Sigmund Freud in the after years of World War I.

Note:  All narrative material and personal photographs and memorabilia appearing on this website are the property of the authors and protected under copyright law. ©  January 21, 2000. Publication of narrative text and reproductions of covered images without permission is prohibited.

© 2000

Revised October 2008

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