Continuity and Integration

By Harold I. Eist, M.D.
APA President

This is my 23rd column; presidents usually have 24. This being my second-to-last column, I thought you might be interested in some books that would support you in your efforts to continue what we have begun this year. Sir William Osler recommended that physicians should read the classics every night before retiring. I followed his sage advice for years, finding such reading inspiring, rejuvenating, instructive, and an important antidote to burnout. Often after a hard day struggling with the demons afflicting my patients and our field, I would be drained. Literature, poetry, and music were, among other things, potent battery rechargers. I pass Osler's recommendation along to you, if you are not already following it. Over the past several years, I have had to largely give up the solace and inspiration of that kind of reading, because of urgent demands of APA leadership. Not only have these demands usurped my daily dose of personal enrichment, they have populated my dream life.

Many of you sent me books and other reading material that provided considerable additional ammunition in our struggle to maintain high-quality, nondiscriminatory, compassionate care for those suffering from mental illnesses. These generous offerings made up, in part, for what I gave up.

Now I will return the favor. This list is not exhaustive but, if you desire, it will lead you further and further into a literature devoted to social justice and the necessity of freedom and fairness if we are to serve the public effectively. These titles are not given in their order of importance, nor are they presented in the order in which I read them.

Darkness At Noon, by Arthur Koestler, is a classic for anyone opposed to totalitarianism. It challenges the communist doctrine of dialectical materialism and consequent logic. It challenges the view that ends justify means and that individuals have no merit but are merely cogs in the inexorable unwinding of history. Rubashov, the book's main character, wonders how communism can save freedom by destroying it, just as we wonder how "managed care" can save health care by systematically destroying it.

The Captive Mind, by Czeslaw Milosz, winner of the 1980 Nobel Prize for Literature, is another classic. Milosz describes in careful detail how totalitarianism perverts and co-opts the human mind, particularly the minds of intellectuals. For those of you under corporate pressure to engage in medical practices that are wrong, this book can be of help in assisting you to determine how far you have slipped into rationalizations that are destructive to yourselves, those you serve, and your communities.

Milan Kundera, a brilliant Czech expatriate now living in France, in his recent series of essays Testaments Betrayed, addresses these very same issues. He describes the brilliant poet Konstantin Biebl, who was an "enthusiastic communist." He notes that Biebl ". . . took to writing propaganda poetry of a mediocrity as alarming as it was heartbreaking"; shortly thereafter, he threw himself from a window onto a Prague pavement and died. "In this subtle being," said Kundera, "I saw modern art betrayed, cuckolded, martyred, assassinated, self-destroyed."

I had the whole Board of Trustees read Sun Tzu, The Art of War. It will help you to think strategically and tactically in your struggles to maintain the integrity of our field. A second volume, The Lost Art of War, by Sun Tzu II, will continue to assist your growing tactical empowerment.

Ralph Estes's book, The Tyranny of the Bottom Line, superbly describes the amorality of modern corporate America and describes how current corporate culture leads good people to do bad things. In his seminal book, The Ecology of Commerce, Hawken describes positive alternatives to modern corporate greed, a shift from conspicuous consumption to resource preservation, from downsizing to job maintenance, and from greed to social responsibility.

William Greider, in his book Who Will Speak for the People?, addresses current attacks on democracy by special interests, particularly "free market advocates," and suggests solutions to aid us, the people, in regaining control of our democracy. His most recent book, One World, Ready or Not, addresses the manic character of international corporations, their totalitarian orientation, lack of loyalty to their communities and countries, and the urgent need here for appropriate regulation. It is as if the demise of Soviet Communism led many of the corporations in the free world to forget that it was our values that ultimately prevailed, and that substituting one form of unreasoned totalitarianism for another leads to no net gain.

Nicholas Anders, the Wall Street Journal health reporter (a publication not known for its friendliness to physicians in general and psychiatry in particular), deals the managed care industry a heavy blow in Health Against Wealth, although he bends over backward to be restrained and "fair." A managed care reviewer in the New England Journal of Medicine attacked the book for being "anecdotal" and suggested genuine scientists would laugh it out of the room. This, of course, is what genuine scientists should be doing with "managed care" itself--an experimental approach, not science based, being destructively imposed on the public, without informed consent.

This brings to mind The Human Rights Reader, edited by Walter Laqueur and Barry Rubin. It contains many superb essays on human rights that we all need to study in these times of valuing dollars before people's lives. At what point does this constitute a violation of basic human rights?

Benchmarks of Fairness For Health Care Reform, by Norman Daniels et al., spells out the necessity of having the best health care for our people so that they have equality of opportunity. Dana Ackley has written a valuable book, Breaking Free of Managed Care, which I think you will find of considerable interest.

Finally, I recommend that you look at two documents I read at least once a year: the Constitution of the United States of America and the Hippocratic Oath.

(Psychiatric News, May 2, 1997)