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Looking for the proverbial silver lining in an age filled with gloomy professional news has become a goal for some of our district branch newsletter writers. With headlines telling us that our incomes are shrinking and that even our ability to control our practices is a thing of the past, it is refreshing to see some DB writers looking for reasons for optimism.
"Thriving on Change" is the title of Dr. Robert B. Schoor’s essay in the August issue of the Central California Psychiatric Society Newsletter (Sam A. Castro, M.D., editor). In noting how the practice of medicine has changed, he still believes that "as psychiatrists, we can be at the center of the change."
"The Science is advancing rapidly; the Art needs to be practiced. We have more tools than ever, and the knowledge is more readily available to the public." The problems for psychiatrists, Dr. Schoor points out, are finding a way to sort out these resources and making sure there is an efficient way for patients and others to avail themselves of them.
"I try to think in an unattached way, ‘What is best for society?’ Should we increase access to all treatment that is available? How is that best delivered? Should we support the practices of all the ‘barefoot’ doctors who work to improve the plight of their fellow men? Should we level the playing field by letting the psychologists prescribe psychotropics? Should they also prescribe anticonvulsants, hormones, antihyper-tensives, and new classes of medications as they arrive? What about just legalizing all psychotropic medications along with the illicit drugs? Would society be better off with easier access and then letting the ‘informed’ consumer decide the best way to self-medicate? If we decriminalize the distribution and use of illicit drugs, what penalty should be left for the distribution and use of psychotropics?"
The struggles of our psychiatric associations, local and national, to deal with these issues may result in these organizations’ reinventing themselves in a positive direction, Dr. Schoor suggests.
"The American Psychiatric Association is reorganizing to be more responsive. The California Psychiatric Association has restructured to have greater input into the legislative process," he observes.
"Even as the sky is falling, I have the opportunity to reflect with my colleagues about how our world will look without a sky and how we will thrive. Most of us seem as busy as we care to be. We are faced with challenges at every turn. This is what keeps us at the ‘top of our game.’ Enjoy it. Be thankful to be a part of it and talk positively about our future. If we can’t cope with change, how can we help anyone else?"
But sometimes it is the tragedy we see in our patients’ lives that we need to put into another perspective to protect ourselves emotionally and feel good about what we do. In another essay Dr. Teresita Bacani-Oropilla observes, "[Psychiatrists] are among the few who are privy to the pain and sorrows of those who put up a facade for the world to see. In the course of their daily work, they find that behind the pretenses, all is not well."
Her article, "The Shine in One’s Eye," appears in the summer/fall issue of the Kentucky Psychiatrist (Robia Fields, M.D., editor). Dr. Bacani-Oropilla describes the fine line between idealism and cynicism and between optimism and pessimism.
"Most young psychiatrists enter the field starry-eyed. In the process of earning a living, they aim, with hearts full of compassion, to ease the burdens of people’s sufferings. They do, but despite their best intentions, the work can be so demanding and the responsibility so great that there is danger of being disillusioned. Like little drops of water that continually drip and leave a mark on stone, repeated assaults on a person’s idealism can wear one down.
"It is not difficult in the face of seemingly persistent lies, for example, to lose one’s naivete and become a cynic, to be forever suspicious of motives, and to stop believing in the goodness of human nature. Pessimism can dilute one’s bright hopes for the future if one begins to believe that human flaws are irreparable. In expending so much energy intervening in the existential crises of others, one may neglect one’s own.
"Fortunately, these avowed helpers of humanity do not necessarily have to dwell only with the negatives. True, they are the instruments that uncover the problems that cause pain, but by the same token, they are usually the first to share the initial rays of hope. When patients improve, when jobs are resumed, when families gain better understanding of their members, and when peace reigns in the home once more, their psychiatrists hear about it.
"To periodically take stock and be aware of one’s vulnerability; to preserve oneself so as to be useful to others; to remember that by one’s experience, guidance, and influence, tragedies behind the glittering facade can be averted, these are the ways to ensure the shine in a psychiatrist’s eye."