Throughout my medical training, I have often had the opportunity to receive journal articles from various colleagues. I may be in the minority (but I suspect that I am in the majority) of the medical community with my tendency to place the article in my "To Be Read" stack.

Recently, I was given a particular work addressing the decline of medical students selecting psychiatry as a career (Sierles and Taylor, 1995). As chair of the APA Committee of Residents and Fellows, I have had the opportunity to hear this topic debated and dissected in multiple arenas of the psychiatric community. Prior to my third year of medical school, I was one of the majority who never contemplated psychiatry as a career—even with an undergraduate major in psychology. However, the positive and pivotal influence of an outstanding mentor and the opportunity to work with a group of residents who challenged me academically served to kindle my interest in psychiatry as a career.

The manner in which I obtained the article speaks to the anxiety and mourning that I began to experience. The treatise was given to me by a third-year medical student when I was the chief resident with the Consultation-Liaison Service at Walter Reed Army Medical Center in Washington, D.C. This particular individual was exceptional, having demonstrated a natural inquisitiveness and ability to view patients from multiple perspectives. The predicament was that he clearly had no intention of selecting psychiatry as a postgraduate specialty. The staff lamented the loss, attempted any leverage that might persuade, and eventually grieved and sought to leave well enough alone. Another one lost. Then the article appeared in my mailbox—a cruel joke? No, it was meant as a gift to commence a dialogue.

Based on this student’s observations and our discussions about recruitment issues, he wanted us to appreciate that by the third year of medical school the issue of recruitment was almost over. He observed a problem, witnessed our struggle, and sought to help us with our stress—a true consultation and liaison situation. Our problem is one of image, not lack of high income or procedures, or chaos in the field. His notion of psychiatry had changed immeasurably as he observed and participated in patient care on our service. He witnessed the power in combining the biological and psychological, the privilege of discovering an individual’s unique story, and the progression in applying multiple perspectives to lessen both psychological and physical torment. His question to us was why he and his colleagues did not know about our particular skills and perspectives. He said that we have a dilemma with our image—indeed, we are hindered by it. There should be no great astonishment that if our specialty is suffering from an image problem among medical students, there is no momentous improvement once they become our colleagues in the various medical specialties.

The focus on recruitment needs to decelerate until we labor on our image. The parallel process between our profession and our patients is striking. We have tended to marginalize ourselves in the medical community much as our patients are on the fringes of the health care movement. Feeling this marginalization, we have rushed to embrace the totality of the biological and psychopharmacological to guarantee to our patients, ourselves, and our colleagues that we are physicians. In a society that is desperately seeking serotonin as an immediate answer, we have given away much of our rich heritage of discerning the dynamics of the patient as an individual presenting in unique circumstances with a particular narrative. It takes time to comprehend and appreciate the patient—a situation that involves a conspicuous delay of gratification. Psychiatry is able to tolerate the clinical ambiguity and ambivalence inherent in this delay more so than probably any other medical specialty. It is this process that makes our field so extraordinary and rewarding, but we appear to be fleeing from this endeavor much as the rabbit attempts to elude the wolf.

The medical student who presented me with the article had come to appreciate the richness of the process of knowing an individual not as a disease, but as a human being living with a disease. Our image will improve as we communicate to medical students an appreciation for both the complexity of the individual and the pleasure in delaying gratification as we take the time to understand the person. The irony of the situation was that as psychiatrists we understand this, but it actually took our patients to communicate it to our medical students. They spoke of their trials, triumphs, and tragedies, not their receptors, neurotransmitters, or limbic system. He began to grasp the various metaphors in their narratives and sought not so much a diagnosis as a comprehension. He indirectly discovered our secret that while we attempt to effect change in our patients’ lives, their stories spur us to flourish and mature both professionally and personally.

I am in no way suggesting that we should downplay the tremendous strides our profession has made in understanding the intricacy of the brain and the depth of the mind. The biological treatments available have made pivotal changes in the lives of our patients and their families. However, it is worth noting that psychiatry did not appear to have difficulty with recruitment when few somatic treatments were available. I suspect that many who entered psychiatry during those years were partially drawn by the challenge of the individual narrative and the opportunity to be influenced by the stories told. While a response to a psychopharmacological intervention is dramatic at the time, the evolution of an individual life is unquestionably astonishing. In our daily practice, it is the transformation in the patient’s life we witness, not an increase in serotonin. So let us recapture the life narrative as part of our image, and recruitment may well follow image. It is a gift we owe our patients, our colleagues, and the art of medicine.