xxAACP Newsletter, Volume 14, Number 2, Spring 2000
President's Column: Why We Do This
The occasion of stepping down has thrown me into some serious
reflection. I hope I can refrain from being too maudlin as I share my
thoughts with you on why we do what we do in this profession. What I see
reflected in our e-mail discussions and in the many wonderful personal
encounters I have had with our members is a commitment to be of service.
Clearly we all have a mix of motivations in entering medicine and in
choosing psychiatry, but AACP members seem particularly infused with a
passion for public service. We work for lower pay and often have to put up
with awful working conditions. We must struggle constantly to stay
relevant and fresh in difficult jobs. It seems to me that compassion for
very ill individuals, and a belief that we can contribute substantially to
improving their lives, keeps us going. Living with our patients through
their social catastrophes and the personal tragedies that plague their
lives makes us keenly aware of how our society works, or doesn’t work. By
serving the most marginalized of our citizens we gain insights into our
social order that are rare and precious. The cornerstone of community
psychiatric practice is taking social context into account both in
assessing problems with our patients and in planning effective treatment. We are the ones who know
that our fabulous pills don’t do the job alone. We are the ones who have
learned to team well with family members and with our patients in new more
respectful ways. We are the ones who take roles on teams with our
colleagues in different professions, and at different levels of training,
and who can avoid the traps of medical arrogance. We lead by demonstrating
our usefulness as clinicians and as individuals. For the kids that I serve
I am in the offices of our parent advocates inventing new ways to provide
my professional perspective for their kids. I get to meet with the social
service folks and teachers and I am often relating to the police and the
courts. What a drama! What gritty stuff we deal with. What a joy it is to
have such a vantage point on our communities.
But we are in a constant struggle to assure that our clinical
perspective is heard in the halls of our bureaucracies and our
legislatures. We suffer when poor public policy impinges on our patients.
I have seen so many of you advocate for more humane treatment of persons
with severe mental illness. You have committed yourselves to a socially
conscious practice. You teach such a way of practicing, and you carry the
values and passion for such a practice into incredibly diverse venues.
What great ambassadors we have become for our profession amongst those who
harbor negative stereotypes of psychiatrists as arrogant and irrelevant
figures. We are called upon constantly to defer to the realities of
funding, to rationalizations for inadequate care, yet we are asked to
advise on what is essential for good care. Such balances take great
maturity. Being effective in such advocacy takes charm, wit and a measure
of good luck. Community psychiatry gets in your blood. Even if you have to
retreat from the rough and tumble of agency politics for a while, out of a
traditional community based role, we still think and act with the concepts
and values of community psychiatry.
Another question that fascinates me is why some of us do and some don’t
assume leadership in our profession. I know that I am bugged when I see
things not being done right. I am driven to sit in meetings and to relate
to those trying to run mental health systems. For me this has led me to my
current job in Seattle, working as a medical director for my county in its
attempts to run a HCFA waiver managed care plan. What I notice is that
many of my colleagues think I am a fool for having sat in all those
meetings and having taken on the impossible task of medical direction of
my county’s child and adolescent mental health programs. Many more wonder
what on earth got me to offer to be president of this organization. I must
confess I don’t know the answer, it couldn’t have been any other way. What
factors motivate some to volunteer for leadership had better be figured
out soon. In all aspects of our society, getting people to take on
leadership roles has become a major headache. We suffer from the fact that
quality individuals avoid public service in the political arena. It is
true in psychiatry as well. It is a tremendous sacrifice for us to lead
major organizations such as the APA, the Academy or even the AACP. Most
strive more to become experts in setting good limits and to not let
responsibilities cross the boundaries of our personal lives. Many smaller
organizations, which have championed particular aspects of our profession,
struggle to survive for lack of leadership. I like to think of us all as
taking turns at various leadership roles, each doing something according
to our aptitudes and the timing in our life. I can share from my
experience that assuming a leadership role in the AACP has been inspiring,
growth promoting, passion enhancing and just plain fun. Let me urge you
all to consider some sort of leadership roles, either in your home
communities, where you can be ambassadors for community psychiatry, or
nationally. As Immediate Past President I am, according to the bylaws, the
chair of the Nominating Committee. It will be my job to hunt down the next
raft of leaders for the AACP. I urge those of you who have some
inclination to be on our board to contact me over the next two years. Even
if it doesn’t work out for you to be on the board or assume some major
role in the AACP, being part of a pool of potential leaders assures our
strength as an organization by invigorating our leadership selection
process. I will be looking for those of you who, like me, are bugged by
things not being done right, who have tolerated sitting in meetings, or
grinding out drafts of proposed documents, and who are caught up in big
ideas about making things better for our patients and for our profession.