April Fool's Lessons From a Psychiatrist

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Each year, around April 1st, I start thinking even more about the foolishness in the world. As I approach the age of 70, I cannot help but reminisce about my own career and the foolishness I personally exhibited. Being retired, I can convey what I did without much fear or embarrassment.

Politics

When I went into medicine and psychiatry, I had assumed that politics was irrelevant as we all devoted ourselves to patients. I decided that I would let my boss handle any “dirty politics” that came up. Wrong! Medical establishments are subject to the same organizational group processes and financial needs as any other company.

What’s worse, psychiatrists can-and do-use their psychoanalytic knowledge for their own organizational advantage by interpreting the behavior of colleagues (sometimes negatively). Freud call that “wild analysis” and cautioned against it. It also can be unethical, as the needs of colleagues are a secondary ethical principle in the AMA Principles of Medical Ethics.

Peer counseling

When I started in community psychiatry, I strongly supported that so-called paraprofessionals be on staff. They came from the same inner-city communities as our patients, and many professionals came from the suburbs. They seemed potentially invaluable as “cultural brokers,” sources of knowledge about cultural values of the patients, as well as symbols of the center’s concern for the community.

I didn’t think, though, that patients could someday assume a similar role for other patients-that is, to become members of our staff. I assumed that their psychiatric illness would interfere with being a stable and reliable employee, and that in addition there might be confidentiality concerns.

I should have known better. I had already seen the value of peer counselors while leading an alcohol rehabilitation clinic in the Army, but somehow I couldn’t apply that to psychiatric illnesses not involving drugs and alcohol.

Fortunately, as the recovery movement gained momentum, some patients would improve enough to fulfill a desire to help their peers. And they have.

I learned this from some of the patients I helped lead, but I learned especially from one of the staff members. This staff member came to believe in the empowerment of patients and made a believer out of me and so many others.

Patient gratitude

As a patient during my own childhood, it was clear that physicians were very much appreciated for their expertise. Psychiatrists turned out to be perceived differently.

Not many patients wanted to express appreciation for psychiatrists. There was also the stigma of the field itself. If patients felt shame for their problems, they would be less likely to express gratitude for help, especially in any public setting.

No, patients usually walked-or ran-the other way when they saw me in public. Thankfully, though, this is no longer the case now that I have retired from clinical work.

Money

Money is often called the “root of all evil.” I used to naively think that concern for money in medicine was irrelevant or would tarnish us. Of course, we would-and could-do anything necessary to help a patient. Wrong, once again!

Working in community mental health, where resources were limited, was a wake-up call for me. For-profit managed care, which seemed to put profits above patient care, spread the quest for money over most of medicine.

Foolish lessons

There are probably more foolish things I did. One might have been to turn down my wife’s suggestion that we open a clinic for ADHD. She was a pioneering learning disabilities teacher.

Just think, I could have avoided the red tape of working for an organization. As time went on, it became apparent that most children didn’t outgrow ADHD.

Perhaps what I did and believed foolishly will be of some preventive use for others. And, perhaps you can share some of your own foolishness for the benefit of our readers. After all, we celebrate April Fool’s Day for sound psychological reasons.