Changing the World, One Word at a Time

COMMENTARY

We all want our work to have an impact, to make a difference.

Working for government, as I have now for over 13 years, offers its fair share of opportunities to change policy and practice at city, county, state, and federal levels. I have witnessed moments I treasure and those I would just as soon forget. The latter, especially, seem to concentrate when we want to get something done-which can, at times, be a hardy test of will against entropy, myopic obedience, and self-interests. Whoever said working for government is a form of leisure has never been there, or has never tried to be more than a functionary.

Years ago, when I was Mental Health Commissioner for New York City, I was on a panel with one of my public health heroes, Dr David Satcher (Surgeon General in the Clinton administration). Dr Satcher is an elegant man of few words, and substantial actions. He asked me how my work was going and I bemoaned how hard it is to achieve what I believed were much needed public mental health reforms in New York.

He let me go on for a bit but I stopped when I detected some restlessness on his part. I asked him what he was thinking and he said that it should be hard to get something done. He remarked that public health decisions impact not one person or a small group of people but, instead, thousands, even hundreds of thousands of people-or more. The degree of proof and the process necessary for change of that magnitude, he continued, was necessary, in fact due, given the power implicit in government leadership roles. That was not just wisdom, it was avuncular guidance for this junior public health official.

[[{"type":"media","view_mode":"media_crop","fid":"37927","attributes":{"alt":"medical writing","class":"media-image media-image-right","id":"media_crop_7014879257753","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3767","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"float: right; width: 229px; height: 212px;","title":"©OlivierLeMoal/Shutterstock","typeof":"foaf:Image"}}]]It was clear I needed another front for engaging the good fight, not just a means of expressing my frustration. It needed to be a venue that could, possibly, advocate for and energize action.

I decided to put on paper my experience working for the NYC government. While I had done my share of professional writing of books and articles, I had not written for a lay audience. I began by writing about homelessness, a major problem in New York, and a successful (though resisted) policy focus of the Bloomberg administration.¹ My submission went nowhere with the major New York publications. A good friend suggested I send the piece to The Huffington Post, then an up and coming journal, 4 years old and yet to become the most widely read online English-language “paper” in the world. He knew an editor there and gave me her e-mail address.

The HuffPost editor wrote back promptly, to my surprise; she asked a few questions about my article that I could answer and edit accordingly. Two days later (!) my post was published. Speak about a dopamine hit. No endless review process that typified a medical journal, with publication 6 to 12 months later (if at all) when the moment was lost and far too few would ever see, no less read, the article.

Emboldened by my success, and buoyed by the immediacy of publication, I sent in 2 more articles, each a bit more forward in their POV (point of view). They, too, went up with dispatch and my editor wrote saying, “We like your work; keep sending it in.” I wrote about paying the piper for using “neuroenhancers” (aka psychostimulants), antipsychotic medication use in children, and whether you can trust your psychiatrist. Potential topics seemed endless, coming at me from my work and the everyday concerns that abounded in communities across this country.

A year and quite a few HuffPosts later, I described an experience on a frigid, wintry night on homeless outreach in Manhattan in 2005, when my office, in partnership with other City agencies, was desperately trying to make new City policies be actual practice in homeless services.² Policy reform is a beginning, a foundation; but implementing what has been decided (and funded) is no easy feat: trying to change behavior often evokes tenacious resistance-in programs as well as people.

But I had discovered a means of communicating broadly about what mattered for public health and safety-and a way to gather the support not of other government bureaucrats but of citizens and families-voters-whose voice makes a difference when it comes to getting something done in the byzantine chambers of government and the real world of program reform. I made clear with every article that the opinions were mine, not of my state agency. But stories and facts don’t need an official as an author when they carry their own truth and narrative power.

Almost 5 years ago, colleagues at the HuffPost asked me to be the medical editor for mental health at a time the journal was looking to strengthen its medical and health reporting. I was keen to do so to help improve the quality of what was published as well as bring on many experts to write and contribute to the public’s understanding of mental health and addictions.

I have never been paid to be an editor at the HuffPost or to write the now over 200 posts, chats, videos, and interviews I have done. I have received a bit more than $100 over many years with Psychology Today, and nothing from US News & World Report and other publications for which I have had the privilege of writing. I have received modest royalties for a New York Times-International Herald Tribune op-ed and the 2 books I published (in 2013), one for families of people with mental illness³ and the other for fun.⁴ In other words, my accumulated literary compensation is not an effective way of paying the rent.

Eight semesters ago, with my colleague Dr Deborah Cabaniss, I began teaching medical writing for the lay public in the Department of Psychiatry at Columbia University College of Physicians and Surgeons; our seminar has been oversubscribed every semester and will start again this fall. More recently, Drs Lisa Gornick and Drew Ramsey and I began doing workshops at The New York Academy of Medicine on the same topic. Interest has been great among health, mental health, and neuroscience professionals in giving voice to their work in the public media. We are participating in and holding writing workshops at APA meetings as well.

Laurie Martin, Digital Managing Editor of Psychiatric Times, asked me to contribute an article on my career or something for residents and fellows. I never imagined as a young-even not so young-doctor that I would be able to say I have a day job working for New York State and an evening and weekend job as a medical journalist, editor, and writing coach. I often wonder which of my jobs achieves more on my mission to improve the lives of people with mental and addictive disorders, and their families. I am glad I don’t have to decide.

Disclosures:

Dr Sederer is Medical Director, New York State Office of Mental Health; Adjunct Professor, Columbia University Mailman School of Public Health; Medical Editor for Mental Health, The Huffington Post; and Contributing Writer, US News & World Report. www.askdrlloyd.com. Twitter: @askdrlloyd.

References:

1. Sederer LI. Real progress on homelessness. Huffington Post. April 23, 2009. http://www.huffingtonpost.com/lloyd-i-sederer-md/real-progress-on-homeless_b_178217.html. Accessed July 9, 2015.
2. Sederer LI. What does it take to get something done? Huffington Post. June 8, 2010. http://www.huffingtonpost.com/lloyd-i-sederer-md/the-homeless----how-to-pr_b_529364.html. Accessed July 9, 2015.
3. Sederer LI. The Family Guide to Mental Health Care. New York: WW Norton & Company, Inc; 2013.
4. Neugeboren J, Friedman MB, Sederer LI. The Diagnostic Manual of Mishegas (The DMOM). North Charleston, SC: CreateSpace Independent Publishing Platform; 2013.