Commencement Addresses for Psychiatrists, #1: Then

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PSYCHIATRIC VIEWS ON THE DAILY NEWS

Now is the time when we hear about time-honored commencement addresses at colleges and other schools. My wife and I just went to an 8th grade one for our granddaughter. One particular piece of advice stood out to me: learn from your mistakes. We as clinicians make many of them, which are to be expected and not malpractice.

Among other speeches, I noticed that the news broadcaster Lester Holt stressed at Villanovathat generations are defined by the events around them. That would include psychiatrists, I assume, and is one of the rationales for this ongoing column about psychiatry and society. Oprah recommended making a difference in someone’s life, which is surely an offshoot of what we do. For my residency alma mater, the University of Chicago, Bret Stephens gave a speech to the undergraduates “about speaking your mind when other people do not want you to.” I suppose that is why my residency Chairman fondly called me a gadfly!

Commencement speeches at medical school graduations are common, too. The well-known American news commentator Katie Couric just gave one for the 50th anniversary of the University of Massachusetts Chan Medical School. Given the experiences of her family and herself with cancer, I took special note of her recognition of physician burnout and her prescription for us:

“Demand more for yourself and your colleagues!”

I do not recall any similar commencement speeches for my psychiatric residency training, almost 50 years ago now. Nor were there any at the academic institutions where I worked. The closest were those where awards for teaching—for which I appreciatively received from medical students and residents—and the brief acceptance speeches.

If I imagined what a commencement speech might have been for my residency class commencement in 1975, here is the conceit. I will pretend I gave it, even though I was not the Chief Resident of my class.

__________

Dr Moffic, giving a speech.

Welcome classmates, faculty, staff, and—of course—family, to our final day of residency. It is June 30th, which also happens to be the 7th wedding anniversary for Rusti and me, which makes it a double blessing for us, and the number 7 is considered a lucky day. But we in psychiatry have been taught not to count much on luck, but on analysis, connections, and science.

One connection could be made to Bob Dylan, that master lyricist who seems to use our technique of free associations in his lyrics. Most relevant to us today is an early song from 1964, “The Times They are A-Changin,’” He sang this song on the same night that President Kennedy was assassinated. For us, just consider this second verse for a selective review of psychiatry during our residency years:

“Come writers and critics who

prophesize with your pen

And keep your eyes wide, the chance

won’t come again

And don’t speak too soon, for the

Wheel’s still in spin

And there’s no tellin’ who that it’s

namin’

For the loser now will be later to win

For the times, they are a-changin’”

We have learned not to “speak too soon,” but to listen carefully with our third ear to our patients.

How about the phrase “for the loser now will be later to win”? We are in a time of transition for psychiatry, it seems, turning from our emphasis on Freudian psychodynamic psychotherapy to psychopharmacology in the treatment of nonpsychotic conditions. We have new medications for depression and anxiety, and even some psychoanalysts are learning to use them. Remember, Freud once predicted that psychiatry would eventually become more biological.

Yes, as Dylan said, “the wheel’s still in spin and there’s no tellin’ who that it’s naming.’” Here we are a year after brave gay psychiatrists and their supporters pushed successfully for homosexuality to be declassified as a mental disorder, replaced with a new diagnostic code for those distressed by their homosexuality.

Also in 1974, President Nixon resigned for his role in the Watergate scandal. He had a major influence on psychiatry. In 1970, the Controlled Substance Act put all psychedelics under Schedule I Classification, which launched President Nixon’s War on Drugs and essentially ended the promising research for their clinical effectiveness and risks. Secondly, he led the passage of the Health Maintenance Act of 1973 that allowed HMOs to expand and become for-profit.

“Come writers and critics who prophesize with your pen and keep your eyes wide, the chance won’t come again.” What mistakes will psychiatry make, as all professions do in their learning process? Will there be a new trade publication that publishes articles about all the aspects of the field, including our mistakes? Let’s see the answers in 50 years or so.

I will close with a revised song title for us:

The Psychiatric Times, They Are A-Changin’

Dr Moffic is an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry. A prolific writer and speaker, he received the one-time designation of Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. He is an advocate for mental health issues related to climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of Psychiatric Times.