Disclosing Ourselves: A Review of 4 Psychiatrist Memoirs

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BOOK REVIEW

Self-disclosure has a strange place in the history of professional psychiatry. Freud revealed so much about himself in his landmark book, The Interpretation of Dreams, that is, through the analysis of his own dreams. But as psychoanalytic therapy developed, a very different ideal emerged: the psychiatrist as a blank screen.

As an outcome of this seeming reversal, psychiatrists and other physicians have been reluctant to disclose too much about themselves, and they run risks if they do. Despite our professed goal of reducing the stigma surrounding mental illness, we have had limited success in reducing it in ourselves.

Finally, this reluctance to publicly self-disclose seems to be dismantling. When Psychiatric Times^TM sent out a call for self-portraits in 2019, we were overwhelmed with more than 50 high quality and moving submissions.

These 4 memoirs of psychiatrists expand those kinds of brief self-portraits into book-length revelations. The specific workplace emphasis of each varies: the psychiatrist in private practice who specializes in treating other doctors; the pioneering community psychiatrist; the group therapist facing death; and the Orthodox Jewish psychiatrist considering a move to Israel. In fact, all of these memoirists are Jewish (Dr Myers by conversion). Complementing this trend, Psychiatric Times^TM recently posted a review of a memoir by Lloyd Sederer, MD, Ink-Stained for Life, reviewed by Steven S. Sharfstein, MD. Both of them are also Jewish.¹

In the spirit of self-disclosure, as we go along I will mention how I know these authors, as that not only influences objectivity but also adds relevance. I am Jewish, too. In addition, I have done a workplace multimedia memoir at my wife’s suggestion, but it was designed only for family and friends. It takes courage and self-confidence to put forth a memoir, even more so a memoir for a public audience. The following are brief reviews of these 4, in order of my reception of them during 2020.

Becoming a Doctor’s Doctor: A Memoir

by Michael F Myers, MD; Michael F. Myers/Amazon Publishing, 2020

236 pages • $14.99 (paperback)

This was the first memoir I received. Immediately, the title and author called to mind to a submission by Myers for our 2019 self-portraits. The title was similar, “Becoming a Doctors’ Doctor,” and it was posted on March 19, 2019.² Since I was excited to see this book-length expansion of the earlier article, I offered to review it for Psychiatric Times^TM.

I have long admired Myer’s work and knowledge. We have shared several panels and presentations at American Psychiatric Association (APA) meetings on burnout, mental illness, and suicides by psychiatrists and others mental health caregivers. Moreover, I resonate with some details in the book. I, too, have worked with stress-laden, married medical students, although with the addition of my wife as co-leader. We had some lived experience with that, being married before my second year in medical school.

Although Myers’ book is called a memoir, it contains much more than his own experiences. Not only is it a memoir of Myers, a psychiatrist who treats other doctors, but it also seems to be a collective memoir of many doctors, doctors who needed (and were fortunate enough to receive) psychiatric help from Myers. There are aspects that reminded me of a detective story, as he deftly pieces together information from his personal and professional life. One example of this is LGBTQ challenges, that is, the combination of concern about self-disclosure about sexual and gender preferences, along with other personal mental health challenges. Without giving too much away, let us just say that Myers makes personal revelations throughout the book.

In essence, Dr Myers developed and established the field of mental health care for physicians, starting with the tragedy of his roommate’s suicide during the first year of medical school. As any reader who has treated colleagues knows, the pressure and stress is enormous, whether that is a medical student or other physicians. Such patients are VIPs of sorts, and we have an ethical responsibility for the well-being of our colleagues. The unique responsibility of treating colleagues made it hard for Myers to balance the needs of his patients and his own personal life. Take for example the time he lost his bid to become president of the Canadian Psychiatric Association. One of his patients reacted by saying: “Thank God.” She knew that the demands of leadership could take Myers away more. However, he did win the second time he ran.

Even though Myers has had numerous successful outcomes, perhaps the emotional centerpiece of the memoir is the disguised Dr Z. Dr Z’s suicide reminded me of the need to be cautious whenever a depressed, suicidal patient seems to look and feel better for no sound psychological reason. Myers’ ’humanity is on display as he struggles when asked to speak at the funeral. Dr Z’s last request is that Myers help his (Dr Z’s) mother, and Myers does so successfully.

Once upon a time, network therapy was popular, and that seems particularly relevant for physicians, as Myers comes to view the physician patient as part of a connected network that often needs to be part of the evaluation and treatment.

Myers also grapples with his own failed first marriage, despite working successfully with so many medical couples. Like another author in this review, Herzl Spiro, MD, PhD, the second marriage is reported as going quite well, in part because he belatedly understands his own “otherness.”

If he ends his memoir with optimism for the future, he has played a major role in making a better future possible. He applauds the emotional openness of physicians and other health care workers on the frontlines of COVID-19 care. He should know.

I wrote this review on December 1st, World AIDS Day. Myers played a major role in helping victims, including physicians, of that viral infection when it was devastating communities everywhere. I cannot hope but that he is right to be hopeful, as there is only so much that someone like Myers can do in a lifetime, and now we have the added psychological epidemic of physician burnout.

Of Hope: A Memoir

by Herzl R. Spiro, MD, PhD; Balboa Press, A Division of Hay House, 2020.

123 pages • $28.95 (hardcover)

Continuing in the spirit of my own self-disclosure, I should say that Spiro has been a relatively close colleague of mine in Milwaukee since my arrival in 1989. Moreover, I am mentioned on page 61 when he writes:

“I had tried unsuccessfully to recruit Dr Moffic, former chair of the International Association for Social Psychiatry, when I was chair.”

Spiro was referring to the time when he was chair of the department of psychiatry at the Medical College of Wisconsin (MCW) in the late 1970s and early 1980s. After the necessary and belated transformation of antiquated warehousing of public patients in Milwaukee with mental illness, President Ronald Reagan halted the necessary federal funding to community mental health centers like this one in Milwaukee. Years later, I became responsible for some of the remaining public community systems at MCW. Once I retired in 2012, they were eliminated. One unfortunate lesson learned is that it is so much easier to destroy than build such quality services.

In his community psychiatry leadership, Spiro interacted with many other leaders of society concerned with the care of poor minorities. The star who integrated baseball, Jackie Robinson, apparently helped Spiro establish the first legal methadone clinic in 1969 to reduce heroin addiction; Spiro helped out Martin Luther King, Jr. by serving on the stand-by medical team in case of illness or physical harm from violence for the March on Washington; Rosalynn Carter, the wife of President Carter, was the keynote speaker at the opening of those new community mental health buildings in Milwaukee.

Spiro’s clinical skills are displayed particularly well in an example from the years 1956 to 1959, before and after the availability of chlorpromazine. In 1956, when he worked at Vermont State Hospital, a catatonic patient was always lying in the doorway, and Spiro carefully stepped over him. Three years later when Spiro came back for a visit, the patient lauded chlorpromazine and Spiro, saying: “You were always kind. You were careful not to kick me.”

Another clinical highlight was treating scores of Holocaust survivors for free in Baltimore early in his career. Spiro came from a long line of rabbis, including his father.

The second half of the memoir focuses on his more than 20 years of work in Israel. By then, he had met and married his second wife, the artist Barbara; this turned out to be a successful partnership that has continued to date. In Israel, he helped apply the principles of community mental health to that newly developing country, but specifically helped to absorb thousands of Black Ethiopian Jews, with relative success in avoiding the racism he encountered earlier in Baltimore.

Contrary to his dismay over the “failed community mental health revolution,” it continues to this day in new, influential, and creative ways, including his own recent clinical work in a federally funded outreach community health center. Perhaps we can hope for a courageous and competent president like John F. Kennedy in this regard, someone who will put together another system, perhaps one that would be part of a single-payer system.

In our “Ethics” chapter for the 2012 Handbook of Community Psychiatry,³ Herb Bateman and I wrote that hope for realistic recovery was among of our ethical essentials.

It is fitting that Spiro’s memoir is titled Of Hope. It starts with a quote from the great Holocaust survivor and teacher, Elie Wiesel: “Despair is the question. Hope is the answer.”

It closes with his own quote: “That is my story of hope.”

Becoming Myself: A Psychiatrist’s Memoir

by Irvin D. Yalom, MD; Basic Books, 2017

343 pages • $26.74 (hard cover)

Yalom’s memoir, although published earlier than the prior books, came to me recently in another serendipitous way. I was co-teaching a class on the biblical Book of Ecclesiastes with my son, a rabbi, Evan Moffic and that book clearly connected with what is sometimes called existential psychiatry, the branch of psychiatry having to do with the struggle to find meaning in one’s life. It was first popularized by the psychiatrist Victor Frankl, MD, in his perennial best-seller, Man’s Search for Meaning,⁴ when he discovered how to find meaning in love and work even in a Holocaust concentration camp. Yalom reached out to (and connected with) Frankl, and then turned to the psychologist Rollo May, PhD, who had taken up the mantle of existential psychology. Yalom then focused existential psychology on death and dying, summarized in his book Staring at the Sun.⁵ So, in this roundabout but connected way, the Book of Ecclesiastic led to Yalom’s psychiatrist memoir right when I was putting together this review.

However, existential psychiatry is not Yalom’s only claim to fame. He, in essence, popularized group psychotherapy. I recall reading his then-recently released text The Theory and Practice of Group Psychotherapy⁶ when I first was learning how to do that back in 1973. Yalom had realized that many psychological problems came from inauthentic relationships and that groups could be training grounds for relating to others.

Besides these 2 major psychiatric breakthroughs, his memoir conveys so much more, including material about his immigrant parents who never talked about the old country of Russia, and how he decided he wanted to be a doctor.

He gives many examples of always trying to learn and improve himself. For instance, after reading about the rise of empathy in Steven Pinker’s book The Better Angeles of Our Nature,⁷ he was awakened by a recurrent nightmare since he was 12. Riding his bike, he saw a girl on her porch, who was attractive even though her face had red spots. He called out “Hello, Measles!” Suddenly, her father rushed out and confronted him about how he likely made this girl, Alice, feel. He was too fearful to answer any query. After the father finished, Alice asks Irvin if he wants to play. He declined, feeling so ashamed. This time he finally consciously remembered that he once called out to a girl in real daylight as he rode past on his bicycle, “Hey, Measles!” He realizes that he still feels guilty about taunting her, and he ends the vignette by saying, “Forgive me, Alice.”

Although elder psychiatrists routinely sought personal psychotherapy during residency, Yalom went well beyond that. He underwent psychoanalysis, which was helpful, but he later realized that he never talked about his own death and dying. That he did more with Rollo May, PhD, seeing him in therapy twice as well as socially.

In his personal life, he has had a long marriage to Marilyn Yalom, and together they have 4 children. She is also a writer, including the books A History of the Breast⁸ and A History of the Wife.⁹ (She died on November 77, 2019, not long after his memoir was published.) At the time of finishing his memoir, Yalom was 85 and still seeing patients.

He writes that the basic lesson he learned is that life is lived meaningfully and happily through a creative pursuit of learning in order to end up with a regret-free life. When that happens, we truly can become ourselves.

Off the Couch

by Yaakov Freedman, MD; Brooklyn, New York: Menucha Publishers, 2020

349 pages • $24.99

I met Freedman online on the recommendation of our emeritus editor-in-chief, Ronald W. Pies, MD. I was seeking an Israeli psychiatrist to provide a perspective from Israel on Anti-Semitism for a book that I was editing, Anti-Semitism and Psychiatry: Recognition, Prevention, and Interventions.¹⁰ It actually took me a while to realize how Orthodox he was Jewishly.

Not long after that book was published, he published his own, based on his experiences as a young psychiatrist working in Israel with the Orthodox Jewish community. One of his goals was to bridge gaps between spirituality and medicine, a goal that makes his journey of interest to any mental health caregiver who appreciates the need to address spirituality and religion in their work, and especially the challenge of helping the orthodox of any religion who are dubious about psychiatry.

The first part of the book is more like a memoir, qualifying it to be included in this article. He tells the autobiographical story of going to Israel from Boston, not long after he was an award-winning chief resident at Harvard University.

He recalls being a difficult child, with detentions and suspensions being handed out to him “like chocolate” at school. He thanks his father, principals, and deans for not throwing him out. (It sounded familiar to me from my growing up.) Coming from an Orthodox Jewish background, he was also encouraged to be “a doctor of the souls,” combining medicine and the Torah.

As his professional story starts, he was asked by Rabbi Naftoly Bier: “What can you do to help the Jewish people to the best of your ability with the skills that Hashem has given you?”

Despite his work and family being “everything I could have dreamed up and more, I was missing something. . . My life was perfect, and yet I was missing something.”

He was further troubled by weekly anti-Semitism when a new patient would call him a “dirty Jew” and even spit in his face. No wonder he was interested in contributing to Anti-Semitism and Psychiatry.

At a conference in Jerusalem, he was challenged to come to Israel by an Israeli psychiatrist who just happened to be sitting next to him. To be sure that he was not getting the so-called Jerusalem Syndrome, a kind of temporary insanity caused by exposure to the spiritual power there, he sought out his wife right away. She was a social worker and psychotherapist, and she led the way to leaving.

A great test in his life came when his wife had a precipitous drop in blood pressure from hemorrhaging while delivering their baby. When he heard that the chance of the baby living was 0%, he rejoiced, feeling that it was now in Hashem’s hands. That baby survived and thrived. I was in tears reading this story, both for the outcome and my own sense of receiving daily divine serendipities this past year.

The rest of the book covers stories of his daily work, complemented by religious study. Given that he is still in his early career years, perhaps we can look forward to a full memoir later in his life, Hashem willing as is said.

Conclusions

For years now, I have been writing periodic eulogies for Psychiatric Times^TM of psychiatrists who have passed away. The goal was not only to honor their lives, but also to leave us with lessons learned from their careers.

Memoirs provide a way of honoring and learning from others while they are still alive, without the accompanying sadness over their passing. It takes self-disclose to a different and higher level. Anyone familiar with the heroic journeys described by Joseph Campbell will see these as heroic journeys, too, full of obstacles.

The reader probably readily notices that all of these memoirs were by men, and that includes the memoir reviewed by Sharfstein separately. What does that mean? Perhaps it is indicating a change in the guard for psychiatry. During the earlier stages of the development of psychiatry male Jewish psychiatrists were over-represented. That is no longer the case. More psychiatrists are coming from different backgrounds, bringing hope for further advances in cultural psychiatry.

All these landmark memoirs are worthwhile reading for anybody in our field, their loved ones, and members of the public who would like to demystify psychiatrists. We sort of read minds, but not in the way the public thinks. I am sure others will also see connections to their lives, as I did.

Self-disclosure is often therapeutic, so was reading the self-disclosures in these memoirs. May they be the harbinger of more to come.

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 being a Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in ٢2002٠٠٢. He has recently been leading Tikkun Olam advocacy movements on climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of Psychiatric Times^TM.

References:

1. Sharfstein S. Ink-stained for life. Psychiatric Times^TM. November 11, 2020. Accessed December 10, 2020. https://www.psychiatrictimes.com/view/stains-of-ink

2. Myers M. Becoming a doctor’s doctor. Psychiatric Times^TM. March 19, 2019. Accessed December 11, 2020. https://www.psychiatrictimes.com/view/becoming-doctors-doctor

3. Bateman H, Moffic HS. Ethics for community psychiatry: evidence-based policies and procedures. McQuistion HL, Sowers WE, Ranz JM, Feldman JM, eds. Handbook of Community Psychiatry, 2012 Edition. Springer; 2012:607-612.

4. Frankl V. Man’s Search for Meaning. Beacon Press; 2014. https://www.penguinrandomhouse.com/books/206272/mans-search-for-meaning-by-viktor-e-frankl/

5. Yalom I. Staring at the Sun: Overcoming the Terror of Death. Jossey-Bass; 2009. https://www.amazon.com/Staring-Sun-Overcoming-Terror-Death/dp/0470401818

6. Leszcz M, Yalom I. The Theory and Practice of Group Psychotherapy (5th ed.). Basic Books; 2005. https://psycnet.apa.org/record/2006-01425-000

7. Pinker S. The Better Angeles of Our Nature: Why Violence Has Declined. Penguin Books; 2012. https://www.penguinrandomhouse.com/books/302858/the-better-angels-of-our-nature-by-steven-pinker/

8. Yalom M. History of the Breast. Ballantine Books; 1998. https://www.amazon.com/History-Breast-Marilyn-Yalom/dp/0345388941

9. Yalom M. A History of the Wife. Harper Perennial; 2002. https://www.amazon.com/History-Wife-Marilyn-Yalom/dp/0060931566

10. Moffic H, Peteet J, Hankir A, Seeman M, eds. Anti-Semitism and Psychiatry: Recognition, Prevention, and Interventions. Springer; 2020. https://www.springer.com/gp/book/9783030377441