A Change Of Calling

I told you(s) that I’m leaving Green Acres, but I haven’t had time to tell you where I’m going. It’s also taken me a while to say it with a straight face. I’m making a 180-degree professional turn and taking over a private practice in Tonytown, a lush suburb of the Smallish City. Or what passes for “lush”, anyway, in the Smallish State.

Truly, this new job couldn’t be more different from Green Acres without leaving the field of shrinking altogether. After six years of working with some of the Smallish State’s most dispossessed, most hopeless, most dangerous, most impoverished, most risky, most thankless, most shocking, most ill, and all-around most demanding individuals, I will now be working with some of the state’s most educated, most affluent, most intellectual, most ambitious, most accomplished, most connected, and all-around most demanding individuals. Okay, so the demanding part will probably not change—but everything else will.

I’ve already started, one day a week, at my new office. Unlike the vast majority of my Green Acres patients, most of my new patients have actual jobs, are staying home with young kids, or are in school. There are PhD candidates, artists, writers, attorneys, midwives, master carpenters, musicians, several therapists, and even another psychiatrist. After a dozen or so intake appointments, I’ve not had one single death threat, not been spit on, and had nothing thrown at or even near me. Believe it or not, several people actually thanked me, even though I couldn’t see that I’d done much of anything for them yet.

It would be easy to argue that these folks don’t really need my help. It would be easy to argue that I won’t be doing a great service for the world the way I have been in the public sector at Green Acres. It would be easy to label my new gig as “cosmetic psychiatry”. These, indeed, have been my fears and misgivings going in.

After much reflection, though, I’ve decided that it’s not so clear-cut. The truth about Green Acres is that my people there rarely get much saner, or stay any saner very long. Even when I can help them get saner, they often don’t want to be so, and to many of them the process of getting saner seems far more loathsome than insanity itself. Largely, my job has been to coax, cajole, convince, bargain, and, if necessary, strong-arm people into sanity—not to make them happier, necessarily, but to make society safer from their rages, or prevent society from having to feel guilt when they suicide. After discharge, a substantial proportion of patients decline, resist, or avoid further treatment, relapse, and are involuntarily readmitted (the Smallish State has, until recently, been highly protective of patients’ rights to refuse all treatment once they are out of the hospital.) In the past year, this situation and pattern has lead to disastrous results for a few of my patients. Admittedly I am taking a somewhat bleak and cyncial view of my role at Green Acres—but six years there will do that to a person.

In contrast, my new clientele, while overall less ill, are highly motivated to get better. They are so motivated that they will call me repeatedly for an appointment, rearrange their schedules to see me, and, in some cases, pay out of their own pockets. A lot of these people, I think, are going to get a lot better. And these are people who, when they get a lot better, will have considerable positive impact on the world. One person I’ve already met was significantly impaired by bipolar disorder as a young woman, but, with treatment, has carried on a prolific career, producing research results which have become household knowledge. Tens of thousands of people should thank the anonymous psychiatrist who helped this person get on lithium (it wasn't me, but I'm hoping I might be the first one to help the next person like her.)

Looked at another way, these are people whose talents are sorely missed by society when they become even moderately disabled by mental health issues. Working at Green Acres has felt somewhat like coaching a Special Olympics team; my new job feels more like coaching the Major Metropolitan Area's major-league baseball team. Who’s to say which is more important? More rewarding? Which job offer would you accept? (Before you assume that the major leagues pay more than the Special Olympics, let me disabuse you: my income in private practice will be considerably lower than my salary at Green Acres.)

And the final simple truth is that I desperately need a change from the work I’ve been doing. It has felt like an episode of Survivor, lately. In the past decade or so, no other Green Acres ward shrink has lasted more than three or four years; two or three years is about the burn-out average. There’s a reason for this pattern; it’s time for me to recognize I’m not immune to it, and that no number of blue-water ocean voyages will provide the antidote. Off I go into a new adventure—wish me luck.