April-June 2011 Bulletin

Why I love being a psychiatrist--C. Donald Williams

It’s good to be lucky--to be born in a time and place with opportunity to discover a passion and pursue it. When I was in the 9^th grade I was nosing around in the city library and located the “Great Books of the Western World” published by Encyclopedia Britannica. There were 60 volumes in the series, devoted to the subject categories of literature, history, philosophy, and science. It also contained works from 20^th century authors; the one that captured my attention was Freud. I remember my first exposure to The Interpretation of Dreams, his discussion of the history of dream interpretation, and then, excitingly his presentation of dreams with their analyses in italics. Now, recalling this first exposure to a Rosetta Stone approach to understanding the meaning of patterns of thought and feeling, I again have an emotional response. The intensity surprises me. It feels fresh and at the same time familiar. I knew it was important to me and that I did not want to lose sight of it. Ever.

Some of you may also have read the March 5, 2011 New York Times piece titled, “Talk doesn’t pay, so psychiatry turns instead to drug therapy.” The article begins, “Alone with his psychiatrist, the patient confided that his newborn had serious health problems, his distraught wife was screaming at him and he had started drinking again. With his life and his second marriage falling apart, the man said he needed help. But the psychiatrist, Dr. Donald Levin, stopped him and said: ‘Hold it. I’m not your therapist. I could adjust your medications, but I don’t think that’s appropriate.’” I think this is inexpressibly sad and is profoundly antithetical to what matters to me.

My lucky times stand out; I went to a college with small classes and superb faculty. I went to my first choice medical school. I took several classes from the psychoanalyst chair of the Department while a medical student before he left and the Department turned strictly to biological psychiatry. I did a child fellowship which made all psychotherapy easier.

It was not all a shining path. The Department developed an anti-analytic bias that was impossible to escape, and I began practice in my community disconnected from the life source of my discipline and felt lost for about 10 years.

Then some more luck. I began doing group therapy, attended the AGPA, became certified, and have an active group as well as individual therapy practice. I began therapy with an analyst and did 10 years of work that reconnected me with me. It wasn’t pretty, but it was necessary and invaluable. I began a 23 year supervision/consultation with a senior analyst which polished the Rosetta Stone and brought the work of analytic psychotherapy into clearer focus. He has been a wonderful mentor and teacher.

The really big piece of luck was joining AOOP in 1994. I liked the atmosphere and the people and kept coming, even though I didn’t see how I was ever going to do corporate consultation or executive coaching in a place like Yakima. Within 3 years I led a workshop encouraged by a former AOOP President and taught courses at the APA annual meetings with Ron Schouten for 5 or more years, which introduced me to creative people in the discipline and opened other doors.

Taking advantage of all I learned about healthy organizations from AOOP I formed an LLC that licensed 3 patents on transdermal pharmaceuticals for the treatment of pain, taking one product through FDA phase 2. We didn’t make a dime, but it was a great ride, and what I had learned about teamwork through my AOOP connection worked for Pharmaceutical Application Associates LLC; we all remained friends, even when it didn’t pan out.

I created a Mission Statement for my practice, which I would never have done without AOOP. It makes a huge difference. I refer to it. I adhere to it.

10 years ago I decided consciously that I would endeavor to always be doing something different and better in my practice compared to the year before. My connection with Ron led to an opportunity to co-author a textbook chapter in 2000, followed by invited papers in peer reviewed journals on an annual basis from since 2006. These require scores of hours, have led to original ideas, and they place me in contact with reviewers and editors that contribute enormously to clarity of concept and accuracy of expression.

In 2008 and again in 2010 I obtained formal training in the MMPI-2/MMPI-2-RF because the psychiatric IME’s I see are inconsistent and lack objective foundation. Using my own practice I have learned that attorney and doctor workers’ comp referrals have essentially identical test characteristics, both in terms of dimensional severity and their diagnoses. This is exciting to me. Because of a paper I wrote for Harvard Rev Psych using this information I developed a friendly relationship with a leading authority on the MMPI-2 and MMPI-2-RF. We are in discussions about writing a paper that will begin to link psychiatry and psychology. In the meantime a 3^rd edition of the textbook is coming out with a chapter in which I describe the use of psychological testing in IME’s and to measure progress in treatment.

I approach each treatment consultation, psychotherapy and IME with enthusiasm since they each represent an opportunity to learn. Going to work I feel privileged to be a physician and psychiatrist, to have the opportunity to be creative and bring all I have to offer on whatever challenge appears. I know that the work is important to me, my patients, and to the people I evaluate for other professionals.

I feel lucky almost beyond words. If I were to learn that I had but 24 hours to live, I would be sad to leave life, but I would have no regrets about how I spent the preceding days, weeks, months, and years. I don’t want to lose that. Ever.