ABSTRACT
Paul Stepansky of The Analytic Press invited me to open this section of more recent essays with an older one, my very first published in Psychiatric Times (June 1993). He recognized it as the testament of a psychiatrist whose professional identity had "hit bottom." It was only the large response from similarly despairing practitioners around the country that encouraged me to continue making what had seemed at the time like a lone cry in the wilderness (and that emboldened Psychiatric Times to offer me a spot as a regular columnist). I still keep a folder full of letters from psychiatrists responding to this piece.
Rereading it from this distance, I am struck by the fact that most of the themes I have written about since are sounded here and that American psychiatry today is much the same, only more so. The sexual boundary-violation scandals have died down, but hardly disappeared. There is even more emphasis on medicalization and standardized, purportedly "evidence-based," psychotherapies. While the Decade of the Brain did give research neuroscientists a much fuller appreciation of the complexity of the mind-body connection, much clinical practice remains back at the "chemical imbalance" level of understanding.
On the other hand, an alternative consensus still survives among therapeutically oriented psychiatrists like my readership— more than I might have guessed. Squabbles among the "schools" of therapy have very much lessened as it becomes clear that flexible pragmatism is the only viable option for us.
