Category Archives: psychiatry

How Corporate and Governmental Greed Used The Distance Rule To Control You and Your Beliefs.

The following is my personal opinion.

Over the years, I have observed a phenomenon in various situations: I have dubbed it the Distance Rule. The rule is simple: the greater you can separate yourself from a person or group, the easier it is to justify or ignore harmful actions against that person or group. 

The converse rule, which I call the Closeness Rule, also applies.  The more one can relate to a person or group, the more difficult it is to justify harmful actions against that person or group.  

There is a qualifier.  These rules apply to individuals who have a moral center.  Those with sociopathic tendencies will do whatever is in their best interest, as their ability to empathize with another person is absent.  

Lastly, there is the phenomenon that I call Convenient Sociopathy, where it is so advantageous for an individual or organization to dehumanize an individual or group that they find a rationale to do so, often using the Distance Rule. Think of the corporation Enron, which regularly turned off electric power to parts of California, which caused harm to the most vulnerable while increasing the wealth of Enron’s shareholders. 

Entire nations can use these rules, often employing propaganda to reach a goal. This tactic is always seen in war situations.  During WWII, American propaganda portrayed both the Japanese and German citizens as bloodthirsty monsters, making it easier for US soldiers and the homefront to unite against them.  Naturally, similar campaigns were launched against Americans in those countries.  

Additionally, a systematic propaganda campaign was developed against non-Arians in Germany in the 1930s, and specific efforts by Germany, Italy, and Spain were developed to eliminate a particular minority population, the Jews.

Other groups were also targeted, from Eastern Europeans, to Romani, to gays, to those with physical, mental, and psychological issues. Creating an emotional distance between these groups and the general population allowed ordinary citizens to do the most horrific things to human beings.

It is easy to devise a method to separate one group from another. However, this process is more effective if the aggressor uses an easy-to-identify characteristic such as race, religion, economic status, education level, sexual orientation, or nationality. The aggressor’s goal is to gain power and control. That power can be expressed in privilege, wealth, or other forms of domination. 

A common characteristic of serial killers is that they dehumanize their victims, using the Distance Rule to turn them into objects for gratification. This can be seen in predators who kill for sexual thrills, such as John Wayne Gacy and the BTK killer Dennis Rader.  

The ability to distance from others to justify a behavior can be seen in less global ways. As a psychotherapist, I would see patients use the Distance Rule to create an emotional separation from a spouse when they enter into an affair relationship.  At the same time, I would witness them using the Closeness Rule to idealize the affair partner as further justification for their actions. I have never heard a person active in an affair say something like, “My spouse is great, but I decided to cheat on them anyway.”  Typically, an excuse is made focusing on their spouse’s flaws, lack of sexual response, inattentiveness, or whatever.  Likewise, the AP is usually characterized in an ideal way as the one “who understands me,” the one “I can talk to,” or the one “who appreciates my sexual prowess.” 

This Distance Rule is commonly seen in the corporate world and was promulgated by Jack Welch, the former CEO of General Electric. Before Mr. Welch, most large corporations’ strategies were for long-term, steady growth. Giving a workforce a sense of stability and rewarding them for their loyalty was part of that growth equation. Jack’s focus was very different. He saw a corporation as a profit-generating machine for stockholders and felt that the role of a corporation was to benefit those individuals. So be it if a job could be done less expensively in another country. A division that was not as profitable as another one should be closed and damn to the factory workers and communities that they lived in. Using that method, Jack made a lot of money for GE’s shareholders and himself.

GE survived as a corporation. However, this Distancing Rule sometimes destroys not only lives but also corporations. One example of that phenomenon is former Sunbeam CEO Albert Dunlap, known as Chainsaw Al for his business practices.  

Sunbeam Corporation was a 100-year-old company that made small appliances under the Sunbeam and Oster brands. These were well-regarded US-made appliances. My mother used a Sunbeam Mixer daily from the 1950s until the 1970s, when she was gifted a Kitchenade Mixer. That original Sunbeam Mixmaster was a quality product.  However, due to mismanagement, Sunbeam was less profitable than possible, so they brought in Chainsaw Al to improve the bottom line. Al fired around 50% of Sunbeam employees, closed down most of Sunbeam’s factories, and reduced their product line, destroying the lives of many.  Robert Reich, then secretary of labor, noted, “There is no excuse for treating employees as if they are disposable pieces of equipment,” Chainsaw Al promoted stock options, which meant that any profit for Sunbeam shareholders would also benefit him.  He was incentivized to do whatever it took to inflate Sunbeam’s stock, and that is precisely what he did, using fraudulent and illegal tactics that resulted in Sunbeam filing bankruptcy in 2001. Al left the corporate world with millions in his pockets despite paying off federal fines and penalties for his illegal practices. His fines were a small price to pay. Sunbeam was sold several times to larger entities, and Newell Brands now owns it. You can still find Sunbeam-branded products, including a crap version of the Mixmaster, which is now manufactured in China. No one aspires to have a new Mixmaster as the once legendary product has fallen far from grace.

The top 1% of income earners are those so isolated from the general population that the populace can become an object to achieve further gain rather than human beings with lives, families, and aspirations. 

I know of a university student who was given an internship at Amazon.  She was treated well in that temporary position, but she was appalled that workers were treated like machines.  For instance, lower-level workers were written up if they ever sat down.  Can you imagine?

Educated professionals can also be treated like commodities. For decades, we have been told that the secret to success was to become educated. Universities grew and prospered as US tuition reached stratospheric proportions.  Students studied complex STEM disciplines like engineering and computer science with the promise of a secure and financially stable life. Currently, many of these individuals can’t find jobs or have been laid off as they try to cope with massive student debt, excessive mortgages, and rising inflation.  

A particularly heinous practice in the US has been incentivizing shareholder profits in health care.  Let me first say this clearly: there is no justification to murder another person. However, I can understand the anger and rage placed on corporations that enrich themselves by acting as the unnecessary middleman in an industry that is supposed to help people and not cause harm.

We have been sold a bill of goods that says our health system is the best in the world; it is not.  Did you know that citizens in 48 other countries, including Costa Rica and Albania, have greater longevity than in the US?  Did you know that many citizens in countries with universal health care are happy with it and can’t imagine the healthcare shenanigans that happen in the US?  Did you know that medical debt is the number one reason for bankruptcy in the US?  Did you know all developed countries except the US have healthcare for all? It is accepted as a benefit of an enlightened society, just like free education, fire departments, and public libraries. No one says, “I don’t want my kids to learn how to read and write because it will turn our country into a socialist state!”

Many attempts have been made to establish universal health care in the US starting in the 1800s, including efforts from Presidents Theodore Roosevelt, Franklin Delano Roosevelt, and Harry Truman.  Are you aware that beyond profit interests, one reason for this not happening was racism?  Efforts for universal healthcare in the US started after the Civil War, but they were shot down by politicians, mainly from the South, as universal healthcare would have to include blacks.  White legislators noted, “Free assistance of any kind would breed dependence, and when that came to black infirmity (Ed note: sickness), hard labor is a better salve than white medicine.”  This should not be shocking as blacks have been excluded from many social reforms.  Large numbers of blacks were excluded from the 1935 Social Security Act, and structural discrimination limited black’s access to the GI Bill.

Private health insurance became a popular perk used by companies to entice workers during WWII when wages were frozen. This perk became a factor in amplifying the health insurance industry. 

Somehow, PR has made us believe that healthcare isn’t a right but a privilege.  To that end, 27 million US citizens are uninsured despite programs like Medicaid and the Affordable Health Care Act. This impacts all of us and our economy and is often the case due to governmental barriers at the state level.

Traditional Medicare is a government-run healthcare program that its users generally like.  Its administrative costs are 10 times less than private health insurance programs like Medicare Advantage. Traditional Medicare has a near-zero denial rate for accepted procedures. Lastly, its network of hospitals and doctors is vastly more expansive than any Medicare Advantage program.  Medicare Advantage subscribers often give up traditional Medicare and sign up with a private insurance company because they are promised trivial perks. Getting free stuff sounds terrific until you have a significant and expensive need and your Advantage program denies or delays approval.  

Regular private health insurance also practices these tactics.  A loved one of mine had a spinal fusion, and we were told that she would be in the hospital for 4-5 days due to the complexity of the procedure. After 24 hours, the insurance company was pushing for discharge, and despite my efforts, my loved one was discharged at 36 hours. My loved one wasn’t making sense, could barely stand, and was in terrific pain. We had to provide complete nursing care at home for many days.  Thankfully, I’m retired and have the knowledge and family support to take on that role.  How many others don’t have those resources?

Medicare Advantage programs are under government investigation for fraudulent billing practices and denial of claims. It has been proven that Medicare Advantage offers a lower quality of care while costing the government more than traditional Medicare.  So why are seniors always being pushed to go with an Advantage program?  Well, there is a reason that insurance companies spent over $117,000,00.00 in campaign contributions and lobbying efforts in 2024. We already have government health insurance in conventional Medicare, and it works quite well, but it doesn’t make a profit for shareholders and CEOs.

By using the Distance Rule, insurance clients become objects to be manipulated to increase profits for shareholders and employees of the company.  The recent tragedy of the murder of the CEO of United Health Care brought to the forefront the level of corruption in the industry.  Yes, that CEO was being investigated for insider trading.  Yes, he made 10 million dollars in his last year’s salary.  Yes, he illegally sold 15 million dollars of UHC stocks when he knew the stock was about to tank due to an FTC investigation.  That is horrible, but nothing compared to a 32% denial of claims by UHC.  That means almost one-third of requests from mammograms to life-saving surgeries were denied. Those denials were made by a computer program, not a medical expert, and that software is reported to be wrong 90% of the time! Consider the consequences and damage to our society by turning human beings into objects that can be manipulated to gain corporate profit. 

You may think insurance company denials are based on preventing evil doctors from performing unnecessary procedures, but that is not true. Some of the most significant legal investigations involving health care are due to insurance companies’ fraudulent billing of Medicare/Medicaid. Additionally, many doctors have stories of insurance companies denying payment even after getting pre-approved for a procedure. When insurance companies do pay, they can delay payment for months, causing hardship for practices with large overheads . Many rural and less endowed hospitals have been forced to close because of these and other practices, leaving entire communities without health care.

Insurance companies know that only about 0.2% of denials are ever appealed.  Clients may not know that they have that right to appeal or may not have the psychological energy to launch such a process during their health crisis.  Recently, our family had to face an insurance denial.  A loved one was diagnosed with a rare and life-threatening condition that was so complicated that it required traveling to a university hospital. A very long, complex, and potentially dangerous operation needed to be performed, and the university hospital got pre-approval for the procedure from the insurance company.  The operation took over 7.5 hours and involved a team of the hospital’s top doctors, including department chairs. Yet, 6 months after the operation, we received a bill for thousands of dollars as the insurance company denied a PART of the operation. I’m a physician; how do you deny PART of a pre-approved operation for a life-threatening condition?  That makes little sense. I did appeal the decision and was rejected twice by the insurance company.  I eventually filed a complaint with my state’s insurance commission before the charges were reversed. If only 0.2% appeal an insurance denial, how many of those 0.2% also know you can file a complaint to a regulatory commission?  Likely, not many.  Bonus for the insurance company. 

In our modern society, individuals are becoming more isolated from each other. People work from home, friends connect via text messages, and groups isolate themselves due to their ever-widening economic status. All of this makes it easier to apply the Distance Rule.

I live in an affluent community. I see entire families dining at expensive restaurants on weekdays. It is a place where people walk down pristine walking paths sporting designer clothes.  A place where many belong to a gym because they rarely do productive physical exercise.  It is a wonderful place to live, and I’m very grateful that I am fortunate to have called my town my home.  However, a short drive in almost any direction can take me to a different place.  A place where poverty is evident.  Where grocery stores don’t exist. Where schools are places of violence.  A place where poverty drives crime, addiction, and fear.  I generally avoid those places, as most of my neighbors do.  We don’t have to think about the plight of those human beings; they are far away, making it easy to objectify them.  Objects that we can blame and then ignore. “That’s not my problem.  Look at how successful I am,” we say—ignoring the opportunities that we have had. That is how things work in our society.  If it doesn’t directly impact the individual, it is ignored.  However, as we continue to distance ourselves from others on all levels, the result is that we will also eventually suffer. 

I was raised in a working-class neighborhood but managed to attend one of the country’s best medical schools.  Everyone who works hard enough can do the same, right?  Wrong.  I had many advantages in my favor.  I lived in a stable home and never worried that we would be evicted.  There was always food on the table.  Both sides of my family are academically oriented.  My parents strongly emphasized the importance of education.  I didn’t have the advantages of some, but I had many more benefits than many.  This enabled me to use my only gift, my ability to think, to my advantage.  Would that be the case if I was always hungry or afraid to go to school because I could be shot?  I don’t think so.  

Yet, it is still easy for me to objectify others using the Distance Rule.  I have to actively put myself in the shoes of others. I have conservative friends and family, and I make an effort to understand their positions.  I have working-class friends whose reality differs from mine, and I try to put myself in their shoes. When I drive through a poor neighborhood, I try to comprehend those people’s obstacles.  When dealing with a persecuted minority, I imagine what their life must be like on a day-to-day basis.

Recently, I have had someone I know come out as trans.  She possesses the courage and resolve that few, including myself, have.  However, as a minority, she will suffer from the Distance Rule. In my professional life, I have worked with trans people.  They represent an extremely tiny percentage of the population.  Their wish is simple; they want to have freedom to live their life and to be left alone.  There is NO evidence that they want to convert others to their position or that they get off from entering a bathroom. They just don’t want to be persecuted.  Yet, look at how easy it has been to use the Distance Rule to objectify them and make them into an object of hate. Why do this? If you want to control a group, find another vulnerable group they can fear and hate and then promise to protect the majority group from that imaginary threat. A method as old as time.

We live in a society where the distance between different groups grows daily.  That distance may be measured in terms of physical distance, monetary distance, educational distance, belief distance, racial distance, sexual orientation distance, liberal vs conservative distance, and just about any other separation you can think of. Consider this quote from our Pledge of Allegiance, “One nation, indivisible, with liberty and justice for all.”  Think of the power and wisdom of that statement.  When we apply the Distance Rule, we negate this promise.  In the short term, it makes our lives easier.  In the short term, it allows others to manipulate us and makes some richer.  But what about the long term?  What about our country and its promise to treat all fairly? In a country that should be the greatest on earth, such separations make the rich richer and the poor poorer. This can only lead to eventual collapse and disaster. That is common sense. Did you know that the three wealthiest individuals in the US have more money than the lowest 50 percent of the population? Three individuals have more wealth than the combined worth of 167 million humans. Their distance from that population is unfathomable. 

Government and industry leaders have employed the Distance Rule to split populations so they could manipulate them and extract power and wealth from them.  Why do we buy such a ridiculous concept that hurts everyone except for a few at the top? 

If you accept even ten percent of the premise of this post, it is incumbent on you to move from passive acceptance of the status quo to active pursuit of a better way.  You need to reject the Distance Rule and embrace the Closeness Rule. You need to look at how we are all more similar than different. At the same time, it is imperative to accept those slight differences that we do have and not buy into the manipulation of others who use minor differences as weapons to separate us.  

Find common similarities between you and someone different from you.  Listen to their dreams and their life struggles. You don’t have to adopt their ideas; they don’t have to convert to yours.  It is OK to be different. At the same time, open your mind, as you may find that some of your beliefs may change as you understand who they are as human beings. In turn, they may do likewise. Focus on the humanity of others. Immanuel Kant developed the Categorical Imperative in the late 1700s. The Golden Rule is as old as time. We know what we need to do, but we are manipulated to do otherwise.

A talking point from this last election was, “Are you better off than you were 4 years ago?”  It was a powerful point and likely won the presidency.  However, it was a manipulation because the statement should have been, “Are you better off than you were 40 years ago.”  For most, the answer would have been “No.”  But that reason is not because of the immigrants, or blacks, or trans people, or whatever.  It is because wealth has steadily moved from the poor to the rich.  That is the reality that the 1% doesn’t want you to know. They effectively used the Distance Rule to deflect blame onto vulnerable groups that can’t defend themselves. Remember, we are always stronger when we work together.  We are weaker when we allow others to separate us into groups, as that weakness can be exploited to all our detriment. 

Peace,

Mike

How I Became A Psychiatrist

When I told my father my plans he was clearly displeased.  It was a spring day, and I was talking to him in his south suburban backyard. “Dad, I’m going to specialize in psychiatry.”  His response was quick and sharp, “Why would you want to do that?  You should become a real doctor.  Psychiatrists aren’t doctors.”  

By that point in my life, I had long charted my own course.  I listened respectfully, but internally, I ignored his commands.  I no longer needed his approval, and my conversation was more perfunctory rather than advice-seeking. He had his agenda, and I had mine.  Since my decision would directly impact me, it was my decision to make.  I subtly changed the topic to something that I knew would interest him. It was a deliberate manipulation on my part to a neutral subject, and the conversation moved forward.

His question was valid for other reasons. Why had I decided on this career path? My answer was both surprising yet understandable.

There are certain key events in my life that I write about repeatedly. They serve as markers that indicate significant changes in my knowledge of myself and the world around me.  They are the road signs to my life.  Many other factors are equally important, but these events note a change in understanding or direction.  A fork in the road that led to a different journey.   

I often talk about my dyslexia, a diagnosis that is only partially accurate.  I use the term because it is relatable.  In reality, I have a variety of processing differences that can make simple tasks difficult for me.  For instance, I can visualize abstract concepts but can’t assemble a simple children’s jigsaw puzzle. This processing disparity was evident when I was in second grade and couldn’t read. In the early 1960s, the concept of learning disabilities was utterly foreign at the Catholic grade school that I attended.  My teacher, a nun, recognized that I was smart and erroneously concluded that my inability was caused by a vision problem, which prompted my parents to get me a pair of glasses.  This was a significant expense, and my father was not pleased, but he complied. 

I was hoping for a miracle and was crushed to discover that they did little to translate the incomprehensible set of symbols that moved around the page with a mind of their own.  I was at a phase in my life when I thought that any imperfection in me reflected poorly on my family and parents, and I was terrified of gaining even more displeasure from my father.

Yet, I had a certain confidence in myself, likely boosted by my teachers, who would comment on how smart I was.  I had to devise a solution, and I felt confident I could. But what resources did I have?  How could I take something I already had and use it as a tool?  The answer came to me via the Sunday comics. There was a strip called “Nancy” that was very simple in both its storyline and vocabulary. I could piece together the words by tying them to the pictures.  The traditional way I was being taught to read would never work for me because I could not see the separation between words and lines of text.  However, if I viewed a word as a shape instead of a series of letters, I could decipher its meaning.  My brain could do that, and print started to make sense.  I did many other things to teach my brain how to read. Soon, an entire world of information was revealed to me. By the time I took my 4th-grade achievement tests, I was testing at the 11th-grade level. 

I was a big kid, so I can’t say that I was the object of a lot of bullying.  I was part of the mass group of kids; neither a member of the popular crowd nor the reject group.  I had friends, and I did things.  Yet, I felt like an imposter.  Subjects that interested my friends didn’t particularly interest me, and things that I was interested in held no interest with them.  I learned that to be accepted, I would have to show interest in what interested them while hiding those things that I was interested in. 

My salvation was science, and my teachers were the pseudo-scientists of the B science fiction movies that I would watch on late-night TV. My ultimate hero and male role model was Don Herbert, AKA “Mr. Wizard” of TV fame.  Mr. Wizard seemed to have the answer to how everything and anything worked. He showed me that there was a method to understanding, a way to prove ideas, and a methodology to learning.  What he demonstrated formally was consistent with what I had been doing organically.  Mr. Wizard didn’t know me, but he understood me.  He had to, as what he was explaining on TV was exactly how I was already solving problems.  Mr. Wizard allowed me to feel “normal.”  I no longer believed I had to fake who I was; at least one person understood me. 

My success in learning how to read taught me that authorities didn’t always know what was best and that there were solutions to seemingly impossible problems if I allowed myself to think outside the box.  Mr. Wizard gave me a formal set of rules to test ideas. Science and math provided the tools to implement those solutions.  I was suddenly empowered. 

It was only natural that I would pursue science, and as I have said in a previous post, the most logical course of action would have been to obtain a Ph.D. and pursue a university career. I’m a rational person who examines potential outcomes, plots a course to achieve a particular goal, and then pursues that goal with force and dedication.  It works… well, sort of… well, sometimes…well, hmmm..ummm…keep reading.

I have already told you how I successfully reached my goal of graduate school and even had the school pay for my education. A perfect plan?  Then, despite all logic to the contrary, I had an irresistible urge to abandon my plan and apply to medical school, which was an insane idea that was bound to fail.  I knew that I would never be accepted into medical school.  All of my logic, all of my “scientific method,” and all of my dreams were tossed aside for a whim. Yet, that was precisely what I did; I allowed a force outside of myself to control my actions.  I was as shocked as anyone when multiple medical schools accepted me. Many of them referred to how meaningful my personal statement was to them. Here was a kid who couldn’t read in second grade who was now moving doctors with his writing.  Life is strange, isn’t it?

I have always had an immense interest in the interface between chemistry and biology.  My graduate work centered on changes to proteins as they are extruded through a bacteria’s cell membrane.  During my application to med school year, I left grad school and got a research job at the University of Chicago using tissue culture models to study Multiple Sclerosis.  We were using a cutting-edge technology (this was in the 1970s) called monoclonal antibodies to create specific markers.  Even then, I could see how such a targeted method could be utilized clinically, from cancer treatment to fighting infections.  However, those advancements would be decades in the future.

Logic would dictate that I pursue an area of medicine that incorporated my scientific knowledge with clinical practice.  The options were plenty: internal medicine sub-specialties like infectious diseases and endocrinology to specialties like Neurology.  I knew that one of those areas would be a perfect fit.  However, they weren’t.  

I was so excited to do my internal medicine rotations, but they disappointed me. I spent 90% of my time running down labs, examining scans, and writing notes.  The time that I spent with patients was minimal.  It felt like I was back in the lab, but my subjects were humans this time. As a family practice doctor, I may have been happy as that medicine was more integrative.  However, family practice options were discouraged at Northwestern.  When I asked the medical school dean why, he responded, “Our mission is to produce specialists.”  Despite this, my problem-solving and goal-direction abilities pointed me toward an internal medicine subspecialty. It was where my background and interests led me. 

Psychiatry was never a consideration.  I had some fears about the profession.  My mother was frequently hospitalized for ketoacidosis, a condition caused by her out-of-control diabetes.  Once, she was in a medical unit that shared a floor with Christ Hospital’s psych unit.  That unit had an imposing locked metal door with a thin slit window made more solid with embedded mesh wire.  It was scary looking, but young me was curious.  I crept up to the door and, with all the courage I could muster, looked into the window, not knowing what to expect. From out of nowhere, a face appeared directly opposite me.  A deranged and disheveled-looking man started to shout at me and threaten me. His face was one inch from mine, only separated by a thin piece of glass.

Along with his verbal threats, he started to beat on the door, and I could feel the vibrations inside my chest. I wanted to escape but felt frozen.  My heart was racing, and I was overcome by fear. Eventually, I broke away and ran down the hall.  In the background, I could hear laughing.  At the time, it sounded like an insane laugh reminiscent of those heard in horror movies. In retrospect, I believe it was the laugh of someone who felt he had just played the greatest joke on an unsuspecting, nosey kid.  However, it took me quite some time before I deciphered that realization.  I was freaked out for years, and at one point, I even had a fear that I could accidentally be locked up in a psych unit, never to escape.  

Our family has an intuitive psychological understanding, which stems from my mom. However, I never thought of pursuing psychology in any form. I was a science guy and never took a psychology course as an undergrad.  

Medical students rotate through all of the specialties as part of their training, and at Northwestern, all M3s are required to do a 6-week general psych rotation. This rotation was a low priority for me, and my main concern was completing it as simply as possible. I wanted a site close to Northwestern’s downtown campus for convenience and picked the least desirable one because it was only a block away.  I knew I would get it because no one else would want it.  It was a drop-in center for the sickest psych patients, the most chronically ill.  There, they could socially mingle, play a game, attend a group, get medically seen, and renew their prescriptions. Fellow students told horror stories about bizarre behavior and poor hygiene.  No one wanted that rotation, so I picked it.  I could survive anything for six weeks, and I wouldn’t have to travel to a distant site to complete my obligation.

My first day was as expected: bizarre, often disheveled individuals milling about, talking, and sometimes shouting to themselves. Mismatched clothes, sometimes garish makeup. “It is only six weeks out of my life,” I told myself. “I’ll do this one day at a time.” I had many obligations at that place, from doing initial psychiatric evaluations, to being a group therapy leader, to helping manage meds, to injecting patients with long-acting antipsychotics.  However, I also had more free time than was typical for a clinical rotation.  I started to hang around the day room.  Sometimes, I would sit in the day room and read; at other times, I would play a game with a client. Eventually, something strange happened.  Patients would come up to me and start a conversation. Those conversations were not about meds or the latest therapy; they were about their lives, hopes, and dreams.  They would ask me about me, not in an intrusive way but in an interested way. I was becoming part of their group.  They seemed to look forward to seeing me.

One day, a client could be rational, on the following day, completely psychotic. As they gained trust in me, they let me into their life, and I developed an admiration for them.  Despite having constant hallucinations and delusions, many could still navigate the world, form relationships, and problem-solve.  I would lack these abilities under such circumstances. Many lived a life of scorn and rejection, yet many of their desires were no different from mine.  They wanted to connect with others, have value, and have those basic needs that we all require. In this crazy setting, I was doing what I wanted: helping someone improve their life, even if it was just a tiny bit. Knowing the biochemistry of psych meds helped, but just relating to them as human beings was just as important. I looked forward to showing up, playing a game of checkers, or talking to them about their past and present lives.  I always felt different growing up, but kind individuals seemed to find me and convinced me that being different was OK. 

Here, I was dealing with people who had problems very different from mine, people who were very different from me, yet all I could see was how similar we were underneath.  These were human beings, not trash.  They deserved to have the best life that they could. I felt called to spend time with them.

Once again, my logic, planning, and goal-setting were about to be tested.  I had so much training in hard science, but much of Psychiatry was soft science. However, my course of action was right before me and couldn’t be ignored.  Hard science told me that I could use powerful drugs to block dopamine receptors and reduce psychotic symptoms.  However, soft science showed me that listening and relating to another human could be even more powerful.  My beliefs were being challenged, but I was willing to listen. But was this experience a fluke? The only way to find out was to test the hypothesis, and I did that by picking psych electives that were completely different from my drop-in center experience.  I did, and my mind did not change.

And so it started: residency, becoming chief resident, jobs, co-founding a clinic, working with the underserved, then… then…then.

Do you ever think there is some guiding force beyond yourself that directs you if you allow that direction?  A guardian angle? God’s direct interest in you? Some other force. Despite all of my planning, logic, and science, my best decisions in life seem to come from outside of me.  Interesting, no?

I spent many years sitting at this desk in my co-founded clinic.