In last year's May column, I presented some examples of the best of psychiatry in celebration of the annual meeting of the American Psychiatric Association ("In Search of Sublime Psychiatry," The Ethical Way, p. 66). Sublime was defined per the Oxford English Dictionary as "of such excellence or beauty as to inspire great admiration or awe."
I found several worthy examples. Those highlighted last year--the recovery movement, volunteer work by psychiatrists, and the prospect of mental health care reform--inspired awe because of their potential for excellence and for offering genuine help to our patients.
We begin this column with a follow-up aimed at assessing those previous choices. I also offer a few additional possible examples.
As I mentioned last year, the best model of the recovery movement in a clinical context was deemed to be the MHA Village in Long Beach, Calif., led by Dr. Mark Ragins. The village maintains its high rating because Dr. Ragins continues to push the envelope for recovery.
One of his latest projects is his effort to develop 'A Recovery Progress Report Card," a tool aimed at assessing quality and progression of recovery programs. As a fellow member of the American Association of Community Psychiatrists I support the recovery process as much as practically possible.
Dr. Michael McBride's work offers an example of sublime psychiatric volunteering. He went twice to Germany and once to Iraq in an effort to help deliver mental health services to people in the armed services.
Now he has returned to work for our local Veteran's Affairs facility and continues to address the psychiatric needs of those discharged from military service. His latest workshop is "Depression, PTSD, and Suicide: Treatment of Returning Soldiers and Their Families."
In the interest of full disclosure, I should mention that I was one of Mike's teachers when he was a medical student, and I worked closely with him in our local National Alliance on Mental Illness. My pride in his work could have influenced my selection, although he has been recognized by many others, also.
Another highlight from last year was the mental health care reform work by Dr. Leslie Hartley Gise in advocating for a single-payer system as promulgated by the Physicians for a National Health Program. I have long been a PNHP member, but much less involved because I felt that it has somewhat neglected mental health and hasn't adequately addressed quality of care. But Dr. Gise sees a window of opportunity as President Obama begins to address health reform and has redoubled her efforts.
My call last year for additional examples of sublime psychiatry proved futile: No nominations came in. Is our field really as mundane as that suggests? Is it the economy? Perhaps the recent reorganization and downsizing of the APA will result in some sort of sublime work in progress. So far, that effort seems to be about cost savings, but not necessarily a new vision. Stay tuned.
Over the past year, I have noted some very worthy, atypical work that should at least be mentioned. One example also relates to the psychiatric trauma of the war in Iraq, and pertains to mental health services for the Iraqis in that country. Mental health services were inadequate before the war and have been devastated since--given the departure of psychiatrists, damage to hospitals, and safety concerns tied to outpatient care.
Into that void came a psychiatric network of professionals under the International Medical Corps. Many Iraqi psychiatrists remaining in Iraq have suffered their own personal traumas. Our ethical responsibilities in these cases were stated by Dr. Amir Afkami from the department of global health at George Washington University, Washington (Psych. News 2008;43:15).
'As American professionals," Dr. Afkami wrote, "we have a responsibility in Iraq. We can help by going there to give lectures or by inviting Iraqis to come here for study."
Perhaps there is something about practicing psychiatry in other countries that invites opportunities for work that is sublime.
The number of psychiatrists might be inadequate in Iraq but is miniscule in Cameroon, according to Dr. Jean-Pierre Kamga Olen, a Cameroonian psychiatrist (Psych. News 2008;43:16).
In addition to providing desperately needed services, Dr. Kamga Olen wants to explore cross-cultural aspects of psychiatry from which all of us might learn. The cross cultural approach includes the tendency to somaticize depression, as well as the difficulty of distinguishing mild bipolar from lethargy tied to heat and humidity seen in some parts of West Africa.
There is a dearth of psychiatrists in some areas of the United States, Indian reservations, in particular.
After the March 22, 2005, tragedy in which a 16-year-old Red Lake Indian Reservation student killed several people and himself, the psychiatrist L. Read Sulik organized several Minnesota psychiatrists to take turns flying to Northern Minnesota to help.
Suicide rates have dropped, two American Indian psychiatrists were hired for the hospital, and intervention with the school system took place (Psych. News 2008;43:7).
I was invited this year to a national forum held March 20 in Washington called Psychological Aspects of Global Warming. At that forum, I learned about developments relating to psychiatry that are worthy of being called sublime. This conference addressed an ethical issue often ignored in mental health: the psychiatric implications of the climate change crisis. As the journalist Andrew C. Revkin wrote to me in an e-mail "the psychology of [global warming] is clearly the hardest part."
Again, in the interest in full disclosure, I should mention that this issue, global warming, has been near and dear to me for 2 years, since my granddaughter was born. I wrote a column on it ("Taking the Temperature on Global Warming," August 2007, p. 63), wrote many other articles, and have done multimedia presentations with my wife on the topic.
The informed part of this disclosure is to state my conscious intent to have more mental health professionals become interested in this issue, for the ethical imperative seems clear to me: All mental health professional ethical guidelines advocate participation in activities that will benefit the community. Addressing the psychological aspects of global warming is certainly one way to fulfill that obligation.
The first thing that seemed sublime was the diversity of knowledgeable professionals from different fields that seemed united in understanding the necessity of making mental health part of a strategy for addressing climate change. In addition to several psychiatrists and psychologists, the forum included a retired U.S. Navy lieutenant general, a professor of communications, an epidemiologist, a director of a national self-help organization, environmental lawyers, the executive director of the Presidential Climate Action Project, a filmmaker, an organizational consultant, and a philosopher.
The first sublime surprise that I heard came from the retired military man who reported that our military was very interested in the psychological aspects of global warming. He argued that the U.S. military views climate change as a security challenge and therefore in the purview of their mission. In fact, he said that the military hierarchy now views climate change as the greatest threat to stability in certain parts of the world, which in turn could lead to greater terrorism risk for the United States. He welcomed any contributions psychiatrists could make to reducing global warming risks.
Perhaps even more importantly, the military seems to understand the need to act despite uncertainty when the risk is high enough. Many still contend that much uncertainty exists about the cause, extent, and future of global warming. Likewise, on the battlefield, soldiers and generals occasionally must make decisions quickly in the absence of certainty. Mistakes can occur, but it is generally thought that the benefits outweigh the risks. We use this risk/benefit frame-work in our everyday clinical practice.
An organizational consultant, a psychologist by training, presented what seemed to me to be a sublime idea aimed at fostering more interest in global warming. Having written about "empathy deficits" and building on our emerging knowledge about mirror neurons and our empathetic potential, he suggested we find ways for people to develop more "empathy for the future."
People with or without children can attempt to access and/or develop this kind of empathy. Also, most people who oppose global warming initiatives, or don't believe global warming to be problem, can still be very concerned about the well-being of their children and grandchildren. A future task for us, then, is to find ways to develop this expanded sense of empathy.
A community psychologist at the conference professed concern that global warming is already affecting poor communities the most. The other sociodemo-graphic groups at higher risk are the elderly and infants. In addition, those who feel that their future already has been severely imperiled, such as the Inuit male teenager who fears he will not be able to hunt in a traditional manner because of the effect of global warming on wildlife, have higher rates of depression and suicide.
The climate activists conveyed a most poignant challenge for mental health clinicians. Dedicated activists are becoming burned out and feeling traumatized, and some are even leaving the field. Sometimes they feel that they are living in a parallel universe and that most people around them don't understand their concerns. Everyday weather changes can take on different--and often ominous--meanings. The challenge for us is to support environmental activists psychologically.
In the Fall 2008 Special Issue of Wildlife Professional, Larry Schweiger, president and CEO of the National Wildlife Federation, quoted the psychologist Rollo May as saying: "Every profession requires people with creative and moral courage to envision, appreciate, and direct change." May we be creative and courageous.
DR. MOFFIC is a professor of psychiatry and behavioral medicine, as well as family and community medicine, at the Medical College of Wisconsin, Milwaukee. He can…