"One should practice morality urgently, as if the god of death had seized one by the hair."
--paraphrase of Sanskrit by Daniel Herwitz, director, University of Michigan's Institute for the Humanities
By the time you read this column, we will have had our annual American Psychiatric Association meeting, where we often try to highlight much of the best of psychiatry. In contrast to foolish psychiatry--which I discussed in my column last month--I do hope this one becomes an annual May column in celebration of the meeting.
What to celebrate, though? The answer and inspiration first came to me while on a trip my wife and I signed up for last year called 'A Sublime Journey: The Art and Architecture of Northern India." I then wondered, If sublime can apply to art, could it apply to psychiatry? After all, weren't we all taught the "art" of medicine?
I'd seen the word sublime used as an adjective in many contexts recently: sublime apple pie, the sublime poetry of John Milton, Mozart's sublime clarinet concerto, and sublime love. But I was not able to find any reference to sublime psychiatry. Was I on the wrong track?
Since this is an ethics column, I considered the American Medical Association's ethical principles. Some may think these principles themselves are sublime. But our APA must not. After all, as I mentioned last month, the task force charged with revising our ethical principals is looking at whether the notion of maintaining appropriate boundaries is outdated ("Sex and the Psychiatric Clinician," Clinical Psychiatry News, April 2008 p. 62).
What about the individual principles? The ethical expectations are quite modest; none expect the sublime. For example, ethical treatment only needs to be "competent," not ideal. But this shouldn't stop us. Most of us usually strive for the best, whether working in patient care, or on presentations or publications. Perhaps our work could be considered sublime whenever it reaches those heights.
Given my limited and biased perspective, I decided to ask colleagues for possible examples. (I cite them hereafter with their permission.) To define sublime for this request, I looked in my Oxford English Dictionary, which gave the primary definition as: "of such excellence or beauty as to inspire great admiration or awe."
In the beginning of a running discussion I had with Dr. Chuck Joy, he noted the difficulty of holding "sublime" and "psychiatry" in the same thought. Art, yes, and possibly the use of arts in psychiatry, such as art therapy, music therapy, or movie therapy. But what about everyday psychiatry?
Dr. Joy, a psychiatrist and poet, went on to wonder whether feeling awe and wonder might indicate a counter transference problem needing consultation. Uh-oh, I thought. This notion might take me right back to the issues discussed in last month's column on foolish psychiatry. Did our winner feel awe and wonder as his attempts to treat a colleague ended up in an intimate relationship? Would I just be doing another column on foolish ways under the guise of the sublime? As our discussion progressed, Dr. Joy and I got to some possibly sublime intellectual concepts in psychiatry, such as Dr. Donald Winnicott's idea of the "good-enough mother." We were getting closer.
Recovery Is Sublime
One intellectually sublime concept that can be translated into clinical practice is the recovery movement. The issue that seems to push the recovery movement beyond the usual to the sublime is that at its essence, the move-ment has revised the expectations upward for how treatment should be approached for those with so-called serious mental illness. When able to do so completely, psychiatrists often have been left with a sense of awe at what can be accomplished, in contrast with the limited expectations--and even pessimism--associated with treatment as usual.
The recovery movement has been slowly gaining momentum. …