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. …