I was not prepared for psychiatry to become a kind of second class pseudo neurology for poly "feel good" pharmacology. Comfortable with psychopharmacology , I still enjoyed the contributions of anthropology, epidemiology,chemistry, biology, neurosciences, developmental psychology, sociology, cultural, philosophical and theological considerations that were so much a part of my training. Individuals were seen as multifacetted diamonds in the rough. The coping mechanisms of the mentally ill, the deranged, the deviants, diseased and impaired, the outcasts and the marginalized were all understood as adaptation. If someone was particularly offensive my teachers taught me to ask how this behaviour had been necessary to the development of the individual. Alternatively I was asked what it was about my supposedly tolerant and civilized upbringing that would cause me to be so judgemental about this clearly human presentation. Was I really sure that my way was the best way? I was taught the story of the Diogenes the philosopher who asked by Alexander the Great, "is there anything I can do for you?" replied, "you can step aside so as not to keep the sunshine from me". Such self sufficiency as Thoreau at Walden Pond was as important to a psychaitrist's development as the book, "If you meet the Buddha on the road, Kill him."
It was the heyday of medicine and we dreamed of Canada leading the world in healing. We didn't see her as sending the little sister soldiers to big brother America's conflicts. Rather we envisioned Canadian hospitals ships and a space age medical corp, and peacekeepers world reknown for their daring rescues. We felt that as Canadians we could best serve the world by wedding the remarkable education systems and multicultural environment to the task of curing disease. The canadian medical system was foremost in the world not where it sits today with increasing waitlists and patients paying for everything but the most basic services out of pockets which of course the ill by nature of illness experience as sorely depleted
Then the beaurocracy took over or something. Suddenly administrations redefined healthcare as political expenditures and for profit models. The question became how do we promise the tax payer health care, give them something else and charge them for both. Politics was pigeon holing all doctors in the dinosaur realities of archaic reductionist fear driven paradigms. Truth became a things of the past. Overnight we'd gone from the sublime to the me Jane, you Tarzan world of brute force and big is better. Rather than serving as consultants with the genius that comes from long years of reflection, intense debate, and in depth experience with basic research and love of learning we were suddenly poorly paid slaves to the fickle self serving designs of pillagers who claimed survival of the fitness was the only true religion. There would no more be anything but "applied research and the university medical school was nothing more than a glorified 'trade school' and factory.
Thank God, Addiction psychiatry came along and again said there's no such simplistic answer to life. No perfect pill. No quick fix. No instant happiness. Simple answers, yes. But no simplistic solutions that could come in a cereal box despite the marketting. The individual problems again were seen as community problems. The mind problem was a brain problem as well. Addiction was the microcosm for the macrocosm. The heart and soul were overnight restored to adult psychiatry.
Once more there was this place where relationship was as important as illusion and the question 'what is enough' was being asked had surfaced. Not just as 'resource management' but rather in terms of Maslow and Seligman. Moderation was again a central theme of medicine. A different kind of reasoning was being asked for in this era of emotional, spiritual and cultural intelligence. Collaboration and respect was demanded but not for the 'position authority' of insignia but more for the scars and tattoos of experience.
Not surprisingly an individual 'cured' of an addiction would re acquire that same addiction if they were subjected to the same environment so family, community, friends, work and schools all became involved in the psychiatric process. The term psychosomatics returned as mind body realizations derived from modern PET and fMRI scans.
Daily in clinical practice, one on one, the addiction psychiatrist had to answer "who am I to question this man's addiction to death when I myself may be no better in my addiction to life". Thanatos or Eros? The teeter totter tug of war or dance of love. Here the healing began. At the front lines. And I loved it after the sterile stupidity of one shoe fits all. The healing was in the process.