Learning to Play

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Two Cultures

Psychotherapy and psychopharmacology, do they mix?

 


I had my debut. I led a discussion of psychoanalytic psychotherapy with about 25 psychiatry residents in different years of training and with very varied backgrounds. I remembered being a psychiatry resident and feeling that psychoanalysis was an elite activity. The practioners were an elite group and so were the patients. I was idealistic. I wanted to help large amounts of people. Psychoanalysis is intense. There are limits to the number of people one can help. I felt a need to justify my state-funded education by giving back to the community. However, as time went on, I realized that I needed tools to help people. Psychopharmacology was one tool, but it was not enough. What other tools were there? Psychoanalytic thinking opened the door to a means for an in-depth look at personality. The depth of thought was attractive to me.

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How do I convey the love of ideas to rookie psychiatrists who look to science to help people. I love science too. I want to say that. Scientific rigor is valuable, as is the never-ending rigor of exploring personality development. I return to my question. How do we embrace the mind, while still appreciating neurobiology. How do we create a bridge? How do we have mutual respect?

I am reminded of the 1959 Rede Lecture by British scientist and novelist CP Snow. Its thesis was that the breakdown of communication between the "two cultures" of modern society-the science and the humanities-was a major hindrance to solving the world's problems. Just as many humanities scholars do not know much science, so too, many neurobiologically trained psychiatrists do not know much about theories of human motivation.

The question is how do we train psychiatrists when the paid faculty are at the edge of scientific breakthroughs, whereas the volunteer faculty are trying to encourage an exercise of floating ideas. This question deeply troubles me.

I want to convey twenty years of private practice. I want to give them an idea of what they could expect if they pursued a practice which included psychotherapy. At the same time, I feel like that task is not possible. Their practice will be nothing like mine, as mine is nothing like my teachers. The times are different. The tools are different. The understanding of the human brain has changed. A private practice of psychotherapy is a dynamic experience. It grows in the same way a child grows. I get older. My long-term patients get older. My child folks become adults.

I return to my major tenet. I may not be sure about how to approach something, but I need to "show up". By that I mean that I need to try, even though my task is messy. Therein lies my challenge. In a parallel way, I convey the messiness of private practice. Embracing uncertainty is my theme-a theme that has been taken up by great thinkers. Looking to those great thinkers seems to be very wise. Freud was one such great thinker.

 

Shirah Vollmer, MD, is an Associate Clinical Professor of Family Medicine and Psychiatry at the David Geffen School of Medicine at UCLA.

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