Nassir Ghaemi M.D., M.P.H.

Mood Swings

The Last Column: Charles Krauthammer's Terminal Illness

"No good deed goes unpunished."

Posted Jun 11, 2018

The conservative columnist Charles Krauthammer announced a few days ago that he had terminal cancer.  His column was his last, as he took leave from his readers. It was touching and honest.  It made me think about a tangential connection I’ve always had to a commentator who I mostly felt was wrong.

When I was a psychiatric resident at Harvard, doing rotations at Massaschusetts General Hospital in 1993, I first heard of Charles Krauthammer.  I heard about this former resident, who had become paralyzed from a swimming pool accident while a Harvard medical student.  Despite the paralysis, he completed his residency and entered the only specialty one could manage reasonably well in a wheelchair. 

His mentors were in the consultation psychiatry program at MGH, two senior psychiatrists who happened to be Jesuit priests:  Drs. Edwin (Ned) Cassem and George Murray. Perhaps surprisingly for a Jewish man from New York who later was a stolid advocate of the Israeli right, Krauthammer became a protégé of the two Catholic priest-psychiatrists. Cassem was thin, mild and friendly; Murray rotund, loud, and grouchy – an odd couple of Jesuit psychiatry.  There was a mildly right-wing air to the consultation program at MGH too. When you entered the program’s office suite, you were greeted by a kindly Irish-American secretary, sitting below a poster of a Marine holding a rifle, with the words “No good deed goes unpunished” emblazoned across it. 

A few weeks into the program, following Cassem and Murray around the hospital to attend delirious and delusional patients, taught you what the poster meant.  Most of us went into psychiatry to help people; our problem was that we wanted to help people too much.  The problem with a lot of our patients is that too many people had been enabling them all their lives; what many needed was limits – less help, not more.  In fact, it was helpful not to help.

It wasn’t as simple as I make it seem here.  It was, and is, complex – this job of the psychiatrist who has to care and set limits at the same time.  What the consultation program emphasized was the limit-setting, but the caring was there behind it. 

MGH and Boston in the 1970s, when Krauthammer was there, was a very liberal place. And the “psychiatric marine” aura in the Consultation Program was a reaction, a mild one, but a reaction to what must have felt as an excessively left-wing world.  Maybe it isn’t a surprise that Krauthammer went from leftist Boston to a job as an assistant to the science adviser (Dr. Gerald Klerman, another MGH psychiatrist-mentor) in the Democratic Carter administration, and then, having caught the Washington bug of political tug-of-war, quickly drifted rightward to become the consistent conservative commentator of national renown.  He scored a weekly column in the Washington Post, which he has kept up since 1984, and later became a regular on Fox News.  He supported Reagan, opposed Clinton,  backed Bush, bucked Obama.  All along, he was a hawk on Israel. 

In those long years in his prime, I found myself in deep disagreement with Krauthammer.  It seemed to me that he had taken the “no good deed goes unpunished” motto too far, as if there was no use to good deeds at all.  Maybe it was because he was Jewish and I was Muslim; or that he was from New York and I was from Tehran; or that he came of age in the radical 1960s and 70s, while I did in the conservative 1980s and 90s.  We were different; but we were both psychiatrists, with the same teachers.  I could sense sometimes that he spoke from his psychiatric experience, from insights that came from long nights in the hospital; he seemed detached, cynical at times, but still one sensed experiences with human nature that his peers in political commentary never knew.

And then, in his last years, he stood up to Trump, at least in the president's fellow-traveling attitude toward white nationalism.  In that stand, Krauthammer showed that he preserved an integrity that power couldn’t impact.

Back in the MGH psychiatric consultation office, I once saw a folder named “Krauthammer.” I looked inside and found clippings from some of his newspaper columns.  His old teachers were keeping tabs on him.  I never talked politics with them, but I had a feeling that they might have sympathized with Krauthammer’s contrarian conservatism.  I didn’t share their politics, but I appreciated the contrarian attitude.  There was an integrity behind the itch to stand up to the status quo, even when the status quo might have been more right than its critique.  The irony was that the protégé became an icon of the new conservative status quo of Reagan’s America, the man who first intoned that we must “make America great again.” And at the end, Marx’s dictum came true: History repeated itself, first as tragedy and then as farce, and Krauthammer found himself faced with another Republican president whose conservatism he found to be unacceptable.  True to himself, he rejected the new status quo.

Ned Cassem passed away about a decade ago; George Murray a few years ago.  I learned a lot from them about staying true to principles, about setting limits, about knowing your own limits.  They taught generations of residents to think lucidly and to mix empathy with firmness.  They demonstrated that spirituality could be made real, and engage with the most difficult parts of life.  I don’t know what they thought about the unique path taken by this student, but that file on Krauthammer suggested to me that they approved. Had they lived to see his final act, I think they would have approved even more.       

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