AACP Newsletter, Volume 13,
Number 4, Autumn 1999
Commentary:
Making History
What will we do? What will we do in psychiatry in the next century or even in the next ten years to mark this time? I would like to propose that we in the AACP take the next year, the millennial year, to be a year of discussion about vision and leadership. It is a discussion I hope we can carry out in the pages of the newsletter, on the web site, on the list serve and through personal communication. It is timely to do this and we are in a fortunate position to do it. Psychiatry is clearly under assault economically and philosophically. On the one hand resources to address psychiatric illnesses are being curtailed and on the other we see the increasing biological nature of psychiatry being narrowly interpreted to the point where some are suggesting that psychiatry is neither necessary nor useful. Some are proposing that we become neurologists. Both of these forces are producing a reactionary stance in organized psychiatry. We need to defend the guild and we need to defend the psychological. Clearly these two things are important and we do need to do both of them. But the reactive stance, the idea that things will go back to how they were, I think, contaminates them and lessens the likelihood that they will be successful. Community psychiatry, however, is in a position to cast a forward vision about psychiatric services in the next century. It understands the psychological and the social as well as the biological underpinnings of psychiatric disorders and the relational basis of psychiatric services. We understand population oriented health care and the need to establish priorities and work with allies and within limits. The question for us is, Can we lead?
What does it take to lead now? Many of us are already leading in some way; most likely in clinical settings in the teams we are on, in the clinics we practice in, perhaps even the agencies we work in and communities we live in. But I suspect we may not recognize our leadership role explicitly and we may not be gearing up to lead in the way we need. We may have ideas that we don’t have the capacity individually or collectively to lead. We may believe that in order to lead one needs money or time or institutional authority or followers in place. From my perspective these may all really just be excuses for not leading or believing that one cannot lead because none of them are truly necessary to exercise leadership. In my opinion leadership just requires two fundamental things. First it requires a commitment to a vision that allows one to accept the burdens of leadership. If you are not sure what you believe in leadership is a difficult job. Secondly, leadership exists in its exercise, in action. Even when you are sure of what you believe in it is work. It requires building alliances, it requires flexibility, it requires being judicious and considerate and passionate all at the same time. To make change it requires a radical persistence. Psychiatrists by their nature are not always good leaders because of our reluctance to exercise authority or claim a voice or work in partnership. Sometimes we are too good at listening, too good at staying the same. Sometimes we are too self-centered with our focus on our patients and on the privacy of our individual practices. Because of these things many “non-community” psychiatrists have a hard time becoming leaders in their communities. They do not understand the social network and connections that organize the community and they do not participate in them. Community psychiatrists, on the other hand, have only to accept the responsibility of leadership to begin to do it because most of us are already well aware of the importance of the social framework of our communities and the importance of our participation in them.
Both psychiatry and the community need us. The question for us is how will we make history?
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