Winter 2019 Issue
By John Urbach, MD, DLFAPA
I wish all our members and friends a healthy and happy holiday season. It was a pleasure to see many of you at our fall meeting in Virginia Beach, where our program on “personalized psychiatry” explored how principles of precision medicine will yield more specific treatments for our patients in the coming years. We were also delighted to have a record 36 poster presentations by students and residents from across the Commonwealth. They demonstrated impressive clinical acumen, creativity and research skills. We had unprecedented support from our meeting sponsors as well.
As we leave the 2019 Virginia elections and enter 2020, it may be worth reflecting on the place of “politics” within organized psychiatry. Many of us can remember the widespread social activism of the 1960’s and 70’s and the controversies it generated. Psychiatrists, individually and collectively, were outspoken about several issues of that time, as both citizens and advocates for mental health. In the 1980’s and 90’s, many in the profession became skeptical of our playing such a role, advocating for more focus on scientific and practice issues. The “Decade of the Brain,” the completion of the Human Genome Project and an explosion of controlled research findings certainly advanced our field. Practice-oriented legislative efforts did continue, with a bipartisan team enacting our first mental health parity law in 1996.
We currently find ourselves in a national political climate that observers consider the most polarized and divisive in decades. How should our profession respond? Do we maintain a posture of “scientific neutrality”? Attempt to use our therapeutic skills to “build bridges”? Embrace the tradition of “speaking truth to power”?
Some engagement may be a duty. If our daily work is built upon objective data and narrative truth, then realities do matter, and alternative opinions do not justify alternative facts. When issues come to our communities, affect our patients and threaten the health and safety of our society, the political and professional become entwined.
Global issues can also be local: Climate change, temperature extremes, and severe storms are disrupting lives with significant medical/psychiatric sequelae. We know the importance of “warning signs” and the potentially tragic results of symptom denial. A looming crisis for our planet and public health is a danger that must be confronted.
On November 14 in California, yet another school shooting occurred. It was the latest of several such incidents in 2019 alone, with many more mass shootings in other settings. We have developed a ritualized response to these events, but made little progress in curtailing them. On our border, more than 5,400 children, some as young as a year, have been separated from their parents, often in stark conditions with poor physical care. Our understanding of childhood development and psychological trauma obligate us to speak out. The FBI reported that personal attacks motivated by bias or prejudice (“hate crimes”) reached a 16-year high in 2018. As doctors caring for vulnerable patients, we understand the power of stigmatization to harm and endanger. As members of a diverse profession, we know that recognition and respect strengthen us all.
Physicians generally, and psychiatrists in particular, can be exemplars in advocating for their patients, and for the well-being of their nation. Even the work of providing basic healthcare for all our people, let alone parity, remains incomplete. In the coming year, let’s take every opportunity to engage in promoting constructive change.
March 20-21, 2020
Hilton Richmond Downtown
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