For as long as I can remember, I have been passionate about science and people. In high school and college, I worked in laboratories supervised by psychiatrists engaged in the study of neurotransmitter systems in the brain that influenced mood and behavior. Psychopharmacology was in its infancy, and I was drawn into the excitement of learning how to use the scientific method to determine which neurotransmitter systems might be major players in how the brain works.
At Wellesley College, I majored in biology from 1974-1978. My understanding of science deepened as I studied molecular biology, biochemistry, genetics, developmental biology, and animal behavior, both in the classroom and the lab. Having grown up and attended public schools in suburban Denver, Colorado, Wellesley was a thrilling and confusing young adult transition for me. The sexual and the feminist revolutions were just beginning. Wellesley was an incubator, exploring women's issues and LBGT rights in ways previously societally taboo. My peers were a diverse, multicultural, sophisticated, and brilliant group of women who came to Wellesley to forge their individual identity development uncoupled from the constraints of coed education.
At that time, seeking mental health treatment was frowned upon as a resume blotch and a lifelong stigma. Throughout college, I learned to reframe the influences impacting me. I learned to sit with mixed feelings, uncertainty, and not knowing while striving to organize information and experience in my own nascent identity.
I knew that I wanted to go to medical school. I thought that I wanted to be a neuroscience researcher running a lab. A cherished mentor whose lab I worked in during college steered me toward Case Western Reserve University School of Medicine in Cleveland, Ohio. I attended medical school there between 1979 and 1983.
Case Western Reserve was known as one of the few medical schools that approached learning through a collaborative systems model. We studied all aspects of the brain at once: neuroanatomy, physiology, endocrinology, diseases, etc. Case Western Reserve was also one of the first schools which allowed students to follow a patient during the first two years of medical school. I was taught that forging strong physician/patient relationships was crucial to better healthcare outcomes.
Although I was on a career path that I chose, I found the all-consuming nature of medical school difficult and isolating. Cleveland was not Boston or New York. As I persevered through adversities, I was guided by my exceptionally caring and understanding mentor, who happened to be a psychiatrist. I'm not sure that I could have made it without his kind validation and encouragement.
During my psychiatry rotation in medical school, I felt that I saw a way out of my growing uncertainty regarding my direction in medicine. I was newly inspired by my studies in psychiatry to seek information, synthesize, and create ideas.
My first inpatient was a man in his early 30s, crippled and wheelchair-bound by multiple sclerosis. He was living with his elderly parents - Holocaust survivors who were so riddled with Posttraumatic Stress Disorder and their anxieties about their son that they could not allow him an iota of independent time or thought. Their family dynamic was exploding. My patient was depressed, anxious, angry, and unmanageable at home. His parents did not know how to cope differently. My first outpatient was a woman reared to be devoutly Catholic, who tried to break out of that mold but found herself depressed and ostracized by her community. All of the questions and the treatment approaches in psychiatry were complex and intriguing to me. Throughout these experiences, I changed course to train toward becoming a practicing clinician.
I did my psychiatric residency at the University of California San Francisco, Langley Porter Psychiatric Institute, from 1983-1987. From the start of my psychiatric training, I was deeply educated both in psychotherapy and pharmacotherapy.
At that time, psychoanalytically informed psychotherapies were the predominant treatments taught within psychiatry. Psychiatry residents were strongly encouraged to seek personal psychotherapy. I did, so I know how the process of psychotherapy feels and works from a patient’s perspective.
In my training over 3 years, I learned how to approach individual and group psychotherapy for all major psychiatric and personality disorders. I learned treatments for long-term and brief psychotherapies in inpatient and outpatient settings. My training taught me how to assess the ways each patient is organized: biologically, psychologically, and interpersonally; how to assess personality styles and psychological capacities; how to assess ways of coping, resilience, and adaptability; how to translate awareness into behavioral change and personal growth. During my senior year of residency, I specialized in psychotherapy of Post-Traumatic Stress Disorder, working with Mardi Horowitz M.D. whose paradigm for treatment remains a seminal approach for this disorder.
I have been a general adult psychiatrist for 30 years, practicing at the interface of psychotherapy and pharmacotherapy as an in-depth generalist. I offer an integrated model of psychiatric and psychological treatment, emphasizing the mind/body interface. My modal patient has one or more psychiatric diagnoses and has failed one or more trials of psychiatric medication in a split treatment model (in which the primary care physician or the psychiatrist has prescribed while a psychologist or MFT has overseen therapy). There was usually little to no collaboration among those two treatment providers. I believe that treatment outcome is optimized with a strong physician/patient alliance.
I approach each patient as an ally and a collaborator in both biological and psychological treatment. I listen carefully to my patients. I enlist and I carefully consider feedback. I explain my own thought processes and my knowledge base to my patients so that we may make decisions together. My approach is pragmatic: I seek to help patients see options and find solutions to real life problems. I change my approach if it is not helping or if new information emerges that indicates a change in treatment strategy. I help my patient to overcome roadblocks to thinking, feeling, and behaving differently.
It is part of the art of psychiatry to understand how and why each patient can, or cannot, change. My patient ultimately determines who they want to be. I am a guide to options and possibilities; not an arbitrator of how patients should live their lives or who they should be. The process of therapy is nonjudgmental. It involves acceptance and understanding of how and why each patient came to be who they are. I have a keen understanding of what medication can and cannot do; of what is disease, and what is personality/psychology; and of how the mind can facilitate or block the ability of medication to work on the brain. I help each of my patients to understand their biological “wiring” and how circuits can be “rewired”.
If you already have a psychotherapist, then it is important to make sure sure that we can establish a collaborative relationship. I am glad to speak with your therapist about the possibility of collaborating in your care. That collaboration would then involve comprehensive evaluation, medication management, and appropriate periodic conversations with your therapist to ensure that both of us are informed about, and are in agreement with, treatment approaches and goals.
Since 1987, about a third of my practice has been medical/legal work. I have evaluated over 4,500 injured workers, and authored medical/legal reports in compliance with the labor codes legislated for Worker’s Compensation. This work has helped me to maintain a fund of knowledge about general medicine. The comprehensive evaluation of the total injured worker necessary in a 2-4 hour period has sharpened my skills in rapid, precise interviewing for accurate diagnosis and treatment planning. I have evaluated patients for civil law suits involving allegations of mental injury (e.g. claims of excessive use of police force, claims of sexual harassment, claims of discrimination and retaliation, neighbor disputes). I have served as an expert witness, writing reports and testifying at deposition and at trial for both plaintiff and defense. Writing medical/legal reports for a non-medical reader has made me a more clear and precise communicator and educator in my patient care. Formulating narratives encompassing injured workers' entire life history has helped train me to formulate psychiatric/psychological hypotheses quickly, test them, and rework my hypothesis. Additionally, I have written Fitness for Duty Evaluations and Evaluations for Disability Retirement.
I feel very lucky that I chose to be a psychiatrist. Every day at work I get to participate in interesting people’s lives. That’s a privilege that I take seriously, although boisterous laughter not uncommonly wafts through the walls to the waiting room. I get involved with and attached to each patient that I treat. If I cannot forge that connection, then I help that individual to find a better match or a preferred mental health product.
With my patients, I get to explore all sorts of worlds that I otherwise could not access. I get to constantly broaden my own experience and see alternative points of view, ways of being and living, and solutions to problems. I have been lucky to be a life-long learner in a profession that, while not easy, always has remained rewarding and positively challenging. I get to sit with my patients through deep emotion, uncertainty, lack of knowledge, self-doubt, frustrations, and mixed feelings on both of our parts. That is part of the process of positive change and growth in psychiatry and in being human.
At Wellesley College, I majored in biology from 1974-1978. My understanding of science deepened as I studied molecular biology, biochemistry, genetics, developmental biology, and animal behavior, both in the classroom and the lab. Having grown up and attended public schools in suburban Denver, Colorado, Wellesley was a thrilling and confusing young adult transition for me. The sexual and the feminist revolutions were just beginning. Wellesley was an incubator, exploring women's issues and LBGT rights in ways previously societally taboo. My peers were a diverse, multicultural, sophisticated, and brilliant group of women who came to Wellesley to forge their individual identity development uncoupled from the constraints of coed education.
At that time, seeking mental health treatment was frowned upon as a resume blotch and a lifelong stigma. Throughout college, I learned to reframe the influences impacting me. I learned to sit with mixed feelings, uncertainty, and not knowing while striving to organize information and experience in my own nascent identity.
I knew that I wanted to go to medical school. I thought that I wanted to be a neuroscience researcher running a lab. A cherished mentor whose lab I worked in during college steered me toward Case Western Reserve University School of Medicine in Cleveland, Ohio. I attended medical school there between 1979 and 1983.
Case Western Reserve was known as one of the few medical schools that approached learning through a collaborative systems model. We studied all aspects of the brain at once: neuroanatomy, physiology, endocrinology, diseases, etc. Case Western Reserve was also one of the first schools which allowed students to follow a patient during the first two years of medical school. I was taught that forging strong physician/patient relationships was crucial to better healthcare outcomes.
Although I was on a career path that I chose, I found the all-consuming nature of medical school difficult and isolating. Cleveland was not Boston or New York. As I persevered through adversities, I was guided by my exceptionally caring and understanding mentor, who happened to be a psychiatrist. I'm not sure that I could have made it without his kind validation and encouragement.
During my psychiatry rotation in medical school, I felt that I saw a way out of my growing uncertainty regarding my direction in medicine. I was newly inspired by my studies in psychiatry to seek information, synthesize, and create ideas.
My first inpatient was a man in his early 30s, crippled and wheelchair-bound by multiple sclerosis. He was living with his elderly parents - Holocaust survivors who were so riddled with Posttraumatic Stress Disorder and their anxieties about their son that they could not allow him an iota of independent time or thought. Their family dynamic was exploding. My patient was depressed, anxious, angry, and unmanageable at home. His parents did not know how to cope differently. My first outpatient was a woman reared to be devoutly Catholic, who tried to break out of that mold but found herself depressed and ostracized by her community. All of the questions and the treatment approaches in psychiatry were complex and intriguing to me. Throughout these experiences, I changed course to train toward becoming a practicing clinician.
I did my psychiatric residency at the University of California San Francisco, Langley Porter Psychiatric Institute, from 1983-1987. From the start of my psychiatric training, I was deeply educated both in psychotherapy and pharmacotherapy.
At that time, psychoanalytically informed psychotherapies were the predominant treatments taught within psychiatry. Psychiatry residents were strongly encouraged to seek personal psychotherapy. I did, so I know how the process of psychotherapy feels and works from a patient’s perspective.
In my training over 3 years, I learned how to approach individual and group psychotherapy for all major psychiatric and personality disorders. I learned treatments for long-term and brief psychotherapies in inpatient and outpatient settings. My training taught me how to assess the ways each patient is organized: biologically, psychologically, and interpersonally; how to assess personality styles and psychological capacities; how to assess ways of coping, resilience, and adaptability; how to translate awareness into behavioral change and personal growth. During my senior year of residency, I specialized in psychotherapy of Post-Traumatic Stress Disorder, working with Mardi Horowitz M.D. whose paradigm for treatment remains a seminal approach for this disorder.
I have been a general adult psychiatrist for 30 years, practicing at the interface of psychotherapy and pharmacotherapy as an in-depth generalist. I offer an integrated model of psychiatric and psychological treatment, emphasizing the mind/body interface. My modal patient has one or more psychiatric diagnoses and has failed one or more trials of psychiatric medication in a split treatment model (in which the primary care physician or the psychiatrist has prescribed while a psychologist or MFT has overseen therapy). There was usually little to no collaboration among those two treatment providers. I believe that treatment outcome is optimized with a strong physician/patient alliance.
I approach each patient as an ally and a collaborator in both biological and psychological treatment. I listen carefully to my patients. I enlist and I carefully consider feedback. I explain my own thought processes and my knowledge base to my patients so that we may make decisions together. My approach is pragmatic: I seek to help patients see options and find solutions to real life problems. I change my approach if it is not helping or if new information emerges that indicates a change in treatment strategy. I help my patient to overcome roadblocks to thinking, feeling, and behaving differently.
It is part of the art of psychiatry to understand how and why each patient can, or cannot, change. My patient ultimately determines who they want to be. I am a guide to options and possibilities; not an arbitrator of how patients should live their lives or who they should be. The process of therapy is nonjudgmental. It involves acceptance and understanding of how and why each patient came to be who they are. I have a keen understanding of what medication can and cannot do; of what is disease, and what is personality/psychology; and of how the mind can facilitate or block the ability of medication to work on the brain. I help each of my patients to understand their biological “wiring” and how circuits can be “rewired”.
If you already have a psychotherapist, then it is important to make sure sure that we can establish a collaborative relationship. I am glad to speak with your therapist about the possibility of collaborating in your care. That collaboration would then involve comprehensive evaluation, medication management, and appropriate periodic conversations with your therapist to ensure that both of us are informed about, and are in agreement with, treatment approaches and goals.
Since 1987, about a third of my practice has been medical/legal work. I have evaluated over 4,500 injured workers, and authored medical/legal reports in compliance with the labor codes legislated for Worker’s Compensation. This work has helped me to maintain a fund of knowledge about general medicine. The comprehensive evaluation of the total injured worker necessary in a 2-4 hour period has sharpened my skills in rapid, precise interviewing for accurate diagnosis and treatment planning. I have evaluated patients for civil law suits involving allegations of mental injury (e.g. claims of excessive use of police force, claims of sexual harassment, claims of discrimination and retaliation, neighbor disputes). I have served as an expert witness, writing reports and testifying at deposition and at trial for both plaintiff and defense. Writing medical/legal reports for a non-medical reader has made me a more clear and precise communicator and educator in my patient care. Formulating narratives encompassing injured workers' entire life history has helped train me to formulate psychiatric/psychological hypotheses quickly, test them, and rework my hypothesis. Additionally, I have written Fitness for Duty Evaluations and Evaluations for Disability Retirement.
I feel very lucky that I chose to be a psychiatrist. Every day at work I get to participate in interesting people’s lives. That’s a privilege that I take seriously, although boisterous laughter not uncommonly wafts through the walls to the waiting room. I get involved with and attached to each patient that I treat. If I cannot forge that connection, then I help that individual to find a better match or a preferred mental health product.
With my patients, I get to explore all sorts of worlds that I otherwise could not access. I get to constantly broaden my own experience and see alternative points of view, ways of being and living, and solutions to problems. I have been lucky to be a life-long learner in a profession that, while not easy, always has remained rewarding and positively challenging. I get to sit with my patients through deep emotion, uncertainty, lack of knowledge, self-doubt, frustrations, and mixed feelings on both of our parts. That is part of the process of positive change and growth in psychiatry and in being human.