Love at the Annual Meeting
Douglas A. Kramer, M.D., M.S.
I don't know the official name, but immediately following what I experienced as the Ginger Anthony Opening Plenary, I had the privilege of introducing a Media Theatre presentation of the film, An Ecology of Mind: A Film by Nora Bateson (2011). What I experienced in the Plenary was the immense love for Ginger by AACAP members and staff, and a more general sense of the lovingness of the persons and group as a whole. Permeating this over the past 28 years is the love story of Ginger and James. Her "legacy" to us, Kristin Kroeger Ptakowski and Heidi Buttner Fordi, continues this most important quality of her tenure. The interrelatedness of all of these factors is also not lost on me.
As I arrived only slightly tardily for the Media Theatre, a friend waved slightly to me as I rushed down the aisle. I had not seen her for two years, her child psychiatrist husband and my good friend having passed away about a year ago. Wasn't that incredibly thoughtful of the Academy to have invited her? Another legacy of Ginger for someone to have thought to do so! It also was a two-sided thoughtfulness - as I had not grieved for him - until immediately following the program. Others may not have either.
Still experiencing the love that had permeated the Plenary, I was reminded of my mentor Carl Whitaker (1976, 1989) likening family treatment to a surgical procedure, the anesthesia for which is the love of the therapist. It was Carl, about 35 years ago, who told me to read Gregory Bateson's (1972), Steps to an Ecology of Mind. I did so walking back and forth in the surf line on the beaches of Maui, enchanted by the ideas and the setting, the latter apropos to the book - the relation of ocean to beach (Kramer 2005).
Following the showing of the film, the subtext of the film being the love of daughter for father and father for daughter, an important discussion topic that emerged was the physician-patient relationship. I recalled my relationship with my physician of over twenty years or so, not coincidently Carl's onetime next-door-neighbor, and physician to many physicians and their families in south-central Wisconsin.
I remember two stories Whitaker told me about Jack: (1) A patient was dying of gas gangrene at Madison General Hospital, physicians and others walking around bemoaning the sadness of it all. Jack heard about the patient, rented a private airplane, and took the patient to Chicago where there was a barometric chamber. The patient survived. (2) Jack was making rounds on a patient with pericarditis at the same hospital. The patient had once been a trumpet player in the band at the Copacabana in New York City. The nurse interrupted him to say a friend of the patient's would like to talk to him. Jack said, "Take a message and I'll call him back from the office." The nurse came back a minute later with the message, "He said he's Frank Sinatra and he'll talk to you now." Years later, I saw the same patient and came to appreciate the good sense in talking to the band director now - HIPPA be damned.
I told the following story in the An Ecology of Mind discussion: At my first visit with Jack as a patient, I was rattling off a series of health concerns I had. He stopped me, held up his left wrist, and said, "Doug, I don't wear a watch." I recalled that conversation during a visit with him in Santa Rosa following the Annual Meeting. He told me he had learned that from his father, a family physician in West Virginia. Jack mentioned Sir William Osler (Golden, 1999). I can see many of the same characteristics.
I told another story about Jack at the Media Theatre: He had become my mother's physician during the last few months of her life. Following every consultation Jack arranged with various specialists, she always said they were very nice, and then after a pause she would always add, "but I like him the best." My sister and I were talking with her intensive medicine specialist in the ICU shortly after she passed away when Jack came by to pay his respects. After a short discussion, he said to me, "I love you." I wasn't surprised that he said this, but I can imagine the surprise of the specialist, a younger but decent man, who had probably not heard that conversation with a physician before.
I believe the themes of the morning - friendships, relationships, caring, love, and the Academy, perhaps provided a supportive atmosphere for the wife of our former colleague deciding to make a comment, following the film, about her husband. She spoke of his commitment to his patients, how he saw his last patient at home less than a month before he died. She spoke of his illness and his treatment, and his continuing to live in her heart and the hearts of their children, and I am certain the hearts of his patients, in a way that reflected the joy and love he experienced in life, and the joy and love he brought to his career in child psychiatry.
Jack reminded me Saturday of something else his father taught him - that the person of the patient is more important than the illness with which they present, and that it is essential that the patient know this. He began his interviews, not with questions regarding symptoms, but with questions about the patient, making it clear that he finds them interesting - as human beings. This interest in the person defuses the illness, untangles the person from their illness, and perhaps reawakens the self of the patient to better counteract the illness.
Considering what I experienced in the Ginger Anthony Opening Plenary, at the An Ecology of Mind Media Theatre, at the Presidential Interview with Heidi Buttner Fordi, our new Executive Director, and with the Fellows with whom I worked the last several years I practiced (Kramer 2010), I see a future led by a group of people who have the "anesthesia" that makes treatment possible. I feel very fortunate to be part of a group in whom and between whom there is so much compassion. This bodes well for our profession, and most importantly for the parents and families who entrust the lives of their children to us.
Lastly, I believe the sciences of interaction, including those of gene-environment interaction (Suomi 2004), epigenetics (Weaver et al. 2004), nonlinear brain dynamics (Freeman 2008), and others yet to be discovered, will provide a scientific foundation for valuing the qualities inherent in friendship, relationship, caring, and love as physicians, including psychiatrists, explore diagnosis, prevention, treatment, and etiology in the 21st century (Kramer 2012). Cartesian dualism, and her sister scientific reductionism, have obscured for some those things that physicians have always known. I certainly sensed them to be very much alive and well at the AACAP Annual Meeting (San Francisco).
Bateson, Gregory. 1972. Steps to an ecology of mind. New York: Ballantine Books.
Bateson, Nora. 2011. An ecology of mind: a film by Nora Bateson. Director & Producer, Nora Bateson. Co-Producer & Editor, David Sieburg. Bullfrog Films. DVD.
Freeman, Walter J. 2008. Nonlinear brain dynamics and intention according to Aquinas. Mind & Matter 6 (2):207-234.
Golden, Richard L. 1999. William Osler at 150: an overview of a life. JAMA 282 (23):2252-8.
Kramer, Douglas A. 2005. Ethology, psychiatry, and an infertile mule. AACAP News 36 (2):68-69, 77.
Kramer, Douglas A. 2010. An open letter to training directors . . . AACAP News 41 (6):267-268.
Kramer, Douglas A. 2012. The decline of the biopsychosocial model and the demise of psychiatry. AACAP News 43 (3):120-121.
Suomi, Stephen J. 2004. How gene-environment interactions can influence emotional development in rhesus monkeys. In Nature and nurture: The complex interplay of genetic and environmental influences on human behavior and development in rhesus monkeys, edited by C. Garcia-Coll, E. L. Bearer and R. M. Lerner. Mahwah, NJ: Lawrence Erlbaum Associates.
Weaver, I. C., N. Cervoni, F. A. Champagne, A. C. D'Alessio, S. Sharma, J. R. Seckl, S. Dymov, M. Szyf, and M. J. Meaney. 2004. Epigenetic programming by maternal behavior. Nat Neurosci 7 (8):847-54.
Whitaker, Carl. 1976. A family is a four-dimensional relationship. In Family therapy: Theory and practice, edited by J. Philip J. Guerin. New York: Gardner Press.
Whitaker, Carl. 1989. Midnight musings of a family therapist. New York: W. W. Norton & Company.