Lifer Report
March 2012
Richard Ward, M.D.

At the recent Toronto meeting, I seemed to be the oldest member there (James Anthony, our patriarch, unhappily was not able to be there). So, in the old timers' committee meeting, which I attended as a guest, the suggestion was made that I write something for the newsletter about my experience of retirement. That seemed harmless. Lightheartedly I agreed to do that. Yet I was scarcely out the the meeting room door when I realized that I had a problem. I may be long into the retirement years, I'm 91 plus. But if we are really going to be honest about this thing, I would have to confess. The truth is, I have never actually completely retired. I still see patients, maintain an office, pay for malpractice insurance, go into work most days of the week. Can I really speak about MY retirement?

Actually, yes I can. Retirement takes many forms these days. Long gone is the old pattern of retreat to a warm climate, Florida or Arizona, and non-stop golf and drinks on the patio, with the children coming to visit once or twice a year. That is a casualty of our increased longevity and health. If you retire at 65 and live into your 90s, can you keep doing the golf and drinks bit for 25 years? People these days devise all kinds of mixed patterns of retirement and continued work. Mine is just one of those patterns - retirement in stages.

In the 1st stage, I retired from the full time medical school faculty at Emory more than 25 years ago. Bernie Holland, who enticed me south from the Jewish Board of Guardians in NYC in 1960, and with whom I worked closely for many happy years, had retired as Psychiatry chairman in the early 1980s. I knew that life would not be the same. Jeff Haupt was reshaping the department to take advantage of the new profitability of in-patient services, the child section was capably managed by Mina Dulcan, and I, spread out, as always, between child psychiatry, the psychoanalytic institute, the residency teaching program, and other things, was sick of the endless committee meetings. For years, sitting around the table at Child Board exams, I had listened to examiners from the rest of the country tell how happy their lives had become since ending their indenture to their respective universities. And, unlike them I wasn't even quitting early; I was already past 65.

That summer I took a European trip that included the Dalmatian coast. Thus it happened that the official day of my retirement (July 1st, 1986), found me on the nude beach of the island of Hvar. While I was in the water enjoying the views, a couple passed by, as my wife reported to me when I came out of the water, with the man sporting a T shirt labelled "Emory University Department of Physical Education". My God, I thought, they're checking up on me! I guess that that was the incident that marked the celebratory moment of my retirement.

My new private office was not really set up for children, but I tried to keep my hand in child psychiatry. I worked part-time supervising the child unit in a nearby private psychiatric hospital (Parkwood Hospital). Parkwood, for some time had maintained a program of fairly high quality. Its owner had been less interested in year to year profits than in building up for a big sale, and until that happened he allowed a high level of staffing, and good support for educational and training activities. Back in the 70s, during our days of troubles with Jimmy Carter as Governor of Georgia, and the problems with the clinical programs at the Georgia Mental Health Institute, Jerry Wiener had even explored the possibility of making Parkwood the base for our child & adolescent psychiatry fellowship program. But that didn't work out then, and now the sale finally came. The new owner, CPC of California, talked the talk about greater efficiency while maintaining quality, but the deterioration started and was inexorable. I didn't last there. They eventually wanted a younger child psychiatrist who would bring in his own patients and market the service aggressively.

For a few years I did child custody evaluations. They were very interesting and challenging though somewhat hazardous; usually one side hates you. I took notes in my own version of shorthand, notes that nobody else could read. But that advantage turned sour when I began to have difficulty in reading the notes myself. My handwriting, never very good, was getting worse and worse. I visualized being challenged in court on the accuracy of a quote, when I couldn't exactly be sure what my notes really said. The alternatives, tape recordings and transcripts, seemed much too much of a hassle. So I gave it up.

That was the way my second stage of retirement went, a gradual withdrawal from active practice of child psychiatry. The patients I have now have mostly been with me for a good while; they range in age up to the geriatric years, a couple of them in the process of retirement themselves. They are a residue of my former analytic practice in the University: I gave up analysis itself long ago, taking seriously the notion that it was unethical to take on a long analytic process when I couldn't guarantee to be alive for the full course. That was more than 20 years ago. Today I work less than 15-20 hrs a week (you get half price on malpractice insurance). But for me it is still a rare privilege to be able to share in the lives of people who want to work on their problems. It keeps me centered in my own life. I am quite capable of getting overwrought and obsessed with my various activities in private life, especially frustrated by computer hassles.To be called away from that and have to pay attention to real life problems, that brings me back to earth. It is something I will reluctantly give up, when the time comes.

Of course there are other aspects of work that take up time. There is paper work, keeping accounts, paying taxes, CME requirements. Psychopharmacology was never a part of my training years. I even missed Thorazine. But I enjoyed seminars in Boston, before Biederman & Co. got into their recent difficulty with their side income from big Pharm. On the side, those seminars gave me an excuse for extra visits to my grandchildren in Massachusetts. Last year I took a delightful summer course in Neurology for non-neurologists, in Kennebunkport, and also visited relatives in Maine and New Hampshire. I do a lot of reading, of course, but have to admit that very little of that is psychiatric. I have done no reading in the psychoanalytic literature since I retired from Emory, and I don't keep up much with the Academy Journal, either.

Many colleagues in the Atlanta area, like to have a 2nd house in the country, usually in the Georgia or North Carolina mountains (the Atlantic coast is too far away), where they spend increasing amounts of time, and finally plan to retire. I got that out of my system early in my career in NYC, where we built a house in Montauk, 3 hours from the city, and spent most weekends there during the work year and a full month in summer. The weekends were short and spent mostly in running to the hardware store, dealing with plumbing and painting problems, building garden walls, and things like that. No time for travel. Even in that great summer month, the fabulous beach we overlooked, our main reason for being out there, we rarely visited. We went down there only when guests came out from the city. I resolved not to do that in Atlanta.

My interests hold me in the city. The house I live in is the most comfortable house I have known, and since I am fortunate enough to have a wife who is 14 years younger than I, and a talented fix-it of all household problems, there has been no pressure to find simpler living quarters. We are close to the university, which is good for my multiple health problems, but also good for continued intellectual stimulation. I have been active in the Emeritus College, even serving as their representative on the University Senate. That brings me in contact with university wide faculty, which I enjoy; I've not much kept in touch with the Psychiatry Department (except through patients), even though the Analytic Institute there is thriving. (The department, until recently, has been under the direction of Charlie Nemeroff, who now has had his own difficulties with income from big Pharm) But I rarely miss an Emeritus meeting. Sometimes I give talks, usually on subjects in which my knowledge is far from profound (wind up an old professor and he can lecture on any subject you want, whether he knows anything about it or not). A couple of years ago, I reluctantly gave a talk about Freud (dealing with the revelations of the 1980s). More recently I gave a talk on children's dreams. This one was in honor of David Foulkes, a psychologist who did the last part of his research at Emory, and whose overall brilliant work on children's dreaming (Children's Dreaming and the Development of Consciousness - paperback 2002) deserves to be far better known, especially in the AACAP.

I have enough time for a book club, which is a major source of enjoyment (and where I talk too much). The group is of retired professors, with a slight preponderance of medical faculty over the rest of the university, but no other psychiatrist. The books have been great, and the discussions always lively and rewarding.

But so far I realize that I have not given much account of my main retirement activities - the activities that more than fill up the retirement time that I don't spend at work. They fall, I guess, into three main areas, areas into which I continue to put effort, and perhaps try to learn new things. I am not sure that this is principally a matter of enjoyment. Maybe it just reflects a stubborn unwillingness to give up projects that I got engaged in years ago, and have never stopped. I have always seemed to have a penchant for putting my greatest effort into areas which frustrate me because I do not really have any special aptitude for them, but which I still find rewarding. This is true of music (piano playing) and languages (currently Mandarin Chinese), which are two of these areas.

First, however, I have to admit that computers represent an area that eats up a lot of time and energy, all with an uncertain benefit. Certainly they do expand the scope of things that I can do, but at what cost. Our family got into computers back in the early days of Apple 2s, when my son was graduating from high school. Back then I ran my accounts with Personal Finance Manager, if anyone remembers that program. When I started my own office, I ran the business side of it with an Apple 2E. I delighted in writing a macro that magically did all the resetting of the program from month to month. Today it's Quick Books that oversees my financial life, and my recorded music is all in I Tunes and in the I Cloud. Apple says that I have just under 14,000 "songs" there (actually a good chunk of that is not music, but the I Cloud calls everything a "song".) The world of computers changes rapidly and it takes time and effort to keep up. This includes some time devoted to computer club meetings. It used to be that our records and memorabilia were safe in file cabinets and boxes, provided we took care to put them there. Now with electronic storage, paying attention to the needs of our computer systems is no longer optional. All of it is at the mercy of hazards and not enough back-up. Once touted as the archives of the future, CDs and DVDs have been a sad disappointment; digital copying to external hard drives is quick and easy but you have to remember to do it, and also to plan for the eventual failures there too.

Music is a more pleasant area. Recently, the one psychologist in my book club, recently retired and a specialist in memory, has gladdened my heart by joining with me regularly to talk and to play 4 hand piano music. Life without music is unimaginable to me. I am a season subscriber to the Atlanta Symphony Orchestra, and have been ever since my daughter became old enough to go to concerts with me. I have a large library of recorded music, mostly in the computer (I Cloud). It's almost all classical; the rock revolution passed me by, and I am embarrassed to admit that I lived through the Beatles era too busy to pay much attention. I don't tend to listen to the radio in the car. Actually I am too restless to spend long periods of time just sitting still and listening to music, which accounts for my intolerance of Mahler symphonies - you have to get in training to sit through Mahler symphony in concert. Recently I have found a work-around for this; watching DVDs of the symphony orchestra playing (e.g. Abbado and the Lucerne orchestra, or MTT and the San Francisco Symphony). The photography is beautiful and I enjoy watching the musicians. Taking these in appropriate doses, I get to know the music and end up really enjoying Mahler.

The piano, of course, takes some time devoted to practice. I am fortunate to be able to continue playing at all, however badly. For a while there, rotator cuff problems in both shoulders made it tiring to lift my arms, and limited my choice of music. Now I am back to playing rags. I have never stopped taking piano lessons. My long suffering piano teacher has also been willing to play 4 hand piano with me when I have no solo prepared for her critique, which is most of the time.This is an intense pleasure; I love the sound of a piano, both when it's played well and not so well. I recently fell in love with Gabriela Montero, a young Venezualan pianist. Her command of the keyboard (Beethoven's 3rd Concerto) is really wonderful. I watched it, from only a few feet away. at the Symphony. It gives me a vivid sense of how different it is to be really talented.

The other area is language, and the language is Mandarin Chinese. How I originally got involved with this is a story too stupid to tell. I have absolutely no legitimate use for the language, and now am only somewhat embarrassed that after so many years of dabbling in it, my command is as poor as it is. Recently that has impelled me to work somewhat harder at it, and even to set for myself what is for me a difficult project. That is to develop a fundamental grasp of how to draw from memory the basic 800 or so characters in the language. This is a task somewhat apart from the usual talking and reading in the weekly Chinese class (It takes knowing 2500 to 3000 characters to read Chinese, but that is recognizing characters, not drawing them from unaided memory, which seems to be a almost totally separate skill). The task interested me, quite beyond interest in Chinese, as part of a general curiosity in how we really learn things in education, as well a side interest in finding out whether my 91 year old brain could wrap itself around something that was so completely foreign to it. I had found, in testing myself with this, trying to draw from unaided memory even a simple Chinese character, even one I thought I was quite familiar with, I encountered nothing but fog, with no idea where to start. I am convinced that in my brain, this taps an totally undeveloped area. There is some evidence to back this up. In Japan, where the language has both a character form and an alphabetic form, stroke victims sometimes lose one and not the other. They seem to depend on distinct parts of the brain.

So, a little more than a year ago, I set out to do a little work on this almost every day. Following the principle that we only learn from what we do ourselves (being shown how by others, or copying from a book, is almost worthless) you begin with whatever you can summon up from memory and build from there. Flashcards prompt you with the word (English and PinYin) and you can compare your crude renditions to the correct forms, in other words you learn from your mistakes. I find the process both frustrating and fascinating. It forces attention to little details that it was never in my nature to pay attention to before. But it works. After a year, in that area of my brain where there was nothing but fog before, there is a substantial vocabulary now, far from perfect, but building up associative links as I keep at it. In tests, which are an essential part of the process, I generally score in the 50-75% range.

My investment in this kind of self torture stems in some part from frustration, over the years, with the way Chinese teachers have tried to teach me their language. Their way has been modeled on the way Chinese children are taught in primary school, endless repetition (repeat after me), and graded reading. It doesn't work well, I think, for western adults, and the Chinese government, now interested in spreading through the world a knowledge of their language, is beginning to grapple with this. I have been interested in exploring for myself what would be more effective ways of studying what has always been difficult for me. Most Chinese appear to have assumed that while western adults may be able to learn spoken Mandarin fairly well, a real grasp of the character language is not something they are likely to achieve. I almost certainly won't ever achieve that anyway. But the principles that stand out in such clear relief in the process of trying, I think can be applied to learning the spoken language as well.

Retirement, as in aging generally, involves adjustment to losses as you go along.

I have mentioned the loss of my ability to take legible notes forcing me to give up custody evaluations. A bad hip, and problems with both rotator cuffs have forced me to give up tennis, for which I had a passion not long ago. Now I am reduced to simple walking as my major form of exercise. Aside from an increasing difficulty with names that sometimes trips me up, nothing has yet impaired my ability to deal with patients. A few weeks ago, in the context of a vigorous therapy interchange, one of my patients suddenly came up with "You haven't lost it yet, have you". Good technique probably would have required that I should have explored the background of this comment of his. I elected to let it pass, in grateful silence. But I know that losses in this area are bound to come.

Losses in a different category are equally saddening to adjust to, the loss of family, friends, and colleagues around me. My siblings have all passed on, and with them, the only people who shared the scenes of my childhood in Lebanon. The psychiatric colleagues I see in the building at work, are all a generation or even two generations, behind me. This spring, God willing, I will attend my 70th reunion at Amherst, but the fraternity brother I most looked forward to seeing there has suddenly passed away; luckily I have one college roommate left out of two. In the Academy, Norm Bernstein and Irv Phillips were the first to go, and that was quite a while ago. Recently, with the help of the new directory, I found out with joy that Joe Green is still alive and kicking, though sadly limited by macular degeneration. I remember how my mother, in her last years, complained that the people in her retirement community tended to treat her as a fragile little old lady, because they were all a generation younger than her. This is a part of retirement from which there is no escape. The memory of your life experiences increasingly become an unshared part of yourself, which you could only bore the people around you with talking about, or you can write down in a memoir. As Lucretius said, two millennia ago, the only thing we can do is enjoy the beauty of the world while we are still in it.