by Leonard J. Hertzberg, M.D.
[Summer 1997; Vol. 24 No. 2]
A major reason the MPS presidency means so much to me traces back 50 years. Ira Glasser, Executive Director of the ACLU, summed up matters succinctly in a recent New York Times article. Commenting about Jackie Robinson and what it meant to be a Dodger fan in his youth, he stated that in the '60's every ACLU member his age was a Dodger fan and shared similar feelings about Jackie Robinson. He stated that although statistically unverifiable, he realized years later that it was the Yankee fans who grew up to believe in oil depletion allowances, and that it was Dodger fans who became civil rights activists. Similarly, psychiatrists of the 1960's were politically liberal and our heritage has evolved into the activism of the 1990's. I have been an avid Dodger fan dating back to 1947 and like all of you, I entered the field of psychiatry with much idealism and desire to help others and make the world a better place. To have the privilege of being President of the MPS, I feel a great responsibility in contributing to improve our society and to see that our patients receive the care they deserve.
It's been over 30 years since I began residency training; in that same year, 1966, a political scientist named Arnold Rogow conducted a comprehensive survey of psychiatrists which resulted in almost 200 responses. The survey revealed the two major career satisfactions of psychiatrists were helping people and being socially useful; the third most gratifying aspect was obtaining a stable income with financial security. The fourth most important career satisfaction was that of working conditions. The first two factors remain highly significant for persons entering our field. It is the uncertainty of earning an adequate living and having decreased autonomy in the work place that have limited the number of future psychiatrists. Too many psychiatrists in salaried positions are feeling over-worked, under-paid and under-valued. Managed care has similarly affected private practitioners who have felt the financial sting of economic hardship concomitant with restriction of autonomy in providing patient care.
The 1966 survey revealed much of the idealism which has continued within our profession. During that era we were much more politically liberal than any other physician group; historically, we have been strong supporters of peace, integration, and the need for a welfare state as a safety net for the poor and disadvantaged. In 1968-69 a petition was sent to the APA to take a strong stand against poverty and racism. Psychiatrists during that time supported government intervention to counteract the mounting problems within our cities. Psychiatrists more than any other physician group and far beyond the general population condemned the Viet Nam war. Liberal views toward civil rights and civil liberties were integral values. We manifested much less prejudice toward minority ethnic groups as well as gays. We strongly supported the rights of admitted or suspected Communists to maintain positions in industry, schools, and our universities. We admired politicians favoring peace efforts and advocating measures to counteract poverty and discrimination.
The psychiatrists of the 1990's have not merely supported civil rights and civil liberties issues, but in many instances have become the front-line political activists. MPS members have been at the forefront nationally in their activism. From championing the protection of civil liberties regarding the confidentiality of medical data to the rights of patients to choose the mental health professional of their choice, many of our members have become national leaders. Meanwhile, the heritage of the Maryland Psychiatric Society has continued to be enriched with many of our members being acclaimed researchers, educators at our residency training centers, and outstanding practitioners.
Psychiatrists in the 1960's were discouraged about the future; fears of an impending World War III, another Great Depression overtaking the worldµs economy, and potential for race riots were issues for great concern. Social issues remain paramount with psychiatrists of the 1990µs. With the privatizing of the public mental health system into managed care for Medicaid recipients, drastic cutbacks are occurring which reflect federal and state political agendas. Our society has grave concerns for the potential disruption of care for the most severely and chronically impaired of our mentally ill; great concern also exists for the loss of work positions for many practitioners including psychiatrists in our communities. Idealism and morale are being undermined by loss of autonomy, job insecurity, and economic hardship. Nonetheless, the MPS has once again stood on high moral ground; the Council has unanimously supported the Public Psychiatry Committee and Executive Committee recommendation to have a formal position which reads: Psychiatric services must be preserved for that group of individuals who will require longer term treatment. Individuals who are denied inpatient psychiatric services in private facilities must be provided such services in the public sector.
Despite the hazards facing our patients and the well being of our members, there are multiple factors that give rise to renewed optimism. Our alliances with advocacy groups such as AMI and the Mental Health Association bode well for preserving care of the mentally ill and easing-if not erasing-the stigma of mental illness. There is a vast explosion of biological research regarding mental illness; many university centers as well as pharmaceutical and biotech companies are committed to the development of neuroscience research for treatments to alleviate the symptoms of mental illness. The press continues to criticize the many injustices of managed care while the legislature continues to hold managed care companies increasingly accountable for their practices. Major gains have been made on the managed care front. Many HMO accountability bills are ripe for passage next session. Our alliances with Med Chi and the APA promise much success in supporting fairer treatment practices for patients and physicians alike.
High visibility public figures such as Mike Wallace, Dick Cavett, Art Buchwald, and William Styron have come forth to acknowledge their history of mental illness and the benefits they have derived from psychiatric treatment. Primary care physicians are devoting decreasing time to their patients while non-psychiatric, mental health practitioners lack the necessary skills-and licensing-to integrate the biologic and psychotherapeutic needs of patients. There has never been a greater need for psychiatrists skilled with both psychotherapeutic abilities and pharmacologic knowledge to treat the complexities of our patients' illnesses.
Additional recent developments give further rise to optimism. On January 1, 1998, a parity law will be implemented requiring that insurers set the lifetime annual reimbursement caps similarly for mental and physical illness. Recently the Equal Employment Commission clarified the American Disabilities Act of 1990. The ruling declared that business owners may not discriminate against otherwise qualified workers who experience mental illness. Reasonable steps need to be taken to accommodate employees with psychiatric or emotional problems.
In summary, these times are indeed challenging, but vast opportunity exists for the psychiatric profession. The MPS is most fortunate in having so many dedicated, hard working members who serve the organization and our patients in meaningful ways. I look forward to working with all of you in the year ahead to further our profession and the lives of our patients.