By Bruce Hershfield, MD
[Winter 2006; Vol. 33, No. 1; Pg 9, 14]
Q:
Please tell us about what you are doing now—your professional activities, your
writing.
Dr.
L: For 34 years I was a member of a large multi-specialty group here in
Columbia, and in 2004, CareFirst, who had come to own it, shut us down. Each of
us who wanted to continue to work had to make other arrangements and it was at
that point that I started wondering what I had learned in all those years of
talking to people. Since I’m fond of aphorisms I started writing things down
that I thought were true but not so obvious as to be clichés. They included
things like, “We are what we do,” and “Every relationship is under the
control of the person who cares the least.” I ended up with 30 of them. So
that the book would be longer than three pages I wrote an essay about each one.
I sent them to a publisher who had published a book I had written before and he
decided to take a chance on it. That’s how “Too Soon Old, Too Late Smart”
came to be.
Q:
And it’s done quite well.
Dr.
L: It has. It’s gone into its eighth printing and has been translated into 19
languages. When it became obvious that people were buying it who weren’t
personally acquainted with me I was a little surprised,
When a book sells, the publisher asks for another and so 18 months later
the second book came out.
Q:
What is the name of the second book?
Dr.
L: “And Never Stop Dancing.” It’s “30 more true things.” The
publishing game is a strange one. What sells usually in the nonfiction category
are celebrity books, diet books, and the business is very much driven by what
people buy as opposed to the quality of the ideas or the writing. My first book,
for example, “Only Spring,”about the death of my 6 year-old son, was sold to
a major publisher and just didn’t go anywhere. I guess the story was just too
sad. What really helped “Too Soon Old” was an article in the Style section
of the Washington Post. This let to an interview on the Diane Rehm Show on NPR
and suddenly the book was number 20 on Amazon.
Q:
Has your writing helped you in your psychiatric work?
Dr.
L: It has, although there has been an interesting phenomenon. People have
contacted me from distant places and some of them have even traveled here after
reading the books with the expectation that in a session or two I was going to
work some magic in their lives. Of course, you know as well as I do that that
seldom happens, and what I have to confront then is disappointment and failed
expectations. What we derive from any book is kind of like a Rorschach test.
When we read something we bring to that encounter all of our own experience and
what we get from it may be valuable, but it is definitely unique.
John
Updike wrote an essay some years ago in which he talked about a time as a young
writer meeting well-known writers. He was almost always disappointed in them
They turned out not to be, in person, the paragons of wisdom and wit, that he
imagined they were from reading their work. And now that he had become a writer
to be met he could see the same disappointment in the eyes of people who met
him. Something of the same thing has affected those who come to see me after
reading my books. I seldom feel that I am living up to their expectations.
When
the publisher asked for a second book, I told him that, “Just about all I
think I know about the human condition is in the first one. That’s why it’s
such a short book.” He replied, “There must be more than 30 true things.”
I never thought about what genre the books would fall into, but they inevitably
end up in the “self-help” section of bookstores. I think of them as
collections of ideas as opposed to instruction manuals on how to live, which I
don’t feel qualified to write.
Q:
How did you decide to go into psychiatry?
Dr.
L: I went to West Point, served a couple years in the 82nd Airborne,
and then decided I wanted to go to medical school. In those days the Army gave
people a leave of absence to do this as long as you paid your own way. I came to
Hopkins. I thought I wanted to be a pediatric surgeon, but in the course of a
rotating internship at Walter Reed I spent some time in the Dept. of Psychiatry.
I discovered that when I was awakened in the middle of the night to see someone
in the emergency room that I was much more interested if it was a psychiatric
patient than someone in a medical crisis or with an acute abdomen. I decided
that, if I’m going to be doing this for the next 40 years and if I’m more
interested in ideas than lab tests, then I might as well admit it now. Then I
went to Vietnam as a general medical officer. I had some real problems with that
war and when I came back the Army allowed me to resign. It was July of 1969 and
I came to Hopkins and sat down with Jerry Frank whom I had come to know and
admire as a medical student. What a wonderful person he was! He listened to my
story and walked me up to see Joel Elkes, the Chairman, and they took me on as a
resident. I had nowhere else to go and am eternally grateful for their kindness.
I completed my adult and child training there.
Q:
Who influenced you most in your psychiatric training?
Dr.
L: It was definitely Jerry Frank, and to some extent, Sy Perlman, the director
of training. He was a formidable guy, feared and admired by the residents. In
those days I was active in the anti-Vietnam War movement because of what I had
seen there. On one occasion I was identified in a newspaper story as a
“Professor of Psychiatry” at Hopkins. Dr. Perlman called me into his office
and said, “I never want to read anything like that in the newspaper again. And
you know why? Because I AM a Professor of Psychiatry at Johns Hopkins!” I
definitely got the point. He also was kind enough to give me a 6-month paid
leave of absence from the residency program so that I could work in the 1970
Congressional campaign for Paul Sarbanes. One of Dr. Perlman’s conditions for
the leave was that I get into psychoanalysis with Bob McClary, which turned out
to be a life-changing experience, both personally and professionally.
Then
Dr. Elkes asked me in the third year of the residency to come to Columbia to
work with his wife, Charmian, who was the Chief of Psychiatry in the new
Columbia Medical Plan, the first HMO on the east coast. I’ve been here ever
since.
Q:
What are your plans for the future?
Dr.
L: These books have put me in the position of making psychiatry my avocation.
I’m working about half-time, indulging my passions for sailboat racing and
writing essays. Over the years I’ve had the opportunity to do a number of
things but I’ve always felt grounded by the chance to talk to patients. I was
fortunate that our medical group was owned by an insurance company because
paradoxically – and I’m very fond of the idea that our lives are governed by
paradox – I was able to practice the way I wanted to. I see my share of
patients for medication, but I also have a substantial psychotherapy practice,
which is a good balance for me and something I want to continue to do. In my
practice now I don’t deal with insurance companies and am free of the tyranny
that has come to affect so many of us: fighting for managed care reimbursement
and seeing people one after the other for brief appointments just to manage
their medication.
Q:
I read your piece about the Iraq situation on the op-ed page of the Baltimore
Sun. What kind of feedback do you get from essays like that?
Dr.
L: Over the years I’ve been interested in politics and the direction of the
society at large. I’ve written regularly on these subjects for a variety of
publications, mostly the Baltimore Sun and the San Francisco Chronicle. This has
been an important activity to me. I have been allowed to have my say and involve
a constituency larger than any of us can have by personal contact. It has also
allowed me to make use of my life experience as someone who has had some unusual
things happen to him. I think it is also increasingly important as we grow older
to have a sense of being listened to. To be ignored is the ultimate rebuke to
our humanity and it is a sad fact that the elderly have a devalued status in
this society.
Q:
The first piece by you that I remember reading was your description of how you
came to meet your birthmother.
Dr.
L: That was one of those interesting events in my life. Writing about them has
been a way of processing them. Not only tragedies like the deaths of my sons,
but other things like learning of my adoption as an adult and my search for my
birthmother. These are life-altering experiences and writing about something is
a good way to figure out what to make of it.
Patients,
of course, are an endless source of inspiration and stories. Psychiatry is a
performance art. We talk with people; they tell us their secrets and their pain.
They benefit from the conversations or not. But it’s all words in the air; our
case notes are sealed and unless we write something down, the experiences are
lost except to our memories. But we’re changed by these stories just as our
patients are and the truths they lead us to are worth preserving. Writing down
what we have learned also constitutes a kind of “ethical will,” something to
convey to succeeding generations in the same way that we distribute our
property. I think that we have some obligation before we die to enunciate
whatever we think we’ve learned about life. So that was also a motivation to
write these books, because I thought that whether anybody buys them or not, my
children and their children will have this gift from me.