Bowling Alone: The Collapse and Revival of American Community
by: Robert D. Putnam
© 2000 Simon & Schuster

Reviewed by: Joseph M. Schwartz, MD
President, Maryland Psychiatric Society
Robert Putnam proposes in his provocative and controversial book Bowling Alone that Americans are no longer joining organizations as they had in past decades. The resulting isolation has potential profound negative implications for individuals and for society in general. For example, he presents data supporting the conclusion that people who do not belong to any groups have twice the one-year mortality of people who join just one. He correlates the progressive isolationism of Americans with a breakdown in civil society. We are becoming less involved and less caring.

His ideas are of interest to me for two reasons. First, as a psychiatrist, I am interested in people's social interactions and how their social networks help alleviate distress and demoralization. Second, as the president of the MPS, I am interested in explaining why only approximately half of eligible psychiatrists join our organization. [This statistic is applicable to WPS as well. Ed.] There has been a decline in membership in most professional societies as well as religious organizations, political organizations and unions. Why is this?

Attempts by organized psychiatry to woo members by focusing on tangible membership benefits have not been successful. People are motivated by self-interest, but they realize that often the cost of membership in a society exceeds the monetary value of any tangible benefits. Members who join merely to receive tangible benefits tend not to participate further than just paying dues. Active members, on the other hand, seem to recognize the intangible benefits of membership including the maintenance of our professional identity, the representation of our profession to others, and the camaraderie and fellowship that comes from belonging and participating.

Organized psychiatry is fighting an uphill battle against the continuing trend of non-participation. The implications of the general trend of non-participation for society are worrisome. The implications for psychiatry and individual psychiatrists are dire. We need a critical mass of active members in order to demonstrate the legitimacy of our organization, and to provide enough people to do the necessary work. If you are a member who is not yet actively participating, please join a committee. If you know psychiatrists who aren't members, encourage them to join. Tell them they'll live longer.

Blink: The Power of Thinking Without Thinking
by: Malcolm Gladwell
Little, Brown and Company, 288 pages, $26.00
Reviewed by Lise Van Susteren, MD

Blink - it's hot right now - on the NYTIMES and other best seller lists and with good reason. It's an easy read and a convincing report on the impact of the unconscious. For skeptical souls, it is also a convincing report that the unconscious EXISTS. In the first weeks after I read it, I referred it to several of my patients to bolster my "sermons" about how the unconscious often "has the wheel" and needs to be examined in order to figure out why we do some of the things we do. It proved to be good ammunition. One of my patients couldn't figure out why the shark partners in the law firm didn't give him more of the money he deserved. Taking a page out of Gladwell's book, I was easily able to convince him that his nonverbal communication - deflated demeanor at meetings, his ambivalence about coming across as competent, etc. - signaled that he wasn't going to demand anything despite putting in many more hours than the partners, who earned four times what he was paid. The next day he gave up his victim role (at least temporarily) and phoned the managing partner.

Blink tells us not to split hairs, to go with our gut. Most of our agonizing over decisions is a waste of time - and can even lead us astray. However, Gladwell is referring to what we psychiatrists are experts on. Truth emanating from the unconscious is really a split second integration of a lot of knowledge and experience. Our expertise may simply be what we like or find comfortable. Although he brought it up, Gladwell should protect his readers a bit more by warning that all split second decisions may not be good. A snap decision in the wrong hands can get a person into trouble; the unwary reader may not hear it that way. There is a danger in believing that your instincts are always right.

Gladwell's useful message is that the unconscious is full of valuable data. The message for our patients (and us) is that there is an art to managing that information. Gladwell discusses hidden bias and other pitfalls. The savvy person who picks up on signals from the unconscious would do well to welcome the "data" springing from the unconscious but refer it to the thinking part of our brain - examining it for snap judgments that lack balance, practicality or simply show patterns of responses that reflect the reality of early life experiences, not the present ones. For sorting all this out a good psychiatrist should come in handy.