© 2000 Simon & Schuster
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 - 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.
