When You Are Well, You're Well

I am a psychiatrist who last had professional activities in the Commonwealth of Massachusetts.

There is a peculiar and sometimes downright toxic phenomenon occurring there, which is costing the state lots of money, harming patients, and depriving potential patients here in Connecticut of my services. It is not clear to me if the problem is prevalent elsewhere, but it is occurring on such a wide scale in Massachusetts that I believe it is worth making public.

There is a notion there that once psychiatrically sick, one is always sick. This is just not so. It is manifested by the phenomenon that if one takes psychiatric medications and has had psychosocial problems in the past, he or she must continue to see a therapist. In at least one clinic where I worked as a staff psychopharmacologist, this was a hard and fast rule. I had a number of patients who were functioning quite well in their lives, and only needed refills of their medications. However, I was not allowed to prescribe for them unless they also saw a therapist for at least fifteen minutes. My patients complained bitterly, finding these "check-ins" with a therapist unnecessary, intrusive, and regressive. Yet, I had no choice but to pass on the policy of the clinic that the meetings with a therapist were mandated if my patients were to see me.

It's been said, "What goes around, comes around." This has certainly been the case for me personally in this regard. I have a very long history of various types of psychotherapy, including psychoanalysis, which began well before my entering the psychiatric profession. However, thank G-d, I am well grounded now and have been functioning at a high level (a psychiatrist I consulted with in the last year gave me an Axis V GAF score of 90) without ongoing psychotherapy. The last therapist who came to know me well over a lengthy period put in writing that she does not see a clinical need for ongoing psychotherapy. The medical director at my last clinic job, a seasoned psychoanalyst and psychopharmacologist, supervised me weekly and found no work-related indication to mandate psychotherapy for me. Yet the Board of Registration in Medicine in Massachusetts refuses to license me unless I am "monitored" by a physician health program, and the director of the program refuses to "monitor" me unless I agree to participate in ongoing psychotherapy. It is not enough for him to have someone in his program observe my mental status on a regular basis to ascertain my continued stability. As my former patients experienced, I too find this clinically unnecessary intrusion regressive and distressing. Furthermore, I have an extensive history of trauma and it is unhealthy for me to retell it to another professional, which would be necessary for him or her to fully understand me and advise appropriately. In fact, there have only been a small handful of psychiatrists who have correctly appreciated my psychological reactions to trauma in the past. The most recent one agrees that psychotherapy is not currently indicated in order for me to practice psychiatry effectively.

I am so tired of being a patient and eager to continue my life without dependence on a psychotherapist that it causes me migraine headaches to even think about starting another psychotherapeutic relationship. Two neurologists have advised me that the answer for me is to avoid such stress. So the end result is that in my healthy state, I have become too well to practice my profession. The message is, whether a clinic patient or a high functioning physician, that once sick, always sick.

I would suggest that the psychiatric profession, at least in the Commonwealth of Massachusetts, reconsider this stance. It should also be stated that refusal to go along with this clinically ungrounded policy, and the resultant experience of anger and grief that it caused me in having to give up the profession I once loved, is not an indication for continued treatment. Rather, it is an indication for the profession to acknowledge that when a former psychiatric patient is well, she's well. Any emotional distress resulting from the profession not acknowledging this is an iatrogenic condition in the clearest sense of the word, and there are available social supports which are more effective, cheaper, and more loving than the support which a professional could provide in this situation.