Meatball Psychiatry

My wife and I watched a fascinating movie the other night, “Interstellar.” It appeared in 2014 and I managed to stay awake for the entire 4 hour long film. It’s set in a dystopian future in which the Earth is a place of blight and dust storms. What gave it a sense of reality are clips from a 2012 PBS TV documentary in which survivors of the 1930s depression era Dust Bowl describe their experiences of that disaster. I’m not going to give away much about it except that one of the fresh messages in it was that it’s probably not space aliens who are trying to manipulate, rescue, or mess with humans–it’s us. The movie also speculates about the science of wormholes, gravity, black holes, and how humans experience time, specifically how the past, present, and future may be connected.

It reminded me of the Ancient Aliens show on the History Channel, which is sometimes fun to watch. The narrator often say something about the pretty wild speculations of persons like Giorgio Tsoukalos (alias the “hair dude” about whom there are many memes): “Insert wild speculation here…could this be true? Ancient Astronaut theorists say “yes.” Do they ever say no?

On the other hand, “Interstellar” seems to make the point that we ought to be trying harder to solve our own problems rather than hoping ancient alien astronauts will rescue us from our bad judgment. Although it’s less entertaining, teaching the next generation about how to think for ourselves makes more sense than relying on aliens to save us.

A related topic that I think about a lot is what I’ve been doing for a living and now in phased retirement from, Consultation-Liaison Psychiatry (C-L Psychiatry). It’s a hit-and-run one man smokejumper service where I work. According to the Academy of Psychosomatic Medicine (APM), the name of the specialty will likely change to C-L Psychiatry, as will the academy’s name, to the Academy of C-L Psychiatry. That will make me and a lot of other practitioners happy, including Dr. Don Lipsitt, MD, who wrote a book that is, in large part, a polemic against the name Psychosomatic Medicine: “Foundation of Consultation-Liaison Psychiatry: The Bumpy Road to Specialization.”

Another book I’ve just ordered is “Danger to Self: On the Front Line with an ER Psychiatrist” by Dr. Paul Linde, MD. I happened to google the term “Meatball Psychiatry” a few days ago and, my blog post was at the top.  But Dr. Linde’s book also popped up and I read an excerpt in which he criticized the tendency to refer to emergency psychiatry as “meatball psychiatry.” He clearly doesn’t care for it and thinks it’s insulting. Although I respect his opinion, I’ve never thought of it that way and I sometimes mention to medical students and residents my comparison of what I do to meatball surgery in connection with the Mobile Army Surgical Unit (MASH) along with the TV show of the same name. Incidentally, I discovered an on line article about an Iowa connection to the MASH unit and it was Unit K in Council Bluffs, which was purportedly the predecessor to the MASH unit.

Anyway, I respect the idea of the MASH unit. I think the surgical care had to be quick, smart, and brave, and the surgeons were dedicated to making fast decisions that saved lives of heroic soldiers. I think ER Psychiatry and C-L Psychiatry are a lot alike and the meatball psychiatry analogy to meatball surgery probably fits.

One of the residents currently rotating on the C-L Psychiatry service asked me about my phased retirement. I told him about the structure of it, that it’s gradual, designed to help ease older physicians into retirement. Often, our work gives a us a sense of meaning and it can be hard to let go of it. I was interested in what he was planning to do because he’s a talented senior, like many of the residents. He’s targeting outpatient clinic work, which I told him made a lot of sense, comparing the predictable schedule with my hectic, even chaotic career.

This short conversation in the hallway made me wonder about what the service might look like in the future, after I’m fully retired. I find myself hoping that it will evolve into something way beyond the smokejumper model, the fire brigade of psychiatry. I teach trainees about what I often call meatball psychiatry. Most of them respect it. I’m nowadays not as afraid to walk away from it.

A third and final related issue is health care reform. This is certainly not going to be fixed by aliens but often enough it sure seems like aliens are messing with it. Civility, statesmanship, and leadership seem to be missing. It’s our responsibility to shape the health care system and to teach the next generation how to sustain it for their children. We can do it.

“Leadership is a choice, not a position”—Stephen Covey.

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