P&S Journal: Fall 1994, Vol.14, No.3
Where is Psychiatry's Mind Today?
Dr. Anna Schwartz
For Dr. Anna Schwartz, psychiatry seemed like a natural extension of her early interest in literature, her undergraduate major at Harvard. "Here was a chance to listen to people's stories, the thing I had always loved about literature."
The daughter of two psychiatrists, she thought initially of becoming an internist, "because, of course, we don't want to be too much like our parents." But in her third year of medical school at Cornell, the clinical rotation in psychiatry inspired her.
"I realized that psychiatry is the only field in medicine where there is the time and, more importantly, the expectation that the doctor needs to know all about the patient's life. I enjoyed that rotation most; that was what I looked forward to getting up for in the morning. I was much more interested in thinking about psychosis than, say, the pathophysiology of the liver."
Dr. Schwartz credits P&S's residency program-which she completed this year-with affirming that interest. "This program has so much to do with why I love psychiatry. It's exciting to be at a place where the things we're learning are things that have been discovered or written by people we see all the time. Dr. Robert Spitzer, Dr. Eric Kandel, Dr. Roger MacKinnon...these people are not only leaders in their fields, but also teachers with whom we have regular contact and are on a first-name basis with. We really feel at the center of things."
Dr. Schwartz says the friendliness and intellectual openness of the faculty set the tone for the residency group, which she describes as unusually collegial and supportive. "In some places the ideological split in psychiatry between the biological psychiatrists and the dynamic psychiatrists (psychoanalysts) leads to warring camps who have little communication," says Dr. Schwartz. "That's not the case here. We're exposed to teachers from all parts of the spectrum and taught that the two camps are not mutually exclusive, that each has something to learn from the other. It's not 'Does this patient need biology or psychology?' It's always going to be a mix of the two."
As a psychiatrist, Dr. Schwartz says the upheaval in the health care system has instilled some nervousness in her and her colleagues. "Even as residents we felt the effect of new reimbursement policies, of having to justify patient care to a third party," Dr. Schwartz says. "There is also the fear that with the larger trend in medicine toward specialization, we're moving toward a time when psychiatrists will only be reimbursed for being prescription writers and that the psychotherapeutic aspect will suffer."
Still, Dr. Schwartz remains optimistic. "I think all the reimbursement changes are actually more frightening in other branches of medicine. Psychiatry has always been the orphan of medicine and psychiatric illness has always been viewed with suspicion. If anything, there is greater societal awareness now that mental illness is real and should be reimbursed as legitimately as any other illness."
Dr. Schwartz has begun a one-year postgraduate fellowship in public psychiatry at P&S. She will spend three days a week in a Washington Heights community service clinic and two days doing course work in public policy and mental health service delivery. She hopes to integrate her interests in public health and psychiatry by combining a private practice in Manhattan with administrative and clinical work in community mental health.