By Ravi Chandra

Years ago, a woman asked what I do.

“I’m a psychiatrist.”

We chatted a bit, and then she said, “well, that’s ok – you just can’t take your patients’ problems home with you.”

I replied, “well, actually you can’t be a good psychiatrist unless you take your patients’ problems home. They’re on my mind and in my heart throughout my life.”

That pretty much ended the conversation.

A lot of people don’t understand what we do, or the training, skill, and creativity it takes to do it. I’m not trying to be grandiose, but there aren’t many psychiatrists who don’t go above and beyond the “9-to-5” in some way, whether it’s calling in prescriptions, taking urgent calls on nights and weekends, finishing notes at some ungodly hour, reading up on potential new treatments for their patients, worrying about their patients in the middle of the night, or in my case, spending enormous time writing, to work with the complicated and ambiguous transferences or transmissions of my patients and culture in deep distress. I received the Kun-Po Soo Award for Achievement in Asian American Psychiatry this year, based on my writing. The title of my talk: “The Struggle with the Battleship of Biases is Real: Dark Horses, Black Sheep, Scapegoats, Underdogs and Claiming Face in the Asian American Psyche.”

There is a rather long list of biases many of us face, and we must find ways to struggle with them, and not succumb. Jaron Lanier wrote in You Are Not A Gadget, “there’s a danger that you will become entrapped in someone else’s recent careless thoughts. Struggle against that!” Careless thoughts, hot takes, and orchestrated biases come from cognitive rigidities or conscious or unconscious defenses and strategic plans. If only we could converse and collaborate to strengthen shared understanding. If only the care, empathy, and curiosity about, say, ambiguity, ambivalence, social anxieties, splitting, and anxieties about intimacy and vulnerability could be transmitted to the broader culture somehow. But society currently does not function that way. To speak plainly, power resists insight, and forces enactment. Instead of broadening comfort with ambivalence, we have power trips bending and breaking reality. But reality persists. We can choose to make our enactment of our shared reality a creative and collaborative act to stimulate growth. Care for mental health and substance use disorders should not be partisan. 

I didn’t suit up in an inflatable animal outfit for my day on the hill with five other psychiatrists, like those in Portland did recently to protest an ICE detention center. I guess we’re not quite that flexible yet. Maybe next time! Instead, we focused on finding common ground on issues like telemental health, the ongoing workforce shortage, collaborative care investments, and the importance of continuing funding and time-tested structures for mental health and substance use disorders, and SAMHSA. 

The APA’s legislative priorities have broad bipartisan support, and our legislative team in DC seems like they’ve worked hard to scope out the territory of the “art of the possible” in the concrete world of policy. They welcomed 175 of us, and gave us brief trainings in storytelling and advocacy work (it was my first time), and sent us to meet with aides in various House and Senate offices. 

The team that carried the day for NCPS included Drs. Parveen Dhillon, Chesley Rose Ekelem, Zachary Jacobs, Karthik Sarma, Donna Tran and myself. Together, we met with attentive, concerned, highly professional, qualified, (and probably overloaded and under paid) policy aides in the offices of Representatives Vince Fong, Sam Liccardo, and Speaker Emerita Nancy Pelosi, as well as Senators Alex Padilla and Adam Schiff. Each of us took turns sharing stories from our practice tied to the APA’s game plan.

The APA roadmap seems be proof of concept for bipartisan work, as sure as the sparkling synapses of the left and right hemispheres of our brains usually communicate. The priorities mentioned already had significant bipartisan support. If only we could add more psychosocial cortex on the disconnected lobes of our collective psyche to return reason, compassion, and relationship to our decision-making processes, and lower the temperature. But it is a fact that America has more volcanoes than any other nation on Earth, a synesthetic, perhaps psychosomatic, manifestation of the tensions we are seeing in our era of warring mind states. 

“Thar she blows!”

At least volcanoes can make new land. 

We must have an Atlantis coming up between our eruptions, I think.

Aides called the current times “weird,” and “challenging,” among other euphemisms for both the shutdown and the surreal state of division and challenge in our democracy, which is showing clear signs of decline into autocracy, if we’re not already there yet.

Democracy is not about getting our way – but the “unalienable rights” to “life, liberty, and the pursuit of happiness” are in the Declaration of Independence. That’s us, folks. Psychoanalyst Ian Hughes writes that democracy itself has evolved out of anguished encounter with malignant and tyrannical leadership. I would suggest that mental health is deeply impacted by encounters with abuse and even tyranny, and that these are commonplace, in families, nations, and the international community. But as history has shown us, better things can grow out of encounters with tyranny.

Society is the sum of our love, and we are in critical deprivation, dearth, disconnection, precarity, loss, and distress. Freedom of speech is our Constitutional right, and I am glad to use my voice in all the ways possible. Voice is both influence and agency. Harvard historian Danielle Allen points out that loyalty (which at the extreme involves silencing dissent in favor of more rigid members of the group) and exit are other options for civic engagement. Encounters like ours are traumatizing. Judith Herman points out that the traumatized scan the social world for three camps: perpetrators, allies, and betrayers. I’ve added a fourth: the scapegoat. Psychiatrists have been seen as all of the above in recent years, and perhaps we have been.

Each of us is a village, existing at a confluence of rivers. A successful world relies on villages that participate in a shared economy of well-being. As psychiatrists, we have our perspectives on what is happening to the water. I’ll go with Beyoncé’s “Love Drought.” Our cultural parents are both love and violence. As would-be “parents” or at least part of the team of doulas in the culture, psychiatrists of course carry their own loves and aggressions. But what parent hasn’t learned something new from their child? I hope we can help this culture which is struggling to breathe. A slap on the butt, a pat on the back, maybe a nasal cannula, and most of all, a mother’s breast. The women in the culture need psychiatry’s support most of all, because they have perhaps born the greatest brunt of our misunderstandings over the years. We’ve got to change this “whole women are from Venus, psychiatrists are from Mars” dynamic. 

To meet the extraordinary challenges of the day, we must adhere to our ethical codes of societal obligations. We must become better compassionate allies to our patients, colleagues, and communities. You could say there is a splitting force in the treatment team for our nation. As psychiatrists, we can certainly bring salve for how we are split against each other, recognizing that warring mind states and rigidities of leadership are contagious and lead to mirroring. As we receive the “transference” or “transmission” of toxic division we can use it as prompt, and transform it with our own self-reflection, self-care, learning, personal and communal growth, creative expression, and care grounded in the best of who we are, as psychiatrists knowledgeable about the unconscious and conscious ways people and groups get into trouble.

But one thing seems clear to me: euphemisms aren’t going to do the heavy lifting. And enforcing biases of traditional psychiatry towards avoidance, abstinence, apoliticism, and “neutrality” will prevent dialogue and interpersonal growth, and open the door for darker things to come. Suffering is a crisis in connection; the opposite of suffering is belonging. Surely, our main goal, then, as psychiatrists, should be greater belonging, in our own ranks. Undoubtedly, some of the most significant calls of disconnection are coming from within our own house, and sometimes with tragic consequences. I refer to the recent death by suicide of one of our stellar NCPS members, Dr. Nolan Ryan Williams of Stanford and SAINT fame. I have no idea if the rending of our sociopolitical fabric had an effect on him, but our futures together has irrevocably altered by his loss. However we choose to engage with the times, we must be grounded in grief, but also the joy and hope at the possibility of our work and time together on Planet Earth.

I define a doctor as someone who is moved by their patients’ suffering. This October, I was moved to travel to DC in hopes of supporting their care. I hope more NCPS members are able to find the time and means to be moved by their patients on this strange and alarmingly tectonic plate of American life.

We have to eat what’s on our plate, don’t we, or else lie in the bed we make.

~ Ravi Chandra, M.D., DFAPA is a psychiatrist and writer in private practice in San Francisco. You can find him on Substack.