Friday, July 19, 2013

Blog Wisely. Go Forth and Blog Wisely.

My friend Dr. Paul Puri, a sometime classmate of mine at the New Center for Psychoanalysis, has just begun a blog of his own at His opening post--"Yes, Your Doctor Should Be Blogging"-- addresses an issue I've wondered about for a while, and his conclusions are similar to my own, so I am cross-posting his piece, along with this, my brief exploration of the issues he raises.

Like so many people (both in and outside of the field) I've been a writer, teacher, political activist, and even amateur musician for decades, during most of which I was trying to garner as much notice as I could. If I don't blog, out of a prudent desire to keep a low profile with my opinions and interests, I will be represented on the web exclusively by things I said, did, and created in my 20's and 30's, when I had no notion of joining the helping professions. If instead I blog about psychotherapy, psychoanalysis, literature, current affairs, culture, and philosophy--as I've done intermittently since 2008--then I present myself to the google-using public as the person I've become in the long meantime, the person they will actually be dealing with if and when they meet me.

Those are the choices: let my output from the 1990's to 2008 represent me in the public arena, or use whatever growth and learning I have since acquired to develop an online presence that represents my current sensibility, concerns, and ideas.

In working with a client, a clinician's self-disclosure makes sense only when it is done in the interest of the client--building rapport, normalizing, and not much else. Self-disclosure in a blog makes sense along similar lines; it should be context-appropriate, arising in the natural course of the expression of defensible opinion (which is what I believe "blogging" to be). If I publish a post about the legal and ethical status of animals--condemning the 2008 Austrian decision that chimpanzees are not persons, and celebrating India's 2013 ruling that dolphins are--then everyone will know that in general, I support animal rights. That's good. Other posts demonstrate or suggest other values with which I am proud to identify. Let me spell out seven of them:

1. feminism, the belief that people deserve equal respect whatever their gender identity;
2. respect for the scientific consensus (see, e.g., Oishi and Kesebir, 2011; Picket and Wilkinson, 2011) that shows extreme income inequality to be detrimental to the mental health and well-being of all members of a society, whatever their income;
3. the view that the arts help people live their lives;
4. connection to the past, especially through the Humanities; 
5. a positive valuation of the role of healthy sexuality in a fulfilling adult life;
6. awareness that infinite growth on a finite planet is not possible, and that the limits of nature affect the human prospect individually and collectively;
7. the belief that empathy and debate, rather than affiliation and violence, should drive policy.

Values like these are explicitly avowed in the mission statements of many mental health organizations, including The Relational Center (where I am currently a Marriage and Family Therapy Intern), The Wright Institute, and Division 27 of the American Psychological Association

Someday soon, I think I'll change the name of this blog to include PSYCHOTHERAPY. Meantime, please enjoy POETRY, POLITICS, COLLAPSE.

Jamey Hecht, Ph.D. (English and American Literature, Brandeis University, 1995), M.A., (Clinical Psychology, Antioch University 2012), M.F.T.i. (California Marriage and Family Therapy Intern # 73628).

Here's Dr. Puri:

Yes, Your Doctor Should Be Blogging
18 JUL 2013
And so it begins…
A new blog. Another among thousands. Is there particular utility or reason to follow this one? I’d like to imagine that this will have usefulness to your life. This is more than just thoughts on psychiatry, but really the thoughts of a psychiatrist who is both enamored with and annoyed by his own field. And with modern culture. So everything.

Which raises the question – should a doctor really be blogging? Within medicine there’s a culture of secrecy. We protect our own, not letting on about our problems. Our venues of criticism fall into “peer reviewed journals,” which itself is prone to problems like publication bias. Those in charge perpetuate thinking in line with their own. Which reflects how medicine functions – by majority opinion. We are expected to practice within the “standard of care,” which is the normal practices of other doctors in our area. Practicing medicine is after all a privilege, granted by the state medical board. Best to not ruffle feathers.

But doctors are not robots. We are people. People who think for ourselves. We’ve gone through four years of medical school and further years of specialty training, and during that we’ve seen through the fallacy of the omniscient physician. We don’t know everything. You can drive a bus through what we don’t know.

And that raises a different responsibility. With all that training comes the ability [probably] to study science critically, to be literate in science and read between the lines. Medicine is not science. It is a craft, or at best an art informed by science. Doctors have the responsibility to use that science as best they can to help others. That may be in a clinical setting, but can also be in public opinion. It’s a social responsibility for doctors to speak up. Pharmaceutical companies and others have their pulpits, funded by much more money than I do. The internet is a venue for others to express their opinions, and it seems a doctor should share his thoughts as much as anyone else.

Now, I know my patients might read this. And showing actual opinions might shatter the neutrality that some choose to believe is necessary in treatment, especially in psychotherapy. Patch Adams challenged that, amidst its flaws. I don’t particularly buy in that neutrality. In medical circles it’s talked about as “professionalism” to present a specific image of the profession. That’s fine, but the illusion of neutrality should be shattered. At least a little.

I ran into a patient at the gym the other day. He didn’t know I saw him. But if he did it shouldn’t matter. I have to hope he’ll respect my expertise even if he saw me on a weight machine. Then maybe we can all start having more real conversations.

I’ll be writing about my thoughts on the field of psychiatry, on medicine, and on challenging the idea that any one view is the most valid. Hence the quote and title of the blog, which is as applicable to medicine as it is to religion, or anything else.

“There are [at least] 21 paths to the top of the mountain. If anyone says he is on THE path, he isn’t even on the mountain.”
Stay tuned.
Paul R. Puri, MD

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