A few days ago a friend and former colleague sent me news that a paper that we had begun at least three years ago (what is that in "blog years?") had finally appeared in the print world. He wrote it, I merely advised and proofread. But while I've been physically removed from the university for two years now, it occurred to me that only now, with the paper trail complete, was the academic experience complete, with closure as the cliche goes. As my first peer-reviewed article appeared in 2000, this nicely rounded the experiment up at a decade.
When I was a senior resident in the late 90's, the department chairman at the time, Allen Frances, M.D. (he of DSM-IV notoriety) rounded a few of us up to discuss our career prospects. At that point I had developed a strong interest in the history and sociology of psychiatry, and told him so. He nodded vaguely, as I recall, and said something about that being a worthwhile "hobby" (his word) to pursue alongside my real career of clinical work and, perhaps, more respectable (and funded) research.
At the time I privately took some offense, for the philosophical dimensions of psychiatry were a primary passion of mine; all of the mainstream trappings of the profession were necessary evils. The clinical experience has always been crucial, but its props (the diagnostic categories, the meds, etc.) I have always taken with some grains of salt. When I entered an academic position at a different institution, it was understood that the "props" (to include inpatient work and ECT) would earn my keep and justify my salary, but the deeper motivation for me was the intense and hard to define strangeness of the psychiatric endeavor itself.
So began a rather parallel career. On a theoretical (not, I hope, a personal) level I fumbled my way toward hysteria as the route to the pervasive but often acknowledged role of narrative and value(s) in clinical work, and I found, in poetry and short fiction, promising windows upon this state of things. In my mainstream work I tried to do good, broadly speaking, for people (ranging from administrators to patients) who want what they contingently want and upon whom thoughtfulness, unfortunately, is all too often wasted. But as I never really felt at home in the psychoanalytic community--it has always seemed a bit hieratic, a bit hothouse to me--a niche wasn't easy to find. I always felt that literature had more to teach psychiatry than vice versa.
Unless one counts a few paid trips to conferences (granted, Emily Dickinson in Hawaii is hard to beat), I was never funded a cent for publications or presentations over those years. My clinical work paid the way, so in that sense Allen Frances was right, my humanistic leanings were a kind of professional hobby in a way. I was an amateur, although hopefully in the best sense of the term. This was probably as it should be; why should taxpayers pay for an academic physician to indulge in esoteric speculations perhaps of no use to anyone (and surely not of measurable use) when he could be doing the "real work" of seeing patients?
I confess I never greatly enjoyed teaching medical students or psychiatric residents, at least not in the classroom setting and not the kind of mainstream stuff (the "descriptions and prescriptions") that they most wanted to know (I don't fault them, as they were responding to a professional and economic system with its own incentives). I mention this somewhat sheepishly, because teaching is one of those things--perhaps like growing your own vegetables or volunteering in soup kitchens--that is considered universally praiseworthy. But I most enjoy those activities that are done for their own sake, and for that reason the best learning takes place outside of a classroom. There were the occasional exceptions, the thoughtful ones; good teachers speak to a group of 30 for the sake of the 5 or so who truly care, or in the hope of increasing that 5 to 10. I'm just not wired that way; an autodidact by nature, I have found my best teachers in libraries, bookstores, and the "book of nature" for the most part.
The reason I finally left academia was the realization that, in medicine at least, tenure means nothing in the absence of separate funding. I was awarded tenure and...nothing changed; I still had to maintain a busy clinical practice to earn a few precious hours per week that I might devote to thinking and writing. But the kind of topics I care about are to medicine what, say, poetry is to the publishing world--it doesn't make any money for anyone. So it occurred to me that I didn't really need the academy; I could do clinical work anywhere to finance my parallel interests in literature and psychiatry. Clinical work--the fact of suffering--is the existential engine, but the narrative mode is the way I prefer to steer.
So the Ars Psychiatrica blog was the unfinished business of my academic career, the things left over that needed saying that I hadn't gotten around to sending to refereed journals. It was nice to publish in three seconds rather than three years, although many, many posts could have benefited from stringent peer review. I have always admired writers who, instead of whining about people not buying their stuff, arrange to have a day job that will earn them a living (T. S. Eliot at the bank, Wallace Stevens at the insurance company). I do get tired of contemporary journalists and writers complaining about the Internet threatening their livelihood. Why don't they do what the rest of us have to do, learn a trade that they can get paid for? I'd love to get paid for keeping a blog, but it isn't going to happen.