Oh yeah, life goes on...
In residency one of our teachers, George Vaillant, used to tell us that our job as residents and inexperienced 25 year-olds was to learn the wisdom of our grandparents so we could help people as psychiatrists. He spent his academic career studying Harvard grads and others to see how they did as they aged. What I learned from the Harvard studies is a lot of people took the amazing head start they were given and threw it against the wall to become nothing. Substance abuse and bad marriages, mostly, something to learn from now.
Sometimes I sit with a person even who is facing some terrible life dilemma and think about Vaillant’s words. I’m much older now, I’ve heard and experienced many more things. But what Vaillant said is essentially true. “Long after the thrill of living is gone.”
There probably needs to be some explaining here…in the US to become a doctor you go to college for 4 years, then medical school for 4 years, then after that you do a residency. In psychiatry it’s 4 additional years. Some other specialties are 3 years, some are 5 years plus fellowships before you practice individually. Doctors in training all over the world give up all their previous training to come into the US system which, for all its flaws, incentivizes teaching junior residents because they will be covering for you and eventually take your place, and they also do a lot of covering for the attendings in high end academic settings like Harvard and Parkland in Dallas, where I trained. If you make it in the US you are prepared for anywhere and also the US where attendings get a nice meaty raise.
God, that’s boring. Vaillant knew that. One of my fellow residents asked him about a research project she was interested in and he told her unless she had family money (he was famous for the Harvard studies but now he did most of his research in New Zealand and Nordic countries) it wasn’t worth it. Vaillant was so famous it didn’t really matter where he was. Where we were was of secondary importance. He was wise but he was not kind.
I had a class with Vaillant’s ex wife, Leigh McCullough PhD, that was perhaps the most useful time in all those Wednesday hours we did for four years in residency. She had invented a new protocol for psychotherapy where she went to the Nordic countries and had them run the studies of how psychotherapy worked. She recorded all the sessions on video and had graduate students grade them and then saw which patients got better. She figured out that a combination of cognitive/education and emotional work enabling people to address their emotional blocks head on worked best. (If you are interested it is all spelled out here) With all the psychotherapy studies out there, her work was the one closest to actual human practice and the one that has given me the most guidance for my own practice amidst everything before or since.
Leah McCullough died of ALS in 2012. I didn’t appreciate her when she was our teacher and I didn’t question Vaillant enough. I had everything, really, graduating from a premier Harvard residency.
It’s true, though, what George Vaillant said. We learned the wisdom of our grandparents and sat with out hands at our sides trying to figure out what to say to our patients until we had more experience.
When I look back at these writings and myself I wonder about the adolescent musings stirring me now. You realize eventually I’m going to use this platform to go beyond my sad emotional journey of the last few years to some actual fucking useful information.
Y’all have broken my heart though. It’s not that far from the green days of residency to a failed Nordic project to post-millennial discoveries that aren’t boring only because I had so much to lose. The new subscriptions will tell.