The aging psychiatrist: Why older is better

CrossCurrents

By Dr. Mary V. Seeman

Many things happen to psychiatrists as we age. We become more experienced, more skilled at what we do. But at the same time, the field evolves and leaves us further and further behind. Add to this the inevitable numbing of our senses, our ever-dwindling supply of neurons, plus the stubborn determination to keep on doing what one has always done, and we have the aging psychiatrist: seasoned, yes, better for wear, but stuck in her ways and still insisting that “evidence” means the evidence of her own eyes. (Evidence-based medicine means the results of methodologically correct large-scale trials).

I began working with patients in 1960. But if I needed to talk to someone, would I choose a young psychiatrist or an old one? Probably an old one.

I’d prefer an older psychiatrist because I wouldn’t want to be grilled about symptoms. Younger psychiatrists feel obligated to make a DSM diagnosis at first meeting because that is how they have been trained. Older psychiatrists prefer to talk and get to know the patient. Diagnosis is of secondary importance and is only really required for officialdom. Being diagnosed is like being given a label, a numbered tattoo instead of a nuanced portrait. The young, of course, have a point. Diagnoses are hard to make once you know a person well because there is too much that does not fit into categories. The only time to make a diagnosis with certainty is during that first hour when data points are few. I was amazed when, on retirement, I referred my clients to others and could not, with any confidence, assign a diagnostic label to individuals I had been following for years. Yet in a one-shot consultation, diagnoses seem so straightforward.

The second reason why I would choose an older therapist is because I think he or she would be more understanding of my foibles, less prone to judgement. I could be wrong, but I think that part of being seasoned is that you accept the human condition and don’t jump up in amazement when someone tells you they have been secretly in love with their wife’s sister for 50 years, or that they snort cocaine before performing heart surgery. I prefer the equanimity of someone who has seen it all.

The third reason I would choose an older person is because I don’t want to hear “I know how hard that must be for you” repeated 10 times in the course of an hour. I don’t want any stock phrase, for that matter, especially not the word “OK”: “How do you feel?” “Terrible.” “OK.” “How old is your mother?” “She died a month ago.” “OK.” “Are you having trouble sleeping?” “Yes.” “OK.” “Ever thought of suicide?” “Yes.” “OK.”

Older psychiatrists may not hear well, so I may have to speak up, but I can count on their listening skills being hyper acute. Their sight may be relatively poor, but I know they won’t lose sight of the issues I bring to them. Their hearts may be hypertrophied and irregular, but that’s what I am looking for – a big heart that beats along with mine. Gait may be slow and balance precarious duty when they walk you to the office, but I know they’ll be fast on the uptake and stand firm and unswayable in the face of social pressures and passing fads.

Having lived through troubles of their own, older therapists tend to be more strength-based: “You hear voices? That’s all right. Voices can serve a lot of good purposes. They’re a comfort when you’re lonely.” “You see imaginary shapes? That’s nothing to worry about. The world needs visionaries.” “You can’t stand people? I know exactly what you mean. Solitude is a wonderful thing.” “You’re skeptical about other people’s intentions? I know what you mean. It’s smart to be cautious.”

Aging brings with it what social gerontologist Lars Tornstam calls gerotranscendence. It’s experienced as a curious redefinition of time and space that allows for stronger connections with past and future generations and the acquisition of what we refer to as wisdom. Death is no longer fearsome, and so life is no longer frightening. Instead of fearing life, the elderly imbue it with renewed mystery and subtlety. Transcending one’s own petty concerns means caring genuinely more for others. Material goods lose their meaning entirely. Ambition seems like a foolish game. Competitiveness goes. There’s often a return to the exuberance and self-confidence of youth. Anything seems possible (a paradox because very little is). Superficial relationships hold no interest and being alone with your thoughts takes on a whole new appeal. Social norms are less constricting and the world becomes a richer place. Right and wrong don’t differentiate quite as sharply as they once did, and forgiveness is easier.

All this translates into becoming a better therapist. In this sense, psychiatry is a smart professional choice. There aren’t many disciplines where your skills actually sharpen in your later years. But that could be fantasy. The pianist Artur Rubinstein not only re-wed (and to a young wife!) at age 80; it has been said that, astoundingly, he surpassed himself on the concert stage. The truth is he played fewer pieces, practised each one more often and slowed down before a fast bit to give the illusion that he could still pick up the tempo, which, unfortunately, he no longer could.

Dr. Mary Seeman was inaugural Tapscott Professor and chair of schizophrenia studies at the Centre for Addiction and Mental Health in Toronto. She is a professor emerita, University of Toronto.

• Print
  Follow us on
  
  Share