The Thoughtful Psychiatrist
Reflections on Psychiatry, Psychotherapy and Human Beings
Jonathan D. Salk
Welcome. I have been psychiatrist for 35 years, but I’ve been thinking about human beings for my entire life.
At one stage in my training, I had to do evaluations of children and adolescents in an outpatient clinic headed by a young psychiatrist named David Feinberg. It was engaging, complex, sometimes a slog, but always fascinating. I found that I often had to look through many lenses from different points of view to understand a child and family, put together a formulation and map out a plan. Actual patients did not always hew to the reductive nature of psychiatric diagnosis, and I found myself considering and blending perspectives from medicine, psychiatry, neuropsychology, neurobiology, different schools of psychotherapy, child, adolescent and adult development, family dynamics, learning profiles, school environment as well as social and cultural influences – even human evolution. It was rare to see a child with, say, ADHD who did not have contributing factors from at least a few of those realms, and I put those considerations into my notes and evaluations.
One day, I was walkng down the hall of the clinic with David Feinberg and he said, off-handedly, “I was reading through charts the other day, and I found myself remarking, ‘Gee, I don’t often see anything like Salk’s notes; they’re just so….thoughtful.'”
Initially, I found that amusing, but after a moment, I realized the truth of it. I did think deeply about my cases and about the human beings in my care.
In the following years, as I ventured into practice, I often thought of putting together short pieces, essays, stories about people and about my work, calling it “The Thoughtful Psychiatrist”. Over the years, the press of clinical responsibilities, marriage, children and extended family, combined with an in-born hesitancy to publish precluded carrying that out. Now, at the end of my career, I find it’s not too late to offer up my reflections and share them here.
I hope they may have some value to a few readers.