I have spent some time reading this summer. And a lot of time listening to Audiobooks. Not sure what my goals are, but I do like to keep on learning. I’ll track some progress and short-term targets here in this post, I guess.
- Song of Solomon
- Psalms (To Do)
- Proverbs (To Do)
- John (To Do)
- Acts (To Do)
- Various Apocrypha (To Do)
– Farewell to Arms
– Zakaria’s education book
– The Happiness Hypothesis
– The Myth of Sisyphus
– Justice (Michael Sandel)
– Capital in the 21st Century
– Dreams of My Father
– Audacity of Hope (To Do)
I’m feeling a little ambitious, but not in the “get something done” way so much as the “think abstractly about ways to improve yourself” type of ambition.
Here are some reasonable goals for the near future (<5 years?):
1) Lend to every country on Kiva (currently ~50/84). So 34 to go. I already have several hundred dollars deposited into Kiva so this won’t actually require 34×25 = 850 dollars.
2) Get >200 lbs on the big lifts (okay let’s just say bench press and squats since I can’t deadlift with good form). Currently around 165 bench press and 135 for squats (although the latter is increasing much faster than the former obviously; I struggled with getting squat form down for a while and now I’m making good progress with it). I weigh about 185 lbs right now, so this shouldn’t be very hard. God if I did five pounds extra per month with bench I’d finish this by next year.
3) Become half decent at meditation? I don’t know why it is so difficult for me to meditate consistently but it is. So I don’t know what a reasonable goal would be. Meditate consistently? Yeah. Meditate daily.
4) Read a lot of books. Okay now I am clearly in violation of the SMART concept – measurable goals. Read a book a month? Keep learning? Audible has helped me quite a bit with “reading” new books, which has been cool. I’ve spent a lot of time reading the Bible this summer, which has been a rather curious enterprise, since I’m an atheist, but an interesting one too. I’d like to become basically familiar with the major religions, so that would entail reading some of their big books. I also find Biblical Apocrypha really interesting, so it’d be cool to read some of the rejected books too (eg the Gospal of Judas!).
Today one of my coworkers and I got in an interesting discussion (or maybe an argument) about why relatively few medical students become psychiatrists. She just finished her first year at a pretty prestigious medical school.
I claimed that it boiled down to stigma against mental illness, while she argued that the difference is explained by other fields of medicine being “cooler,” “more interesting at least to some people,” and “more hands-on” (which I pointed out does not at all contradict the stigma explanation).
I (like most people I imagine) am not very good at faithfully and fairly recounting how arguments played out, especially when they get a bit heated. So I’ll from here on try to make this objective (by which I mean independent of my conversation with my co-worker) and just flesh out a few interesting points that came up.
Psychiatrists are paid less and research is funded less than for other specialties
As New York Times writes, “Psychiatrists rarely earn enough to compensate for their additional training. Most would have been better off financially choosing other medical specialties.” Psychiatry is among the least paid medical specialties, though it looks like the pay is increasing faster than in most other areas. Interestingly, HIV/Aids specialists receive the lowest salary of all, and they also treat a stigmatized population.
Psychiatrists are least likely to accept insurance plans, possibly because they are systematically under-reimbursed, even for the same procedures (that article also says that half of counties lack a regular psychiatrist!). Research on mental illness is significantly underfunded relative to the disease burden it creates.
Are other specialties more interesting, hands on?
Surely for some people and not others – like everything else. Maybe some people really like feet or skin or hearts or reading x-rays. But for this to make sense in explaining the shortage of psychiatrists, it has to take the stronger form that psychiatry is systematically less interesting than other forms of medicine. And that sounds a little difficult to believe to me. (I am also inclined to think that if the average psychiatrist made $340,000 a year like the average orthopedic surgeon, interest wouldn’t matter much).
The brain is an incredibly complex organ. Mental pathologies are extremely powerful and disruptive forces – they ruin lives and cause all kinds of bizarre behaviors. Additionally, considering that the lifetime prevalence of mental illness is one in two, and depression and substance abuse are higher among medical students than the general population (discussed later), it is fairly likely that a medical student has personally experienced a mental illness or observed its effects. It seems to me that, all else equal, you would be more likely to go into a field of medicine which has affected you or someone you know than not.
Anyhow, psychiatry sounds a lot more interesting to me than Orthopedics, for example (the highest paid specialty by far) or Plastic Surgery (another high payer). Surgery is a lot sexier than psychiatry (in addition to being much better paid) and I think this is a product of the stigma.
Are future doctors too sophisticated for stigma?
The hypothesis for this line of thinking is pretty intuitive: stigma comes from misunderstanding and misperception of mental illness. Medical students and doctors, who know a lot about mental illness, don’t make these mistakes, so they are less likely to stigmatize mental illness.
Unfortunately, it’s not true. Not at all.
According to an Journal of the American Medical Association study (specifically of med students at UMichigan), mental illness stigma may actually be higher among medical students, who, in addition to being more likely to be depressed than average, are more likely to attribute depression to “weak coping skills” and more ashamed about revealing their negative emotions. This sort of makes sense to me, as medical students strike me as the kind of people who endorse a very strong “protestant work ethic”, “internal locus of control” type of outlook. One that says if you want something, work hard and you get it; if you have a problem, work hard and you’ll solve it.
The implication is, unfortunately, that if you can’t solve a problem, you aren’t working hard enough. It’s your fault, something to be ashamed of. It’s not hard to see how this attitude, coupled with a high-stress, hypercompetitive environment, would be ripe for high levels of depression and self-stigmatization. After graduating, doctors tend to avoid seeking mental health care.
And in the population at large, while more people attribute mental illness to neurobiological factors than in the past, stigma is actually higher, according to an American Journal of Psychiatry report. Being able to attribute illness to neurobiology doesn’t make people more accepting of illness; in fact, it may make it seem intractable, a rigid characteristic about a person that will never go away.
Mental illness stigma deters people from Psychiatry
Furthermore, there are plenty of published anecdotes (eg here, here, here) of psychiatrists describing the stigma they received for choosing their profession. A Columbia Professor of Psychiatry writing for Scientific American describes this comment made by another faculty member: “Tell all students who get low scores on their board exams not to worry, they just need to change their career plans and go into psychiatry.”
Psychiatry is also, as far as I know, the only branch of medicine with a dedicated movement opposed to its existence. Ever heard of anti-cardiology?
Get vaccinated for the safety of you and others.