In 1987 he left politics and returned to psychiatry, serving as a Foreign Service medical officer to 26 countries based in Zaire. There he provided psychiatric care to Americans serving in the Peace Corps, Foreign Service, and other organizations. When Washington’s seventh district Congressional seat became available, he returned from Africa to run for office. He was elected in 1988 to the 101st Congress and is serving his seventh term; he continues to work to pass legislation guaranteeing all Americans comprehensive health care coverage.

I had the opportunity to speak with Dr. McDermott about his interwoven careers in psychiatry and politics; what follows is a summary of our conversation.

JVO: I understand you were the first member of your family to attend college. What led you to medical school?

JM: Well, I think I always was interested in medicine. I thought about being a medical missionary as a kid. I was raised in a family in which that was an honored activity. My mother was sick when I was a kid, so I was interested in the disease she had. It was a combination of things, really.

JVO: When in your educational career did you first decide to pursue psychiatry?

JM: I don’t know exactly where that came from. I remember writing a paper about being a psychiatrist when I was in the eighth grade. I don’t know where I learned about Jung and Freud, but I was always interested in those issues.

JVO: How did you happen to serve in the U.S. Navy Medical Corps?

JM: In those days everybody had to serve. I dealt with casualties from the war; it was basically the people you saw in the movie "Apocalypse Now." They were kids who joined the Navy thinking they could stay out of the war and who wound up being right in the worst of it.

JVO: What prompted your interest in politics and your decision to run for office when you returned to Washington?

JM: I wanted to do something about the war. I never planned to be a politician, but I got so angry about the war that I just decided I would run for office. I ran for office a month after I left the Navy. I didn’t know anybody in Washington, so I started from the bottom. I didn’t know anything when I started. I learned a lot of things by making mistakes, but sometimes that’s not a bad way to learn.

JVO: In 1987 you left politics to work as a psychiatrist in Africa. Why?

JM: I was spending so much time being a politician that I was afraid I’d become a bad doctor. So I went to work for the State Department and took care of official Americans overseas. It was basically crisis intervention for State Department people. I really was like a "fireman," in the sense that I was always putting out fires. I had 26 countries I was the psychiatrist for; if there was a problem in a country I’d go down, see the patient, evaluate the situation, and make recommendations about how to proceed.

JVO: What drew you back to Washington to run for Congress?

JM: I thought that if I could win a seat in Congress, I would have a chance to work on national health. One of the glaring messes is that our country doesn’t have a national health plan. I worked on that in the state legislature, and I was very excited about the possibility, but it didn’t quite turn out very well after Mrs. [Hillary] Clinton’s efforts got bogged down.

JVO: Was being a psychiatrist a help or a hindrance in that election? In serving in Congress?

JM: I think it’s probably more threatening to people than it is helpful. People are sort of put off by psychiatrists—you know, they’re supposed to be able to read your mind. Those ideas make people antsy.

JVO: As a psychiatrist, do you find that people in Congress talk with you about their problems?

JM: Sure, of course. They come and tell me about their own circumstances or problems with their kid, etc. Members of Congress are just like everybody else: they’ve got wives, husbands, kids, mothers, and fathers. One issue my colleagues come to talk to me about is aging. There are a bunch of us dealing with elderly parents who are deteriorating in health. When you’re 30 years old, you never think your old man’s going to be 90 some day, and you’re going to have to figure out how to take care of him. A lot of people in Congress who are 50 to 60 years old are now dealing with parents who are elderly and it’s difficult. It’s a hard society for old people. People come to me all the time to talk about their problems.

JVO: What are the biggest challenges facing psychiatry today and in the years ahead?

JM: Well, I think one of the interesting challenges of psychiatry at the moment is that you have a whole country that’s uneasy about having lost its security blanket. There was a general denial that the U.S. was a part of the rest of the world until the 11th of September, and suddenly it turned out that we’re like Israel, India, East Timor, and Sri Lanka, for example, where there is terrorist activity. Americans have never thought that we’d have to deal with that on a sustained basis. The events of September 11 really shattered the illusion that the Atlantic and Pacific oceans somehow shielded us from any involvement in some of the major problems of the world.

Recent times have been hard on a lot of people. For example, you have folks in which PTSD symptoms from the Vietnam War that had quieted down for years are now being reawakened. I’m not sure psychiatry has caught up with what’s really going on out there. People are struggling—they want to go back and have a normal life. It’s very hard to do that, because it’s not real easy to just say "let’s just live they way we were." I also think psychiatry is going to continue to struggle with trying to help people deal with "real anxieties" and what are "unreal anxieties." ▪

Dr. Oberstar is a first-year resident at the Harvard Longwood Psychiatry Residency Training Program in Boston.