More on Menninger Move

I am writing in regard to your article in the November 3, 2000, issue on the merger of the Menninger Clinic with Houston-based Baylor College of Medicine and Methodist Health Care System.

I am an alumnus of the Karl Menninger School of Psychiatry and served as a Menninger staff psychiatrist for two years. Since leaving Topeka, I have been attempting to “carry the torch” of the psychodynamic Menninger philosophy in my interactions not only with patients, but also with biologically trained psychiatrists. In my discussions with clinicians in the U.S. and Canada, and to the frustration of us all, the psychiatric standard of care seems to be deteriorating into a uniform “med check,” which means scheduling four to six patients an hour, with referral to psychologists and social workers to “talk to the patients.” I am told that in parts of Canada, out of frustration with results from these “med checks,” the family practitioners and internists are now enrolling in specially designed courses to learn focused psychodynamic psychotherapy so that they can treat their own patients rather than refer to psychiatrists.

The above-mentioned vision of psychiatry is in sharp contrast to an old quotation from William C. Menninger, M.D., which beautifully summarizes the Menninger treatment philosophy and goals:

The Criteria of Emotional Maturity

•  The ability to deal constructively with reality

•  The capacity to adapt to change

•  A relative freedom from symptoms that are produced by tensions and anxieties

•  The capacity to find more satisfaction in giving than receiving

•  The capacity to relate to other people in a consistent manner with mutual satisfaction and helpfulness

•  The capacity to sublimate, to direct one’s instinctive hostile energy into creative and constructive outlets

•  The capacity to love

All over the U.S. and Canada, this kinder, gentler treatment philosophy is gradually eroding under financial pressure and “fact-based” algorithms. As much as we try to reduce scientifically patients into neat, descriptive checklists, they still manage to wriggle out of the categories and frequently remind us of their uniqueness during refreshing (or jarring) meetings, telephone calls, and letters.

I realize that change is often a fine thing, but it is important not to lose sight of appropriate goals. In the “good old days” a competent psychiatrist could be described by the proverb, “A wise man hears one word and understands two.” I worry that soon all subtle nuances will be lost, and we will all be reduced into assembly-line workers in a sausage factory, grinding up the patients and ourselves into interchangeable links.

I sincerely hope that the Menninger merger will prove to be productive and satisfying. However, I fear to the detriment of both patients and clinicians alike that Dr. Will’s philosophy will be lost in the Darwinian pressure to survive in the current economic climate.