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What makes behavioral healthcare leadership so hard?

July 30, 2013
by H. Steven Moffic, MD
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In retrospect, I think one of the reasons I've been so fascinated to blog about successful leaders in other fields, and in other countries, is because of how hard it is to be a leader in behavioral healthcare in the United States. Just think about it for a while. Who comes to mind that is easily identifiable and recognizable as a public leader in our field, no matter what discipline? In my mind, the closest might be the psychologist "Dr. Phil," at least as far as visibility. Maybe our own Ron Manderscheid, Ph.D., in some circles?

I would venture that it's much more common and easier to do so in other fields. Take Drs. Oz and Gupta, surgeons who have achieved prominence as public spokesmen on so many healthcare areas beyond surgery. Take Dr. Drew, who has much notoriety in addiction medicine, whether you believe he is being helpful or not.

On the other hand, in my field of psychiatry, our leaders have been roundly criticized publicly for a premature and less-than-helpful new diagnostic manual, DSM 5. And, if you asked me to name our most famous psychiatrist of recent times, no one comes to mind.

Wouldn't you think, given the importance of behavior for general healthcare, coupled with our presumed expertise in relationships and communication, that some of our leaders would achieve such prominence?

If all this has some veracity, why is it so hard and what, if anything, can or should be done about it?

Perhaps the strongest obstacle is stigma. Not only is mental illness stigmatized, but those trying to treat it are also stigmatized by association. Who wants to be called "crazy"? Not only are patients still called that, our "n" word, but so are psychiatrists and other mental health professionals. A paradoxical compliment to me early in my career was when people said with some surprise: "you seem so normal to be a psychiatrist." It is much less stigmatizing for someone like Dr. Oz to address, as he does, healthy behavior than for a psychiatrist to do so. Whether he understands behavior, and how to change it as well as a psychiatrist, is an entirely different question.

Connected to this stigma may be the so-called "anti-psychiatry" movement. Perhaps first generated by Scientology, such critics have spread to some loved ones of the mentally ill and those dissatisfied with their treatment. For one example, just go to the Mad In America website. Now, that is not to say that such critics have some important things to tell us, but the vehemence and calls for the end of psychiatry can go well beyond constructive criticism. There is nothing comparable in the rest of medicine, no "anti-surgeon" movement, no "anti-neurologists," and so on, though treatment results in some other specialties can be comparable to psychiatry. On the other side of the coin, sometimes the public is fearful that we know more than we do. The fear that we can read their minds is another reason that some of us hesitate to tell people exactly what we do when asked at social occasions. As the saying goes, we can't even seem to win for losing.

Then there is our relatively poor funding. Trying to make do with less, and with less time than is necessary for ethically competent care, is emotionally draining and won't win you many kudos.

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H. Steven Moffic

H. Steven Moffic

H. Steven Moffic, M.D. retired from the clinical practice of psychiatry and his tenured...