Whenever I describe my career path to people, they seem a little perplexed. “Journalism to psychiatry?” they say. “How’d that happen?” I admit, it isn’t a common path. Young people have always left journalism, of course. Many get tired of eking out a living as a freelancer and seek something more stable. Some find that they don’t like the grind of constantly producing copy. And then there are those who are talented and thriving but nevertheless seek greener pastures. In my brief time in journalism, I saw two very talented twentysomething colleagues leave for law school and another depart for graduate school and then become a successful fiction writer.
But leaving journalism to enter a scientific field such as medicine is unusual. In fact, if you’d told me in college that several years later I would walk away from a budding career in journalism, I would have been surprised. Like most aspiring journalists, I had always been interested in politics and policy, and I wanted to be in the thick of it. Like many before me, I wrote for my college newspaper and parlayed my clips into internships and finally a post-college job. The job was at Slate. I was very fortunate.
But there was something amiss. I liked my job in many ways, but I was getting tired of covering daily politics. It was the summer of 2001, and I was writing a news-summary column for Slate called “The Week/The Spin.” As this assignment compelled me to write about what was on the front pages, I found myself writing every day about the Chandra Levy-Gary Condit affair, one of those gossipy stories that people in Washington, D.C., occupy themselves with in slow news seasons. I found it draining.
Of course, burnout from the steady stream of dish from inside the Beltway didn’t require that I leave my profession. I could have carved out a new beat for myself. But there was something else going on. I had always been fascinated with folks who have trouble making it in society—with the people who mutter to themselves on the street; with the plucky outcasts in the photos of Diane Arbus; with the neurotic, obsessive narrators of Philip Roth novels; and with everyday people who struggle with grief and anger and trauma and loss.
I also had some personal connections to mental illness and its treatment. My paternal grandmother had been permanently institutionalized with schizophrenia when my father was 7 years old. Although I didn’t know her well, the knowledge that an unfathomable insanity had robbed my father of his mother had a strong effect on me. Moreover, my own experiences in psychotherapy had a profound effect on the way I viewed the world. It allowed me to be more open to new opportunities and to people and provided me with tools that helped me continue to grow, long after the treatment ended. Over time, it made me more flexible and optimistic.
It also made me want to practice the treatment myself. I was 26 years old, and I had been working in journalism for several years. I wasn’t sure I wanted to make a career out of mental health care, but I figured that I would regret it if I didn’t at least explore the option. I started by dipping my toe in the water—I became a weekly volunteer at both a suicide hotline and a homeless shelter. About six months later, I took the plunge. I quit my job at Slate and took a full-time position as a floor worker at the shelter where I had been volunteering. I didn’t have any formal qualifications, but I didn’t really need any: The position paid $10 an hour and didn’t require a college degree.
This position was everything you might expect. I dealt with the mundane—homeless people bickering over plastic folding chairs—to the profound—people withdrawing from heroin on a mattress in a corner, or lying stiff and cold on a bunk bed after morning wake-up, having overdosed the previous night. (You can read a five-day diary I wrote for Slate while working this job.) Of course, the job was tough and caused rapid burnout. After about a year, I managed to secure a position as a case manager at a community mental health clinic. I now had regular working hours and a caseload of patients to follow up with. But I had no formal training in mental health, was making just $12 an hour, and with only a bachelor’s degree in political science, I had hit my career ceiling as a mental-health practitioner.
Ah, the degree. As a job requirement, this was new ground for me. In the world of journalism, degrees are emphasized about as much as clear, jargon-free prose is in medical records. When I was an editorial intern at a magazine in college, recent j-school grads would send in résumés looking to be hired. They thought their degree gave them a leg up, but many editors are disdainful of this academic professionalization of what, to them, is a trade. In journalism, you’re only as good as your clips. In the field of health care, the degree means nearly everything. Degrees determine “scope of practice”—who is allowed to perform which treatments—and who’s the boss of whom in a hospital ward or a clinic.
The medical profession—and doctors love to think of themselves as professionals, never as tradesmen—emphasizes the importance not just of degrees, but of hierarchy. In journalism, a certain combination of talent, hard work, and luck can land you a very good job at a very young age. In a way, that had been my story—I had been hired for a full-time staff job at Slate immediately after leaving college, which was an enviable “get” for a young, ambitious writer. But in health care, no amount of talent and hustle will let you leapfrog the organizational chart. A crack surgical intern is still just an intern, and until he completes his five (or six or seven) years of residency, he will never wield much influence in his field, no matter how precocious he may be.
So, as a social worker at a community mental health clinic, I had a decision to make. I knew that I liked working with the mentally ill. I enjoyed their stories, I felt privileged by the intimacy they granted me, I could sit with their pain, and I felt I had the ability at least to begin to make things better. But, on a clinical level, I needed some real training. I had gotten as far as I was going to get with on-the-job experience, clinical intuition, and my own reading. And on a practical level, I needed some qualifications to put on my résumé.
My choices were a master’s degree in social work, a master’s- or doctoral-level psychology degree, or an M.D. The master’s-level choices didn’t really tempt me. Those degrees were useful for private-practice therapists, but I would be excluded from certain research and administrative career paths. As a former journalist unaccustomed to such hierarchical restrictions, I chafed at this. I didn’t want my degree to limit what I could do with my career.
A psychology Ph.D. or Psy.D. had its appeal, but ultimately I chose the long and winding path—the M.D. I was influenced by many things. For one, my therapist in college had been a psychiatrist, and I held him in high esteem. I also liked the practical bent of medical training. Given the choice between spending five to seven years in a narrowly focused doctoral program, burdened with an esoteric thesis, or spending a similar amount of time learning about treatments for all forms of bodily illness, I preferred the latter. But mostly I knew that much of what interested me about the field of mental health was the interplay between the psyche and the body, between the “science” of psychopharmacology and the “art” of psychotherapy, between the mind and the brain. At the end of the day, psychiatry is the discipline that truly allows one to straddle these multiple ways of looking at a person’s mental suffering.