Bowling Alone: The Collapse and Revival of American
by: Robert D. Putnam
© 2000 Simon & Schuster
Reviewed by: Joseph M. Schwartz, MD
President, Maryland Psychiatric Society
Robert Putnam proposes in his provocative and controversial
book Bowling Alone that Americans are no longer joining organizations
as they had in past decades. The resulting isolation has potential
profound negative implications for individuals and for society
in general. For example, he presents data supporting the conclusion
that people who do not belong to any groups have twice the
one-year mortality of people who join just one. He correlates
the progressive isolationism of Americans with a breakdown
in civil society. We are becoming less involved and less caring.
His ideas are of interest to me for two reasons. First,
as a psychiatrist, I am interested in people's social interactions
and how their social networks help alleviate distress and
demoralization. Second, as the president of the MPS, I am
interested in explaining why only approximately half of eligible
psychiatrists join our organization. [This statistic is applicable
to WPS as well. Ed.] There has been a decline in membership
in most professional societies as well as religious organizations,
political organizations and unions. Why is this?
Attempts by organized psychiatry to woo members by focusing
on tangible membership benefits have not been successful.
People are motivated by self-interest, but they realize that
often the cost of membership in a society exceeds the monetary
value of any tangible benefits. Members who join merely to
receive tangible benefits tend not to participate further
than just paying dues. Active members, on the other hand,
seem to recognize the intangible benefits of membership including
the maintenance of our professional identity, the representation
of our profession to others, and the camaraderie and fellowship
that comes from belonging and participating.
Organized psychiatry is fighting an uphill battle against
the continuing trend of non-participation. The implications
of the general trend of non-participation for society are
worrisome. The implications for psychiatry and individual
psychiatrists are dire. We need a critical mass of active
members in order to demonstrate the legitimacy of our organization,
and to provide enough people to do the necessary work. If
you are a member who is not yet actively participating, please
join a committee. If you know psychiatrists who aren't members,
encourage them to join. Tell them they'll live longer.
Blink: The Power of Thinking Without Thinking
by: Malcolm Gladwell
Little, Brown and Company, 288 pages, $26.00
Reviewed by Lise Van Susteren, MD
Blink - it's hot right now - on the NYTIMES and other best
seller lists and with good reason. It's an easy read and a
convincing report on the impact of the unconscious. For skeptical
souls, it is also a convincing report that the unconscious
EXISTS. In the first weeks after I read it, I referred it
to several of my patients to bolster my "sermons"
about how the unconscious often "has the wheel"
and needs to be examined in order to figure out why we do
some of the things we do. It proved to be good ammunition.
One of my patients couldn't figure out why the shark partners
in the law firm didn't give him more of the money he deserved.
Taking a page out of Gladwell's book, I was easily able to
convince him that his nonverbal communication - deflated demeanor
at meetings, his ambivalence about coming across as competent,
etc. - signaled that he wasn't going to demand anything despite
putting in many more hours than the partners, who earned four
times what he was paid. The next day he gave up his victim
role (at least temporarily) and phoned the managing partner.
Blink tells us not to split hairs, to go with our gut. Most
of our agonizing over decisions is a waste of time - and can
even lead us astray. However, Gladwell is referring to what
we psychiatrists are experts on. Truth emanating from the
unconscious is really a split second integration of a lot
of knowledge and experience. Our expertise may simply be what
we like or find comfortable. Although he brought it up, Gladwell
should protect his readers a bit more by warning that all
split second decisions may not be good. A snap decision in
the wrong hands can get a person into trouble; the unwary
reader may not hear it that way. There is a danger in believing
that your instincts are always right.
Gladwell's useful message is that the unconscious is full
of valuable data. The message for our patients (and us) is
that there is an art to managing that information. Gladwell
discusses hidden bias and other pitfalls. The savvy person
who picks up on signals from the unconscious would do well
to welcome the "data" springing from the unconscious
but refer it to the thinking part of our brain - examining
it for snap judgments that lack balance, practicality or simply
show patterns of responses that reflect the reality of early
life experiences, not the present ones. For sorting all this
out a good psychiatrist should come in handy.