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Half a century ago, I donned an Intern’s Uniform: white pants, white socks, rubber soled shoes, a short white coat with pockets filled with medical tools, a safety pin holding a tourniquet to my chest near the name-tag that said "doctor." It wasn’t just pride in finally achieving something, it was driven more by something else – fear. I didn’t feel like a doctor – more like a lethal imposter soon to be exposed. The uniform and the haggard sleepless look was at first a disguise – the way we interns swathed ourselves in "doctor" until some of it worked its way inside. Over the years in training, the uniform changes: coats get longer; pockets bulge less; the clothing under the coats gets more specific – green scrubs for surgeons, blue scrubs for OB, shirts and ties for Internists, etc. It’s the loud public marker for the gradual process of identity formation.<\/p>\n
In my Internal Medicine days in Memphis, the psychiatry house officers wore white coats except in the mental hospitals ["white coats" had gotten a bad name in mental hospitals]. I didn’t know it then, but the psychiatry residents only wore white coats in the biological programs – radiating up and down the Mississippi River from St. Louis. Years later in Atlanta as a psychiatry resident, I never saw a white coat [except for the animal handlers in our rhesus monkey lab]. Then, in the mid-1980s, our new Chairman showed up wearing a white lab coat, and they began to appear on the faculty and younger residents. Psychiatry was "rejoining" medicine. When Dr. Nemeroff came to Emory several years later, white coats became more the standard. By that time, I was long gone.<\/p>\n
Since wearing white coats didn’t have anything to do with protection from splatter, I guess it was more symbolic – a symbol of "doctor-ness" of some kind. I don’t know if it was about collegiality with other physicians or "medical-ness" with patients or both. But it didn’t suit<\/em> me. It felt contrived. I had done the white coat progression as an Internist followed by three years in the Air Force with two layers of uniform, so I was uniformed out. To be slightly serious for a moment on this weighty topic, my understanding of the relationship between psychiatrist and patient did not include authority<\/em> – symbolic or otherwise – so I was more than happy to shed the mantle and would’ve felt silly putting it back on – true to this day.<\/p>\n This late-summer day’s ramble has an origin, if not a known ending. I was musing about identity. Psychiatrists themselves and the field of psychiatry itself always have had the most ill-defined identity among the medical specialties – except in drama where a hypothesized split between the professional and personal identity makes for endless plot twists – Hannibal Lecter comes quickly to mind. I guess there’s a cartoon identity. One rarely sees a dermatologist in a New Yorker cartoon, but bearded psychiatrists are frequent flyers. We started life as Alienists working in Mental Hospitals and Sanatoriums, then the Victorians brought the consultation rooms into the mix. But the white coated psychopharmacologist hasn’t found a dramatic personae. And I’ve noticed that unlike physicians in other specialties, psychiatrists don’t show up in the direct-to-consumer television ads mumbling about side effects or giving advice, nor are they much the stuff of dramatic presentations. So in the television series In Treatment<\/strong>, it’s back to the old consulting room set [or maybe the group room on Celebrity Rehab<\/strong>]. The psychiatrist as expert psychopharmacologist<\/em> seeing patients for brief medication checks hasn’t caught anyone’s literary fancy. <\/p>\n
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