Insight Matters
Winter, 2004

Editorial: OPA Psychiatrists Are Nice. Is That A Good Thing?
by Henry A. Nasrallah, M.D.

Several pharmaceutical representatives have told me over the years that they enjoy calling on psychiatrists more than other medical specialists because we are more cordial towards them, give them time to talk, and overall, show them more respect . That prompted me to think about how we psychiatrists are different from our physician colleagues, and why.

OPA members are obviously diverse, yet similar. Our demographics, work-settings, subspecialties, political preferences, and personality structures come in all flavors. But there are common themes that we share. For one thing, we are "nicer" to drug reps, but probably to people in general. We are more accepting, more tolerant, less hostile, and more supportive - all qualities that grease the therapeutic process with our distressed patients. The interesting question is whether those qualities draw us to psychiatry as a career choice or if we develop those qualities by virtue of our training and experience as psychiatrists. It's the old nature vs. nurture controversy, which has scientifically morphed into a debate on the interaction of genes and environment rather than causality by either.

Then, I started wondering: while these warm interpersonal qualities may be adaptive for our daily work with the mentally ill, could they be somehow maladaptive outside our work setting? These musing prompted me to think about us, the OPA members, and how we all behave organizationally in a world replete with challenges, competitors and changes. Do nice people finish last in a do-eat-dog world? Do we coalesce and fight back effectively when faced with major threats to our profession, our incomes, our doctor-patient sanctity, or our freedom to practice medicine without ridiculous constraints? Or does our collective "nice" instinct prompt us to "understand" the motives of those assaulting us, to accept the "complexities of human behavior" and to adopt a "live and let live" stance ?

My observations indicate that psychiatrists within the OPA do not react homogenously to major stresses around them, but that some are vocal fighters, a minority withdraw and become cynical and bitter, and a large segment oscillate between those two extremes. The cynics blame the APA/OPA and abandon ship (alas), while the fighters vigorously deploy their energy in the mother organization. But most members appear to just go on, standing on the side-lines, quietly discontented, and focusing mainly on their day-to-day patient and family obligations. This quiet majority appears "too nice" to fight back or to drop out from the OPA altogether, but they are an inactive majority whose valuable intellect and talent are the OPA's dormant talent and hidden treasure trove of organizational energy.

It is funny that my musings about how pharmaceutical reps' positive comments about us psychiatrists made me drift into the macro-behavioral profile of psychiatrists. But what is not funny is how many OPA members are suffering individually instead of joining hands and re-energizing the OPA into a powerhouse of competent professionals solving problems, asserting themselves, achieving lofty goals, and successfully advocating for their patients and for the noble medical profession of psychiatry.

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