Floyd P. Garrett, M.D.
Interview and Frequently Asked Questions

Initially my desire was to be a general practitioner. In medical school I thought I wanted to pursue Internal Medicine and sub-specialize in cardiology. During my internship I began to realize that this was not really what I wanted, so I joined the U.S. Navy during the Viet Nam Conflict and spent two years assigned to the Marines as a General Medical Officer. Only when I was just about to get out of the service did I finally realize -or admit to myself- that I just did not want to return to an Internal Medicine residency. So I decided to "try a year of psychiatry residency" to see how I liked it. And I suppose I must have liked it - for here I am, thirty years later, still practicing psychiatry!

 

Q. What was it about psychiatry that interested you enough to "try a year" of residency in it?

Like most medical students and interns of my day, I had regarded psychiatry and psychiatrists as the lowest of the low in terms of medical specialties. We laughed at and made fun of the whole field, looked down on those who tried, usually without success, to teach us something about it, and viewed the subject of emotions and medical practice as unscientific and absurd. Psychiatrists, we thought, were weirdos themselves, doctors who for some reason couldn't live up to the strenuous requirements of the medical calling and who therefore bailed out and became the equivalent of glorified social workers. We wanted to deal with hard data, lab tests, physical findings, X-rays and other topics with which we felt comfortable. Underneath all of this contempt and criticism of psychiatry, of course, there was a great deal of fear that there might really be something to it after all, and that we ourselves might not be as well-adjusted or sane as we liked to tell ourselves.

My actual interest in psychiatry crystallized during my last six months on active duty, when I was a general medical officer at a Marine Corps dispensary on Okinawa. Many of our patients had personal problems and concerns that they had no place else to talk about. And I was quite surprised to discover for myself, almost by accident and basically because I was bored and had nothing else to do, that just listening to people could help them to become better. I had of course been told that before. But I didn't believe it until I saw it myself.

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Q. It sounds like your original desire to be a general practitioner underwent some drastic changes.

Considering how I made my original career choice, it could hardly have been otherwise. For my determination to become a physician began when I was eleven or twelve years old. It was derived chiefly from seeing some TV re-runs of "Dr. Kildare" movies, the original ones, starring Lionel Barrymore as Dr. Gillespie and Lew Ayres or Van Johnson as young Doctor Kildare. Nobody in my family was a physician. I had no idea what I was getting into. It wasn't like it was in the movies.

 

Q. If you had to do it all over again. . .?

What a frightening thought! I'm not sure I could. I definitely would not try. I suppose if I were given a second shot I would aim for something like a college professor in an obscure institution somewhere. Of course that would bring its own set of problems. All in all, I'm happy matters have turned out as they have. I can't think of anything I'd really rather be doing at this stage of my life and career.

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Q. What interests you today about the practice of psychiatry?

Pretty much the same thing that interested me in the beginning: How, under the right circumstances, people are able to change and grow. Since I began my training in 1971, psychiatry has become far more concerned with medications and brain chemistry than it was then. There have been some amazing advances in this regard - and more are on the way. But what really interests me is the human or psychological dimension - the so-called "talking cure."

 

That's not quite what I said! I said that what really interests me is the human or psychological dimension - not that I don't think medications are helpful. It's not a matter of Either-Or but of Both-And. Many conditions benefit from appropriate medications, although of course many do not require medication. It's a very individual thing. When medications are needed and used correctly, they actually assist the individual in understanding and working through whatever problems they may have.

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Q. But don't tranquilizers just cover up a person's real problems?

Not if they are prescribed properly and taken correctly!  Of course if a person is given or takes too much of a medication, or takes it for the wrong reason, there can be negative results - including making it harder for them to know what is going on in themselves. But the other side of the coin is the person who is simply too anxious or depressed to be able to think straight for very long. In situations like that, relieving the anxiety and depression with the right medicines can actually help the person to identify and deal with what is bothering them. In these circumstances medication is the first step in the larger process of understanding and changing themselves and their environment.

 

Q. What are the most common problems you see in your practice?

I suppose they could all be put under the general heading of "unhappiness," though the reasons for that unhappiness vary considerably. Some form of depression is undoubtedly the most common condition most private psychiatrists encounter. Naturally this will vary according to the type of practice and the kinds of patients one deals with. But depression, whether biochemical in origin, psychological, or as often happens, both, is the commonest finding.

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Q. What causes depression?

Lots of things, and sometimes several things at the same time. Depression is a very confusing word and can mean different things at different times. It refers both to a primary condition and to a symptom - as well as to a mood or state of mind that may or may not be abnormal. On top of that, it is perfectly possible to be depressed and not even know it. There have been many classifications of depression in an attempt to end the confusion. But for the average person, this has only added to the problem. Taken alone and in isolation, the word depression has practically no useful meaning in psychiatry. It must be located and understood within the broader context of a specific individual to be meaningful.

 

Q. What is a nervous breakdown?

Another term that means whatever the person using it chooses it to mean. Nervous breakdown is even less useful than depression, since there is no agreed upon definition whatever of the phrase. It is not a category or concept used by psychiatrists at all. In common speech it refers to a severe emotional crisis of some kind. It's interesting that so many people seem to believe that it actually means something more definite than this - so much so that they may at times fear undergoing this quite harmless and imaginary phantom, the dreaded nervous breakdown. Probably the most common thing that is meant when this term is used by laypersons is moderate to severe clinical depression. But it literally means whatever the person using it chooses it to mean. It is not useful.

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Q. Do you consider yourself a Freudian?

Only in the sense that everyone in our culture is a Freudian - whether they realize it or not. Freud's way of thinking and many of his insights have become an essential part of who we are today. It is literally unthinkable to suppose that we could do without Freud. Freud was a pioneer who was mistaken about many things, sometimes in a particularly embarrassing manner when viewed from our modern perspective. But what he got right, he got spectacularly right. He was a modern Archimedes who found a place to stand from which he moved our world. But it has been a long time since most psychiatrists took his doctrines of libido(the sexual etiology of all neuroses) or the Oedipus Complex seriously as universal explanations.

 

Q. Is it true that psychiatrists have their own share of emotional difficulties?

Not just psychiatrists, but absolutely everybody has their share of emotional difficulties! Nobody gets through life unscathed - despite how it might look from a distance or from the outside. There simply are no normal people - if normal means to be free of personal problems, stress and conflict. And although every individual is to some degree different, I think it is probably safe to say that, in general, people attracted to the mental health professions as a career probably have experienced more distress than average in this regard. This is probably a result of being more sensitive to begin with, as well as, in many cases, some difficult times in childhood. I certainly fit this description.

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Q. Are there any books you'd recommend for people interested in psychiatry?

Almost all of the popular self-help titles have something of value in them. We've tried to list some of our favorites at appropriate places elsewhere in the web site. Many of the links to outside sites also contain suggested reading material on various mental health topics. People seem to vary tremendously in their ability to benefit from reading such books, with some people swearing that such reading has changed their lives, and others, the majority, either not reading them at all, or not noticing much benefit from doing so. If I had to pick one book to read for general self-understanding and personal growth, it would be Neurosis and Human Growth: The Struggle Toward Self-Realization, by Karen Horney M.D. This work deals with some basic, probably universal human Dilemnas that everybody faces - regardless of specific diagnosis. But in general, I have not been too much impressed with the beneficial results of reading in these matters. Sometimes reading itself is an attempt to avoid or escape from difficult relationship issues - or to try to get by without letting others in on one's problems. Reading seems to work best when there is someone around to discuss things with.

 

Q. And finally, do you have any words of wisdom to impart after three decades of clinical work?

The fundamental human problem seems to be that of wanting, sometimes in fact demanding to have one's cake and eat it too. That is, we seem almost hopelessly inclined as a species to desire to have things and circumstances that are either inherently contradictory(for example, complete freedom and complete security at the same time) or are, for some more particular reason, impossible to obtain(as in the case of a relationship which has many good qualities but is not 100% to our liking 100% of the time). Learning to recognize and deal with the fact that having one's cake and eating it too is not possible is probably the main task we all face in coming to a healthier and happier adjustment to life.

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