The following manuscript was published as part of the March 2018 s/p The Match — One Year Later theme issue.
I first heard of Yayoi Kusama last year when her spellbinding exhibit came to the Smithsonian’s Hirshhorn Museum and Sculpture Garden in Washington, D.C. Admittedly late to the international zeitgeist of Kusama, what initially drew me in was her story — a Japanese-American avant-garde artist who suffered from severe mental illness and successfully transformed that suffering into riveting artwork. This past year, at the age of 87, Kusama held simultaneous interactive exhibitions in the United States and in Japan. Since visiting her exhibition last Spring, I’ve become increasingly fascinated with her art and her capacity to channel her illness — growing up in the mountains of Japan, immigrating to the United States with the determination to make it as an artist, and living for long periods of time in a Tokyo voluntary psychiatric unit (where she has her own art studio).
What does any of this have to do with medicine, residency or psychiatry? I’ve spent the past two months interviewing fourth-year medical students who want to become psychiatrists. As associate program director for the adult psychiatry residency at George Washington University, the question of what it takes to be a good psychiatrist is at the forefront of my mind as I go through the application season. This is a question I’ve come back to many times on my own journey in medicine and psychiatry. At each turn, I have a slightly different view. When interviewing aspiring residents, it would be easy to focus solely on academic performance. In the short amount of time I share with residency applicants, it’s crucial to assess competency in all of the rigors that are required of us as physicians — Step scores, pre-clinical coursework, and the like. However, as part of the residency leadership, I find myself consistently mindful of the qualities that are less tangible, and as such, not as easy to catch on a standardized exam.
When describing her art, and her mental illness, Kusama has said, “I am always standing in the middle of the obsession against the passionate accumulation of repetition inside of me and I am lost in this indescribable spell which is holding me.” The discipline of humanistic psychiatry emphasizes our patients’ strengths, and seeks to build hope and resilience, as opposed to confining psychiatric practice solely on diagnosis and symptom control. The parallel between Kusama’s description of her art and her mental illness exemplify this conceptualization of psychiatry.
Being a psychiatrist requires the strength and confidence to face what Kusama calls “this indescribable spell” along with our patients. We need the capacity to feel kindness and gentleness in handling vulnerable corners of our patients’ psyches. It is important that we respect our patients — as Dr. James Griffith, chair of the George Washington University Department of Psychiatry and Behavioral Sciences has described, humanistic psychiatry is more about “doing with” rather than “doing to” a patient. For me, the interview season provides a unique opportunity to “see” psychiatry from the perspective of our applicants. Residency training is a difficult time and we all come to psychiatry with different personal philosophies and motivations for doing this work; these beliefs are what keep us rooted in the profession through the inevitable ups and downs. It is for this reason that it is so important to be aware of what drives us, both as faculty and as trainees. In the day-to-day shuffle of academic and clinical practice, I rarely get the chance for this type of reflective conversation with my colleagues. From November through January, I have the unusual opportunity to have these conversations with future colleagues who will make a mark on our field.
Yayoi Kusama reminds me that it is possible for our patients to soar, not just in spite of their sensitivity, but because of it. I firmly believe that the skills we teach are those needed not only to make good psychiatrists, but also to develop and sustain a fulfilling career in psychiatry.