On the afternoon of December 28, 2001, I had an epiphany. It had been a busy day: patients in the morning, a ton of phone calls from residents about vexing patient problems on the C/L service, several journeys on the "Net" to quickly research answers to questions by accessing literature, and a question from a faculty member about a spouse regarding when it is appropriate to use an implantable defibrillator for an arrhythmia (sending me into a frantic literature search in uncharted territory for me). I felt, and I don't often feel this way at work, "lucky" to do what it is I do. I went next door to share the epiphany of my good fortune with my long-term colleague and mentor, Don Kornfeld. Laughing, he responded, "Glad you finally realized it." What occurred to me on that day led me to ask Laura Roberts to consider something in Academic Psychiatry that would illustrate the breadth of what is encompassed in academic psychiatry. She agreed, leading to this part of this issue of the journal. As you will read in the pages that follow, for some of our participants, the realization of being an academic arrived with the invitation to write something for the journal.

The core of academic psychiatry is people who struggle to understand through self-study, collaboration, and personal instruction in order to offer the best clinical experience to patients and help others to do the same. What I also realized on that day was that people were often talking about the demise of academic psychiatry. Training programs were increasingly pressured to have residents do more and more clinical work, leaving little time for study, reflection, and discussion. It seemed to me that "academic" had come to be defined as psychopharmacology or biological research, and the power in institutions was not in the hands of the people devoted to education but belonged, instead, to those who brought in the big dollars, no matter how little they actually contributed to the educational process. I am lucky to have been mentored by some of the greats in psychiatry, but I know that many of the names in the field now spend little or no time involved in education. Thus for me, academic requires that the individual spend part of the workweek in the process of education. This activity must be a central part of the person's identity as a psychiatrist.

What you will read in the following pages are brief diaries from a group of physicians who consented to contribute a "day in the life" of an academic psychiatrist. Dr. Roberts and I invited a group of people of varying academic ranks to contribute a brief description of a typical day, trusting that each individual would give it a personal touch. These are not the only academic psychiatrists in the world. These are a few of the academic psychiatrists in the world. The variety among the responses is remarkable. You will read how they combine clinical, administrative, educational (self and other) activities, along with having real lives and responsibilities to their families. I am struck by how hard they work. They get up early, they have multiple responsibilities, and they, often quite literally, rush from one activity to another. Most of the people work at home in the evenings and/or on weekends. There are several themes that run through the writings, and almost every single person commented that there is no typical day. This may be the hallmark of the modern academic psychiatrist (i.e., multiple responsibilities that are very different in nature). All of them see patients, no matter what else they do. Thus, another hallmark of those in academics is the foundation of clinical practice. The higher up on the administrative ladder one is, the more of one's time appears to be spent in meetings and problem solving, and the less of one's time is spent in educating. Balancing work and home appears as an issue for most everyone and is neither gender nor age specific.

To start off this special section, I thought I would share a bit about me and how I ended up in a place to have that epiphany. At the age of 11, following a dream about Ben Casey, I decided to become a neurosurgeon. It was obvious to me at 11 that I idolized him and the role of the doctor who healed using his skills. It was not obvious to me that I was influenced by positive and negative Oedipal identifications, as my father was a clinical psychologist. Over the next few years, I realized I did not possess the physical talent to become a neurosurgeon. The next best choice was to become a psychiatrist. I saw psychiatry as an endeavor that used the physician's skills directly, rather than using the scalpel to effect change. While many other professions attracted me over the years, particularly artistic endeavors, medicine kept exerting a powerful pull. This was aided by my mother's rejoinders that one could always have avocations WHILE having a career as a physician. As a teenager she helped me get summer jobs in hospitals and taught me how to perform blood gas analysis in the days when this was done by hand. As we all know from our experience, to get into medical school I had to have done reasonably well in college. As I look back now, it is remarkable how different my performance was in graduate and then medical school from that in high school and college. Suddenly the level of effort was matched by academic success in a way that I had never experienced before. What was again obvious, though not to me, was that I did well because I loved what I was doing. When I applied for a scholarship for medical school, I was asked for my goals. Unaware of the naïve grandiosity and poor predictive value of the statement, I wrote on the application, "To become a psychoanalyst and to cure schizophrenia." As I was 19 years old at the time, I can only laugh tenderly at myself.

Why relate this to you as a special feature focused on being an academic psychiatrist in Academic Psychiatry? In pursing a career in medicine, I found that I was pulled in many directions. My abandoning neurosurgery was confirmed when I discovered I could not think in three dimensions. I watched the neuroanatomist draw with both hands simultaneously and talk about brain structures in three dimensions, but I saw only a blackboard image. (It was not until 1978, while studying for the boards, that the 3-D structure of the brain made sense to me. The lesson here should have been obvious, but I was too anxious about passing the boards to pay attention, i.e., that learning something requires relevance of the information.) In medical school I loved internal medicine, particularly immunology. I loved pediatrics too, but recognized that my personal history of a long hospitalization with polio as a child rendered me emotionally too closely identified with the patients. My colleagues and mentors repeatedly questioned why I would consider giving up real medicine for psychiatry. Explaining that psychiatry offered a challenge not available in medicine often fell on deaf ears.

In all of graduate school, medical school, internship, and through my residency, it never occurred to me that part of the thrill was the process of learning in order to use the knowledge. Part of the use of the knowledge was the excitement of teaching. I always was teaching somebody something: one of my sisters something about science, a friend who was struggling with a subject in college or medical school, as a hired tutor in a program in medical school, or self-defense at the "Y." There was the challenge of understanding something in a way that it could be discussed with someone else. There was often the frustration that teachers did not do this, leaving me feeling confused and inadequate. This was something I tried to avoid in being an educator, but knew that I frequently failed when I tried to "teach," instead of work with others to help them learn.

One day, years after I finished the residency, the fellowships, the analytic training, and the brief foray into traditional psychiatric research, I discovered that I had become a psychiatric educator. Not surprisingly for someone who loved medicine and psychiatry, I became a C/L psychiatrist. That I became an educator was a surprise to me, though I see how likely it was to occur. I spend my days immersed in what is the greatest profession on earth, academic psychiatry. Each morning and late afternoon, I see patients in psychotherapy/psychoanalysis and prescribe medications for my own patients and other therapist's patients who are sent to me for consultation. Over the years, I have changed my early morning schedule to be home when everyone else awakens. I still get up early to have time to read the New York Times in quiet, but I am now the human alarm clock for the family. On days when I do not return until after 11:00 P.M., the morning is the only opportunity to see my family. During the bulk of each day, I run a consultation-liaison service at a tertiary care medical center. What that means is that I see patients, but mostly I have the pleasure of working with psychiatric and nonpsychiatric residents. On an average day, I get at least a dozen telephone calls (it can be much, much more) from residents to discuss cases. I am available to join a resident to see a patient at the bedside, either a resident I am personally supervising or any of the residents rotating on the C/L service. When not in the office, I carry a pager so the residents can reach me, or I'll carry a cell phone when out of beeper range. In more than 20 years of educating residents in psychiatry I have never received a call that seemed unnecessary. Being on-call can be a terribly lonely experience, and I relish the thought that being available might make it a tad less lonely and a bit more educational for the resident. Typically, I talk to several colleagues from my own and other institutions about problematic cases, often focused on difficult issues of psychotherapy or psychopharmacology. I round with the residents three times each week, discussing cases and trying to focus an academic discussion around the case material. There are various lectures to a variety of residents, occupational therapy (OT) or physical therapy (PT) students, grand rounds at places I can drive to, or impromptu discussions on a medical/surgical ward about topics related to a consultation. That seems like the one place where you can get the attention of the house staff, imparting pearls you hope they will remember for the next patient.

I meet with a fellow in C/L weekly to go over cases, supervise on supervision, and to work on a writing project. There are a reasonable number of requests each year to write chapters in books or write review articles. Several years ago, I realized it was not fun to write alone, and thus I have collaborated, in most everything I write, with a junior colleague. I did not learn how to write until I had to write a chapter with a famous senior faculty member soon after graduating from the residency. Though having my writing torn apart and harshly criticized was a painful experience, I kept reminding myself that the goal was to learn how to write scientifically. The way I repay and what I feel ended up being a gift is my working with younger colleagues in writing, trying to remember how painful it can be to be criticized, and trying hard to offer critique. In order not to feel completely overwhelmed by anxiety to perform all of these tasks, I read as much as I can. In this regard, the resources available to me are indispensable. I have two wonderful libraries and access, via my computers, to a wealth of information (I have a computer at the hospital, in my office, and at home). I am one of those people for whom computers and the Internet make my academic career possible. Somewhere in this I do what I call "gentlemanly research," which means I try to answer questions I have about things. The good part about that is it can be done without funding. The bad part about this is it can be done without funding. I have been funded twice in my career. The first time was to write a training video about stigma and Acquired Immune Deficiency Syndrome (AIDS), and I did a project demonstrating a change in students' attitudes. The second time was to produce a CD-ROM for families with patients in the intensive care unit (ICU). In keeping with Mark Twain's adage about the correlation of a parent's knowledge and the age of the child, I finally agree with the intelligence of my mother's rejoinders about artistic pursuits and a career in medicine.

My institution has been supportive of my involvement in national organizations such as the American Psychiatric Association (APA), the Association for Academic Psychiatry (AAP), and the Academy of Psychosomatic Medicine (APM). This puts me in contact with some of the most interesting people in the world at meetings and at home. E-mail now makes this fantastic sounding activity a reality. Attending meetings has exposed me to things of which I had no previous knowledge (e.g., dopamine receptors, evolutionary biology, and the challenge of educating as an "expert" being the ones that stand out). Through organizational involvement, I face the challenge of taking education from the local setting to the large-scale as part of program committees. Working on program committees has given me the opportunity to spend time with several of the organizational leaders in our field. A little-known fact is that there is a tremendous learning experience afforded to those who get to work closely with presidents of national organizations.

Academic psychiatry may be under great pressure, but it cannot be permitted to disappear. Fortunately, there will always be remarkable people in academics, like those who have opened their lives to us for this "Day in the Life" series. There will always be physicians who will employ their talents to guide others in learning the craft of psychiatry. The students will not always be psychiatrists, which is crucial in keeping the field grounded in the reality that most of the treatment for psychiatric disorders is not performed by psychiatrists. My goal in putting together this section of Academic Psychiatry is to demonstrate that they are we (i.e., that readers of the journal realize that many of us are academics). I have the fantasy that some who read these "Day in the Life" briefs will become enthralled by what they read and will choose to join the ranks of those of us in this noble, creative, flexible, and exciting career. I know for a fact that you will all be amazed as you peer into a day in the life of each of our contributors. We must all thank them for taking the time to share themselves with us and for the inspiration such intimacy engenders.