Back in the saddle

Dr. Samuel Brown recently retired after decades treating Chicoans in crisis. First he practiced psychiatry; then he parlayed his credentials in palliative care to a medical directorship at Butte Home Health & Hospice. But a funny thing happened after he took down his shingle: He missed working, particularly with patients.

So, at age 74, Brown is back in the workforce. This month he became medical director of Enloe Behavioral Health, assuming the post previously held by Dr. Niraj Gupta, who now can focus exclusively on treatment. Brown also will play a major role in the Supportive & Palliative Care program, in development at Enloe for patients who are chronically and/or critically ill.

Brown recently sat down with the CN&R for an interview that showcased the warmth, thoughtfulness and openness that have engendered the admiration of patients and practitioners alike.

CN&R: What brought you to Enloe Behavorial Health after years at hospice?

Brown: I attended a few meetings at Enloe after I retired, and I was so impressed by the change at Enloe. There was this incredible surge of interest in improving the quality of care and the whole Planetree orientation toward the patient. I was really impressed by that and wanted to be a part of it.

Actually, I was going to make a move from hospice to something close to it: They’re in the process of developing a palliative-care in-patient program. It was going to take until January for Dr. Marcia Nelson [Enloe’s vice president for medical affairs] to put it together and present it to the board. In the meantime, things got really busy over here [in Behavioral Health], so [CEO] Mike Wiltermood asked if I would come over here and help Dr. Gupta out.

How does your collaboration with Dr. Gupta work?

I did come over as medical director; he had a terrific volume of patients, so it was very hard for him to fulfill the directorship issues and see all the patients he was seeing. We’re working really well together right now, except the fact that he’s away [on vacation]—I really appreciate him now.

With all the changes in health care, how has it been for you transitioning back to psychiatry?

You never forget how to ride a bike, but this is probably [like] going from a Schwinn to a racing bike—pleasure to an Armstrong experience in the Tour de France. After 12 years in hospice, the change I’ve seen more than anything else in psychiatry is the length of stay that is allowed by the insurance companies has become so short that it puts a tremendous amount of pressure on the physicians and the whole staff to get the person on their way as soon as possible. I’m adjusting to that.

What is your approach to psychiatry?

Partly because I’ve been doing this a long time, my training was very Freudian; that’s the only thing that was around. Recently someone asked me, “What’s the definition of mental health?”—and that’s one thing where Freud was probably right on. He said, “The ability to work and play.” I’ve expanded that to say, “To be able to work and have meaningful relationships that are fulfilling.” We all have neuroses or chinks in our armor, but if you can do those two things, I’d consider you to be in reasonable mental health.

How do you help patients reach that state?

I think that for people who are fairly seriously mentally ill—the ones we see in the hospital—first and foremost I try to have them understand there is a clear biological component to their illness. That’s been a hard sell over the years; the ’90s was the decade of the brain, and what I think we’ve learned about the mechanisms of the brain takes away some of the onus that mental illness is somehow a weakness.

So I think there’s an important place for using pharmacology appropriately—but that’s only half, and sometimes less than half, of the story. Once you get the person to a place where they can think clearly again and analyze situations, after that it becomes facilitating personal growth. There’s way too much emphasis in psychiatry on what’s wrong, so one of my approaches is to always look for what strengths this person has and I start there. It builds confidence and it builds rapport; then we use that to move into areas where there are problems and difficulties.

Are you going to be busier in “retirement” than as a “working man”?

It has turned out that way, but the truth of the matter is both of my grandparents and parents worked well into their 80s, and I think I am following in their footsteps. When I took some time off, to be honest, I really missed work—I don’t know if that’s pathological or not—but most of my life I’ve been in a field where productivity is driven by external pressure. What happens when I try to retire is that’s absent and I don’t feel I’m being productive, and I enjoy that feeling, so I hope my health holds up and that I can continue to work.

At least you’re in a hospital setting, so if your health doesn’t hold up …

I’m right across the street!