Couch Trip 2002--Dr. Freud, Meet Mr. Greenspan

For the last century, economists have borrowed heavily from the mental health field in describing dramatic economic phenomena of the last 300 years. Who can forget the “depression” of the 1930s or the “panic” in sell-offs in 1987 or even the tulip “mania” of 1636?

To this lexicon we have added “irrational exuberance,” a term that Federal Reserve Board Chairman Alan Greenspan made famous but that economist Robert Shiller was instrumental in coining--with the help of his wife, a clinical psychologist.

Recently, Charles Kindleberger’s “Manias, Panics, and Crashes,” a historical treatise on financial crises, has become virtually a de rigueur text for psychiatrists. Indeed, in this natural cross-fertilization between psychiatry and economics, psychiatry has been the true winner by renewing itself through a host of fresh metaphors.

Economic ideas have begun to pervade the psychiatric interview. For example, when patients come in for consultations, I find myself borrowing some of the terminology of my financial colleagues. I might say to a patient, “Given that your marriage stinks, that you hate your career track, that you barely have a communicative relationship with your children, I think your prior exuberance was irrational. Now you are simply going through a ‘correction.’ ”

I go on to explain the concept of vicious circles. Having hit some of life’s rough spots, I explain, you have stopped investing in yourself. A period of “growth and expansion” can replace the previous contractions in one’s development.

Just as countries must go through major structural changes to stem economic crises, individuals in the midst of personal crises must recognize their need for structural changes in their lives. It helps to employ the language of the International Monetary Fund.

“You have used up all your emotional reserves,” I might tell certain patients. Or, “There is absolutely no transparency in your internal affairs.”

Recently, the concept of a double-dip recession has become a useful diagnostic term. Occasionally one encounters individuals who, beset by new traumas, experience a recurrence of depression after an initial fragile recovery.

Patients often inquire about their long-term prognosis. “In the long run, we’re all dead,” I assure them, quoting from my favorite psychiatric mentor, John Maynard Keynes.

So, why do I engage in this conciliation of economics and psychiatry? To reduce any remaining stigma about psychological care. If countries, stock markets and galaxies can experience vicious spirals, then certainly we mortals can acknowledge our similar tendencies.

We are all muddling through, Greenspan and George W. Bush as much as the rest of us. A tweak here, a tweak there seems all we can do, but these tweaks can have a significant effect on our dealings with those momentous and sometimes vicious circles of life.

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Paul Steinberg is acting director of the Georgetown University Counseling and Psychiatric Service.