1. a month and treat their psychiatric illness and their general medical illness. We don’t make a distinction. You don’t make a
“psych” appointment , or a “ medical” appointment. Instead, we treat the whole person.
Gail: If you had to say what your philosophy of medicine is, how would you sum it up?
Risley: To borrow from a colleague friend of mine , “We meet over the patient’s suffering,” that is really what it is all about.
People don’t need doctors unless they are suffering, and our job is to address that suffering. Whether the job is to treat
their physical pain, or their psychic pain, or to help them integrate into society better, or to help them heal their bones. It is
about caring for their suffering.
Gail: I learned from one of your patients, who highly recommends you, that you manage your own bipolar disorder.
How would you say the bipolar challenge affects your ability to be a psychiatrist?
Risley: I don’t think my illness has ever really impacted my ability to provide patient care. I think it is important that the
world recognize that psychiatric illness can be managed well. I got my diagnosis in medical school. A lot of people I know with
bipolar disorder are self-employed so they can have flexibility in their schedule. A lot of it is about perspective. When you go
from a state, say, of being profoundly depressed, to being really up and being hypo-manic, you begin to realize that the same
situation can be perceived on one day as being bone crushingly depressing and on a different day as being an exhilarating chal-
lenge. To recognize that has been a real gift. To be able to have some perspective and not to just go through life feeling that
I am the pawn of forces greater than I am is a true gift.
Gail: What do you think about the influence of the pharmaceutical industry on the way medicine is practiced?
Risley: The pharmaceutical industry currently is the whipping boy because they are the ones making the most money. When a
lot of money is involved, you have to be really careful with the amount of influence it has. Many doctors I have talked to say,
“Oh well, I know they are big, but that doesn’t influence my prescribing at all.” I think that’s dangerous. They do provide
some education, but they also have a lot of money and influence and I try to be aware of that.
Gail: In your writing you mention the importance of an Interdisciplinary approach to medicine. What does that look like?
Risley: An interdisciplinary approach to medicine is one of those things that is a great concept, but really hard to execute.
Medications don’t make the world a better place. I can give you all the Prozac that’s made and it is not going to improve your
world. What is going to improve your world is how you approach it and how you think about it. The medication has a real role if
you are overcome with symptoms and you can’t do those things you need to make your world a better place. Medication, if
properly used, controls the symptoms well enough so you can do the work you need to get better. The work might be some-
thing internal you do, it might be just having the energy for paying your bills, or it might be getting to a cognitive behavioral
therapy group. It takes all forms, but the medication is a small portion of the care. What we have is a health care delivery
system that says, “Well you are a doctor, you make way too much money, and the only thing we are going to pay you for is writ-
ing those prescriptions.” Healing takes a lot of effort.
Gail: What do you think are some of the important things we need to do as a mental health community to achieve bet-
ter quality of care and life for our members?
Risley: The number one thing is that we have to get rid of the stigma around mental health. One of the things that I am
amused and really heartened by is that we providers have people who walk in the door and say, “ I am having this muscle ache,”
and then we start talking, and the real reason they are here is something else. We have been able to break down that barrier
at the Oasis. Generally speaking, Mental Health services are very separate from the rest of medicine and people in need don’t
know how to access the mental health system. The doctors doing the work don’t have access to the tools they need to make it
easy to make that happen. So people are stuck, and they are stuck really only because we refuse to acknowledge that psychi-
atric illness is cardiac illness, it is cancer, it is foot pain, and everything overlaps. I used to think there were clear cut ill-
nesses. But if somebody has a broken bone, how did they get that broken bone? What kind of behavior were they engaging
in? It may be an insignificant piece of it, or it may be really significant. But until you ask, you do not know.
Gail: Your patients have told me that the Oasis has made psychiatric care very accessible to them. What else do you
see unique about the Oasis?
Risley: What isn’t unique about it? It is a big experiment in a lot of ways. It first struck me when I was at Massage Envy
getting a massage. They have a way of reducing the anxiety about getting a massage. I found a lot of parallels with what peo-
ple experience in accessing psychiatric care to the anxiety that might be provoked around getting massage. I was president
of the Psychiatric Society for about two years.
Continued on page 20