RETIREMENT

The Final Months

I have been planning my retirement for a while and was fairly certain I wanted to retire by the end of 2024. At the beginning of the year, I informed the medical director of the clinic where I work about my intention, but I didn’t inform anyone else until six months later. I thought this would be the right time to give my patients and colleagues notice, so they would have enough time to prepare for the transition.

A letter was sent to all of the patients in my practice announcing my upcoming retirement in November 2024. I had anticipated that my patients would be quite distressed by this news, but that was not the case. I was pleasantly surprised when, instead of expressing sadness or disappointment, they congratulated me and told me that my retirement was well-deserved. Many of them were aware that I have been working in the psychiatric field for the past 44 years, and they felt that I had more than paid my dues and earned the right to retire. Their understanding was unexpected, which relieved the twinges of guilt I felt in “abandoning” them.

Of course, the logistical factors involved in transitioning patients to new psychiatric providers are quite significant. Many of my patients I have treated for an extended period, often 4-5 years. Disrupting continuity of care can be challenging, especially since finding new providers that are a good fit - in terms of location, availability, treatment approach, etc. - is quite difficult in this area.

To help facilitate the transition, I have taken the proactive step of providing my patients with a list of psychiatrists and psychiatric nurse practitioners practicing in the region. At the minimum, this gives them a starting point to begin searching and reaching out to potential new providers.

From Head to Toe

While the psychiatric work has been immensely rewarding and meaningful, it has also been intensely demanding, both emotionally and intellectually. I have reached a point where I feel the need to “shift gears” and jump into post-psychiatric waters and explore what is on the other side of the rainbow.

Being a psychiatrist and a physician has been a way of my life, not just a means of earning money or acquiring respectable social status. It is a role that has significantly influenced who I am, my identity, and how others perceive me. As a psychiatrist, I have not only provided care and guidance to my patients but have also been deeply involved in exploring the human psyche. This rare privilege has shaped my sense of purpose, responsibility, and interaction with the world.

In my professional autobiography, Sculpting of a Psychiatrist, I have chronicled the intricacies of my path in the field of psychiatry (1). To illustrate my approach to the profession, I declared in the book that I have been a psychiatrist "from head to toe, front and back, inside and out." This phrase encapsulates my immersion in the field.

In the epilogue of the above-mentioned book, in broad strokes, I listed that I have worked in the academic settings of two universities, combining administrative, clinical, and research duties. I have worked in two countries and diverse settings, treating countless patients, and mentoring and teaching students, trainees in psychiatry, colleagues, and others. I have gained recognition both internally and externally. I have successfully navigated issues, disappointments, and other challenges. Moreover, I have continuously expanded and deepened my knowledge, always striving to improve.

In this sense, I feel a sense of completion. My current sculpture, to use the metaphor from the book Sculpting of a Psychiatrist, is finished. Now, it is time for me to begin sculpting a new one.

Shifting Gears

Retirement marks a significant shift, transitioning from a life defined by professional responsibilities and daily work routines to one of self-discovery and evolving identity. Creating this new identity will be an interesting process, one I am both slightly apprehensive of, but mostly excited about.

This will be my second retirement. In 2018, I retired from the full-time position as the head of the mental health department in the VA healthcare system. The leadership of the hospital and the mental health department organized a well-attended retirement party for me, complete with balloons, speeches, photos, food, and other festive touches. It was a happy event, as I was eager to be relieved of the responsibilities of that demanding job. I used newly acquired free time to prepare my household for the move to Arizona, which occurred a year after my first retirement.

In 2019, I started working at Tribe Wellness Clinic in Sedona, Arizona. This marked my return to direct patient care after my previous administrative role at the VA in Fargo, North Dakota. At the time, Tribe Wellness was a relatively new enterprise - a clinic that combined traditional psychiatric care with a holistic approach to promote wellness and the integration of mind, body, and spirit.

I was in a community of practitioners who organized and practiced daily meditation, yoga, reiki, hypnotherapy, astrological readings, sound healings, and many other tried and tested or esoteric healing arts techniques. I have greatly enjoyed my work alongside this talented group of providers and support staff.

However, the past few years have presented multiple challenges, particularly related to the COVID-19 pandemic. This forced me and others to quickly adapt to a new modality - telehealth. Transitioning to remote care was a novel experience for me, but over the period, I have learned how to effectively support patients and collaborate with other care providers predominantly using video platforms.

Despite the difficulties, I remain very grateful for the opportunity and experience of working at Tribe Wellness. It has allowed me to expand my skill set and work within an integrative, community-oriented model of care.

Retirement Indeed

Retirement is a stage in life that requires finding a new purpose and meaning. Each person experiences it uniquely, shaped by their past roles and future aspirations. For me, retirement means looking beyond the familiar horizon defined by the lifestyle of a physician.

Over the past five years, even though I have officially worked only two days a week, I have maintained daily involvement with my patients. This included responding to emails, processing refill requests, accommodating urgent appointments, and making telephone calls.

As I step away from the demands of my profession, I look forward to relaxing both mentally and physically. This will open me up to the fresh energy flows surrounding my existence, encouraging a reconnection with parts of myself that may have been tacked away.

Adjusting to a new life will be a process filled with possibilities. It will be a period of discovery beyond the confines of my medical career—a new beginning, an opportunity to explore, accept, deepen, and embrace whatever enriches and expands a purpose-driven life.

A Brief Reflection on My Father’s Retirement

As I approach my retirement, my thoughts turn to my father, who retired from his military career 50 years ago at the age of 50. I never fully understood if his retirement was voluntary or forced—probably the latter. Unable to stop working, he found another job, which he kept until our family moved to a different city. This move compelled him to leave that job, and he subsequently suffered from severe depression. My brother believes that this depression was due to both the geographical move and the loss of his job. My father needed to be busy, contributing, helping others, and engaging socially. Like many men, his identity and sense of purpose were closely tied to his work. Losing this led to feelings of loss, purposelessness, and depression (2).

Work often serves as a significant source of social interaction, offering daily engagement with colleagues and a sense of community. Upon retirement, the absence of these regular interactions can lead to feelings of isolation and loneliness. This transition is particularly challenging for those who have relied heavily on workplace relationships for social support. According to the Harvard Study of Adult Development, maintaining social connections is crucial for well-being, especially as one ages. The study emphasizes that strong social bonds are a key factor in promoting mental and physical health, contributing to longevity, and enhancing overall life satisfaction (3).

Keep Developing

The author of the Harvard Study has published several other books on this topic. The one I like the most is The Wisdom of the Ego in which he outlined the model of adult development (4). While all stages of development are important and built upon one another, I will emphasize the last two stages, the most relevant for the later years of life, the typical age of retirement.

Keeper of the Meaning vs. Rigidity

This stage involves preserving the traditions and values for future generations by sharing wisdom, mentoring, writing memoirs, or taking on advisory roles. If there are difficulties at this stage rigidity might be the outcome for individuals who don’t adapt well to inevitable change.

Integrity vs. Despair

Individuals who achieve integrity accept their life experiences, including successes and failures, and feel a sense of coherence and fulfillment. Contrast that with despair, which involves a sense of regret and dissatisfaction with one's life, often accompanied by feelings of bitterness and hopelessness. 

I believe I am well-prepared to navigate these later stages of development, having successfully completed all previous ones. Early on, I developed a basic trust in myself, others, and the world at large. This trust underpins my confidence in my abilities and decision-making, enabling me to approach life with a self-guided, goal-oriented mindset.

I am capable of forming deep, meaningful relationships, and valuing intimacy and connection. I have been productive all my life, oriented toward personal and professional growth. My experiences have equipped me with resilience and adaptability, allowing me to face challenges with an optimistic mindset.

Future Plans

I have a lot of ideas and plans for how I am going to live, and what I am going to do. At the same time, I am oriented toward the present moment with openness and curiosity about what is going to manifest in my life, trusting in the flow of life rather than trying to control it. This is a mindset that I have been nurturing and practicing through meditation, yoga, and qigong.

Despite the above claim, I know that writing will continue to be my central focus. There are many books already present in my head, just waiting for the right timing and inspiration to come into existence. 

I have been documenting the changes I've experienced throughout my life, particularly over the past five years since moving to Arizona. This period has allowed me to reconnect with the natural world and embrace a more spiritual path. I plan to continue deepening my journey by engaging in movement and meditation healing practices, further enhancing my spiritual connection, and opening my energy gates to others, Earth, and the cosmos.

As I step into this new phase of life, I wish you all joy, peace, and the ability to accept the ever-changing flow of life. May it provide you with countless opportunities to awaken to the truth of impermanence and freedom emanating from that realization.

1. Sculpting of a Psychiatrist, by Zelko Leon, 2023

2. Retirement transitions, gender, and psychological well-being: A life-course, ecological model, by Kim, J. E., & Moen, P., The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 57: 212-222, 2002                                                                          

3. Triumphs of Experience: The Men of the Harvard Grant Study, by G.E. Vaillant, Harvard University Press, 2012                                                                                                                                   

4. The Wisdom of the Ego, G.E. Vaillant, Harvard University Press, 1993