Robert S. McKelvey, M.D.
Professor and Division Director

FIRST OF ALL, it has a lot of variety. During the course of a week I evaluate and treat immigrant and refugee children, consult on hospitalized medically-ill children, supervise residents and fellows, teach medical students, conduct research, write articles and books, engage in some outpatient private practice, and interact collegially with many pediatricians and other psychiatrists. No day or week is quite like any other.

SECOND, MY WORK is generally very interesting.
I am fascinated by the effect of different cultural backgrounds on parenting practices and by the adjustment of immigrant and refugee children to a new and often vastly different country. I get to sharpen my diagnostic skills in consultations with children who present with seemingly medical symptoms that often have a strong psychiatric overlay. I love to write and to learn about new things and so doing research and publishing my results provides a very stimulating supplement to my clinical and teaching work. I also enjoy spending time with, and teaching young professionals, many of whom seem much brighter and more competent than I was at their stage of training. Third, I believe that my work contributes to the improvement of children's and families' lives and to the increased understanding of child and adolescent mental disorders. Fourth, I am reasonably well paid, less so than procedural medical and surgical specialists, corporate lawyers, and Microsoft millionaires, but better than many other Americans who labor in far less interesting jobs.

OVERALL, I LIKE what I do because I get to keep on learning and contributing to a fascinating and evolving medical subspecialty. In the twenty-three years I have been a child and adolescent psychiatrist I have seen the field change enormously. Major advances have been made in the fields of epidemiology and psychopharma-cology at the same time that we have had to struggle, in the face of managed care, to maintain worthwhile traditional psychotherapeutic practices and an involvement with the whole child.

WHAT DOES the future hold for the field?
That will depend on many things including politics, money, the American health care system, and the evolution of other child mental health care professions. In my view, it is too complex an equation to allow us to be confident of any particular outcome. However, if the past is any guide to the future it will continue to provide interesting and worthwhile experiences for child and adolescent psychiatrists.

FOR THOSE of you who are from "elsewhere," it may be helpful if I tell you a bit about our surroundings. The Division is housed in the new, spectacularly beautiful Doernbecher Children's Hospital. The hospital is built across a canyon on the side of a hill, overlooking Portland, the Willamette River, and the Cascade Mountains. On a clear day you can see Mt. Hood and Mt. St. Helen's. Not that we have that many "clear days." The Pacific Northwest is a cloudy, rainy place for most of the year. This makes for multitudes of green trees and wonderful, long-lived flower gardens, but also puts us at risk of Seasonal Affective Disorder and caffeine addiction.

Portland is a lively, liberal, people-friendly city with an active downtown area and riverfront. It's only a 30-minute drive into the Columbia River Gorge, 70 minutes to the top of Mt. Hood, where you can ski and snowboard, and an hour and a half to the ocean. If you like outdoor sports, especially hiking, biking, and running, there are many beautiful trails to follow both inside and outside of the city. If you're a sunworshipper, however, you may have to find a new religion.

A NEW ASPECT to our training program that may interest some of you is a rotation through the International Psychiatry Program. The adult component of the IPP has been in operation for over 25 years and deals with refugees from many regions of the world. For the past year, we have been developing a child and adolescent component to the IPP and it will now be a part of every child psychiatry resident's training. During my time in the clinic thus far I have seen Bosnian, Cambodian, Hmong, Kosovar, Lao, Mien, Thai, and Vietnamese young people and their families. It has been a fascinating cross-cultural experience!