Human beings may be induced to sacrifice everything they hold dear and true including their sense of self for the sake of being loved and approved by someone in power and position of authority. George Orwell, Nineteen Eighty-Four
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| Dr. Vaida |
A few years after the move, two of his maternal cousins, eight and ten years older than Razvan, came to live with him and his mother. She was also an engineer and taught high school engineering and electronics. The cousins became father figures.
Razvan felt shame and embarrassment growing up without a father, and divorce in Romania carried a heavy social stigma with it. It was painful, and whenever his father’s name came up in conversation Razvan would be vague. The young boy learned early on to disguise, to hide, his emotions.
Dr. Vaida told me that this struggle was “one of the big reasons” he ended up studying and practicing psychiatry. He feels that “most people (working) in mental health have some kind of problem they want to master or questions they want answers to.” Of course, he hasn’t yet found all the answers, but he has no second thoughts about his career choice.
Communism Under Ceaușescu
Communism itself was bad, but life in Romania under Nicolae Ceaușescu became especially harsh in the early 1980s. There was strict rationing of food (to the edge of near-starvation), gas, heating, electricity, and other necessities to quickly repay massive loans from Western nations. The loss of political freedom, with severe restrictions on acceptable speech, led to a “suffocating environment,” recalled Dr. Vaida.
The “doublespeak” of Orwell’s chilling novel of totalitarianism and brainwashing, Nineteen Eighty-Four (published in 1947), was very real to him. The truth in Romania could only be spoken quietly and only in small safe circles to avoid the secret police, the Securitate, and their many willing neighborhood informants.
(Romanians developed dark humor to cope. One saying went like this, said Razvan: "We pretend we're working. And they pretend they're paying us."
His mother did private tutoring after her day of teaching and she often didn’t come home until nine o’clock. His cousins picked young Razvan up from pre-school, and by the second grade, he was already a “latch-key kid” who took two or three buses for the hour-long trips to school and back home. He remembers answering the phone and taking messages in the evening for his mother while she was away. There wasn't a lot of money.
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| Frigid Bucharest street scene with an overcrowded bus in the 1970s (photo by Andre Pandele) |
By the time Razvan was ten, his cousins left for college and he had to fend for himself. He learned to be independent. And he sensed, even at this age, that he would live and die under oppressive communist rule. This was simply the way his life would be.
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| Razvan's MGF |
Since Razvan’s mother’s family was comparatively well-off she was forced to spend a year washing dishes before she was allowed to go to college. His dad was luckier; he came from a simple background, as they had a small farm, and there were no punitive measures.
Human Biology Clicked and The Fall of Communism
When Razvan was 11 or 12 he became intensely interested in human biology. It “clicked,” and he knew from then that he wanted to be a doctor. There was fierce competition for the six-year medical degree programs so he, like everybody else with the same lofty goal, “memorized” the 11th-grade biology text in anatomy and physiology. Yes, he committed the entire book to memory.
He was accepted to the prestigious Carol Davila University of Medicine and Pharmacy. But he had to serve nine months in the army first.
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| Intense studying at Carol Davila (photo from The Global Research) |
Crowds of Germans began dismantling the Berlin Wall on November 9th. The uprising in Romania began in December in Timişoara. And the regime of the dictatorial cult of personality finally ended on December 22nd after two days of violence during which about 1,000 protestors were killed. Three days later Ceaușescu and his wife Elena were court-martailed, convicted, and executed by firing squad. This was a “tense” but “interesting” time said Dr. Vaida, with irony.
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| Military crackdown on December 17, 1989 in Timişoara, Romania, (photo from Fortpan) |
Dr. Vaida didn’t have much to say about his medical school experience other than that he enjoyed it (and that he had a thousand classmates). But when he took his rotation in psychiatry in his sixth and final year something, again, ”clicked.” He said to himself, “That’s what I want to do.”
His Interest in Psychiatry
The hospitalized patients he saw with severe psychiatric illnesses were fascinating (but they were also shocking). He thought that studying them would give him the opportunity to “know what makes the mind tick.” And that he might find answers to nagging questions about himself; about his emotional difficulties, including his reaction to the divorce of his parents, and his lifelong introversion. He could know himself. He decided to finish medical school with a thesis on anxiety.
While things in Romania would change after the revolution Razvan knew that such change would be slow. Looking to escape, he received a nudge from one of his brother’s classmates who had gone to his medical school. And since his brother had already traveled abroad and eventually moved to the U.S., Razvan could follow his example.
He flew to Budapest for the first step of the USMLE, the exam required of foreign medical school graduates who hope to practice in the States. He passed and applied for a psychiatry residency. He sent applications to "a few dozen" programs and waited. No replies. Without a scheduled interview for a residency, without a job offer, he could not get a visa. He had to stay put for a while.
His girlfriend at the time was a psychiatrist teaching at one of Bucharest's state-run hospitals, where individuals with severe mental illness were often hidden away and forgotten. Razvan spent a lot of time with her over the next year. He said that this was “kind of an (unpaid) internship.” He said it was also “nice to have time off to relax" after the rigors of medical school.
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| Lonely forgotten patient in a Romanian psychiatric asylum in 2004 (photo from darrinjamesphotography.com) |
Residency in Philadelphia
This time he got several replies. It was October 1997 and he was ready. The interview at Einstein Medical Center in Philadelphia (on Old York Road) went well and the program director offered him a position on the spot. He could start in July. But there was a problem: his required English exam had expired. He had to return to Romania for the exam given in June and he missed the orientation sessions for the new residents.
The transition to a new country with an unfamiliar culture was “rough.” First of all, he had no Social Security card and no place to live. A colleague took him in for a few months and the commute to the hospital by bus and subway took an hour. That first year was stressful and difficult, and he struggled academically.
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| Ionic columns in front of Jefferson-Einstein Medical Center (photo from Jefferson Health) |
When Razvan finished the residency in 2002 on a J-Visa he could either return to Romania for two years or work in an underserved area here for three. He chose the latter and was assigned to a medically barren small town in eastern Kentucky, Hazard, in Perry County. Mary said she would not join him “without a future.” So they got engaged. And they would need to have two weddings: one here and one back home. His mother would be happy to organize the affair in Romania.
Kentucky was “very stressful.” Dr. Vaida was sometimes the only psychiatrist for four counties and he was “always overworked.” He didn’t like the job, but he enjoyed the warm welcoming people of Appalachia.
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| Downtown Hazard, Kentucky (photo from VOA by Ashley Westerman) |
At the time, his mother taught and practiced the “hands-on” stress reduction and relaxation technique of Reiki. She was also involved with various spiritual groups from around the world. While here for the wedding, she decided to head to a healing-energy meeting in Boulder.
Sadness
Several mornings later, as Dr. Vaida and his new bride were at home, somebody knocked at their front door. It was a police officer. He told Razvan to call a phone number in Colorado. The number was to the coroner. Razvan’s mother was struck by a car the night before and she had passed away. (A visibly saddened son retelling this story became very quiet, and he took several slow deep breaths as he again felt the shocking trauma of that awful day.)
Razvan flew to Boulder to see his mother at the mortuary and he and his brother (a statistician at the Harvard School of Public Health) made arrangements to return her body to Romania. The airline tickets that had been purchased for the planned second wedding in August were used, instead, for his mother’s funeral.
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| Peaceful Romanian countryside (photo from Eye View) |
When I asked him about professional influences, Dr. Vaida could not recall having a mentor to guide him on his medical journey. You see, without a father, he had been forced to rely on himself. He admitted to me that he “may have some issues with authority, with authority figures.” He said he never learned how to “negotiate” such uneven relationships.
In his adult psychiatry practice, he typically treats patients with major depression, bipolar disorder, chronic anxiety, panic disorder, social anxiety, and borderline personality disorder. He occasionally sees individuals with substance abuse disorder and he sees a good number with the painful and disorienting effects of remote trauma, patients with post-traumatic stress disorder (PTSD). In this disabling condition, in the wise words of addiction specialist Gabor Maté, “the past becomes the present” and rational thinking goes offline.
In a 2014 interview with our local TV station, Dr. Vaida said that a study had shown that specific RNA markers found in blood could reliably distinguish people with major depressive disorder from those without it. He hoped this would lead to earlier and more biologically based diagnoses and personalized precision therapies, even prevention.
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| Still image from the 2014 video interview about a possible blood test for depression (from Fox 43) |
Dr. Vaida manages most of his patients with medication, but he also stresses the need for lifestyle modification including a focus on a healthy diet, regular exercise, and relaxation techniques (such as yoga or tai chi) along with psychotherapy. He said that he spends about 10% of his practice doing talk therapy but that he would like, someday, to be able to do more.
The Effects of Trauma
Razvan and four other psychiatrists from his training program have weekly online meetings to “discuss different things.” Trauma, he noted, is the “thread that goes throughout” the stories their patients tell.
Some of the most challenging patients he treats are those with what has been (somewhat poorly) called borderline personality disorder. These people have often suffered repeated abuse as children. They have low self-esteem, experience very poor relationships with others, and have difficulty regulating their emotions. There is likely a strong genetic predisposition to develop this condition after experiencing early-life trauma, and there are gender differences in how it shows up.
The sufferers may experience chronic anxiety, depression, and full-blown PTSD, and they may engage in self-harm (including cutting and multiple suicide attempts) and substance abuse. Medication (treating the symptoms) is not very effective unless the remote trauma (the crucial underlying problem) is fully addressed.
These misunderstood individuals utilize a lot of medical and psychiatric services and are often poorly served by the health system. Dr. Vaida feels that he connects well with them and he said that it “does wonders if you are able to be there and listen.” Many difficult patients can do quite well following comprehensive treatment.
(One of his friends in New York has adopted the NeuroAffective Relational Model (NARM) to treat “attachment, developmental, and relational trauma.” This compassionate labor-intensive approach uses body-mind mindfulness to promote self-regulation of the body and nervous system. Dr. Vaida is intrigued by this idea explored in depth by Dr. Bessel van der Kolk in his best-selling book The Body Keeps The Score.)
For the past two years, Dr. Vaida has been cutting back his hours as he found that more of his time was “spent on things that are not related to patient care.” He notes that this time-waster is due to “pressure from insurance companies.” The stress of checking lots of little boxes in the electronic record and writing extensive treatment plans that nobody reads is, he is certain, affecting his health negatively.
After Hours
He likes to read but he unwinds by watching movies, most of which deal with emotions. He said that viewing 1984's dark vision of the future "brought back memories." He exercises regularly and he likes to swim. In fact, I first encountered Razvan at the York JCC pool during the second year of the pandemic while doing early morning laps (he does smooth flip turns).
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| Frame from 1984: Winston (John Hurt) writes in his forbidden diary while carefully avoiding the watchful eye of Big Brother (from FilmScene) |
After 20 years in psychiatry, Razvan remains, he said, “fascinated by human emotions, human behavior, what makes people do what they do...and feel what they feel.” He believes in “the goodness of people” and that “good prevails over evil.” His unexpected freedom from communism, from tyranny, and from the sometimes oddly seductive lure of Big Brother “was a miracle,” and that makes him optimistic.
Dr. Razvan Vaida, the hopeful psychiatrist, said that “the solution is to be present and to live every moment and every feeling that you have without having to escape.” That may take some practice.
References and Suggested Readings
1. Orwell, George. Nineteen Eighty-Four. Plume/Harcourt Brace and Company, London, England, 1983. (Original copyright 1949.) (We seem to be headed in that alarming direction.)
2. Roseberry, K., Levey, D. F., Bhagar, R., Soe, K., Rogers, J., Palkowitz, S., Pina, N., Anastasiadis, W. A., Gill, S. S., Kurian, S. M., Shekhar, A., & Niculescu, A. B. (2023). "Towards precision medicine for anxiety disorders: Objective assessment, risk prediction, pharmacogenomics, and repurposed drugs." Molecular Psychiatry, 28(7), 2894-2912. (Dr. Niculescu had done similar work on major depression in 2021; he emigrated from Romania.)
3 Stroescu, Vlad. "My Three Lessons as a Psychiatrist in Romania." Psychiatric Times, October 3, 2019. (If Razvan had stayed in Romania...)
4. Van der Kolk, Bessel. The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Viking. New York, New York, 2014. (Essential work on understanding and treating PTSD.)
By Anita Cherry (2/13/24)
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| An Orange Tulip (photo by SC) |