Voiceover: You're listening to the Intermountain podcast with Dr. Mark Briesacher.

Dr. Mark Briesacher: I'm Dr. Mark Briesacher, Chief Physician Executive at Intermountain Health Care. Today we have a guest host Dr. Anne Pendo, who is interviewing one of Utah's health care heroes.

Dr. Anne Pendo: Welcome to our podcast today. I'm Dr. Anne Pendo with Intermountain Health Care. I’m the Medical Director for the Experience of Care in the Office of Patient Experience. And today I have the honor and pleasure to chat for a little bit with Dr. Louis Moench, a psychiatrist who practices in Salt Lake City at the Avenues Psychiatry Clinic. Lou is transitioning from his out-patient psychiatry practice to doing some consulting and continuing some hospital work, a little bit of hospital work. And one of our objectives, or one of my objectives today is to celebrate Lou and his extraordinary career and also to get some thoughts and perspective from someone who's had years of experience and a lot of opportunity for personal growth and professional growth. So, Lou maybe you could start by sharing a little bit about what has meant the most to you in your practice and what you're looking forward to next.

Dr. Louis Moench: Well I really enjoyed the 41 years that I've been a psychiatrist and would have to say that it's with reluctance that I pass on to another phase of my life. It's been a very rewarding experience for me based on the idea, I suppose, that I thought that I would do better making a living with my head then my hands. And I'm thinking of the adage of an intern as from previous century who I admire greatly, Sir William Osler, who made the observation, "It's as important to know what kind of patient has the disease as what kind of disease the patient has."

Dr. Anne Pendo: Yes.

Dr. Louis Moench: And so I've been very fascinated with the people I've worked with, both colleagues and staff, but especially patients. I find that psychiatric patients are often very courageous people living with the difficult things that they need to live with, and I've been grateful to be a part of trying to make their lives better and ease some of that suffering. Sometimes we think we don't make much progress, sometimes we make a great deal of progress. It's been a mix, like I suppose, other fields in medicine, but I've thoroughly enjoyed it.

Dr. Anne Pendo: Great. I think I'm struck by the word that you used, courageous, because I'm imaging that when you first started in practice, coming to see the psychiatrist was really challenging for your patients to feel that, that was something that they should do.

Dr. Louis Moench: Well, mental illness has been stigmatized through a good many years, in fact, probably centuries. And I think less so now than it was in the past, but you're right, coming to a psychiatrist is not a really easy thing to do for a good many of them. And that sometimes had to be done in a sort of surreptitious way. We tended to put our state hospitals outside the main cities where people wouldn't be aware. We tended to keep people off the streets. We tended to treat folks in a way that they wouldn't be a part of the main stream of society. All that has changed considerably in the time that I've been a psychiatrist starting I guess in the 1960's, so I think we've come a long way since then.

Dr. Anne Pendo: I'm curious to know, too, about how you've seen the treatment of psychiatric illness change. I mean, it's certainly different now than it was when you started in practice. Any observations that you have about that?

Dr. Louis Moench: Well, it depends on how far back you want me to go, but in ancient times, certainly people who had psychiatric illness were thought of as possessed of devils or born during misaligned spheres in the universe and various things like that. And when we got more sophisticated, there were institutions that sprung up to take care of these folks. One place I was particularly fascinated by about three centuries ago was a town in Belgium called Geel, where it was a badge of honor for a family in a household to be able to take a psychiatric patient into their house and take care of them and treat them as normal family members and it was a very enlightened thing. We had institutions, including the state hospital here in Utah, where people were indeed out of society, but a good many of them had three square meals and a roof over their head and some things that many of them don't have now.

In the 1950's, I guess, Freudian concepts were still prevalent in the land and people were fascinated by the idea that there was an unconscious mind that determined what you would do. In the 1960's, there came a significant change where some zealous young lawyers thought everybody should have a liberty interest, and therefore, we should empty the state hospitals with the idea that if you took away the hospital, you would take away the illness.

Dr. Anne Pendo: Wow.

Dr. Louis Moench: Which was not very sound reasoning. There was some biological treatment available back in those days, in fact, starting in 1938 when electro-convulsive treatment first came about, and that was introduced in the '40's into this area by my father and some other psychiatrists who were pioneers in that field. In fact, my father was known to do house calls with his ECT machine to do the treatment at home, but the biological shift in psychiatry started happening mostly when the psychiatric medicines came about in the 1950's and '60's, and since then the shift has been rather major. To the present time, where psychiatry is considered a legitimate scientific profession, I think, the way most medical specialties are, what's happening I think in the future is that people are becoming more and more neuro psychiatrists.

For example, it would be, I think, a significant step forward as we can now do to explain to, say, a borderline personality disorder patient, not that she had a terrible upbringing or underwent traumatic experience, but here's the spot on your brain that is not communicating very well with another spot because of this or that kind of abnormality that makes you overreact emotionally to things. And somehow, if you understand that, you can guard yourself against it a little more fully. I think that's going to be a considerable step forward.

Dr. Anne Pendo: Yeah. I love hearing the history that goes behind your specialty. One of the other components of your career has been your involvement in your psychiatric association and your professional association and I think our audience would like to know what you feel like you contributed? And in what way did you benefit from your involvement?

Dr. Louis Moench: Well, I've been rather heavily involved in the Utah Psychiatric Association, starting with committees and then being the president way back when the president was kind of an entry level position, it seemed. And that got me involved in the American Psychiatric Association and I've also been heavily involved in the Utah Medical Association and the American Medical Association. I've often told people that my ancestors left the old country and crossed the plains for Utah way back in the 1850's, and starting in the 1980's, I've been crossing the country in planes for the American Psychiatric Association. One of the nice things that has happened back there is that I've met some of the very top researchers, top academicians, and shapers and movers of psychiatric thought, and I've been able to be involved in a number of different committees and things.

Probably the most significant being the diagnostic and statistical manual, the DSM. I was on the committee that put DSM 40R together, partly on shaping the psychiatric association's practice guidelines. Partly in creating the guiding manual for electro-convulsive therapy to be used around the country and the world. And so those have been some great opportunities for me, I think. I've very much enjoyed working in that field and that has made me sort of part academician without the pressures of academia to publish and perish and that kind of thing.

Dr. Anne Pendo: Right. And I think ... I don't know what your thoughts are about this, but I'm imagining that your involvement on that broader scale broaden how you thought about treatment and the work that you did, or do, and gave you the opportunity to consult with physicians and experts that you otherwise wouldn't have had the opportunity to.

Dr. Louis Moench: I had a great deal of opportunity to be where the cutting edge of various psychiatric treatments, and I think I was able to contribute something to that by helping them shape their guidelines to what the private practitioner can actually do. A lot of them were sort of skilled in ivory tower medicine but didn't have a clue as to what the average physician in Provo, Utah, or Bozeman, Montana, might be facing.

Dr. Anne Pendo: I think that brings us back almost full circle, right? To your patients, which has really been your passion and compassion for and with your patients.

Dr. Louis Moench: Well, I've certainly enjoyed working with a wide variety of people, some of them very sick. A few of them worried well. I think back at my longest tenured patient now and I started seeing her two months after I started practice in 1976, she's much more functional than she was. My crowning achievement with her at first was to keep her alive, so she's able to enjoy her life much better now. I've learned that patients all deserve respect.

Dr. Anne Pendo: Aw. I love hearing that.

Dr. Louis Moench: Whatever kinds of disfunction they deal with, whatever kinds of things they do that are not in keeping with society's norms, they're still people and they still need to have encouragement, they still need to have support. They still need to have somebody value them.

Dr. Anne Pendo: Yeah. I think that's really a lovely take home message for all of us who are still practicing and who are thinking about medicine as a career. As you look forward to what's next, what are you thinking about?

Dr. Louis Moench: For my own life?

Dr. Anne Pendo: Yeah, for you.

Dr. Louis Moench: Well, I'm transitioning from doing out-patient office psychiatry in the last few years, having given up in-patient practice mostly, to doing basically doing the same thing as a volunteer. I'm treating LDS missionaries now, both those who are still serving on missions and those who have had to return home early because of psychiatric illness. So I still see out-patients, I just don't get paid for it.

Dr. Anne Pendo: So they're able to take advantage of your expertise?

Dr. Louis Moench: That's generally true. One other thing that I'm looking forward to greatly is seeing my wife every once in a while, which didn't happen a whole lot through my 43 year career. But, fortunately, she had the ingenuity to create her own career as a music teacher—and spending a lot more time with her and with the musicians in my family, the thing that I'm going to have some spare time to do now.

Dr. Anne Pendo: That will be lovely. As we wrap up today, any final thoughts that you would want to share with those that might be listening?

Dr. Louis Moench: Well, I think medicine has an exciting future and when asked if you would suggest that your kids go into medicine, I did and one did, and I think it's a very good thing to do. The way medicine is being practiced now is quite different than when I started out. I worry that talking and listening to patients maybe going somewhat by the wayside as we instead focus on assembling big data.

Dr. Anne Pendo: Yes.

Dr. Louis Moench: But as long as we keep the human element in it, I think it's still a very worthwhile profession. One of the really exciting things for a young doctor who may go into psychiatry is the idea that we're being able to unravel more and more of what the brain actually does and that's going to lead us to more solutions than we've had in the past.

Dr. Anne Pendo: Which I think is really exciting and very optimistic, don't you think?

Dr. Louis Moench: Oh absolutely.

Dr. Anne Pendo: Yeah, yeah. Well Lou, I know you've been busy today even though you are quote unquote, "retired," and I appreciate you taking the time to come up and visit with us and to share a little bit about your experiences as a psychiatrist. And I think wise words from a well-executed physician. So thank you very much.

Dr. Louis Moench: Thank you. It's fun to reminiscence when you still can recover your memories.

Dr. Anne Pendo: Good point. Thank you Lou.