At the Intersection of Medicine and Empathy

As a psychiatrist in charge on the Geriatric Psychiatry Inpatient Services at McLean, Alexis Freedberg, MD, often sees patients who are seeking mental health treatment for the first time in their lives. Older adults may experience age-related cognitive changes, such as dementia, or they may struggle with anxiety, depression, demoralization, or other mental health conditions related to significant losses.

According to Freedberg, in treating older adult patients, it’s important to listen to their stories, which cover so much history.

“One thing I love about geriatrics is talking with older people who’ve maybe never talked to a psychiatrist before,” Freedberg said. “To do it well, you have to go back pretty far to understand who this person is and why they’re here now.”

For the first half of her life, Freedberg trained as a classical musician. She majored in piano and voice in college, but toward the end of her undergraduate studies, she realized she wanted to study medicine.

“When you make music, you absolutely touch people’s lives, but I wanted to do something I could concretely point to as helping people every day,” she said.

Freedberg believes her music studies influenced her ability to relate to individuals on a nonverbal level. As a psychiatrist, she is often able to help people in the direct way she envisioned when she enrolled in medical school. She finds it ironic, though, to acknowledge the help she offers is more nuanced than what she had in mind.

“People are more complicated than I ever realized, and life inherently involves more suffering than I ever imagined,” she said. “It’s humbling when you realize the many things that you can’t fix, but I think that part of becoming a doctor is understanding what you can do and what you can’t do, and maybe redefining your role.”

When it feels like there’s no great path forward, Freedberg said, she turns to the teachings of Elvin Semrad, a prominent 20th-century Boston-area psychiatrist.

“He outlined the therapist’s task as a triad—to acknowledge the person’s mental suffering, to help them bear it, and then to help them put it into perspective.”

Freedberg said she can’t imagine “anything more interesting than trying to partner with people to understand how they act, think, and feel, in hopes that they will lead their best lives and hopefully suffer less.” As a result, she has witnessed patients overcome tremendous hardships.

“Older adults are acquiring more life experience, and oftentimes, they’re learning from it. They are gaining new communities. They are learning new skills. They are making new friends. They are experiencing positive changes in relationships.”

Freedberg’s work has taught her just how resilient human beings can be. “People experience change throughout life, including difficult losses,” she said. “It’s amazing to me how people can adjust to change and loss when they have the right support.” She added that the foundation to such coping involves access to things like good housing and good nutrition as well as to psychological, social, and spiritual resources.

Freedberg balances her role at McLean with her position as medical director of behavioral health for Perfect Health, an organization that brings individualized care to older people in their homes. In addition to visiting patients in their communities, she helps other members of Perfect Health’s care team consider and address mental and psychological aspects of well-being just as much as physical.

“I love building a strong interdisciplinary team outside the hospital’s walls like I do inside, particularly when that team can keep people out of crisis,” Freedberg said.

She believes that if caregivers and community members gained a better understanding of the needs of older adults, fewer older adults would need psychiatric services. Freedberg is an advocate who gives presentations to the public and teaches fellows and residents at McLean.

“I feel so fortunate to be able to do this work,” she said. “To be able to integrate medical knowledge with humanity and empathic resonance in the interest of helping others feels like an honor beyond anything I imagined my profession would bring.”