In Rearview: A Psychiatrist Reflects on Practice and Advocacy in a Time of Healthcare System Change Dr. Barry B. Perlman, a graduate of Yale Medical School, recounts the entire arc of his career in medicine and psychiatry, an epoch which saw dramatic changes in our country's healthcare delivery system. The book's chapters chronologically trace Perlman's life from his early interest in medicine and psychiatry, through to his retirement more than fifty years later. Each of the book's 41 chapters focuses on a critical point in his medical education, psychiatric training, clinical practice, the challenges of running a psychiatry department at an inner city community hospital, changes to the mental healthcare delivery system and their consequences for patients and doctors, and participation in advocacy efforts on behalf of persons with serious mental illness. With insight and humor he recounts clinical cases and their meaning, persons encountered in the hospital and political life, and topics central to the practice of psychiatry and medicine, including: early exposure to aging bodies and dying, suicide, violence, poverty, confidentiality, and evidence based practice. One chapter is revealingly illustrated with art done by patients and ponders the question of what makes art, art. Perlman launches each chapter with a recalled Fragment, a pithy introductory statement, which shapes each subject upon which he then elaborates and comments. Each personal commentary places the chapter's theme into a broader context relating it to issues as diverse as personal ethics, societal concerns about psychiatric and medical care, patients' dignity, and how doctors relate to each other and to others including nurses, administrators, social workers, and aides. Readers may find his takes surprising, challenging, and illuminating. His observations are often both unorthodox and thought provoking. He considers the qualities shared between major players in the medical industrial complex and human traffickers. He describes the powerful effects of receiving Firmagon, a testosterone reducing hormone administered during his treatment for prostate cancer, on his efforts to better understand issues related to gender identity. In another vein, Dr. Perlman provides a look into the professional organizations and New York State agencies with which he interacted. He served as the president of the New York State Psychiatric Association and was appointed by NYS Governor George Pataki as chair of the NYS Mental Health Services Council and as a member of the State Hospital Review and Planning Council. In those roles, he participated in shaping public policy. Over the course of several chapters he affords an insider's view of the countervailing forces which influenced decisions which impacted the health and mental health care of New Yorkers. As he makes clear, few are pure and the system in which we all receive care was not primarily designed for the ease of use and benefit of those served. At a minimum, skepticism is often warranted and, occasionally, cynicism. Nevertheless, he emerges as a strong proponent for the engagement of interested citizen volunteers, such as he was, in the state's regulatory processes. He advocates for their involvement as a way to bring a broader, real world perspectives to bear on state agency employees charged with creating the vital regulatory framework which governs how the state's institutions function. Readers who delve into Rearview will be taken on a tour of the multidimensional life of an activist psychiatrist whose professional life encompassed provision of direct clinical care, running a psychiatric department under challenging circumstances, and trying to improve the lives of New Yorkers living with serious mental illness. As Dr. Perlman concludes, he feels grateful to those who encouraged and mentored him, the patients who sought his care, and diversity of professional experiences afforded him.