Yes the mental health profession in NYC has many elements akin to a mafia network. It is very had to remain free of it if you want to work maintaining some sort of academic association, can be easier completely self-employed and staying away from all that but then many people feel isolated and dissatisfied. Not going into it but this issue has been a big part of some things I struggle with myself and still haven't made a clear decision, let alone action. Of course it is much more complicated than just thriving or failing as an academic or clinician as the field is intertwined, in many ways, with hardcore money and politics. I can easily imagine why it took so long for Marty to break free, I am certain it is not just emotional factors but the involvement of serious business that he probably could not cut off and resolve without some serious losses as well. Having made those early decisions and investments must have brought consequences for a long time.