I believe that “mental illness” is a frustratingly vague term. To be sure, there are cases in which a person’s suffering is so profound, and so obviously rooted in physiological dysfunction, that aggressive measures must be taken to treat the disorder. At the other end of the spectrum, however, are the day-to-day inconveniences that we all experience, and which disturb our equilibrium to the point of discomfort and transient suffering.
Between these two extremes lies a vast spectrum of mental states, and what constitutes “disorder” varies among individuals, among professionals, and even among societies as a whole. My personal philosophy is that illness is individually defined; a person will only comply with—and therefore benefit from—treatment only if he or she believes that a problem exists in the first place. In other words, only by recognizing that something might be “broken” does one set out to “fix” it.
I have two major responsibilities as a psychiatrist. First, I work with my patients to help understand the situation which brings them to my attention: How do they see their condition? How did it arise? Do they believe that they could be “better” (in however they choose to define that term), and have they exhausted all resources to achieve that goal? Do they truly need help, and are the tools of psychiatry capable of providing the help they need?
Secondly—and importantly, this can only happen after the patient agrees that there is some degree of suffering that is amenable to change—I work with the patient to design a treatment plan that not only attempts to achieve his or her self-identified goals, but sets out a plan of action to take the necessary steps. Sometimes this plan includes medications, other times only therapeutic interventions. Sometimes a higher level of care (such as hospitalization or long-term rehabilitation) is most appropriate. At times the treatment can be brief, lasting only a few weeks, while at other times a lifelong treatment and recovery plan is necessary.
Whatever the situation, human suffering deserves the attention of a professional who is skilled in the assessment, diagnosis, and treatment of conditions that prevent us from living to our full potential. That professional must also understand that each person’s goals—each person’s “potential”—are different, and the unique needs and desires of each person must be addressed. This is the way I believe psychiatry should be practiced, and I welcome you in your search for a better life.
Thought Broadcast 
Nice blog. Very nicely done, both with respect to content and aesthetics.
(You cracked on me earlier today owing to my reactive surliness over on The Health Care Blog.)
Cheers –
BG
Thanks, Bobby… As you can tell, I have some strong feelings about EMRs (particularly in psychiatry) and plan to post about some of my experiences here. Thanks for visiting!
I look forward to reading and learning.
BG
ps- Are you aware that there’s a bill in Congress to extend the Meaningful Use incentive reimbursements to mental health? Not sure it’ll pass, and not sure people in your discipline would like whatever compliance criteria they set forth.
I look forward to the day when psychiatry moves from an ‘illness-management’ system toward a ‘recovery’ model.
Boston University – Repository of Recovery Resources –
http://www.bu.edu/cpr/repository/index.html
Temple University – Collaborative on Community Inclusion –
http://tucollaborative.org/index.html
National Empowerment Center – Majority Recover from “schizophrenia” –
http://www.power2u.org/evidence.html
Robert Whitaker – Mad in America and Antomy of an Epidemic – Modern Experiments Producing Better Outcomes –
http://www.madinamerica.com/madinamerica.com/Modern%20experimental%20programs%20producing%20better%20outcomes.html
PsychRights – Effective Non-Drug Treatment –
http://psychrights.org/research/Digest/Effective/effective.htm
We have light-years to go… but I think it would be fair to say we ought to begin moving in a new direction!
Duane Sherry, M.S.
http://discoverandrecover.wordpress.com/recovery
Duane, I have to admit I had not read this philosophy statement until now. I think Steve is on your side in not immediately stereotyping, typecasting, and prescription pad at the ready.
Glad to have found your blog. I’m looking forward to further posts.
Steve, I couldn’t agree more with your philosophy. There are just so many elements bastardizing psychiatry today. It feels like a daily struggle to simply treat our patients/clients in a simple/sane way that you so well describe. From the anti-psychiatry movement to insurance companies to government regulation to organized psychiatry to the courts and now to biological reductionism. It is a challenging time for psychiatrists but I am still proud to be one.
Hello. I’m a psychiatric nurse who has also had her turn on the other side of the nursing desk, so I really relate to a lot of your philosophies and ways of seeing things. I truly believe that experiencing acute mental illness as a nurse has opened my eyes and I am so blessed to have come full circle to be a better, more effective nurse because of my experience. I don’t openly share my “history” in the real world, and i admire your bravery for how open you are. I can imagine benefits for sharing, and benefits for keeping it private. I believe your unique experience has impacted you to an important set of values. Otherwise, for example, you wouldn’t understand that people “need to want” the treatment offered/available. I struggle at my place of work as I cannot influence much change in that aspect. Anyway, I am constantly seeking education to challenge my practice personally, so i think your site is amazingly beneficial, with priceless thoughts and enlightening topics. Most of all, I am pleased to hear of how far you have come and all you have achieved in your pursuit of fairness, empathy, and quality care.
I love what you guys are usually up too. This type of clever work and
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