Magazine article Behavioral Healthcare Executive

Psychiatry Stigmatized by Low Expectations

Magazine article Behavioral Healthcare Executive

Psychiatry Stigmatized by Low Expectations

Article excerpt

Some years ago, President George W. Bush made a much-quoted remark about "the soft bigotry of low expectations." It's about the idea that our prejudices about others might be observed and judged not only in our outward actions, but in our inmost thoughts and attitudes.

I recalled this remark after hearing a recent discussion involving community psychiatrists and local behavioral health workers and peers at Case Western Reserve University in Cleveland. The discussion leader, Ken Thompson, MD, suggested that the profession of psychiatry, along with many of those it serves, seems to be the subject of a very distinct stigma or prejudice within society. (Thompson, by the way, is chief medical officer at Recovery Innovations and an associate professor of psychiatry and public health at the University of Pittsburgh. He served as medical director at the SAMHSA's Center for Mental Health Services from 2007-10.)

Psychiatry's image problem, Thompson said, stems from "our inability to point to consistently strong results from our traditional approach to treatment - the thought that peoples problems could be solved with a medical intervention - usually a pill."

"Its clear," he continued, that "we haven't been getting all of the gains [in outcome] that we once thought" and that "the standard paradigm of treatment is petering out. There are not so many new pills, new technologies, or new approaches around the corner." And, while acknowledging that work is ongoing in search of new treatment interventions, Thompson didn't believe that these would "revolutionize psychiatry anytime soon."

It's not enough to "reduce the burden"

While psychiatry shares some woes with all of medicine, notably concerns about high costs and uneven quality, Thompson asserted that psychiatry in particular suffers from the public perception that "it doesn't really deliver - or expect to deliver" positive outcomes on a consistent basis. It thus suffers its own, self-inflicted form of public prejudice - what I'm inclined to characterize as its own "soft stigma of low expectations."

Thompson went on to explain that the effectiveness and value of traditional medical interventions have long been measured by decreases in morbidity and mortality. More recently, both medicine and society have utilized more sophisticated measures that include consideration of "quality of life," or a continued ability to contribute to society. Thus, Thompson mused, society's investment of trust (and funding) in medicine reflects a certain confidence, or expectation, that it will reap an appropriate return.

But psychiatry's interventions have diverged somewhat from those of medicine, Thompson noted. He stated that psychiatry's recent course has been to argue, essentially, that its interventions "reduce the burden" of the mentally ill on society by giving them a chance to live a better life. "This," he said, "is not a useful stance. It's not a very inspiring vision to society or the public." What's worse, he argued, was that "this stance has angered those we serve - the notion that we are going lessen the burden that they place on us."

"A culture of disability"

"We psychiatrists exist because psychiatric diagnoses can be disabling and the people we treat can be disabled for life," Thompson says. While the possibility of disabling illness is ever present, he believes that possibility too often turns into an expectation of disability. …

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