Accentuate the Positive in Psychiatric Care

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“You’ve got to accentuate the positive
Eliminate the negative
Latch on the affirmative
Don’t mess with Mister In-Between”

-- from the Johnny Mercer/Harold Arlen song, Ac-Cent-Tchu-Ate the Positive

Being a blogger, sometimes I am sent books to read or review. One such book just came my way and it ended up being inspiring enough that I thought other psychiatrists should consider reading it, too. It is the journalist Art Levine’s Mental Health, Inc.¹

Although this new book importantly presents the continuing limitations and problems in our mental health systems, and even found some hidden ones, it also tells of the stunning psychiatric islands of therapeutic success, some of which I didn’t know enough about beforehand, including:

[The book] also tells of the stunning psychiatric islands of therapeutic success, some of which I didn’t know . . .

- The Village in Long Beach, led by the psychiatrist Mark Ragins, MD, where medication is deftly interwoven with individualized recovery approaches for those most in need

- The Independent Placement and Support employment approach, pioneered by the psychiatrist Robert Drake, MD at Dartmouth, which emphasizes the therapeutic effects of employment for the mentally ill

- The psychiatrist William McFarland’s pre-psychosis early intervention model for Schizophrenia

- The Open Dialogue programs, developed in Finland, which emphasize therapists working at home with the identified patient and their families

- A psychotherapeutic approach for PTSD developed by the psychologist Mary Neal Vieten, PhD, which is in the humanistic tradition of Carl Rogers.

Mr. Levine’s final recommendation is an admirable addition to the Hippocratic Oath. First, Do No Harm. Then Second, Do What Works. Unfortunately, but realistically, he recognizes that the business aspects of mental healthcare, from the drug industry to for-profit systems, limit the likelihood of those islands of success generalizing broadly. That seems to lead to some pessimism at the end and just a page of speculation of how reform might come about.

But we can take up the cause. We psychiatrists should know best what reform would be best. A single payer system like Canada’s, anybody?

References:

1. Levine A. Mental Health, Inc. How Corruption, Lax Oversight and Failed Reforms Endanger Our Most Vulnerable Citizens. The Overlook Press, New York, 2017.