The Pope Addresses Psychiatry

PSYCHIATRIC VIEWS ON THE NEWS

Confessing our sins is not like going to see a psychiatrist.
-Pope Francis

It’s for ‘psychiatric reasons.’ That apartment (in the Apostolic Palace) isn’t so luxurious either, don’t worry. But I can’t live alone, do you understand?
-Pope Francis

Whether Pope Francis has ever met with, or made a referral to, a psychiatrist, these quotes make clear that he knows something essential about psychiatry. So I started to think about what he might say in a speech to the Assembly of the American Psychiatric Association (APA) based on what he said in his recent address to the United States Congress.

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Allow me the conceit of translating some of the Pope’s remarks to Congress in the language of psychiatry in an imagined address to an APA Assembly.

On managed care
In commenting to Congress on the potential harm of unfettered capitalism, the Pope stated:

If politics must truly be at the service of the human person, it cannot be a slave to the economy and finance.

Is that not our concern about the rise and dominance of for-profit managed care of psychiatry . . . that making a profit has, at times, overcome our primary ethical priority of putting the patient’s needs first? Therefore, I feel confident that the Pope would tell us:

If psychiatry must truly be at the service of the patient, it cannot be a slave to the for-profit managed care companies.

On the environment
Comments on climate change were a particular emphasis of the Pope, who told Congress:

I call for a courageous and responsible effort to redirect our steps, and to avert the most serious effects of the environmental deterioration caused by human activity. I am convinced that we can make a difference and I have no doubt that the United States-and this Congress-have an important role to play.

The APA’s Principles of Medical Ethics, with annotations especially appropriate to psychiatry (2013), Section 7 states:

“A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health.”

Surely, that principle would resonate with the risk to public health and mental health caused by global warming, would it not? Unfortunately, it is clear that organized psychiatry, in contrast to organized psychology, has been relatively silent on this concern of the Pope.

So, to reframe what the Pope said to Congress to what he might tell the APA:

I am convinced that we can make a difference and I have no doubt that the United States-and this Assembly of psychiatrists, who are experts on human behavior, which must include the behavior contributing to climate instability-has an important role to play.

The criminalization of the mentally ill
In advocating for not only the abolition of the death penalty, but also the end of life imprisonment, the Pope told the US Congress:

. . . every human person is endowed with an inalienable dignity, and society can only benefit from the rehabilitation of those convicted of crimes.

Although it is still difficult to draw a clear line between crime that is not associated with mental illness to crime that is, we know that the mentally ill all too often end up incarcerated rather than receiving psychiatric care in the community. Until this changes, it is essential that persons with mental illness receive competent psychiatric care in jails and prisons. Therefore, this comment of the Pope might be easily paraphrased to the APA as:

Society can also benefit from the rehabilitation of those convicted of crimes, and since many of them have mental disorders, you psychiatrists must help to treat them during their incarceration and when they are back in the community.

Other topics
So many other topics that are dear to the Pope could resonate with us: accepting immigrants, which speaks to concerns of cultural psychiatrists; reducing poverty, which addresses concerns of social psychiatrists; avoiding ideological extremism in religion that results in hatred and violence, which dovetails with the overlap of psychiatry and religion.

Pope Francis also warned against simplistic reductionism. Such reductionism plagued psychiatry recently. Many of us have become more bio-bio-bio rather than bio-psycho-social. Indeed, we might confess our waywardness and turn back to the intermittent calls for the even more expansive bio-psycho-social-spiritual model.

I’ll pray that we do so.

Further reading:

• Pope Francis' address to Congress, CNN
• Pope Frances in America, Wall Street Journal
• Pope Francis urges Congress to find fixes for migrant, environmental problems, Wall Street Journal
• Pope Francis implores Congress to accept immigrants as their own, Washington Post
• Pope's speech to Congress: 9 quotes show his reshaping of Catholic politics, CNN