Serving or Empowering in Psychiatry

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PSYCHIATRIC VIEWS ON THE DAILY NEWS

It is always a learning experience to hear from readers.

Recently, I received a query from a medical school classmate of mine who had become a general practice physician. The note was in response to my video titled “Serving the Underserved: Fostering Faith,” posted November 27, 2024. Accompanying the video, in my updated written commentary, I talked about the presumed increase in mental disturbances, especially in regards to the trauma from the current wars and political divisiveness.

He responded with:

“I’m interested in your thoughts about serving vs empowering.”

The word serving came right out of the title, along with the related underserved. I took that reference to mean: how much do I recommend doing for others vs empowering them to help themselves. That felt to hit the essence of how I practiced clinical psychiatry and, perhaps, thereby warranted this general explanation.

In clinical practice, we in psychiatry know there are patients who seem to be currently incapable of taking reasonable care of themselves or are a likely danger to self or others due to psychosis, extreme mood swings, or dementia, among other limitations. It would seem inappropriate to try to enhance their empowerment to carry out the associated actions, which would include putting oneself or others in danger. Often, that assessment leads us to go the route of inpatient or outpatient involuntary treatment. Then, once their capability improves, we can go more to the empowerment route.

Empowering patients to me meant to elicit and deeply listen to their personal perceptions of what help they needed and what they thought might help. After I verified my understanding of what they thought, I added my thoughts. When time was short, I added the question, “What gives their life meaning?” or “What did you think your purpose in life was?”

Following whatever consensus we had as to what was wrong, including a formal DSM diagnosis, I would ask their opinion as to what they thought would help. Or, at least I usually would. I always kept in mind that people from some cultures, (eg, Hmong), would expect the authority—in this case, the psychiatrist—to know what to do. Thus, to ask their opinion would be a sign of incompetence.

A similar approach was taken for treatment, wanting to merge whatever opinion they had to my own. If medication was used, I provided information about options and tried to go with their preference, and repeated that process in follow-up visits.

Ultimately, the goal was to help them become more empowered in their everyday life and goals, and not be unduly restrained by psychiatric symptoms.

So, I would answer my classmate with the following response:

I serve TO empower. Do you?

Dr Moffic (he/him/his) is an award-winning psychiatrist who specialized in the cultural and ethical aspects of psychiatry and is now in retirement and refirement as a private pro bono community psychiatrist. A prolific writer and speaker, he has contributed a weekday column titled “Psychiatric Views on the Daily News” and a weekly video for his series “Psychiatry & Society,” since the COVID-19 pandemic emerged. He was chosen to receive the 2024 Abraham Halpern Humanitarian Award from the American Association for Social Psychiatry. Previously, he received the Administrative Award in 2016 from the American Psychiatric Association, the one-time designation of being a Hero of Public Psychiatry from the Speaker of the Assembly of the APA in 2002, and the Exemplary Psychiatrist Award from the National Alliance for the Mentally Ill in 1991. He is an advocate and activist for mental health issues related to climate instability, physician burnout, and xenophobia. He is now editing the final book in a 4-volume series on religions and psychiatry for Springer: Islamophobia, anti-Semitism, Christianity, and now The Eastern Religions, and Spirituality. He serves on the Editorial Board of Psychiatric Times.