Letter to a psychiatrist

Reposted upon request…

Dear Dr……

I start with one simple idea.

If mental health help is supposed to make life better a good place to start is what makes life better.

The dignity and value of the people you work with should be the fundamental assumption that you start with. That assumption should make a difference in the way you treat people. People are much more likely to emotionally invest in what you are doing if they believe that you are emotionally invested in them. My personal experience, based on 38 years professional experience and a lifetime of personal experience is this is not the starting point of mental health treatment for most people. If someone is important what is important to them is also held important and this is most certainly not the case for most people. They are given the message in a million ways that their value is dependent upon their response to treatment and that if they dont do well they are just not worth much. Treating people as people is different from treating them as patients.

If people feel they cant count on you to be honest they feel like they cant count on you for very much. A major part of honesty is not claiming you know things you dont know or that you are able to do things you cant do. You dont know how people feel. You dont know what people are going through. Many of the theories about mental illness are at best theories and not scientific knowledge. They are still searching for the first chemical imbalance. The medications that are used are at best educated guesses. And side effects are real. And you dont know that people need to take meds for a life time. And you really dont know how much progress a given person can make. All of these things are matters of guesswork, conjecture and faith and to present them as some hard fought and hard won professional knowledge leads to people wondering if they can believe you or not. Credibility is key in all human interactions. And if you mortgage your credibility then you lose all value. Arrogance is severely limiting. People actually believe in you more if they know what you dont know and know you dont know it.

Empower people.
Dont just allow people to make decisions. Treasure people making decisions. And help arm them to make better decisions. Teach them skills that matter in a way they can apply them to their lives. So much of mental health treatment is cookie cutter stuff. Teach people things that allow them become more of the kind of person they want to be and live the kind of life they want to lead. A major part of life getting better is regaining control of the effective management of your life. If treatment is not about recognizing, supporting and treasuring independence it is not about much.

All this is extremely hard to do if you believe people are basically the diagnosis they are given. You cannot believe the basic truth about someone is the label you put on them and then claim to give them a sense of empowerment in their life.

Affirm hope.
Tell people and act like you believe it. It can and does get better for people and you can make it better. It may be slow. There will be problems. But it can and does get better. Life has opportunity for you and is not simply a source of deprivation. Believing in the people you are trying to help is such a basic part of helping.

Many professionals are just cynical. They believe in the end people who are “messed up” are likely to stay messed up and it is kinder not to let people get their hopes up too much. Know you have as much to learn as to teach. If the people you work with have nothing to give you in the end you will find they believe you have little to give them. Life does not get better when everything is a one way transaction.

Let people know they are safe.
Your intent is to in no way, either spoken or unspoken, to diminish them. You dont have a point to make, a battle to win, a position to defend. You are there to help. Period. Tell people they can learn. Many people think they cant. Tell them it may be slow, sometimes painfully slow, but they can still learn. They are not so impaired, so limited, so stuck that they cant learn to do things differently that will make a difference in their life.

There are probably many other things that you could add to this list. Mental health help is a human interaction and they things that make a human interaction helpful and part of improving the quality of life are the same regardless of the interaction. For many people that I have known or talked to the things that I have talked about are not their experience of the mental health system. Sometimes I think we make things way too professional, way too intelligent and way too imposing. Maybe the most important things to know are not just your professional skills and knowledge. Maybe its just what you know about being a good person to another person who really needs a good person.


2 thoughts on “Letter to a psychiatrist”

  1. Dear Larry:

    I wrote a response to this blog and got the same message as before: “Sorry, this comment could not be posted”.

    There was nothing in my comments that could have been perceived as obscene, blasphemous or ‘in bad taste’.

    You told me that I was not being blocked from responding to Hopeworks Community – but something IS preventing me from commenting. I recognize Hopeworks is a religious organization – as such, I try to be sensitive and mindful of how I word things and not be offensive.

    If you ARE blocking me, I wish you would tell me – directly – the reason why. I would prefer this than to continue to try to comment – only to have every one of them denied.

    1. Kay as you can tell you are not being blocked. I would never do that. What ever you did for this comment do for the other. I have no clue what the problem is.

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