Wednesday, March 5, 2014
"The position of the psychiatrist around 1900 was not a particularly happy one. Although he was better able to classify the psychosis and predict their outcome than his predecessors a century before, he still suffered from the same ignorance of the causes of mental illness and he still had to be content with the same miserable methods of treatment. If he worked in an institution or a clinic he saw only severe and hopeless psychoses, and although anatomy and physiology had been so helpful to his medical colleagues, they had failed to teach him anything about the nature of these illnesses except in the case of general paresis. His patients were prisoners, and in a way he himself was a prisoner caught up in the difficulties of the field in which he had chosen to work."
Erwin H Ackerknecht, Short History of Psychiatry (1959)
The state of psychiatry now is, of course, dramatically better from what it was in 1900. Our treatments, although far from curative, have restored majority of psychiatric patients back to functional lives, and the neuroscientific understanding of the causes is progressing rapidly. I was, however, struck by the last line of the passage, which resonated with a chord in me. I am not certain whether he refers to patients as prisoners in a literal sense, but there is a literal sense in which a small subset of psychiatric patients can be called prisoners: the patients who are admitted in inpatient units against consent because their state of mind (suicidality, mania, psychosis, etc) poses an acute and significant danger of harm to self and/or other. Majority of these patients when they are discharged acknowledge and recognize the need for the admission, nonetheless, dealing with these prisoner-patients is unfortunately a difficulty of the field of psychiatry, one which takes an emotional toll on a psychiatrist with moral sensitivity, and a responsibility from which a psychiatrist cannot flee.