Psychiatrist's Dilemma to Social Limitations

People who are aware of their right to have a choice but are denied so by the society in which they live, such people often end up being depressed (or having some other form of mental illness). This presents a tough challange for the psychiatrist, because the social etiology is clear-cut in most of such cases. The patient in question is actually a normal person in a messed up society. The mistake in this case would be to ascribe the psychological problem as being patient's inability to cope with the problem. To adopt that view would be an indirect justification of the messed up society. It would be like saying "There is nothing wrong with the society. The problem is with you. You couldn't cope."

This puts the psychiatrist in a dilemma. He cannot change the social structure in which the patient lives, and treating with drugs would bring some limited symptomatic relief but it wouldn't be a cure, and in psychotherapy, he can't really tell the patient to cope without implying that the problem is with the patient, not the society. And even if he does tell the patient to cope while simultaneously making clear that it is the society's fault, how do you expect the patient to be not depressed! So what to do?

I suppose it depends on how much the social environment can be influenced by the psychiatrist. If the parents are willing to listen, he could explain the problem to them that the disease is caused by so and so factors, and he could suggest a better approach. But if social environment cannot be changed, then I don't think the psychiatrist can do much for a cure.

Of course, there are patients who do have genuine coping problems. I am not denying that. But the distinction can be made by the type of social problem the patient has difficulty with. A person getting clinically depressed over losing a job is a coping problem. A girl getting depressed over a forced marriage is not a coping problem ... it's a moral crime being committed!

Comments

Butters said…
One thing you can do is: outside your capacity as a psychiatrist, help people to organize against these social problems.

If not that, then at least let them know that it's not a coping problem, but a systemic problem of which they are not the only victim.

The problem with Pakistan is that people do not have the courage to take existential risks. It might be good to introduce your patients to the concept of existential cowardice.

I don't know if my advice was of any use at all, lol :P
F. said…
@Butters
If not that, then at least let them know that it's not a coping problem, but a systemic problem of which they are not the only victim.

Isn't that how the problem starts in the first place? When the person realizes it is the system that is wrong, and they themselves are being crushed by the wheels of a social machine of which they no longer identify as a part? They might as well just be dust--if there were more of them, they could have jammed up the cogs, but they don't often get a chance to gather.
I'm just sayin'. :P
Awais Aftab said…
@ Butters

It might be good to introduce your patients to the concept of existential cowardice.

I agree with this. Definitely.