Where Is the Compassion in Psychiatric Care?
My profession too often views compassion as unnecessary and even a weakness.
Posted Oct 30, 2019
“There is nothing weak about kindness and compassion,” former President Barack Obama said in his eulogy of Elijah Cummings, the Democratic Congressman who died last week. “There is nothing weak about looking out for others. There is nothing weak about being honorable. You are not a sucker to have integrity and to treat others with respect.”
While President Obama was speaking about a man working in the highly polarized world of partisan politics, I heard his message as a psychiatrist, working in a field that too often views compassion as unnecessary and even as a professional weakness.
One local hospital’s psychiatric services website states of its mission:
“To provide our patients with the best care, we depend on the compassion, expertise, and strength of one another. We come to work knowing that our patients need us and that our colleagues support us and this allows us to strive daily to be the best health care providers — and people — that we can be.”
Frankly, talk is cheap. Too many hospitals fail to live up to the mission statements they proudly display.
I know many excellent psychiatrists and psychiatric nurses whom I would confidently recommend to someone I love. To me, this is the greatest mark of professional respect. However, a few of my colleagues disgrace their profession and blemish the work of the compassionate, enlightened majority who strive to maintain their patients’ dignity.
Sadly, I have learned from too many of my own patients about unprofessional, demeaning, abusive treatment they suffered at the hands of both doctors and nurses at psychiatric clinics and hospitals across the country. I have witnessed this offensive behavior first-hand since I was in medical school.
Most of my patients who have been admitted to a psychiatric unit describe the experience as traumatic, terrifying, or both. One went directly from my office, accompanied by a parent, to the hospital. Within a few hours, her clothing had been forcibly removed by a group of security personnel, including men, one of whom groped her breasts. She was so traumatized by the abusive treatment she endured that she refused to return to the hospital when she needed help. Instead, she took her own life.
Other patients have recounted being held down and forcibly injected when they were not being aggressive or combative. Another was humiliated by the taunts of a nurse and a ward clerk. (I witnessed this myself.)
Due to the cruelty my patients have encountered, and through many years of experience, I fear for the safety of patients when they become acutely ill. Of course, I worry about the harm their brains and bodies may sustain due to their illness, but I also fear how they will be treated by the staff they will encounter if admitted.
Those admitted to a psychiatric unit are usually very ill, sometimes disruptive, and potentially violent. Due to the severity of their symptoms, they might lack insight regarding the nature of their illness and their need for treatment, yet they are still human beings worthy of respect.
Some staff on psychiatric units excuse their hostile, dehumanizing patient interactions as a necessary response to a dangerous working environment. Their appalling behavior is not about the safety of staff or patients; it reflects a desire, whether by an individual or the entire clinical team, to exercise power over a vulnerable individual. If their behavior is acceptable, reasonable, and appropriate, why do they always deny it occurred? Invariably, the patient is blamed or accused of dishonesty.
Psychiatrists and their clinical teams are given extraordinary power to limit a patient’s freedom and to treat an ill person who lacks insight, sometimes against their will. Patients and families trust us to use that power responsibly.
We are judged as a society by how we treat our most vulnerable members. The abuse of power and the use of humiliation and violence demonstrated by some staff on psychiatric units have no place in a just and civilized society, much less in a medical setting, which is meant to be both safe and settling.
Those individuals who abuse patients, or fail to protect them, must be held accountable by colleagues, professional licensing bodies, and patients and their families. Regrettably, a complaint from one doctor is easy for a hospital to ignore. To provoke meaningful change, we all need to speak up.
I urge anyone who experiences or witnesses a dehumanizing, threatening, traumatizing or humiliating psychiatric clinic or hospital interaction to speak out. Write to the hospital, health authority, or professional college where the event occurred. Then, perhaps the hospitals and licensing bodies will demand that mental health professionals do what they’re supposed to do — care.