Independence Day and the Independence of Our Patients

July 4th is right around the corner. For many of us, it will be a welcome day off from the stress and reward of taking care of our patients.

It, of course, celebrates the independence of our country from England. But there are many kinds of independence that still challenge us day by day: economic independence, physical independence, and of course, mental independence, among them. This is not to detract from the importance of interdependence, teamwork, or community, but rather to try to strike the right balance.

Most so-called mental disorders are a challenge to independence. Severe depression limits the ability to do things; severe anxiety inhibits necessary activities; psychosis can put us out of touch with the reality of others; PTSD keeps past trauma unnecessary alive; dementia puts us in the hands of others without even knowing it; and substance abuse of any kind can lead to dependence on those substances.

At times, mental disorders end up in coercive treatment, either outpatient or inpatient treatment. If not in a psychiatric facility, one can end up in jail or prison instead.  This can seem harsh, traumatic, and unnecessary.

Medications can seem coercive when unexpected withdrawal symptoms prevent ease of discontinuation. Sometimes the coercive aspects of medication are not even recognized or known by the psychiatrist or patient if there are subtle side effects that reduce cognitive functioning. Psychotherapy can sometimes make the patient overly dependent on the therapist, for years and years.

And, if mental disorder is known or conveyed, just try to find a well-paying job, especially in this economy. Or, try to locate a group home in a residential area; no, not-in-my-backyard is a common response. Oh, the stigma!

All of these obstacles to independence are being well-recognized by critics of mainstream psychiatry and behavioral healthcare. Using the power of the internet, they are demanding ways to be more independent and free from the direct and indirect, inadvertent or not, abuses associated with psychiatry.

So, on this independence day, away from work, let us keep the desired independence of our patients in mind and re-dedicate ourselves to that goal.