Patient Care Centered Psychiatry Remains a Dream

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In his paper I review progressive steps I took with dedicated others in a still unfinished effort to understand what it is to be a psychiatrist. My first responsibility after residency was to provider care for 149 patients chronically hospitalized with serious mental illnesses for 2 to 35 years. The obvious disregard for rehabilitation of their disabilities posed a problem of standards of care that I still find unresolved in psychiatry. Their lives were captives of our asylums for the mentally ill. Today these mentally ill languish homeless and in jails, both situations repeatedly shown unnecessary in this paper and by many others. These patients’ rehabilitation of disabilities and returns into society raise for me a Gordian Knot of sources of our human problems of living that look beyond the disorders recognized by psychiatry in its DSM manuals. Why do tragic follies plague our lives entwined with the lives of others? One answer may lie in some colleagues respondes to the original publication of this report. They claimed that I had become depressed. Are we somehow so defeated by the human condition? Depression can be a response best understood as a warning that adverse conditions are to be better understood. Depression can arise from anger about a situation one cannot escape and thereby one mistakenly directs the blame on oneself. Modern evolutionary biology teaches us how we cannot escape being products of our evolution, itself constrained by the universe’s mandate that life must survive. We have been reproduced to reproduce and not to otherwise naturally find health, wellbeing, happiness or survival beyond our reproduction of our lives. We provide for ourselves much of life’s pleasures and pains. We cannot blame ourselves for this responsibility. Can we blame ourselves for not meeting this responsibility? While this paper focuses on the suffering and disabilities of patients with mental disorders, it also documents the stresses of those overextended by a dedication to quality care or by other trying circumstances of living. I have written elsewhere of our evolved vulnerabilities to lasting consequences from PTSD, a reaction more frequent than acknowledged due to stresses from our follies. I experienced it once when a patient was left to die and again when, exhausted by the transience of benefits from his accomplishments reported in this paper, Neil Meisler took his own live in 2009. Can we do for ourselves what evolution has not done for us and mitigate our follies and the human suffering they bring on us? Today, I think so. In 2009 this was still a hope alone. 21st century evolutionary biology and other studies have revealed how certain human traits and limitations are potentially malignant causes of misleading and often destructive follies. I am studying them and hope to recruit academic psychiatry to pursue this social psychiatry task. My 20th century experiences need not be repeated in the 21st century.

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