Monday, August 3, 2009

Let me tell you how I feel… (Things that nag at me)

Henry A. Nasrallah, MD


Every psychiatrist and mental health professional encourages patients to “express your feelings.” Venting produces a cathartic effect, especially if frustrations have been harbored for a while. So I thought I should practice what I preach and tell you some things that annoy me about the contemporary state of psychiatry, which might bother some of you as well.

Why have we allowed our patients to be relocated from hospitals to jails and prisons? How were the mentally ill transformed from “patients” to “felons?” State hospitals have been shuttered, but correctional facilities are a growth industry.

Why have community-based mentally ill patients become “clients,” as if mental healthcare was a business transaction? Would cardiologists or oncologists accept labeling their patients as “clients?” No chance!

Read full text (free access)

Comment on this article

Email the editor


  1. Ronald Abramson, MDAugust 17, 2009 at 8:24 PM

    I would like to comment on several of the points that Dr. Nasrallah made in his editorial of August, 2009. I will take them out of order:

    "Why have psychiatrists in community mental health settings been reduced to writing prescriptions and doing "med checks"..."

    Look to yourself and your colleagues, Dr. Nasrallah. In a recent editorial, you were pressing for psychiatric practice to be reduced to doing forms and rating scales every visit. A couple of years ago I was at a psychopharm course where Dr. Mark Zimmerman, a psychopharnm colleague, advocated for just this. He described as desirable psychiatric practice as monthly 15 minute visits where the patient fills out rating scales and then 5 minutes of "psychotherapy" is performed.
    A couple of weeks ago, I read in "Pharos" the journal of AOA that at Johns Hopkins the medical disciplines are teaching their residents how to understand the "whole patient."
    So, as internal medicine is trying to treat the whole patient, Dr. Nasrallah and other thought leaders are reducing psychiatry to self rating forms. The monthly "med check" lies at the doorstep of our psychopharmacologist thought leaders.

    "Why is it that the more powerful the evidence that mental illnesses are brain disorders...,the more demedicalized community mental health centers have become.

    Because, with the monthly med checks fostered by our psychopharmacologists, psychologists and social workers are running the cases. Under the leadership of our psychopharmacologists, we have given away the store.

    "Why have community mental health center patients become 'clients'...?"

    Same thing. Psychologists and social workers are in charge of the cases and those people consult to clients.

    Dr. Nasrallah,
    By stripping psychiatrists of their psychotherapy functions, we have given away the store to the psychologists and the social workers.

  2. The main reason I see for the word client being used instead of patient is because much of mental health care is run not by doctors but social workers or psychologists. We have been pushed out of the psychotherapy aspect of practice also and the only island we have left is our prescribing pad to fall back on.