Psychiatry and Politics: Can They Mix?
Abstract
Claire Zilber, M.D., is a psychiatrist in private practice in Denver, a faculty member of the PROBE (Professional Problem Based Ethics) Program, and chair of the Ethics Committee of the Colorado Psychiatric Society. She is the co-author of Living in Limbo: Creating Structure and Peace When Someone You Love Is Ill, the winner of a 2017 Silver Nautilus Book Award.
The political cycle, once a seasonal phenomenon, now feels perpetual. It’s in the news, in our dinner conversations, even in our consultation rooms. Psychiatrists may want to engage in political discourse but need a way to preserve appropriate professional boundaries. This column addresses some behaviors to avoid and focuses on productive ways for psychiatrists to express political opinions.
When political discussions arise in your office, protect the therapeutic relationship. Avoid asking patients for whom they are voting, telling patients how you plan to vote, putting political flyers in your waiting room, soliciting campaign contributions from patients, and engaging with patients about whether Fox News or CNN provides more accurate reporting. All these examples risk influencing the patient in a way that is not related to treatment and may affect the patient’s ability to trust the psychiatrist.
When patients are upset about an issue in the news and the discussion tempts you to reveal your personal political views, focus on their emotional response and how the story relates to their own history. This may help you retain your therapeutic role.
Sometimes a news item may have a direct bearing on mental health treatment. In this case, elicit patients’ thoughts and concerns about the issue and contribute any factual information you have that may inform the discussion. For example, if a patient inquires about a proposed local tax increase to fund mental health and addiction treatment, you could provide data about the rising incidence of opiate addiction and the need for more treatment facilities. Offering factual information without direct instruction about how to vote and then returning to how this topic relates to the patient’s treatment preserve the provider-patient relationship.
If patients express concern about a topic at the intersection of psychiatry and the law, such as whether an acutely unstable family member has access to firearms and what to do about it, the first priority is to focus on safety and assess any imminent risk. As of July 16, 13 states have a “red flag” law that permits law enforcement officers and family members to petition a judge to temporarily remove firearms from an individual deemed dangerous to self or others (Psychiatric News, August 17). If you reside in a state that does not yet have this law, it would be ethical to mention this emerging legal trend to your patient and suggest that stories from constituents may help encourage local representatives to introduce or support similar legislation.
Outside of the constraints of the clinical role, psychiatrists have many ways to engage in the political process. Involvement with your district branch’s legislative committee is both ethical and desirable. Section 7 of The Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry concerns the responsibility of psychiatrists to participate in activities that improve public health. Article 1 states, “Psychiatrists are encouraged to serve society by advising and consulting with the executive, legislative, and judiciary branches of the government.” District branch legislative committees help educate political officials about mental health priorities in state and local districts, offer comments on drafted legislation to help ensure it best represents the interests of our patients and profession, and provide testimony during hearings of upcoming bills.
In addition to direct advocacy to legislators, psychiatrists can influence political decisions by donating to APAPAC, APA’s political action committee, or your district branch (Psychiatric News, September 7). Psychiatry’s interests cross the political aisle. The APA and DB political action committees support candidates based on their likelihood to promote issues that are important to our patients and profession, without regard to party affiliation. For example, psychiatry’s concerns about the mental health effects of marijuana tend to align with the position of Republicans, while our commitment to access to health care for all align with Democrats. Political action committees help open a dialogue with politicians and allow our profession to be heard by the people crafting public policy.
Of course, psychiatrists may also choose to engage in politics in the ways open to any citizen. Attend rallies, meetings, and debates. Donate to candidates or organizations according to your personal values. Write letters to the editor. Run for office. When engaging as a citizen, be mindful of the boundary between your professional identity and your political activity. Section 7 of the Principles includes the admonition, “Psychiatrists should always be mindful of their separate roles as dedicated citizens and as experts in psychological medicine.” Refrain from representing your personal opinions as the position of the profession if you are acting outside of the role of a formal district branch or APA position.
There are so many ways psychiatrists can engage in political discourse while maintaining an ethical posture. First and foremost, respect the boundaries of your role with patients. Engage with organized psychiatry’s legislative committees and political action committees. Become involved as a citizen. Help shape the world in which you practice and live. ■
