Social Responsibility

I recently completed more than 75 hours of continuing medical education (CME) as required by my state medical board to maintain my license to practice medicine. The courses varied in content from psychopharmacology, addiction medicine, and psychiatric aspects of HIV and hepatitis C to cognitive therapy.

Almost all the courses were well presented, and all had direct implications for my daily clinical practice as a psychiatrist. Despite the repeated mantra of “supported by an unrestricted educational grant from _____ Pharmaceuticals,” however, it seemed to me the drug industry played a not-so-covert role. I am not against the pharmaceutical industry, nor am I averse to using psychotropic medications in my work. Obviously the days of psychotherapy as the mainstay of psychiatry are history, and I am not suggesting a nostalgic return to yesteryear.

My question is this: What is the role of psychiatry in today’s society? What are our moral obligations? Never in more than 75 hours of CME did anyone raise these and other questions such as, Why are so many people addicted to drugs and alcohol? Why are so many suffering from sexual abuse and posttraumatic stress disorder? Why are our prisons filled with mentally ill people? How can we spend billions on weapons and wars and so little on health care, especially mental health?

I believe it is our leaders who inspire us and set the moral tone. How do we tell our children that drugs are bad when the tobacco and alcohol industry are government subsidized? How do we explain that the richest, most powerful country in the world has millions of citizens who lack basic health care and live in poverty?

There are no role models currently in positions of power. The last leader I can respect is President Jimmy Carter. Even now, he continues to travel the world, quietly promoting morality and decency.

Enough ranting! Do we as psychiatrists have a responsibility to influence our country’s morality? We have the unique privilege to see life as lived by our patients and comprehend human behavior. It is not enough to see them as diseases requiring therapy.

It doesn’t have to be this way. I lived and worked for more than 30 years in Canada. Health care for all is taken for granted there. Sure, there are problems, but I believe the Canadian system is less costly and superior to that of the United States. Malpractice premiums are cheaper. People found with small amounts of marijuana receive a fine, similar to a parking ticket, rather than a criminal record. Canada allows openly gay individuals to serve in the military and is acknowledging that gays can legally marry without society being destroyed. The recently retired prime minister, Jean Chretien, used his power to promote “liberal” values.

As physicians—and psychiatrists in particular—we need to respond to the role society plays in mental illness and find how all those unhappy synapses we keep medicating get triggered.