Psychiatrists’ social contract

Last weekend I had the opportunity to attend the annual World Psychiatric Association (WPA) Congress, which was hosted in Cape Town this year. Over the next few weeks I will be sharing some of the keynote addresses from the Congress.

The Contract between Psychiatrists and Society

In Gujarat, Western India, there is a holy place where many people with mental illnesses go to pray because they believe if they do so they will get better. Some years back, a team of psychiatrists and other medical and health experts set up an initiative where they worked closely with the faith healers at the site with a view to sharing their expertise and helping heal the patients.

The healers engaged closely with the religious leaders, and slowly started administering medical assistance through them. By building up the relationship, the patients, through the healers, started trusting them and accepting their medical input and, in some cases, medication. This co-operative arrangement had yielded great results.

This touching anecdote formed part of the opening address at the World Psychiatric Association Conference by WPA President Dinesh Bhugra, on the contract between Psychiatry and Society.

“The key message to be taken from this is that psychatrists should work together with communities and respect patients,” said Professor Bhugra.
“We should not feel threatened or criticise people for being different. Those are individuals who believe in what they do. We need to find ways of working with them to deliver what our patients would expect.”

In other words, said Professor Bhugra, a key resource in working in this tumultuous and changing world is for psychiatrists to “think out of the box”.
“In Gujarat, they spent two years working with faith healers, getting rid of their fears and concerns, working out, ‘This is what I can do, this is what you can do, let’s work together.’
“People feel threatened by the unknown so co-operation and understanding are essential.”

The same principle applies in Africa, where many people consult traditional healers before seeking medical assistance.

A key part of the contract between Psychiatrists and Society, said Professor Bhugra, is to work out where the boundaries are. We need to ask ourselves, what is it that society expects me to do in treating mental illness, and in return, I, as the Psychiatrist, want the professional freedom to be able to get on with the work, be able to self-regulate, to have sufficient resources and to have respect for what we do.

“The point is that we need to think about services … and that, rather than patients coming to us, we need to be where the patients are. If patients go to a temple or holy mosque, we must be there, rather than saying, ‘come to us’.
“But, both sides should be clear as to what is expected of each other. While we advocate for our patients, similarly, society should listen to me, and say, ‘Here is a person with expertise’.”

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5 thoughts on “Psychiatrists’ social contract

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