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’.”


Addiction Recovery: Why The LGBTQ Community Needs More Safe Spaces


Photo by chezbeate

This is a guest post by Rebecca Moore from, who is researching ways to improve the seamless integration of marginalised groups, including people with disabilities and the LGBTQ community, into society.

LGBTQ addicts face a number of challenges when seeking treatment for drug dependence that heterosexual individuals do not necessarily face. Members of this community need more safe spaces in which to recover from substance abuse issues.

Recent studies show us that up to 30% of the LGBTQ community struggles with substance abuse to one degree or another. Comparatively, less than 10% of the remaining population faces addiction to drugs and alcohol. When LGBTQ addicts reach out for help, however, they are often faced with numerous barriers that the addicted heterosexual population does not have. So, not only do these individuals tend to struggle with addiction three times as often as other individuals do, but they also have more difficulties with getting help than other demographics do.

Experiencing Addiction as a Member of the LGBTQ Community

Across the United States, members of the LGBTQ community face discrimination from a number of sources and places. Even though some regions are more accepting of this population than others are, no area is completely immune to discrimination when it comes to sexual orientation or gender identity. No matter where an LGBTQ member goes, he or she will be discriminated against and will face problems and difficulties that others do not face.

The prejudices that are prevalent among society at large place an incredible amount of strain on members of the LGBTQ community. The constant stigmatization leads many of these individuals to have feelings of worthlessness, confusion, fear, and self-doubt. The bombardment of this discriminatory message causes members of this population to turn to illicit substances as a form of self-medication. To make matters even worse, these same prejudices are then put on them in the addiction and rehabilitation field. So as if their lives weren’t hard enough already, these persons then experience the same discriminations when they try to beat addiction that caused them to turn to drugs and alcohol in the first place!

When society is telling you that you are bad because of your gender identity or sexual orientation, it may seem that your only relief is in the form of drug or alcohol abuse. Unfortunately, this sense of relief is only temporary at best, and it almost always leads to addiction and even bigger problems down the road. When addicts do reach out for help, they often find less support than they need.

Safe Spaces for LGBTQ Addicts

When searching for addiction recovery options, it may be difficult to find a program that is accepting of members of the LGBTQ community. Many individuals face direct discrimination by staff members or other patients at treatment centers. As such, it is necessary to create arenas where members of the LGBTQ community can feel safe while they recover from substance abuse issues. Thankfully, such programs and centers do exist, they are just few and far between at this time, though their numbers are thankfully growing. When one is looking for such a place there will be key characteristics to look for, including the following:

  • Inpatient treatment facilities with programs designed specifically for LGBTQ addicts;
  • 12 Step Programs, Alcoholics Anonymous, and Narcotics Anonymous meetings that accept members of the LGBTQ community, including transgender individuals whose gender identity differs from the sex they were assigned at birth;
  • Rehabilitation centers with staff who are experienced in working with members of the LGBTQ community and have been trained in cultural sensitivity; and
  • Community and aftercare programs designed specifically for LGBTQ members.

Regardless of sexual or gender orientation, you will always have a battle ahead of you when addiction is involved. But help does exist.

Organisations that support addicts in the South African LGBTQ community include the Pride Shelter Trust in Cape Town and OUT in Pretoria.

“Captain Underpants” and the Not-So-Stinky Same-Sex Surprise


Here’s something worth talking about besides the never-ending nonsense in Kentucky. The “Captain Underpants” series, which is widely beloved by children and widely poo-poo’ed by fuddy-duddies, went out with a major mic drop last week.

Read more on the Mommy Man – Jerry Mahoney blog.

Source: “Captain Underpants” and the Not-So-Stinky Same-Sex Surprise