Overcoming social stigmatization
Public perception of psychiatry is distorted by numerous myths that doctors must actively dispel. It is a mistake to assume that a mental illness inevitably makes a person completely helpless. In fact, a malignant course occurs only in certain forms of illness. In most cases of chronic pathologies, long-term and high-quality remissions are possible, during which a person outwardly differs in no way from healthy individuals and is capable of living independently, working, and taking care of themselves.
It is also unfair to blame parents for their children's illness, whether through the transmission of pathological genes or «improper» upbringing. Burdened heredity is not a fatal sentence, and personality traits can conceal hidden talents. Parents bear a heavy burden during periods of exacerbation and are victims of the situation, so society is obliged to share responsibility with them.
In the professional and public environment, it is categorically unacceptable to use diagnoses as insults (e.g., «schizophrenic» or «idiot»), and in the mass media, the use of derogatory terms such as «loony bin» should be strictly suppressed.
Impact of side effects on social adaptation
Successful social rehabilitation directly depends on how well the physician minimizes the visible consequences of pharmacotherapy. One of the main problems is prescribing psychotropic drugs without adequate doses of correctors.
This leads to the appearance of noticeable side effects that alienate others:
- Neurological disorders: unnatural facial expressions, tremor, strange and constrained movements.
- Cosmetic defects: excessive weight gain, facialgreasiness, skin rashes, gynecomastia.
- Sexual disorders: an area that is often unjustifiably ignored by specialists.
Even if acute psychosis is successfully managed, due to the external manifestations of therapy, society perceives the person as «weird». Therefore, rehabilitation is impossible without attentive consideration of all aspects of the patient's social life.
Self-stigmatization and secondary gain
Often, patients themselves and their loved ones unconsciously support the stigma. Self-stigmatization on the part of relatives manifests as extreme measures to conceal the fact of illness, especially when it comes to the patient getting married. Patients themselves may derive secondary gain from their situation: they use the diagnosis to avoid responsibility, refuse to work, and receive increased sympathy and care.
Such disability attitudes (rent-seeking behavior) lead to adaptation to the role of an invalid and rejection of rehabilitation. The medical worker must not support such passivity. Communication should avoid a patronizing tone (such as friendly patting on the shoulder or addressing the patient informally). The optimal communication style is neutral and polite, assuming personal responsibility of the individual for their actions. The physician should point out alternatives but avoid being categorical in their advice.
Physician autonomy and therapeutic cooperation
The principle of autonomy applies not only to the patient but also to the physician. A healthy team atmosphere implies the rejection of authoritarianism, respect for colleagues, and independence of diagnostic opinion. At the same time, the doctor should not fall into extremes:
- Authoritarian approach: dictating conditions and applying coercive measures destroys trust.
- Excessive identification: «dissolving in the patient» and inappropriate pity deprive the doctor of autonomy and hinder the patient's independence.
According to Adolf Guggenbühl-Craig's concept (the image of the «wounded healer»), a doctor's perception of themselves as an almighty savior leads to a direct infringement of the ward's rights.
Even in severe psychosis, cooperation can be built by relying on «islands of reality» — the preserved ability to feel. One should not argue with delusions or play along with them (e.g., agreeing with «alien influence»). It is enough to acknowledge the person's feelings: agree that they are anxious or that voices are interfering with their concentration.
Justice, responsibility, and medical confidentiality
Partnership requires mutual responsibility. The physician has the right to demand compliance with the medication regimen, but overly rigid control emphasizes the patient's helplessness. Respect for autonomy means that the patient can refuse treatment (if there is no threat to themselves and others), taking full responsibility for the consequences.
During a prolonged stay in a hospital, the doctor is obliged to suppress any discrimination and division of patients into «favorites» and «outcasts». The principle of justice requires equal treatment for everyone, regardless of personal qualities or beliefs.
Of particular importance is medical confidentiality. Disclosing information about psychiatric treatment can ruin a person's life. The doctor is obliged to keep this information secret not only from outsiders, but also from the patient's friends and relatives. A situation where the family knows more about the patient's health status than the patient themselves is completely unacceptable. All ethical standards are enshrined in the Code of Professional Ethics of a Psychiatrist (1994) and Declarations of the World Psychiatric Association.
Briefly: answers to topical questions
In which regulatory legal acts are the ethical standards of a psychiatrist's work enshrined?
The basic ethical standards of a psychiatrist's work are enshrined in professional codes and international declarations. These include:
- Code of Professional Ethics of a Psychiatrist — adopted at the Plenum of the Board of the Russian Society of Psychiatrists on April 19, 1994.
- Declarations of the World Psychiatric Association — adopted in 1977, 1983, and 1996.
In what cases does a psychiatrist have the legal right to disclose medical confidentiality without the patient's consent?
Medical confidentiality may be disclosed in connection with court proceedings. To prevent the disclosure of information, the patient or their representative must file a petition to hold a closed court hearing. Personal information must be kept secret not only from outsiders, but also from the patient's family and friends.
What are the criteria for involuntary hospitalization of a patient in a psychiatric hospital?
Involuntary hospitalization is permitted exclusively when the patient has a severe mental disorder that causes specific states. These criteria include:
- Immediate danger — a threat to the patient themselves or people around them.
- Helplessness — the individual's inability to independently meet their basic life needs.
- Significant harm to health — the risk of deterioration of the mental state if the person is left without medical care.
What questions are posed to the forensic psychiatric expert to determine the sanity of the accused?
In criminal proceedings, forensic psychiatric examination resolves issues of:
- the person's sanity, diminished sanity, and insanity at the time of committing a socially dangerous act;
- the responsibility of persons who committed a crime in a state of intoxication;
- exemption from punishment due to illness;
- the appointment and implementation of compulsory medical measures.
Class and exam questions
Can a diagnosis be disclosed to a patient's relatives?
No, information must be kept secret even from family and friends to maintain the patient's autonomy. The patient must always be informed about their condition more fully than their relatives.
How to communicate with a patient experiencing psychotic delusions?
One should not try to persuade the patient with logic or play along with their delusional ideas. The correct tactic is to rely on «islands of reality», that is, on their current feelings and emotions (anxiety, fear).
Does a patient have the right to withdraw from clinical trials after they have begun?
Yes, the patient has the full right to refuse participation at any stage of drug trials, even if they have previously signed informed consent.
What to do if a patient uses illness to evade work?
The doctor is strictly forbidden to support such disability attitudes and displays of helplessness. Communication must be neutral and polite, emphasizing the patient's personal responsibility for their life.
What else to study on this topic
- Criteria for malignant course and formation of prolonged remissions.
- Pharmacological basis for prescribing corrective agents.
- Mechanisms of forming secondary gain from illness.
- Legal nuances of obtaining written informed consent.
- Adolf Guggenbühl-Craig's concept of the "wounded healer".
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Other topics in "Chapter 5. Organization of Psychiatric Care in the Russian Federation. Legal and Ethical Issues of Psychiatry"
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