Can A Patient Have A Bad Attitude?
Posted by Dr. Vollmer on December 14, 2016
A bad attitude can be a symptom of depression. Depression is a mood state we psychiatrists treat. So, is it possible that a psychiatrist says to a patient “the reason you are not getting better is that you have a bad attitude,”? As the story relates to me, I have no way of knowing the validity of that tale, but I want to take a moment to consider the notion of a psychiatric patient with a “bad attitude”. The idea feels so shaming and so blaming to me, I can hardly believe a psychiatrist could express this notion, and yet, at the same time, as more psychiatrists are “pill-mills” and as we know that our pills have limited efficacy, the frustration from the psychiatrist could translate to blaming the patient. Maybe we do not understand our tools, or for that matter, the human mind, enough to understand why people either get better or do not get better. Can we accept that amount of humility in our profession, or do we need to assume that a poor outcome has to do with the patient? The absurdity makes me laugh. If the patient had a “good attitude” what is he doing in our office? We treat “bad attitudes,” not by being accusatory, but by trying to understand the underpinnings of this “attitude,” or to put it another way, we try to understand it in historical context. Of course, historical context takes time and energy, along with carefully honed listening skills, a set of strengths that are no longer taught in Psychiatry Residencies, leading, to what I see, as professional suicide for all of us. The hard truth is that when our pills fail, which they often do, we must be able to use listening skills to help patients sort out their mental suffering so that they can have a narrative which helps them navigate their life, both past and present. If we lose these skills, the job satisfaction will be poor, and patient satisfaction will also be poor. The result, as I see it, will be a complete disillusionment with the field. There, I have ranted again. I just cannot say this too many times or too many ways. The state of my profession is dire, and we need to have an open discussion before we die completely. That is my hope, that these posts will stimulate a forum to push back and encourage psychiatrists to listen deeply, to learn how to listen in a therapeutic manner. The “good ol days” were indeed better than our present. I maintain that point of view and I am open to talking about that further. The gauntlet has been laid. I wait.