A beautiful article from Richard Friedman (Psychiatry, Cornell) about how, while psychiatry can do a lot for mental illness, it can't fix somebody who is just flat out mean.
The "yes, but's" are the critical portions of articles like these. Friedman isn't saying that psychopathology doesn't affect how people behave towards their fellow humans, and that there aren't organic reasons for being an asshole:
Don’t get me wrong. There is plenty of undesirable human behavior that falls well within the rightful domain of psychiatry to understand and treat. But must we turn everything we don’t like about our fellow humans into a form of psychopathology?A year or two ago, I might have found Friedman, to use a Tom Cruise word, a bit glib. That's probably a good thing. You don't want psychiatrists-in-training to have much else besides positive regard for folks with mental illness until they are mature enough in their understanding of psychopathology to begin to parse it away from normalcy.
I'm certainly not there yet, and so its probably good that I continue, at least for the time being, to view folks with mental illness as people who would be good folks if not for the misfortune of illness. I'll keep the fact that there's no necessary truth in that stance in my back pocket until I can figure out how to make sense of it. Folks with mental illness can be nice folk or jackasses, just like folks without mental illness.
A few years ago, I would have read Friedman's article as anti-mental illness and anti-patient. But part of becoming a psychiatrist has to include the process of realizing that folks with mental illness are normal people with a devastating illness that just makes them look like they aren't normal people to the untrained eye. Blaming the victim doesn't help anybody, but deeming the victim blameless removes the humanity from those who suffer from mental illness.
And physicians simply do not have the right, professionally or morally, to take away their patients' humanity.