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Three psychiatrists explain their work

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Questioning How Psychiatric Units Search Patients and Their Belongings

We've been blogging over on Shrink Rap for just about seven years now. We've gotten to know our readers well, but one topic keeps coming up over and over: while some people are happy with the psychiatric treatments they've received and the doctors they've seen, others feel they've been mistreated in some way. They've had side effects from medications, or they've felt humiliated by insensitive words or practices they find degrading. As a psychiatrist, I can see one side of the story easily: safety is paramount, life is unpredictable. As a blogger, I've come to understand that even treatments offered with the best of intentions can cause distress, and whlle this isn't limited to psychiatry, there is a contingent of people who feel strongly. There are anti-psychiatry groups, and psychiatric "survivors," which I think is somehow different from being a cancer survivor.

While psychiatrists, I believe (and I know a lot of them) are well-intentioned and want to help people live fuller, more productive, less-symptomatic lives, our image...well, pardon my French (and not to disrespect the French, I'm using an idiom here)...our image sucks. In the media, we're the cross-dressing serial killers who eat our patients, are awkward and troubled ourselves, and now each and every one of us is a wealthy pawn of Big Pharma. Oh, my. I'm so happy my patients don't see me this way, but I've grown to appreciate that some people do. And if that's not bad enough, psychiatrists are seen as power-mongers who want to control, rather than cure, their patients. Oy. It's the civil libertarians against the shrinks, and time has made it harder and harder to secure treatment for people who are too ill to appreciate how badly they need it.

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I've begun to wonder why our field is so unpalatable. I love my job. I love working with patients, and it's very rare that the work feels adversarial. With this said, I've been struck by the number of Shrink Rap readers who've commented on the indignities of being searched, or even strip searched upon admission to a psychiatric unit. At first I thought, "Oh, that must be routine," and since a patient needs to be defined as a danger to himself or others  to gain admission these days, it doesn't seem unreasonable. The staff have a right to protect themselves, the patient isn't going to get better if they're sneaking in weapons or drugs, and how do you explain to another patient who was injured, "Sorry we didn't notice the knife strapped to his thigh" after the other patient is stabbed? But then readers started writing in that strip searches are not done on all units and some searches are dealt with more sensitivity.

Ah, I need to write an article on this. I put up a survey on Shrink Rap and I'll invite you to take it by clicking HERE. And if you'd like to share a story with me— the good, the bad, I'll even take the ugly—please add your story HERE. The story, after I write it, will be up next week on our Shrink Rap News blog over on the Clinical Psychiatry News website. Obviously, the Supreme Court's ruling last week on Florence v. The Board of Chosen Freeholders reinforcing the right of the police to strip search people arrested for minor crimes got me thinking about this issue more.

Dinah Miller, M.D., is a psychiatrist and writer in Baltimore, Maryland. She is co-author of the book Shrink Rap: Three Psychiatrists Explain Their Work.

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