Dear Steve 2025,
Has the way we care for one another improved? Are you still devastated to see mentally ill people, psychotic and disheveled, lining our streets like discarded byproducts of a polarized society? Do we still abdicate higher ground by hiding behind ill-conceived mental-health laws that value autonomy over dignity and individualism over compassion? I’m reminded of Francis Peabody’s 1925 proclamation, “The secret of the care of the patient is in caring for the patient.” Those words remain most urgent in the care of those who cannot care for themselves. Yet, I’m disgusted by how we’ve lost our guiding principles when dealing with mental illness.
In 2019, if my patient has a brain tumor that compromises decision making capacity, we seek surrogates to act in their best interest and provide compassionate care. Severe mental illness can also rob people of their ability to comprehend reality and destroy their capacity to render rational decisions. Sadly, current laws distinguish mental from physical health so that we cannot apply the same standard of compromised brain function. Our laws remain uninformed by science, and mandate that I release my patients from care if they are not in danger, even when they lack the capacity to think clearly. I wonder if society will stop treating mental disorders as outside of our collective responsibility so we can care for those among us who cannot care for themselves. I hope you look back to 2019 and remember a time when we worked to repair this world.
Tikkun olam,
Steve 2019
Dr. Steven Siegel is the Chair of the Department of Psychiatry and the Behavioral Sciences at USC. www.keck.usc.edu/psychiatry
