Humanitarianism Is Essential to the Practice of Psychiatry

There are many ways to describe modern psychiatry. One thread that seems to run through it is humanitarianism. However, psychiatry has rarely been described that way. Perhaps humanitarianism is so ingrained that it is taken for granted.

“Webster’s College Dictionary” defines humanitarianism as “The ethical doctrine that humanity’s obligations are concerned wholly with the welfare of the human race.” This doctrine is easily translated into psychiatry as reflected in APA’s “The Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry.”

What seems to make psychiatry different than the rest of medicine in terms of ethical humanitarianism is its focus on the essence of human nature, the sense of self, and one’s potential and purpose. Mental disorders imperil our core, and treatment aims to find or restore one’s identity as a human.

A comprehensive humanitarian approach rests on our biopsychosocial model: our biology, with the corresponding use of medication and related interventions; our psychology, with the corresponding psychotherapies; and the social-psychiatric domain, including the social determinants of mental health. Some, including myself, suggest expanding this model to include spirituality and ecology as well, recognizing the psychological impact of various religious practices and the pervasive effects of environment and climate on mental health.

Abraham Maslow’s hierarchy of psychological needs offers a model for applying a humanitarian-based perspective in the daily practice of psychiatry. After assessing and addressing a patient’s physiological needs, safety and security, the humanitarian psychiatrist then turns to the patient’s need for love and belonging, self-esteem, and self-actualization. It’s through fulfilling these higher-level needs that one’s humanity is nurtured and healed.

While opportunities to practice humanitarian psychiatry abound, there are also obstacles to overcome. In my book, “The Ethical Way: Challenges & Solutions for Managed Behavioral Healthcare,” I use a mock company to illustrate the challenges of practicing medicine in a profit-driven managed care environment.

As the saying goes, necessity can be the mother of invention. Faced with increased administrative burdens and decreased visit times, I developed a strategy for my 10-minute “med management” visits. By asking patients what gives their lives meaning and coming to an agreement about how to collaboratively tailor treatment to support those values, I found a way to bring our shared humanity in focus, which in turn, helps healing despite the time constraints.

As Sir William Osler, M.D., said, “Ask not what disease the person has, but rather what person the disease has.” By keeping this principle in mind, we can remain humanitarianism-informed psychiatrists even when confronted with administrative hassles, limited resources, or other challenges.

Viewing psychiatry through a humanitarian lens allows us to see our patients as whole persons, not just collections of symptoms. It reminds us that our goal is not just to treat disorders, but to help individuals realize their full potential as human beings. ■