Letter

To the Editor: When I read the May 2009 article "The Capacity to Vote of Persons With Serious Mental Illness," I was reminded of a question that I began to ask routinely when I was taking a clinical history. I—and the trainees I taught—often found that it was useful in assessing the functioning self of a patient and in establishing rapport.

When posing a series of questions to try to learn how a person usually lives his or her life, ask: "At election time do you usually vote" or "Are you registered to vote?" Because of the low voter turnout in U.S. elections, a negative answer contributes little, if anything, to the evaluation. However, the person's spontaneous elaboration of negative views of elections and politics or of socioeconomic reasons why he or she does not vote is useful information. A positive answer, with or without elaboration, is also useful.

For example, a person known for his combination of sarcasm and paranoia responded, "That is the only sensible question anyone has asked me since I came to this hospital." Another person stated, "I'm glad you asked that question. I haven't registered since I moved here, I have to do that." And another said, "I never used to skip voting, but now after I take care of my mother and then go to work, I'm just too tired to go."

Dr. Cowen is semiretired in Baltimore, Maryland.