Speaking Out for Psychiatry: A Handbook for Involvement with the Mass Media by articles

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CONTENTS

Introduction .............. ............. The power of the media .......................

3 4

1. Who's Watching, Listening and Reading?

2. Why Bother? ............................... Educating the public about mental illness ...... Advocating for the patient .................. Disseminating information about the cost to society of mental illness . ....... ................ Reinforcing the availability of mental health ser vices ............................... ......... . Clarifying the psychiatrist's role Improving the image of the psychiatrist .........

13 13 14

3. A Case in Point: A Radio Mental Health Call-In Show ..

4. Reluctance and Resistances Professional self-image .................... . Confusion of public education and soliciting .... Fear of appearances ....................... Ethical concerns ......................... . Confidentiality ........................... Information/education vs. therapeutic advice Public interest or self-interest ....... .

23 23

14 15 15 16

24 25 26 27 28 28

Speaking Out for Ps ychiatry

public, irrespective of their actual expertise. Psychiatry has been devalued relative to the more media-cooperative mental health professions, if for no other reason than deficient exposure. The general public has little alternative but to accept as valid the porLrayal of psychiatry in parody and caricature. Only public education can begin to overcome the negative image that some of the public: hold about psychiatry and the myths they harbor about mental illness. Only through education can the public recognize the necessity for including mental illness in comprehensive health insurance programs. This handbook addresses how psychiatrists can most effectively be involved in public education and thus combat destructive attitudes. It discusses the various forms of the mass media and the part they play in molding public policy. It looks at some of psychia try's reluctance in the past to take full advantage of the opportuni ties the media offer to educate the public. It provides a guide to some of the practical problems that may be encountered in work ing with the media. It also discusses some of the ethical issues involved and some of the implications of an interaction between psychiatry and the media. This handbook is neither an introduction to the theory of communications, nor an instructional manual on becoming a television personality or a leature writer for a m,\jor daily. Instead. it draws on the expertise of its authors to provide a guide to the most common situations a psychiao·ist is likely to encounter, with sugges tions on how to prepare for them and how to handle them.

The Power of the Media Surveys indicate that most Americans get their first news in the morning from the radio. Many Americans watch hours of televi sion daily. Billions of magazine copies are purchased a year, fre quently to be read, reread, and shared. Newspapers arc ubiquitous. The mass media, like all forms of communication, arc designed to inform, influence and persuade. They do so on a grand scale. No one questions the impact television, radio and print have on

Introduction

American thinking. Many times, however, the views presented are distorted. Intended distortions usually serve the function of pro moting controversy. The need to capture the interest of an audi ence is served by being provocative and creating conflict. Availability to huge audiences is necessary but may not be sufficient to affect public opinion. Professionals in the communicat.ions field appreciate the many factors that determine whether they will be successful. The audi ence, the message, tl1e source of the information, and the type of medium used to express it are critical variables. Not unlike psychia trists, competent editors are a\\1are of their own attitudes toward their audience and the messages they deliver. They must believe in what they are doing to be effective. Editors also understand the needs, the strengths, and the weaknesses of their chosen medium. They sense whether and how they can effectively communicate given material. Finally, they accurately perceive their audience. What. are their communication behaviors ) \Vhat do they read, listen to, watch? What is their rationale for "tuning in" this medium? What is their attitude toward the medium? For any given subject, editors are sensitive to the knowledge of their audience and their attitudes toward both the subject and the source of information. 'fo the extent that editors, consciously or unconsciously, take these factors into account, they arc effective. Their audience accepts and is influenced hy the view they communicate. As psychiatrist<;, we can harness this power in order to teach the public about mental health, mental illness, and the role of psychia try. 'fo succeed, we must address the same factors as the editors. Who compose our audience? What are their attitudes and their communication behaviors? What message are ,ve trying to trans mit? What would he the most effective medium for reaching a given audience with a given message? What are our own attitudes toward those we wish to influence? Do we really believe in what we have to offer? Psychiatrists arc accustomed to soul-searching. We can grapple unassisted with the questions pertaining to ourselves and our message. However, we need to learn more about media and audi-

Speoking Out for Psychiotry

ences. The best teacher is experience; most of us have little. The next best teacher is the experienced. Many professionals in the communications fields are glad to help us use their medium effectively, but we must be aware of and considerate of their particular needs. Some understanding of how television, radio, newspaper and magazines operate will be provided in chapter six. There are some significant differences among them. Nonetheless, they are alike in au essential feature: They are all business enterprises. Whatever other functions they may serve, they need to make money to survive. To make money they must attract and satisfy both audi ences and advertisers. When we deal with media representatives we should appreciate that they are pressured by deadlines, policies, and perhaps politics. More importantly, we should remember that they represent a business. As in any business, their product must be marketable and competitive. Accordingly, we can, without compro mising our standards or waiving our professional authority or sacrificing our dignity, adapt to their functional needs, and they can help fulfill ours.

WHO'S WATCHING, LISTENING AND READING?

Seldom does a week go by on the Today Show, Good Morning America, or the CBS Morning News without a feature report concerning a topic of mental health interest. Even the evening news shows often report on topics pertaining to mental health or mental illness. Subjects such as eating disorders, depression, teenage suicide, the effect.s of divorce on children, alcoholism, and drug abuse are frequent fare in television news. Interest is also reflected in the plethora of mental health call-in shows carried on both national and local radio. In a recent hour on a nationally broadcast radio call-in show, hosted by a psychiatrist, the following eight persons called: I) A grandmother complained that her adult children were allowing the family dog to lick their 16-month-old child on the face. She wondered whether her daughter was "crazy." 2) A 70-year-old widow of four years missed her husband and was concerned about how to meet a man. 3) A 63-year-old man was being treated for de pression with two antidepressants and was concerned about vivid dreams he had experienced. 4) A woman's 17-year-old son, after one and one-half years in therapy with a psychologist, continued to be depressed and very hostile. She was wondering whether a dif ferent form of therapy would be more appropriate. 5) A 24-year-old woman's best friend (a recent college graduate, married, with a child) was just killed in an automobile accident. The caller was in a state of shock and asking for help in dealing with it. 6) A 37-year-old woman asked for help dealing with the termination of a long sustained relationship. 7) A 20-year-old suicidal college student had been experiencing thoughts of dying for three to four years 7

Speaking Out for Psychiatry

It is clearly to psychiatrists' advantage to become involved with the media so they can educate the media and the public about psychia trists' special skills in diagnosing and treating mental disorders. Psychiatrists can clarify their own distinctive role if they let the media and public know wherein their special training, skills and functions differ from other mental health professionals. As a growing number of mental health specialist5 and other physicians become eligible for third party reimbursement and the competition for patients increases, it becomes vital for the public to understand the role of the psychiatrist The media provide an opportunity to educate the public to the fact that psychiatrisL5 are physicians with special skills in the diagnosis and treatment of mental disorders.

Improving the Image of the Psychiatrist Acquiring a positive public image is critical for psychiatrists today. The bad press that psychiatrists have received, the public's igno rance of what psychiatrist5 do, and increasing services by other mental health specialists are factors that. necessitate psychiatrists paying greater attention to the media. Working with the media can enable psychiatrists to promote a more positive image of the pro fession, to instruct laymen about mental health issues, and to demystify psychiatry. More familiarizing efforts are needed like that of the American Psychiatric Association's Division of Public Affairs, which has helped to lrain psychiatrisis to understand and work with the media. In summary, in appropriate media relations there are many potential benefits for the psychiatric profession and the public. The media can enhance the psychiatrist's image and role in the community, improve the conceptualization by the public and other health care providers about mental illnesses and their treatment, raise public awareness of inequities that plague the funding of mental health services, and diminish the stigma of mental illness. All these factors can serve to relieve suffering and decrease the costs of mental illness to society.

A CAS E IN POINT: A RADIO MENTAL HEALTH CALL-IN SHOW

A member of the GAP Pub Iic Education Committee (Ruben, 1986) has hosted a national mental health issues radio call-in show for over four years. The three-hour show is featured every Saturday and Sunday night on over 290 slat.ions in 50 states, and reach;s close to 5 million listeners. During an average hour the host answers 8 to 10 calls. This means that each three-hour show handles about 27 calls, a total of approximately 2,500 calls a year. Of the total calls, about 50 percent concern relationships with spouses, friends, parent� or children; 25 percent want to learn �bout anxiety and depression; 15 percent concern eating disorders (including obesity), Alzheimer's disease, schizophrenia, manic depressive illness, and borderline and sociopathic personality dis orders. The remaining 10 percent inquire about such matters as sexual problems, different types of therapy, how to go about seeing a psychiatrist, how to deal with a troublesome boss or neighbor, or how to find a new job. In addition, over JOO people each week write letters asking for such information as a referral for the name of a drug mentioned on the air or the name of a self-help organiza tion. About 25 percent give detailed information and request specific advice. Who calls and who listens? The program coordinator screens and keeps a log of all the calls. Callers range in age from preadolcs cents to octogenarians. Approximately 40 percent of these are 25 to 45 years old; 20 percent, 18 to 25; IO percent, under 18; 20 percent, 45 to 60; and 10 percent are over 60. Of the 100 calls screened each hour, about 20 are placed on hold to await getting on the air. Callers include students from grade school through graduate school, med17

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Speaking Out far Psychiatry

You may be called on to comment on many kinds of topics, whether they seem related to psychiatry or not. Psychiatrists have been asked to explain reactions to catastrophes, the st0ck market and rock groups, and render opinions on such matters as birth control, abortion or capital punishment. Sometimes even more controversial topics come up.The press these days is interested in the insanity defense and its use and abuse, the lack or need of mental hospital care, and the efficacy of psychiatry. J\"o question from the media should be ignored.The best way of dealing with nonpsychiatric topics is to provide a brief and very general response and then attempt to lead the interviewer to a more appropriate area of discussion. Ir is unethical to offer an opinion or diagnosis of a public figure or an individual in the news unless you have conducted an examination and have been granted proper authorization for such a swtement. You must protect the confidentiality of your patienrs. You may refer to Guidelinesfor PsychuLlrists Working with the Communications Media (see Appendix 1).

The 20-Second Answer Be factual, knowledgeable, and b1ief.Some questions do not have simple answers; some comments do not require a response. "I don't know" is preferdble to inaccurate speculation. To say "No com ment" in response to a question may be seen as hostile. A better strategy is to explain why it would not be positive to respond. Do not be afraid to state that you do not have sufficient expertise in a given area, and if possible, to refer to someone who does. When asked to commelll on a specific individual or incident, explain that you do not have the information to make a judgment, and/or that to comment would breach confidentiality. lise common lay terms rather than complicated scientific jargon. Sometimes tlie use of similes will help convey ideas, hut they must be used carefully due to the potential for misinterpretation.An example of a good simile is: "Bipolar disorder is like an emotional roller coaster with extTeme highs and lows." Tf asked a provocative or complex question, it is appropriate to use such statements or qualifiers as: "There is no

Meeting the Media

clear-cut answer to your question; however, some clinicians feel ... " or "Controversy still exists regarding that issue, but in general the evidence shows ... "or "You have asked a complex question, let me address it in phases ...."As a policy, you should not believe media people who tell you that they will not quote you on a question or ask you to speak off the record.Psychiat1ist�' off-the-record responses frequently seem to end up public knowledge. Reporters can mis understand, change your emphasis, or misinterpret your state ments.T hey rarely do so intentionally. It happens because they are not familiar with your subject or because you have not. taken adequate steps to help them understand the material. Although anything you say may appear in print or on the air, most media experiences will be with journalists who are intelligent, ethical and honest

General lips for a Successful Interview Take time to prepare for the interview, and consider the questions to be asked. Brush up on facts and figures. Keep the reporter's deadline in mind and return the reporter's phone calls promptly. Determine your su�ject, then help tie together the interview by working your theme into your answers to the questions. Rather than providing a one-word response to questions, amplify your answers to assist the reporter in getting the story. Show considera tion for the reporter and his or her objectives. Take the time to explain the technicalities or even the basics of your subject, taking into account the public's viewpoint Identify anything you say as fact or speculation, being careful to separate the two.Avoid picking up negative phrc1sing from the reporter. If the reporter asks, "Why haven't vou found a cure for ... ?" answer, "We now have effective treaune�11S for ... " It is important to correct misinformation and always to tell the truth. Speak dearly and simply and avoid exces sive or complicated medical tennihology. The more easily the reporter is able to grasp your meaning, the greater the chance you will not be misunderstood or misquoted. Avoid discussing hypo thetical situations, and avoid commenting, except as a concerned

Speaking Out for Psychiatry

ordinary citizen, on subjecL� out.side your area of professional expertise. Remember, good reporters, especially those who ,vrite about medicine, arejustas interested in telling the story accurately as you are and want to maintain a good working relationship with their sources. Dealing with the Hostile Interviewer

The interviewer can express hostility through style or content. The rapid-fire interviewer throws multiple questions at you from the outset and throughout the interaction. This person can be handled in a number of ways: l. Mention that he or she has asked a number of questions and ask the host to restate one question. 2. Note that the interviewer has asked several questions and request that he or she choose which one you should answer first. 3. Pick the question you like and give a complete answer. The interviewer who constantly interrupts can derail you from conveying your primary message. Techniques for handling such a person include: 1. Ignore the interruption, complete your answer, then ask the interviewer to repeat the question. 2. Stop what you were saying, allow the interviewer to finish the ques tion, then explain that you will answer the new question next. 3. Consider that you may be rambling and the interviewer may be trying to help direct you back to the subject ar hand. The interviewer may present questions with distorted and inflam matory content, for example, "Why do you psychiatrists control people's minds with tranquilizers?" These questions must be dealt with in a level-headed, objective manner. Your response might be, "There are specific medications for specific disorders that help

Meeting the Media

some people obtain relief from the suffering of mental illness. A tranquilizer is one of these which is used to help relieve emotional symptoms." Try not to lose your temper when dealing with the hostile interviewer. Never walk out of an interview. If you can deal with this type of interviewer so that you come across as a sincere, knowledgeable, ethical psychiatrist, your resultant self-esteem will enable you to communicate clearly with the media audience.

DEALING WITH THE MEDIA

Newspapers

Newspapers, the oldest form of mass media in this country, are the medium most. likely to cover events in the field of psychiatry. Their audience tends to be broad based and undefined. There is selec tive readership, that is, each person reads only that what interest5 him or her. Nonetheless, editors try to engage and sustain the interest of all readers with each story. To the extent they succeed, they reach an audience most diverse. Although they have entertainment features-comics, puzzles, editorials, fashion tips, columns-newspapers focus on news. Gen erally, the news must be timely (its value is diminished if delayed) and of significance to its reader. Event� are deemed more signifi cant if they occur locally or in some way affect the reader directly. If they involve a prominent personality, conflict, a natural disaster or, something of"human interest," they are newsworthy. Psychiatry ufLen makes Lhe news when a sensacional crime or bizarre behavior causes news reporters to wonder about the perpetrator's mental health. Specialized science writers are more likely to write about an advance in psychiatry or a new public policy affecting the mentally ill. There is limited space in a newspaper. The number of pages to an issue is determined by the amount. of advertising obta.ined. The editors detennine what will go into the paper. The owner/publisher or editor-in-chief sets policy and establishes the tone for the paper as a whole. Ideally, advertisers do not influence the way news is reported. In .large city newspapers with a loyal following, rhe adverusers may need U1c covcrngc more than the paper needs their support. 39

Speaking Out for Psychiatry

Small local papers may be less independent, since 55 to 70 percent of their income is from advertising. Depending on the size of tJ1e newspaper, editors as well as reporters will be more or less specialized. In a major city newspa per, not only will there be a Health Science ediLor and several medical reporters, there may be a reporter who covers meutal health issues only. Such reporters cover changes in government policy affecting- mental health, incidents that occur within the local mental health system, and breakthroughs in the treatment or understanding of mental illness. In addition to daily news articles, they write feature stories or series that may or may not relate to news events. The subjects for most of these stories arc decided in the editorial offices, hut medical reporters and editors are open to suggestions; for example, a psychiatrist may mention a newswortJ1y psychiatric event or topic to a reporter with whom he has worked, and the reporter may follow up on the lead. Reporters who are experienced in the area of mental health will often be on good terms with several psychiatrists. When writing a story, they are likely to contact these psychiatrists first for informa tion. The psychiatrist� may then refer them to colleagues more familiar with that subject Reporters may also call individuals whose names are prominent in the literature for the su�ject being treated. 1f puhlic policy is at issue, the appropriate government officials may be contacted. Newspaper coverage has several sLrengths. lt can provide more delails than television or radio and is, therefore, better suited to explain complex issues. Readers can go back if they miss a key point; they can reread an article of interest, or clip it for later reference. Most importantly, newspapers have tremendous credi bility. We believe what we read more than what we hear: "It's in black and white." Newspaper "How To's"

Newspaper inten1iews can he less stressful than r,tdio or television because the psychiatrist is not directly observed and can clarify and

Dealing with the Media

elaborate on certain point<;. However, newspaper reporters seldom come back or call for clarification; therefore, it is vital to be as clear and succinct as possible when first in contact with them. In talking to a reporter, keep explanations simple and straightforward. The newspaper's task is to present the public with technical or complex infonnation in an easily understandable way. Reporters are constantly on deadline and may have only a few hours to research, interview, and write a story. Depending upon the publication and the type of article, the deadline may vary f rom a few hours to a week. Dailies usually have an afternoon deadline. Contact with these reporters is often by phone. They may need information immediately and be unable to wait for a return call. If you are returning a call, have all your information at hand. Try to be as brief as reasonable, and to the point. Because articles for newspaper feature sections require more research, the deadlines are longer than those for the general news section of daily papers. The story resulting from an inter view may not appear for several days or several weeks. Nonetheless, there is still an urgency to the interview. Like their news counter parts, feature writers frequently work on a story under deadline pressure. Newspaper feature interviews are frequently conducted facc-to face. The feature writer will be looking for as much anecdotal information as possible. A feature story is built around personali ties, good quotes, interesting anecdotes, unusual information, and solid facts. Like most reporters, the feature writer is not likely to be an expert on your subject and will look to you for information. If possible, have the reporter call hack and read the story to you or send a prepublication draft for you to proofread for accuracy. If you have an idea for an article, contact either the medical editor or one of the medical reporters by phone. Editors receive copy from many sources outside their staff. If you have written a piece you would like published in a newspaper, it should be neatly typed, with a heading to indicate what it is about, and with your identity clearly stated.

Speaking Out for Psychiatry

rule of thumb, audiences are interested in seeing people and action. However; if poorly planned, the visual component will be distracting. Television viewers are sophisticated, accustomed to seeing the best. They are critical of anything less than professional. Television is a difficult medium with which to work. Not only the subject matter, but the way it is presented, one's speaking voice and one's appearance are all significant. Commercial television is also very competitive-with good reason. It is potentially the most pow erful of the media. Millions are reached instantaneously and arc profoundly influenced: "Seeing is believing." Television "How-To's"

Television provides an opportunity to be seen and heard directly by the audienc e. Tt is possible to present fact� and establish credi bility with poise, gestures, intonation, delivery, speed and appear ance. If not taken into consideration and utilized properly, these visual and audio effects can weaken the impact of your interview. It should be emphasized that your appearance will probably deter mine your credibility and how well the information you offer will be retained. Many TV stations have the potential to put an "overlay" on the tilm \�;th the physician's name and title. This information can be given to the interviewer on a 3" X 5" card or business card to ensure correct spelling and accuracy. Example:John Doe, M.D., Psychia trist; or John Doe, M.D. 'lelevision is a seeing medium so consider what is visual about your subject anrl emphasize it The more action there is-such as people conducting research or equipment in use-the better for background shots. Any visual aids to be used must he discussed in advance with the show's producer. Brevity is the key to TV intetviews. Although you may be interviewed for 20 minutes, only 30 seconds may end up on the air. [f possible, try to open the interview with a succinct summary that tells your s� ory best. Opening statements alert the viewers to what is coming smce they cannot go hack to what was missed. Thereafter, speak in

Dealing with the Media

short sentences. That makes the editing process easier for the reporters. Use interesting, simple language. The viewer will be seeing and heating you only once. Share your enthusiasm with the reporter and ultimately the viewer. If you arc to be interviewed on the air, learn ahead of time where you fit in the program, who is the audience, and what type of questions your host will ask. Frequently a staff person will contact you in advance to review this material. Television interviews are usually more rushed and involve greater time pressure than those with the printed media. lt helps to have a "dry run" or a chance to talk with the interviewers for a few minutes before the show begins. This allows the psychiatrist to establish rappon, decrease anxiety, and anticipate the type of interview that will be conducted. You wiil not be allowed to use notes during the interview. Unless othenvise instructed, while on camera, the psychiatrist. should look at the interviewer and follow the interviewer's lead. Relaxation is the key to success. You should avoid becoming de fensive or antagonistic. Anticipation and preparation can be very useful in knowing the points that you want to ger across or in expecting key questions that you might be asked. Be prepared to use those questions as launching pads for your communication objectives. Anticipate potentially negative questions and prepare responses that focus on positive points. Being sincere and telling the truth is the best approach. Try, if rational, to end each answer on a positive note. If you are being interviewed on a news show, your comments are going to be limited so it is essential to get your ideas across in approximately 20 to 30 seconds. You will have to use a minimum of well-chosen words. If you are lucky, you may get one minute. You should try to answer questions in one sentence. Each reply should be a self-contained message. In that way, in case the interview is being taped, the context of your message will not be lost when the tape is edited. How long you will have to answer your questions will depend on the type of show, where the interview is taking place, whether it is being taped, taped live, or broadcast live. The taped interview may last as long as 10 to 15 minutes, but most ofwhat you

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ĐƭΙΈʊ Ι ʮʋ̀́Ƒ̂̃Ι ȮǼ̪ ˊŰ˝ΏΙ ÐNȯƒ#ÐnΙ Ήʌ͚Ι ɏNΊΙ ĵɭjΙ'ʍΙ yF' ɐ ̫ΙɑĶ:wΕǽ Ι ×ºǾ̬ǿɮVéΙ Ͷ,ȀS Ι ȁgΙ ķΙ &ʯƓŞAĸ¤Ι ̄ȠȂȰɀrΙ ĕ˖ʟƨ8̅0ȃa]Ĺ Ι ˣńɯȄÙĺÑȅʎªÇΙ Ç͛ Ι Ι ĒčĊΙ 6Ι ̭Ǐ ΙąĖĆΙ=4ͬ Ι ʰ±ɰ ¿ƔűΙ ͷʏ¾ȡ̆ǐ²´ÈΙ «Ι ˋȆÒ@ ƿΙ̮ƕş Ú ȇʴ É÷Ι Ă͜© ˥J̇Ι <ʐ ð̯ʑΙ EE ÉΙ 9³¿Ι ¶˜ʤ̈ʱ Ïșͭ ΙȜʒ ˌ]3[Ȉ FÅΙ 8Ι ȉ#Ι ? %Md! ̉qΙ Ĝ Ι C Ǒȱ΋Ι ʲ ˍȊ Z( ¡êΙ ǒ ͝Ȳ Ι O¥ Ι ŏƖΙ ̊͞ȳͅŲøΙ µ ȴȋ W Ι ɱ¬IO BΌëΙBȌ̋̈́ Ι$J Y ̰ȍ ɲ ΙĻɳ6Ι ͮļBΘ ͟Ľ1 ̌ΙH ȎˎΙ§ ȝʓˏΙɒzÀȣƜiþāoΙ ĝˤ͆ːÞΙȵͯɁłˑȶ͸̱ìΙ ȏɴΙľųŴȐ̲ȑʔɵíΙƲʢ̳̍Ί ƗΙ̎1ŅƮƯΙ ʕ Ι$͠ ɂȘQĿÓȒ ɶ nΙ̏.Ι΍ ͡ΙQO Ι aʖȢΙÖ Ι× a Ι̴ ΙŠʗD̵ŀšÔΙ ȓ ǓΙ̶, ΙAŵƘ{Ι ƳʣÁΙ Ι̐iɓÝÜùΙ ĔƩΙ ʘ͢ ÂƙîΙΎʙͣΙ̑,ʚ ȷ6ΙɷƚͰƛ˒Ι͹˓ Ê Ι̷¯Ι ΙɔP*NΖ" Ι ȔÕ`˔Ι

Speaking Out for Psychiatry

Psychiatrists are responsible for constantly evaluating their per formance and that of the profession as a whole and for remembering that their actions reflect on the entire profession. The promise of radical cures or boasting of extraordinary skill or success is considered unethical by the medical profession. Like wise, claiming expertise in broad social matters without proof or positive contributions to solutions can destroy public trust. It is not necessary to comment on every question from the press. The Patient: Confidentiality or Privilege Release of information about individual patient� must be consid ered in a different light from open communication because of the issues of confidentiality. The APA Board of Trustees adopted a Position Statement on Guidelines for Psychiatrists: Problems in Confi dentiality,2 part;; of which are quoted below: The welfare of the patient is the first concern of the psychi anist, and from this concern derives the psychiatrist's obligation to protect the patient's privar.y and maintain the confidentiality of his communications. When, however, circumstances com pel the psychiatrist to impart information about a patient to others, it is robe done in strict accordance with lei.,ral require ments and procedures, ethical guidelines, good judgment, and common sense, and always with the welfare of the patient as the underlying consideration. (p. 1543) A psychiatrist should never reveal, except with proper author ization or; if necessary, under legal compulsion, for example, a court order, confidential information disclosed to him/her by a patient in the treatment process. Consultation with one's own legal counsel may be necessary. (p. 1545) Spectacu/,ar public crimes. In case of persons who have been under psychiatric treatment and who subsequently become involved in spectacular public crimes or whose condition may constitute a threat to the welfare of the community, the

Excerpts from Guidelines

confidenrialitv of records (ot11er than necessary for proper medical treac:rient) should still be maintained. (p. 1545) After death. After the death of a person who has been under psychiatric care, the pertinent principle of medical ethics cited above still applies. The confidentiality of the patient's communications should always be maintained except when the release of information is authorized hy the proper person (i.e., next of kin, executor) or under proper legal compulsion. (p. 1545)

Other matters involving confidentiality have been discussed in . . another pos1t10n statement. I The Psychiatrist as Commentator Although no guidelines or policies can he fommlated that will cover all situations, the following precautions may be helpful: • Ko individual can speak for the profession as a whole. Official statements are made only by the Trustees or those officers of the American Psvchiatric Association empowered to do so. Among the 25,000 1�embers, there is an immense variety of opinions about anv controversial issue. • If one is 'in doubt, one should make no comment at all. • Comments, if any, should be made thoughtfully. The reporter should be told that a statement will be prepared and that he/she will be called back shortly. Restraint should be the guiding rule in all contacts with the press, rd.dio and television. L'nderstate ment is usually more effective than excessive approval or denunciation. • In major cases of national interest, the inquiry may be referred to the i\merican Psychiatric Association Division of Public Affairs office in v\lashington, DC. • Reports may be referred to pertinent published articles or mono graphs that deal with the issue under discussion.

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Speaking Out for Psychiatry

What is sexual dysfunction in a man? Impotency, premature or retarded climax, decreased sexual desire or excitement, or DonJuanism.

Sample Brief Answers

Most certainly: to deal with their feeling, of anger, grief and sadness. Does parental violence adversely affect child development?

What are common sexual problems in a woman?

It is indeed detrimental to normal childhood development.

Decreased sexual desire, decreased sexual excitement, spasm of vaginal muscles, and orgasmic inability.

What is the difference between normal anger and rage?

What i� a fetish? An object, part of the body or a piece of clothing that for a given individual is necessary for the achievement of orgasm. ls homosexuality a mental illness? Homosexuality is a sexual-orientation variant, not a mental illness. What is perversion? Desire for an abnormal sexual object or activity in order to achieve orgasm.

Rage is intense and often uncontrolled anger. Do psychiatri�ts risk physical harm from patients? Most patients are not violent. However, some paranoid, psychotic individuals have been known to act violently toward their psychiatrists. Should psychiatrists be held re.spon5ibl,e for the behavior of their patients? No one can be held responsible for the behavior of another, but if a patient tells a psychiatrist he is going to harm himself or another, the psychiatrist must take steps to prevent such action. What is the role of the psychiatrist in an insanity defense?

Yes.

1o evaluate whether, at the time the offense occurred, the individ ual was suffering from a mental illness that affected his ability to conform his behavior to the requirements of the law.

Anger, Hatred and Violence

Should the insanity defense be abolished?

ls masturbatwn harmless as generally practiced by normal adults?

Does mavie and TV violence increase violent behavwr? This is a controversial issue. A disturbed individual may become violent after watching movie or TV violence. Does pomograpky affect behavwr? Not necessarily, but violent pornography can influence the behav ior of disturbed individuals. Do victims of violence need psychologi,cal help?

The insanity defense is necessary to protect severely disturbed individuals from being punished for actions over which they had no control. Children and Adolescents

What problems signal the need for psychiatric evaluation? Major changes in behavio1� e.g., in social and work relationships, in school behavior, in eating or sleeping patterns interfering with the individual's mental or physical health.

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ĹűɽůĨɾpʛ

Speaking Out for Ps ychiatry

13 million Americans suffer from alcohol abuse or dependence and another 12.5 million Americans sufler from drug abuse or dependence. 1.5 million Americans suffer from schizophrenic dimrders and 300,000 new cases occur each year. Right now, more than 9 million Americans are suffering from depression, manic-depression and other depressive disorders. About 30 million people or 15 percent of the population will suffer from at least one episode of major depression during their lifetime. Nearly one�/ourth of the e'-derly who are written off as senile aclually suffer mental illness that can be effectively treated.

• Mental illness afflicL5 men and women. Studies by the US Alcohol, Drug Abuse and Mental Health Administration indicate men are more likely to suffer from drug and alcohol abuse and personality disorders, and women are at higher risk for suffering from depression and anxiety disorders. All these disorders can be effectively treated. • The personal and social costs of mental illnesses are similar to those for heart disease and cancer. Direct cost� of mental illness are estimated to be $20.9 billion a year. Direct costs of substance abuse rl.isorders are estimated to be $109 billion a year: Added to indirect costs, the total cost of subslance abuse disorders rises to between �185 billion and $190.G billion a year. • 1reatment if available, but on�y one in five people who have a mental illrum seP.k help. About half of those suffering from schizophrenia seek treat ment. Medications effectively stop acute symptoms in 80 per cent of all patients.

Foct Sheets

Fewer than one-fourth of those suffering from anxiety disor ders seek treatment. However, psychotherapy, behavior ther apy, contextual therapy; and some medications effectively treat these illnesses. Fewer than one-third of those suffering from depressive dis orders seek treatment. But with treatment, 80 percent to 90 percent or those who suffer from these diseases can get better. Tragically, only 4 percent to 15 percent of the children sufferi,ng ser ious mental illness receive appropriate treatment.

Facts About: Post-Traumatic Stress Disorder It's been called "shell shock," "battle fatigue," and "war neurosis." But the disorder is not limited t.o soldiers. In the past, it was often misunderstood or misdiagnosed. Rut the disorder has very specific symptoms that, taken together, fonn a definite psychological syndrome. The disorder is called post-traumatic stress dimrder (PTSD) and it affects hundreds of thousands of people who have survived the trnuma of natural disasters such as earthquakes, accidental disas ters such as airplane crashes, or delibernte, man-made disasters such as war. Psychiatrist5 estimate that several hundred thousand of the 3.5 million men and women who served in the Vietnam War are affected by post-traumatic stress disorder. Still more show some symptoms of the disorder. Studies indicate that veternns of heavy combat are more likely to suffer from post-traumatic su-ess disor de1: Not all people who experience trauma require treatment; some recover with the help of family; friends, pastor or rabbi. But many do need professional help to successfully recover from the psychological damage that can result from expe1iencing, witnessing-, participating in an overwhelmingly traumatic event.

The Symptoms Post-traumatic srress disorder rarely appears during the trnurna itself. Though its symptom� can occur soon after the event, post traumatic stress disorder often surfaces seueral month� or even years la!Pr.

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102

Speaking Out for Psychiatry

Hallucinations in which voices threaten, insult rrr command the victim. Less common hallucinations affect the other senses, such as seeing nonexistent things. Emotions are blunt,ed or inappropriate to the situation, such as laughing at sad events. Like many physical diseases, schizophrenia�· symptoms come and go, and its victims have periods when they can function nor mally. Chronic schizophrenia, however, is a progressive dete rioration of the mental processes. • Schizophrenia almost always begins in adol,escence or early adulthood. Some victims suffer only one episode, while others suffer repeated episodes throughout their lives. • Treatment generally combines therapies because the disease is so complex. Antipsychotic medications usually relieve the hallucinations and delusions. Psychotherapy helps victims understand their disease and assists in learning to distinguish reality from distorted perceptions. Family therapy helps spouses, parents or siblings learn about the disease and helps the patient live in the community. Because schizophrenia develops when victims are beginning careers or new social anrl family lives, the chronically ill also may need rehabilitation, occupational and vocational therapy so they can master daily living casks, social interaction and job skills. • Much of the progress in treating schizophrenia results from medications. Fifty-five percent of schizophrenia victims who do not take medi cations will suffer a relapse within two years of being discharged from a psychiatric facility. That compares to a relapse rntc of 20 percent for victims who do take medications. • Though science has not yet found a single cure, schiwphrenia can be effectively treated. One long-tenn study of almost 2,000 patients found that 25 percent fully recovered, half recovered partially, and 25 percent required lifelong care.

l'act Sheets

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Facts About: Substance Abuse • Akohol and drug abuse affl-icts 25.5 million Americans. When its effect on the abusers' families and people close to those injured or killed by intoxicated drivers are included, rnch abuse affects an additional 40 million people. • Alcoholis.m costs a total of $89.5 billion for treatment and indirect losses such as reduced worker productivity, early death, and property damage resulting from alcohol-related accidents and crime each year. Drug abuse drains a total of $46. 9 billion in direct and indirect costs to business and the economy. • Substance abuse victims can't control their use of alcohol or other drugs. They become intoxicated on a regular basis (daily, every weekend, or in binges) and often need the drug for normal daily functioning. They repeatedly try to stop using the drug but Jail, even when they know the drug causes or worsens a physical ailment. Use of the drug interferes with their family life, social relation ships, and work performance. • Substance dlpendence victims suffer all the symptorns of abuse plus a tolerance for the drug so that imreased amounts of it are necessary for the desired effects. Opioids, alcohol and amphetamines also lead to physical dependence in which the person develops with drawal symptoms when he or she stops using the drug. • Tl'n million adults and three million children are alcoholics. These people wil.l die 10 years earlier than nonalcoholics. • Alcoholic drivers kill 28,000 people in trnffic accidents each year. • Alcoholism is a progressive disease that generally first appears between the ages of 20 and 40, though children can become alcoholic. It takes 5 to 15 years of heavy drinking for an adult to become alcoholic; it takes 6 to 18 month1· of heavy drinking for an adol.escent to become alcoholic. Generally, abuse occurs in one of three patterns: regular, daily intoxication; drinkiug large amount� of alcohol at specific times, such as every weekend; and long periods of sobriety interspersed with binges of heavy daily drinking that last for weeks or months.

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