Negotiation is a back-and-forth communication designed to reach an agreement.

 It serves 2 functions: information gathering and behavior influencing.

 Beyond our calling toward health care, doctors often find ourselves in the role of negotiator. Opportunities for negotiation include discussing treatment plans with patients and/or families, consulting specialist physicians about mutual patients, and making requests of administrators.

“Mr L” is a 53-year-old man with history of schizophrenia, alcohol use disorder, type 2 diabetes mellitus, hypertension, 2 myocardial infarctions, and a cerebrovascular accident. He presented to the hospital with mental status changes and was admitted to the internal medicine service for hyperglycemia, hyponatremia, and alcohol withdrawal. Later, “Dr M,” the hospitalist, consults you about transferring Mr L to inpatient psychiatry because of suicidal ideation after the patient said, “I can’t go on like this.”

 Being medically stable, we are hoping for this transfer.

 Hold on. I have concerns about his vital signs and abnormal laboratory values.

 No worry—those are both stable and should improve.

 I am uncomfortable accepting Mr V since our nurses are not able to handle his medical problems if he gets worse.

 Oh, come on. He needs psychiatry—just take him.

 No, he is not sufficiently stable to be appropriate here, given his current issues.

 I am going to call and complain to the chief of staff.

This is positional bargaining. The parties state their opinions, promote their positions while degrading opposing ones, and/or seek compromises or concessions. Positional bargaining can be inefficient, produce unwanted outcomes, and endanger social relationships.

A recommended approach is to acknowledge emotions, foster trust, and demonstrate empathy to establish rapport. This leads to open discussion of rational options obtained through principled negotiation.

 These principles and techniques are listed in the 

Define and Separate the Current Problem From the Interpersonal Issues

The unsolved matter is the problem, not the other person.

 Describe the problem using a calm, reasonable tone, at a slower rate, and practice active listening. This creates psychological safety and invites counterparts to share their needs. For guarded or dismissive individuals, repeating what the other party said (isopraxism) or allowing a few moments of silence may invite them to disclose more information.

Recognizing and validating the other person’s emotions provides momentum for collaborative problem-solving. Overtly stating your understanding of their position facilitates positive momentum. Do not deny or ignore emotions like anger or fear that present. Instead, use “tactical empathy,” which nonjudgmentally recognizes and labels your counterpart’s perspective without necessarily agreeing with it.

 Phrases such as “it sounds like” and “it seems like” are helpful. For hesitant or terse individuals, consider making an “accusation audit” by listing complaints they might have about you or your team; that might invite more mutual discussion.

Interests are desires and/or concerns that motivate people to develop and promote or defend a position. The most powerful of these are the needs for security, well-being, belonging, recognition, and control over one’s life.

 Numerous issues are included in a single position, so it is easier to identify and reconcile interests rather than positions. Appreciation of another person’s situation is a powerful negotiation skill.

To identify the other party’s interests, consider “why” and “why not” they have taken their position. If you accurately mirror, label emotions, paraphrase, and summarize the other person’s stance and interests, they might agree with your impressions. If so, hearing “that’s right” breaks down barriers and indicates agreement.

 In contrast, simply being told “you’re right” may be a superficial comment in an effort to terminate discussion.

Judging prematurely, assuming or seeking a “single-answer” solution, seeking an “either-or” resolution, and failing to consider the problems of the other party are roadblocks to agreeing on mutually beneficial options.

 Try nonjudgmentally brainstorming for possible outcomes. The similarity principle—whereby we trust and/or like individuals who have attitudes, beliefs, or ideas similar to our own—may help in building trust.

While devising possible solutions, it is easier to negotiate when both sides are discussing common criteria rather than when one party attempts to force the other to “back down.” Citing objective goals increases the likelihood that the solution will be “wise and fair.” Examples of such standards include scientific judgements, cost, reciprocity, precedent, and efficiency.

Avoid any allegations of unfairness, which can trigger defensiveness and irrational decisions.

 Invite the other team at the onset of your discussion to immediately alert you if they feel they are treated unfairly. If they suggest unfairness, stop the discussion and ask them to please tell you how they felt they were unfairly treated.

 If the other team proposes a solution and then quickly labels it as “fair” to pressure you to agree, invite them to provide supporting evidence of fairness to both sides before agreeing to it.

Be Comfortable Saying—and Hearing—“No”

The word “no” is the start, not the end of a negotiation.

 It provides a sense of control and may mean various things, such as “I’m not ready to agree,” “I don’t understand,” or “I need to think/talk it over.” This can lead to solution-based questioning. Conversely, premature agreeableness early in a negotiation may be superficial and not foster commitment. Making erroneous statements or mislabeling the other side’s position might elicit “no” from an otherwise hesitant or overly agreeable party. In cases where an initial proposal is unacceptable, you too can say “no” in subtle ways, such as “How am I supposed to do that?” “Sorry, that does not work for our team,” or “I just cannot do that.”

When negotiating with aggressive individuals, a deferential approach with open-ended questions is recommended, as it calms a high-pressure approach, slows the pace, and allows both parties to say “no.”

 Asking open-ended questions—using “how” or “what”—often diminishes defensiveness. This creates an atmosphere of asking for help, promotes goodwill, gives the other party a feeling of control, and replaces a potential confrontation with joint problem-solving.

In many negotiation situations, there are other members involved on each side. It is important to remember the “hidden negotiation” that may occur independently with their other team members. They can either help implement or block a negotiated plan. Asking, “How does this affect the rest of the team?” or “What do your colleagues see as challenges?” helps ensure agreement and successful plan implementation.

 Pay attention to verbal tone and body language; incongruence with the individual’s verbal message signals uncertainty or hesitation.

In any negotiation, there may be incomplete information, behind-the-scenes constraints, or other interests of which one or both negotiators may be unaware. Using leverage may reveal these “blocks” through person-to-person contact and/or informal moments.

 the ability to provide or withhold what the other side wants

 things that could negatively impact the other side

 using the other party’s own standards to illustrate any positional inconsistencies


After implementing these strategies, here is an alternative to the scenario in the Clinical Vignette.

 We’d like to get him to the psychiatry floor; he is medically stable.

 Sorry, but I am concerned about his vital signs and abnormal laboratory results.

 Let us talk more about this problem. The patient has known mental health problems and presented with acute medical conditions, abnormal electrolytes, and alcohol withdrawal. Is that correct? 

(Identifying the problem and inviting collaboration)

 Yes, he is agitated and requesting sleep medication in addition to drugs every 4 hours for anxiety.

 It sounds like your service has been busy and stressed, and is uncomfortable with treating this patient’s mental health issues. 

 I want to ensure that the patient is really medically stable, and I also must ensure unit and staff safety. Yes, we want what is best for our patient and the personnel.

(Presenting shared interests with agreement)

You and Dr M proceed to consider options such as continued psychiatric consultation while the patient remains on the medical floor; transferring to inpatient psychiatry unit with medical backup; and stabilizing medical problems, followed by an outpatient psychiatric referral. Dr M notes off-handedly that he is going on vacation soon and wants the patients on his service to be “squared away” for the covering hospitalist 

You and Dr M finally agree to continue consultation while the patient is on the medicine service for now, and once laboratory and vital signs stabilize at mutually agreed-upon parameters and duration, you agree to expeditiously transfer Mr L to your psychiatry unit with the medicine team’s assistance 

Better negotiation skills facilitate beneficial outcomes for patients, improve relationships with colleagues, and enhance workplace satisfaction.

is a staff psychiatrist at Veterans Affairs Medical Center in Lexington, Kentucky. 

 is professor emeritus at the University of Louisville School of Medicine in Louisville, Kentucky.

Getting to Yes: Negotiating an Agreement Without Giving In. 2nd Edition.

Never Split the Difference: Negotiating as if Your Life Depended On It. 1st Edition

Articles

Use these strategies to facilitate beneficial outcomes for patients, improve relationships with colleagues, and enhance workplace satisfaction.  

How Can Psychiatrists Become Better Negotiators?

The relationship between substance misuse and acquired brain injury (ABI) is well documented. Studies examining traumatic brain injury (TBI) model systems data revealed that more than 50% of patients treated for TBI were intoxicated at the time of injury.

 Alcohol misuse is also a risk factor for stroke. Chronic alcohol misuse has been associated with heart arrhythmias, blood clotting disorders, hypertension, and diabetes, all of which are risk factors for stroke.

Opioids and illicit “street drugs” have also been linked to ABI. Nonfatal opioid overdose is associated with anoxic and hypoxic brain injuries due to the depressive effect of opioids on the respiratory system.

 Use of illicit stimulant drugs (eg, cocaine, methamphetamine, etc) can elevate heart rate and blood pressure to dangerous levels and have been associated with hemorrhagic stroke.

It is important for clinicians to understand the relationship between substance misuse and acquired brain injury, and to accurately diagnose and treat these cooccurring conditions, as a substantial number of individuals with ABI return to risky levels of alcohol and/or drug consumption within the first few years after injury.

 Individuals who continue to misuse substances following discharge from rehabilitation are at higher risk for reinjury, development of mood disorders, increased mortality, and decreased life satisfaction.

A thorough clinical interview can provide a subjective measure of both the extent and the impact of substance misuse. Evidence demonstrates that using motivational interviewing techniques (eg, asking open-ended questions, reflective listening, and eliciting the patient’s thoughts about change) can help obtain information, build rapport, and begin the process of behavior change.

 Gauging a patient’s readiness for change can also guide treatment planning and selection of appropriate interventions in order to meet the patient where they are in the change process.

Standardized assessments provide an objective measure of substance use/misuse. Instruments that have been used successfully with the ABI population include the CAGE Assessment

 and the Alcohol Use Disorders Identification Test (AUDIT)

 for alcohol use, and the Alcohol, Smoking, and Substance-Use Involvement Screening Test (ASSIST)

 and the Substance Abuse Subtle Screening Inventory (SASSI)

Several treatment interventions for cooccurring ABI and substance misuse have been proposed and evaluated. Brief treatment including screening, patient education, and brief interventions may slow the resumption of future alcohol use.

 Other best practices for the treatment of substance use disorders in the ABI population include patient and family education, incentives to encourage treatment attendance and retention, use of motivational interviewing techniques, and interventions to support adaptive coping and adjustment.

Patient and family education with information about the negative effects of continued substance misuse—particularly suppression of cognitive recovery, increased risk for seizures, potential interactive effects of alcohol and prescribed medications, and increased risk for sustaining a second TBI—have been shown to be beneficial in reducing resumption of substance use.

 Some studies suggest that providing firm recommendations regarding abstinence, at least for the first full year following injury, can also impact substance misuse following rehabilitation.

 has suggested tailoring substance misuse treatment and modifying any written materials to account for cognitive and linguistic deficits stemming from brain injury (eg, attention, memory, information processing speed, etc). Additionally, Corrigan

 has recommended a 4-quadrant model that describes the various settings where individuals with ABI can receive treatment, as well as the best treatment based on the severity of the brain injury and severity of substance misuse.

Quadrant I (low severity of brain injury and substance misuse) includes acute medical and primary care settings and interventions that provide screening and brief interventions. Quadrant II (low severity of substance misuse and high severity of brain injury) includes brain injury rehabilitation settings and interventions that provide education, screening, brief interventions, and linkages to community supports and referral for ongoing substance use treatment. Quadrant III (high severity of substance misuse and low severity of brain injury) includes substance use treatment settings and interventions that provide screening, accommodations (for cognitive-linguistic deficits), and service linkage. Quadrant IV (high severity of substance misuse and brain injury) includes specialized brain injury and substance use services, including integrated programming.

Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) have also been suggested as helpful resources in providing education and social support and promoting personal responsibility/accountability.

Finally, pharmacological treatments of substance misuse in the ABI population have been recommended as an adjunct to traditional therapies, or when therapy alone has been unsuccessful.

 Naltrexone, acamprosate, and disulfiram (Antabuse) are US Food and Drug Administration (FDA)-approved medications for the treatment of alcohol use disorder. Naltrexone and acamprosate act to reduce alcohol cravings, whereas disulfiram operates via aversive counterconditioning. It is recommended that these medications be initiated after a period of abstinence, and they may require liver function tests. Naltrexone, methadone, and buprenorphine are FDA-approved to treat opioid dependence. These medications also reduce cravings by binding with opioid receptors.

is the regional director of clinical services at the Centre for Neuro Skills, which operates post-acute brain injury rehabilitation programs in California and Texas. He is licensed in Texas as a chemical dependency counselor and psychological associate with independent practice. He also holds a clinical appointment at the University of Texas Medical Branch (UTMB) in Galveston in the Department of Rehabilitation Sciences.

Substance abuse as a mediating factor in outcome from traumatic brain injury

Non-lethal opioid overdose and acquired brain injury: a position statement of the Brain Injury Association of America

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Cocaine use and risk of stroke: a systematic review

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Alcohol and drug use following traumatic brain injury: a prospective study

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Psychiatric disease and post-acute traumatic brain injury

Motivational Interviewing: Helping People Change

Addiction and Change: How Addictions Develop and Addicted People Recover

Detecting alcoholism. the CAGE questionnaire

AUDIT: The Alcohol Use Disorders Identification Test: Guidelines for Use in Primary Health Care. 2nd Edition

The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST)

. World Health Organization. January 1, 2010.

The Substance Abuse Subtle Screening Inventory (SASSI) Manual, Second Edition

14. Bogner J, Corrigan JD, Peng J, et al. 

Comparative effectiveness of a brief intervention for alcohol misuse following traumatic brain injury: a randomized controlled trial

Substance abuse treatment for persons with brain injuries: identifying models and modalities

Motivational interviewing to prevent alcohol abuse after traumatic brain injury: a case series

Interventions to promote retention in substance abuse treatment

18. Vungkhanching M, Heinemann AW, Langley MJ, et al. 

Feasibility of a skills-based substance abuse prevention program following traumatic brain injury

Family role in substance abuse and traumatic brain injury rehabilitation

. In: High WM, Sander AM, Struchen MA, Hart KA, eds. 

Rehabilitation for Traumatic Brain Injury

21. Corrigan JD. The treatment of substance abuse. In: Zasler ND, Katz DL, Zafonte RD, et al, eds. 

Brain Injury Medicine: Principles and Practice

22. Corrigan JD, Mysiw WJ. Substance abuse among persons with TBI. In: Zasler ND, Katz DL, Zafonte RD, et al, eds. 

Understanding the intersection between substance misuse and acquired brain injury can assist clinicians in accurately diagnosing and treating these cooccurring conditions.

Substance Misuse and Acquired Brain Injury

The shocking thing about psychiatric treatment is that it works. If you are a mental health professional, this “news” will not surprise you at all. But if you are someone outside our field, the news will come as a genuine revelation. And if you are a reader of periodicals such as 

, you will be stunned to learn that the following assertion is true: 

Psychiatric treatments are comparable to those in other branches of medicine.

 By this I mean that we have mental health treatments that are generally equal to the rest of medicine in scientific support, efficacy, and safety. Are our treatments perfect? Hardly. But they are fully in line with the rest of medicine.

I do not blame laypeople for believing that our treatments are ineffective or dangerous. There is a steady stream of books proclaiming this to be true,

 along with prominent articles such as, “How Much Do Antidepressants Help, Really?”

 and “Doctors Gave her Antipsychotics. She Decided to Live With Her Voices.”

 hardly represent antipsychiatry, they articulate a not-so-sneaking suspicion that there is something uniquely wrong with psychiatric treatments. Do they really work, 

 Aren’t they dangerous and toxic in the end? Wouldn’t we be better off without them, coping for ourselves rather than depending on pills and therapists?

Even nonpsychiatric physicians, who understand the reality of mental illness quite well, seem to be sympathetically doubtful of our ability to help. I remember talking to a neurologist friend who declared that he could never be a psychiatrist because it was “too depressing to see people come back time after time with the same problems.”

“Wait a minute,” I replied. “Don’t neurologists mostly treat things like strokes, multiple sclerosis, migraines, and seizures? These do not just go away with treatment.” This prompted an explanation from him about how meaningful it was to work with patients over the long term and see improved adjustment and quality of life. “Yeah,” I said, “that’s what we do in psychiatry.” But I was wrong. We do so much more than that in psychiatry.

The old argument is that we in psychiatry do not have cures for mental illnesses. And this is true. But it is also true of the other chronic illnesses that constitute our major public health problems in this country. Although we do have cures for many 

 illnesses like appendicitis and otitis media, we lack these for most 

 illnesses. We cannot cure heart disease, and we cannot cure diabetes. We do not have cures for high blood pressure, strokes, or most kinds of cancer either. Why is no one in despair about this? Why do we not see regular articles like, “Doctors Gave Her Antihypertensives. But She Decided to Live with High Blood Pressure”? The reason is that we have good treatments for all these chronic health conditions, and using such treatments is not a matter of galvanizing public debate. Yet precisely the same thing applies to the major mental illnesses that—for no legitimate reason—remain a matter of galvanizing public debate. We generally do not cure psychiatric illnesses. But we have good treatments for them all, and no one should despair of getting help.

How do we know this? In 2012, Leucht and colleagues conducted a major meta-analysis for the purpose of comparing psychiatric medicines to medicines commonly used in primary care.

 They combined the results of 94 independently published meta-analyses on both types of medications. They compared effect sizes to evaluate the overall difference between psychiatric and other commonly prescribed medications. The meta-analyses included common general medical conditions such as asthma and type 2 diabetes, and common psychiatric conditions such as schizophrenia and major depression. In all, medications for 20 general medical diseases and 8 psychiatric disorders were compared.

The result: There was no statistically significant difference in effect sizes between the 2 groups. On average, psychiatric medications were moderately effective (with a mean effect size of 0.49), just as medicines for other common medical conditions were moderately effective (with a mean effect size of 0.45). In other words, the prescriptions that patients carry out of a psychiatrist’s office are, on average, just as likely to help them as the prescriptions they take out of their primary care offices.

Psychiatric treatments work. Psychiatric medications work. And psychotherapy works as well. The past 30 years have seen an unheralded revolution in psychotherapy research. Commonly derided as unscientific “psychobabble” in the 1970s and 1980s, well-established forms of psychotherapy have now been scientifically validated in hundreds of published studies. Cognitive behavioral therapy (CBT),

 and various forms of psychodynamic psychotherapy

 are well-substantiated as treatments of common mental illnesses. And there is evidence that the medications and psychotherapy work better in tandem than individually, at least in the case of major depression.

 Moreover, we have less prominent but nevertheless empirically supported treatments such as psychoeducation, mindfulness, exercise, and peer support groups.

 We mix and match these medically legitimate treatments to our patients’ needs and preferences. This, in reality, is what psychiatric treatment looks like.

Contrary to the assumptions of our public intellectuals and media thought leaders, there is no lack of proven treatments for psychiatric illnesses. We can offer an array of scientifically supported treatments for all the major mental illnesses. What we lack is not an effective set of treatments, but a cure for the hearsay that feeds the ignorance, anxiety, and irrational skepticism of our public. What can we do? Speak up. As the only group of individuals who deeply understand the efficacy of mental health treatment, it falls upon us to thoroughly educate ourselves, our patients, their families, our advocacy organizations, and our communities. As always, good news is hard to sell. But reality is on our side, and this should be enough.

is a psychiatrist and director of training for the general psychiatry residency at Tufts Medical Center in Boston. He frequently speaks as an advocate for mental health and is author of

 Science Over Stigma: Education and Advocacy for Mental Health

, published by the American Psychiatric Association. He can be reached at

Lost Connections: Uncovering the Real Causes of Depression – and the Unexpected Solutions

2. Moyer MW. How much do antidepressants help, really? 

. April 21, 2022. Accessed June 22, 2022. 

https://www.nytimes.com/2022/04/21/well/antidepressants-ssri-effectiveness.html

3. Bergner D. Doctors gave her antipsychotics. She decided to live with her voices. 

https://www.nytimes.com/2022/05/17/magazine/antipsychotic-medications-mental-health.html#:~:text=Gave%20Her%20Antipsychotics.-,She%20Decided%20to%20Live%20With%20Her%20Voices.,medication%20and%20toward%20greater%20acceptance

4. Leucht S, Hierl S, Kissling W, et al. 

Putting the efficacy of psychiatric and general medicine medication into perspective: review of meta-analyses.

5. Hofmann SG, Asnaani A, Vonk IJ, et al. 

The efficacy of cognitive behavioral therapy: a review of meta-analyses.

Dialectical behavior therapy is effective for the treatment of suicidal behavior: a meta-analysis

7. Leichsenring F, Luyten P, Hilsenroth MJ, et al. 

Psychodynamic therapy meets evidence-based medicine: a systematic review using updated criteria.

8. Cuijpers P, Noma H, Karyotaki E, et al. 

A network meta‐analysis of the effects of psychotherapies, pharmacotherapies and their combination in the treatment of adult depression.

Science over Stigma: Education and Advocacy for Mental Health

. American Psychiatric Association Publishing; 2021:151ff.

Is There a Cure for Ignorance? The Shocking Truth About Psychiatric Treatment

 is an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry. A prolific writer and speaker, he received the one-time designation of Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. To create a better world, he is an advocate for treating mental health issues related to climate instability, burnout, Islamophobia, and anti-Semitism. He serves on the Editorial Board of

In the midst of Posttraumatic Stress Disorder (PTSD) Awareness Month, it could be said that its culmination is today, PTSD Awareness Day.

Trauma, Conspiracy, and Cognitive-Behavioral Therapy in the Congressional 1/6 Hearings

Would I Do the Same Approving of Abortions for Psychiatric Reasons as I Did 50 Years Ago?

Of course, historically, we have been aware of PTSD, but did not call it that. It is described in classic literature, such as the warriors of Homer’s epic Greek poems, the 

. Such descriptions occurred in many ensuing wars under various terms, including “shell shock.”

The Vietnam War was the more recent stimulus for more formal study, along with concomitant research on World War II’s Holocaust and rape victims, resulting in the formal classification of PTSD in our DSM III in 1980. National PTSD Awareness Month was designated by the Senate in 2014, and recognizes the importance of all kinds of trauma.

Early treatment was electric shock, followed by group therapy in the 1950s. More recently, besides various psychotherapies and medications, EMDR and the psychedelics have emerged. There are no antitrauma medications, in contrast to antidepressants, antianxiety, and antipsychotics.

What makes the call for awareness so important is to keep repeating that the emergence of symptoms—such as hyper vigilance, flashbacks, and avoidance—can be delayed for weeks, months, and even years. Triggers that relate to the original trauma can precipitate the emergence of symptoms time and again.

Some feel that there is a pretraumatic stress disorder, such as is emerging in the expectations of future increased climate instability trauma. In our June 15th video “

,” I wondered if we are now a traumatized country beyond individuals. On the other hand, we have to be careful about over-diagnosing it as a too ready faddish explanation for problems.

The good news is that PTSD can be preventable and, even if not, can lead to improvement from the prior baseline in recovery. Most obviously, it can be reduced by the social elimination of life-threatening traumas caused by mankind, as well as the harm done by multiple less severe traumas. Micro trauma also seems to insidiously contribute to burning out.

As our understanding increased, and unique among psychiatric disorders, it seemed possible to end up with posttraumatic growth, strength, and resilience. It takes community support, learning from the experience, and a new positive vision for the future. No one wants the suffering involved in PTSD, but there is some consolation when we can obtain such a positive ending. When trauma cannot be presented, it still has the potential to give way to joy as long as it is not ignored.

is an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry. A prolific writer and speaker, he received the one-time designation of Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. He is an advocate for mental health issues related to climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of

It’s PTSD Awareness Day: Be Aware!

is an outpatient psychiatrist at Prisma Health-Upstate and clinical associate professor at the University of South Carolina School of Medicine, Greenville. He served on the American Psychiatric Association’s Task Force to Address Structural Racism Throughout Psychiatry, and he currently serves as the Diversity and Inclusion section editor and advisory board member for

Sequelae

As of today, Friday June 24, 2022, the Supreme Court has overturned Roe v. Wade, holding that there is no longer a federal constitutional right to an abortion. This comes on the heels of the early draft of a majority opinion obtained by Politico in May where Justice Samuel Alito wrote they would strike down the landmark case. Going forward, states will determine abortion rights.

 contributors have many thoughts on this controversial decision. If you’re interested in reading more about the abortion issue , women’s health care, and how legislation affects mental health, you should check out the following articles.

“Although clinicians should support family planning and appropriate birth control, psychiatrists are acutely aware that mistakes happen and much of life is unplanned. Thus, there will remain a demand for abortion after access to the procedure or pharmacotherapy is restricted in parts of America.”

“I wondered on and off if I would return to doing what I could when the need for abortion seemed to be endangering the mental health of the would-be mother and fetus—yes, and fetus.”

“Women deserve better. They deserve to feel safe inside and outside their homes, at their places of employment, in their houses of worship, and wherever they might be…”

“Maternal health is correlated with various factors including socioeconomic status, disease burden, and population dynamics. It is a poignant representation of the state of the country. The problem is multifactorial; it needs to be addressed on various levels, and we need systemwide organized and strategic efforts. Our patients are counting on us to address this issue.”

Do you have thoughts on the Supreme Court’s landmark decision? Share them with us at 

What do psychiatrists think of the overturning of Roe v. Wade? 

The Overturning of Roe v. Wade

Well, it is that time for a pop-up column again. As anticipated, the Supreme Court has just overturned 

, removing the constitutional right to abortion and opening up the likelihood of more formal legal denials of abortions in many states.

Though I am unofficially “retired” from clinical practice, I still have my medical license. In anticipation of this happening, I wondered on and off if I would return to doing what I could when the need for abortion seemed to be endangering the mental health of the would-be mother and fetus—yes, and fetus.

During medical school, my original required research project was about whether a pregnant woman’s emotional status influenced the development of the fetus, especially mental-health wise. I hypothesized it did, but never got to complete the research, choosing one on depression in medical inpatients instead. But, thankfully, by now there is more research on how emotional distress in pregnant mothers can adversely affect their babies.

My experience in the first half of my psychiatric residency at the University of Chicago had also been mentioned in the 

 article by the psychiatrist Sally Satel on June 4, “The ‘Open Secret’ on Getting a Safe abortion Before Roe v. Wade.”

 She suggested that I and others were committing small acts of rebellion by stretching ethical boundaries. She quoted me out of the context of the recent 

 article that I had written May 3rd on abortion, “Calling for a Psychiatric Analysis on the Mental Health Implications of Roe v Wade”

“I recommended abortion for all. My mental health analysis at the time was not only about the mental health of the would-be mothers, but their upcoming children if abortion was not done.”

However, the point of my original article was not what I did, but the need for organized psychiatry to prepare how we might respond if 

 ended. It has ended, but I have not seen any such plans. Most of us were taking risks to our reputations with our more underground involvement back before 

. Nevertheless, I would do it again if needed. After all, I have proudly been called a gadfly.

1. Satel SL. The ‘open secret’ on getting a safe abortion before Roe v. Wade. 

https://www.nytimes.com/2022/06/04/opinion/sunday/psychiatrists-abortion-roe.html

2. Moffic HS. Calling for a psychiatric analysis on the mental health implications of Roe v Wade. 

https://www.psychiatrictimes.com/view/calling-for-a-psychiatric-analysis-on-the-mental-health-implications-of-roe-v-wade

Roe v. Wade has been overturned. How will this affect the mental health of both mothers and fetuses? 

Experienced psychiatrists tend to take pride in having good communication skills, such as careful listening and patient-centered communication. That is one reason that dealing with difficult patients, who seem to thwart these skills, is so frustrating. Researchers suggest that 3 sources of difficulty may be present: the patient’s issues, the relationship between the clinician and the patient, and the systemic or social context of the encounter.