Supporting Independence for Patient and Practice

Steven Moffic, MD, a psychiatrist and member of the Psychiatric Times editorial board, offered a reflection on the clinical and societal significance of independence as a construct in psychiatry, framed around the United States' 250th anniversary of the Declaration of Independence.

Moffic observed that while the semiquincentennial has generated widespread attention across fields including law, politics, and entertainment, the psychiatric field has produced little discussion of what independence means for mental health or for patients with psychiatric illness. He argued that this represents a missed opportunity, given that independence—understood as autonomy, self-determination, and freedom from internal and external constraints—is directly implicated in virtually every psychiatric condition. Conditions ranging from posttraumatic stress disorder, major depressive disorder, anxiety disorders, schizophrenia, and bipolar disorder to less formally classified states such as burnout, moral injury, and loneliness each erode the patient's capacity for autonomous functioning, a dimension of psychiatric morbidity that standard clinical outcome measures focused on symptom reduction do not fully capture.¹ Moffic further noted that stigma compounds this erosion, representing an external constraint on independence that operates in addition to the disorder itself.²

Moffic drew a conceptual distinction between the American cultural emphasis on individual independence and the different framings found in other nations—such as France's tripartite values of liberty, equality, and fraternity—suggesting that this emphasis on the individual has particular relevance to how American psychiatry conceptualizes the therapeutic goal of restoring patient autonomy. He proposed that psychiatrists might usefully regard themselves as what he termed "freedom fighters of the mind," working to liberate patients from the internal constraints imposed by psychiatric illness, just as the founders of the republic sought external political independence. He concluded by calling for broader discussion of these themes within organized psychiatry, including within American Psychiatric Association (APA) caucuses and public forums, in anticipation of accelerating changes in the field and society.

Dr Moffic is an award-winning psychiatrist who specialized in the cultural and ethical aspects of psychiatry and is now in retirement and retirement as a private pro bono community psychiatrist. A prolific writer and speaker, he has done a weekday column titled “Psychiatric Views on the Daily News” and a weekly video, “Psychiatry & Society,” since the COVID-19 pandemic emerged. He was chosen to receive the 2024 Abraham Halpern Humanitarian Award from the American Association for Social Psychiatry. Previously, he received the Administrative Award in 2016 from the American Psychiatric Association, the one-time designation of being a Hero of Public Psychiatry from the Speaker of the Assembly of the APA in 2002, and the Exemplary Psychiatrist Award from the National Alliance for the Mentally Ill in 1991. He presented the third Rabbi Jeffrey B. Stiffman lecture at Congregation Shaare Emeth in St. Louis on Sunday, May 19, 2024. He is an advocate and activist for mental health issues related to climate instability, physician burnout, and xenophobia. He is now editing the final book in a 4-volume series on religions and psychiatry for Springer: Islamophobia, anti-Semitism, Christianity, and now The Eastern Religions, and Spirituality. He serves on the Editorial Board of Psychiatric Times.

References

1. Bergamin J, Luigjes J, Kiverstein J, et al. Defining autonomy in psychiatry. Front Psychiatry. 2022;13:801415.

2. Corrigan PW, Watson AC. Understanding the impact of stigma on people with mental illness. World Psychiatry. 2002;1(1):16-20.