The theme for this year’s World Mental Health Day, which takes place tomorrow, is “Mental Health in an Unequal World’ and is meant to highlight the perennial problem of inequity of mental health services around the world: The deficiency in the quality of care provided to people with mental health issues; the paucity of investment in mental health; and the continuing and intractable stigmatisation of and discrimination against the mentally ill.
But there is an inequality which is of a lesser scale that resides within the microcosm of the relationship between a patient and a doctor and is not so obvious – perhaps because it is an inevitable and inherent part of that relationship.
FIDUCIARY RELATIONSHIP
When we are ill, we turn to doctors who we believe would help us because of their expert knowledge, wide clinical experience, prudent judgment and integrity.
This relationship where “confidence is reposed on one side, and domination and influence result on the other” is known as a fiduciary relationship. By its nature, it is not, and never will be, an equal relationship, and the doctor will always be the more powerful figure.
As a psychiatrist, my relationship with my patients is often intimate and profound. During our consultations, patients disclose their innermost concerns, their disconcerting fantasies and fears, their unfulfilled loves and abject failures – things that they have not shared, or ever will, with another. Having to profess these in the shadow of a mental illness with that attendant helplessness and despair can foster exceptional dependence on the psychiatrist.
This story is from the October 09, 2021 edition of The Straits Times.
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This story is from the October 09, 2021 edition of The Straits Times.
Start your 7-day Magzter GOLD free trial to access thousands of curated premium stories, and 8,500+ magazines and newspapers.
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