The Inpatient Psych Ward

Let me describe a scenario of inpatient psychiatry rounds:

Bring the patient to a conference room, in front of an entire team of health professionals, and ask the patient to describe his/her innermost thoughts.  I imagine the patient feels something like this:

The differences between the patient and the health care team in this type of setting are important to recognize.  First, in terms of dress, the patient is often wearing a hospital gown while the team members are wearing white coats and professional dress.  Second, in terms of spatial arrangement, the patient is placed at the head of the table (which is often a position of power), but here serves the purpose as a seat of distinction.  All eyes look towards the patient, the patient is asked questions, and the answers are deemed appropriate or not.  Third, there is an assumed knowledge gap between the side of the professionals and the side of the patient (i.e. there is the assumption that the doctors know more than the patient about his/her own illness).  I think this is especially prevalent in psychiatry when the patient may be seen as unreliable in providing accurate details about their illness.  Hallucinations, delusions, paranoia, personality disorders, and phobias all play into this assumption; it as though the illness is distorting the motives of the patient.

All of these differences contribute to a profound sense of power.  The power clearly lies in the hands of the health care members.  Is power taken away from the patient in this setting?  Is the patient powerless to change the shape of their own illness?  In some extreme cases, power is more literally taken away from the patient in terms of legally stating that the patient no longer has the right to make their own health care decisions.  On the other hand, therapeutic treatment of a psychiatric disorder often rests on the ability of a patient to change behaviors and thought patterns.  I guess that I am struggling with the concept of how we can empower patients to be agents of change and to be accountable for their illnesses despite an inpatient setting that strips them of power and autonomy.

As a quick aside, I am fully aware that there are often necessary reasons to take away a person's power, such as if the person has expressed a wish to hurt themselves or others.  However, I do think that this is not the case in many situations, and it is still a useful exercise to draw out a power landscape.  Awareness of our own assumptions (as well as the implications of how we spatially arrange ourselves in relation to patients) is always an important goal in medicine.