Beyond the Prescription: The Ethics of Psychiatric Care

This is not a story of extremes or rare exceptions. It reflects something far more common — the quiet discomfort of being treated, but not truly seen. Behind every diagnosis lies a life, a context, a set of conditions that medication alone cannot erase. What follows is a reflection on two very different ways psychiatrists may respond when asked: “What more can I do to heal?” And through that, a deeper question emerges — not about the illness, but about the healer.

It had been a while that Chris had been feeling uncomfortable with himself. Eventually, he was advised to visit a psychiatrist. After a few sessions, the psychiatrist determined that Chris was mentally ill and suggested starting a course of medication that would help him feel better. So far, that sounded reasonable — Chris was okay with that.

However, one unresolved question hovered silently in the therapist’s office: What else should Chris do to get better, apart from taking medication? Let’s explore the two common ways in which this crucial question is typically answered.

In the first case, the psychiatrist raised their voice and, in a critical tone, told Chris’s guardian that he needed to live in a safe and supportive social environment — more specifically, one free of toxic behaviors — if they wanted to see him truly improve. The psychiatrist firmly stated that it was a mistake to assume Chris was solely responsible for his condition and insisted that external factors needed to be addressed as well — factors the psychiatrist, as a trained medical professional, had identified as harmful.

The psychiatrist proposed scheduling a few extra sessions involving the guardian and possibly others in Chris’s life. In those sessions, everyone would talk openly about what a peaceful and safe environment should look like — especially for someone dealing with mental illness, like Chris.

At that point, the guardian lowered their head. Deep down, they knew — as did many people around them — that a certain individual in the environment would likely obstruct Chris’s recovery. Yet, instead of accepting the invitation to the next session, the guardian tried to avoid it altogether, likely because it would put them in an uncomfortable position. The psychiatrist then informed them that if there was no participation or open communication, the only responsible course of action would be to either notify the appropriate state authority or, at the very least, refuse to continue seeing Chris — because medication alone is not a miracle cure.

But there is also a second, far more common type of answer.

In this version, the psychiatrist calmly explained that, unfortunately, the science of psychiatry had not yet reached a definitive conclusion about what exactly causes mental illness in a person. It could be many different things, but everything remained hypothetical. As such, they advised that it would be best not to “reopen old wounds” by probing too deeply into the patient’s past or environment. The psychiatrist reassured them that the medication would help Chris feel much better — and politely ended the session.

The guardian left the office convinced they had done all they could. They went on living their life reassured that Chris was now “as well as he could be.”

From these two contrasting experiences, an important question arises:

What is the true role of a psychiatrist?

Is the psychiatrist supposed to be a protector of the vulnerable — someone who actively defends their patients and takes a stand when the environment is part of the problem?

Or is the psychiatrist merely a professional technician of the mind, whose ethical duty is to stay neutral, avoid conflict, and strictly treat what lies within the boundaries of biology and medication?

Should the psychiatrist risk tension — or even conflict — with the patient’s family or social environment, if that’s what it takes to ensure real healing? Or would that be considered unprofessional involvement beyond the scope of their role?

In the end, perhaps this question doesn’t just define the role of a psychiatrist — it defines whether healing is something we do with the patient, or simply to them.