From the Desk of Dr. Kent

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Not Second Class

I’ve been practicing psychiatry for 30 years and have worked in every type of setting in this field. I feel that people with mental illnesses have been treated differently than those that have other non mental physical illnesses. Even people with other brain conditions such as MS, stroke and tumor afflictions, get better treatment and understanding. What is it about mental illnesses that have created this situation? Why do we look at these people with a different lens?

Society and Mental Illness

I think the answer is multifaceted. First, society in general has a poor understanding of mental illness. This results from a lack of awareness, education and false portrayals in the media. Stigma is born out of this atmosphere. We tend to make fun of people that are different and often fear what they may do. The truth is almost always the opposite. Individuals that suffer from mental illness are statistically less likely to be dangerous than the general population, especially the more persistently and seriously mentally ill such as schizophrenics. But because of depictions in movies and television, we have an unfounded fear. Another reason we see people with mental illness differently is they don’t always seem to meet our expected societal standards. They may struggle with the strict employment model, but may excel at creativity, drive and innovation. A New York Times bestseller book: “A First-Rate Madness: Uncovering the Links Between Leadership and Mental Illness” written by Nassir Ghaemi, M.D. a psychiatrist, outlines famous people in history who excelled at certain things because of their mental illness. These include: Napolean, Lincoln, Churchill, JFK and others. Being significantly different isn’t always a bad thing.

Second Class Citizens?

Another factor affecting our perception is that people with serious mental illness tend to have a downward drift socioeconomically. Many in the homeless population are mentally ill. Society has given up on them.

I believe we treat the mentally ill as second class citizens. In almost all areas this is painfully evident. We underfund all aspects of their treatment. We herd them through ERs, clinics and hospitals like cattle. Most psychiatric offices look outdated and plain. But go to any other medical specialty and watch the decor improve. Hospital reimbursements combined with inflation for psychiatric care has gone down in order of magnitude since the 1980s. Hospitals are no longer given enough money to provide individualized therapy. This is not true of almost any other specialty, where medical surgical hospitals are booming all across the country with fancy single patient rooms with views. 

Why does a chemical imbalance in the brain deserve less consideration than a abnormal brain growth or stroke? We certainly treat these people differently in terms of reimbursements and care.

Change Through Understanding

I believe change comes from correct knowledge, understanding and action. We cannot fear that which we don’t understand. We just need to try and understand it better. The two best sites for understanding are at and To take action, try to think and act differently when it comes to mental illness. Stop fearing individuals who have various chemical imbalances in the brain. Embrace their uniqueness and individuality. Support NAMI financially. Speak up when someone is belittled for something they have little control over. Read authoritative sources and open yourself to better awareness.

A prime example of stigma reversal is epilepsy. Decades ago, epilepsy was considered a mental illness. We now know clearly understand it as a physiological condition and it no longer carries a stigma. Today’s well defined mental illnesses I believe are headed for that same fate. Stigma will die with understanding and action.

I feel fortunate to have landed in this exciting field which continues to amaze me all the time. That is why I got involved in deep TMS as it provides yet another way to help people who suffer to get better and find hope.

If you suffer from depression, take the self assessment on this site and see if you are a candidate for deep TMS.

Posted by David Kent at 4/27/2017 7:51:00 PM
Comments (2)
Re:Not Second Class
Something else I've noticed that is a disservice to those of us in the mental health arena (as patients): I never did better than when I was participating in an Intensive Outpatient program. Then I (foolishly) quit all meds and ended up back on the inpatient side, and my insurance wouldn't allow me to reenter the IOP, saying "it obviously didn't help, you ended up back inpatient."

They refuse to pay for another 3 days a week IOP at a couple of hundred dollars a day, but an inpatient stay at $1000/day is no problem? ARGH.

NO other specialty of medicine, that I'm aware of, just gives up on people. You'll never, ever hear "well we aren't going to cover your seventeenth Chantix prescription to quit smoking, because clearly you're never going to quit." What about "no cardiac stent for you, you continue to eat like garbage." "Sorry, we aren't going to amputate your gangrenous toe that you got by being an uncontrolled diabetic, since you won't follow the CDE's recommendations about exercise." "Oh, you have a gallstone lodged in your bile duct? Maybe lay off the fatty diet. Good luck!"

No. They take swift action to correct PHYSICAL things, even if it's the ninth time someone's had to have the same procedure. But when the problem is hidden behind our skulls, when it's not a visible, physical problem, we DO become "second class." Weirdos. Seekers. Anyone who says otherwise, needs to be telling that to insurance juggernauts and the rest of the medical community who just don't seem to get it. Don't seem to WANT to get it.
Posted by on 4/27/2020 2:20 PM
Re:Not Second Class
Understanding and accepting diversity is essential. My therapist at taught me how to control my emotions, and it really helps me.
Posted by on 10/2/2022 9:55 PM
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