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by Jeffrey Freedman, M.D.
In the 19th century, advocate and activist Dorothea Dix greatly contributed to policy reforms in the treatment of the mentally ill. As psychiatrists, we know that words matter, and hers likely contributed to the success of her activism in helping to create the first generation of mental health asylums. In her 1843 “Memorial to the Legislature of Massachusetts,” she wrote: “I proceed, Gentlemen, briefly to call your attention to the present state of Insane Persons confined within this Commonwealth, in cages, closets, cellars, stalls, pens! Chained, naked, beaten with rods, and lashed into obedience!”
Just as Dix did, any citizen or mental health professional can advocate for good psychiatric care in writings that could become widely read. I, for example, have been a frequent letter writer to The New York Times over the past 20 years and to The Washington Post for the past five. Most of my letters have been about psychiatry, although I do, on occasion, write a letter about baseball.
What motivates me to write in my professional capacity? I write letters to advocate for the needs of patients as well as to correct misrepresentations of my profession to the media.
Why do I think it is important for psychiatrists and other mental health professionals to engage in public discourse, which includes writing letters to the editor? Why not write an Op-Ed opinion piece? In my case, I have had no success with Op-Ed submissions; my strength seems to lie in the 150-to-200-word letter. For me, the challenge and pleasure of writing are in condensing a lengthier opinion piece in a way that more powerfully conveys a message.
There are advantages to advocating mental health concerns with newspaper letters. A letter can be composed relatively quickly, although some still require hours to get the right wording for effective messaging. Letters typically appear in the print newspaper up to two weeks later, but for articles where a more immediate response is deemed warranted, a letter can appear online within a day and in the print version a day later. The writer does not have to worry about coming across in a different way than intended, as they might when speaking to reporters.
Advocacy groups encourage writing letters to newspapers, noting that after the front page, the opinion pages represent one of the most widely read sections. However, the viewership method has changed. For The New York Times, for example, the vast majority its approximately 10 million paid subscribers are digital-only, but I still believe the impact of one’s writings may be greater through the design of the old-fashioned print format.
To give an example of why and how I write letters, earlier this year, there was a news article in The New York Times about its survey of more than a thousand therapists about mental health in America. The questionnaires were sent by Psychology Today to its professional members. As psychiatrists had not been included in the survey, I felt it important to weigh in, since the resulting article still referenced my field. I believed the results of the survey were important and merited further public education about the state of mental health treatment, as well as further advocacy. My letter appeared in print version of the newspaper on January 10, 2022, and is copied below:
To the Editor:
Psychiatrists were not included in this Times survey sent by Psychology Today to its professional members, but there were references to my field that illustrate a sad state of affairs.
A quarter of those polled said suicidal thoughts were among the leading reasons patients sought help. Sixty percent said more patients wanted medication. One clinical social worker noted that a person who was suicidal and depressed had to wait three months to see a psychiatrist for medication. That waiting time was not just for psychiatrists: Nearly a third of the therapists surveyed said it could take at least three months to get an appointment with them, if at all.
If a person is severely depressed and suicidal, a professional should evaluate them immediately. I know from being a hospital psychiatrist throughout my career that this evaluation can be accomplished in an emergency room.
The problem is that the necessary, close follow-up care is not accessible to most who cannot pay out of pocket. It is often difficult to find those who will accept fees paid by insurance. As a society, we have to examine our priorities for how money is allocated and whether mental health is worth the financial investment.
Jeffrey B. Freedman, New York
It should be further noted that, in print, this letter was adjacent to a Times editorial entitled, “Russia Invites Calamity If It Invades Ukraine.” Published pieces like these on the newspaper Opinion page can influence attitudes but not necessarily result in action. One can turn blue in the face from repeating the same points or warnings.
Which brings me back to Dorothea Dix. She was a person who “put money where one’s mouth is.” We need more people whose skills and dedication to patient care can help change our society.
