When the illness speaks

Abstract

SUMMARY The nature of culpability and agency in patients with a variety of psychiatric diagnoses is complex. In this article, a psychiatry resident (specialty trainee in psychiatry) reflects on a clinical encounter in medical school to demonstrate some of the benefits (including the removal of stigma) and dangers (including the threat to patients’ agency) of using the medical model to conceptualise psychiatric illness.

The lack of agency becoming part of the self

“…In his clinical reflection, Greenberg (2024, this issue) addresses the question of the causal role we can attribute to mental illness versus the agency of the patient themselves in the explanation of behaviour related to their condition (in Greenberg's example, the suicidal behaviour of a patient with borderline personality disorder). Is it the illness or the person suffering from it speaking and acting?…”