Abraham Nussbaum

When we meet each other, we make each other. When we prescribe a medication, we prescribe each other. We can do it better, especially when prescribing (and de-prescribing) medications for people with mental illness.

In Prescribing Together, my friend Warren Kinghorn and I interviewed clinicians who study how to prescribe well with others. Writing this book, we learned from Francine Conway how to mentalize, from Sidney Hankerson how to connect community, from Sharon Inouye how to listen to stories, from Sarah Fineberg how to deprescribe, and many more.

They all care about the usual metrics– pharmacokinetics, formulations, doses– but even more about the relationships that can be formed around meds.

Those relationships are sometimes called working alliances. Working alliances have a goal, task, and bond. The goal is the “why” of treatment, what the patient and clinician are working towards, whether it be recovery or remission. The task is the “what” of treatment, the activities which a patient recognizes as essential for their health, whether they be thought records or titration schedules. The bond is the “how” of treatment, the affective relationship which develops between clinician and patient as they work together.

A clinician able to form working alliances is more effective for their patients and more resilient in caring for persons with mental illness. Learning to prescribe together helps everyone flourish.

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