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Mental health care as an ethical act

Posted Apr 02 2011 11:15pm

One of the greatest illusions of many mental health professionals is that what they do is morally neutral.  It isnt.  They argue incessantly about the efficiency and techniques which they employ, but too often have a blind spot about the moral context within which they operate.

Choosing to prescribe medication is not just a medical choice.  It is an ethical choice.  And if you dont realize that it can bring catastrophe to the lives of the people you serve.  I know one psychiatrist who has told me that every time he prescribes medication he considers the risks of the impact of the “illness” against the risks of the impact of the medication.  And somethings he believes are not worth the risk.  He no longer prescribes atypical antpsychotics unless he feels like it is a major emergency, and still refuses to use them for more than 6 weeks.  He told me “You dont save someones sanity by killing them or causing their physical health to be so affected the reminder of their life is impoverished.”  I know another doctor who tells me “the track record of the medication is as important as the track record of the illness.”  He says , “How in the world do you prescribe things that probably wont work to make it better when those same things have an equal or greater possibility of having disastrous side effects which may alter the course of someones life.”  I know another doctor though who when a patient complained of akathesia said, “I think your right, but this does seem to be controlling your bipolar symptoms.”  He increased the dosage.

It is an ethical choice when you decide to put someone in a psychiatric hospital.  Too many people treat it as a value neutral choice of a technique because someone supposedly meets the criteria that says they need it.  Psychiatric hospitals dont work.  That is why insurance companies, who wont do anything that you dont prove to them they have to, dont pay.  What they do is retraumatize people already hurt.   As one friend told me, “If you dont look like you need to be there when you get there, you will after you have been there awhile.”  20% of the people who are admitted to psychiatric hospitals are readmitted within 30 days.  40% are readmitted within a year.  The blind assumption is it is because of the severity of the illness.  What if it is just because that kind of care leaves people battered, bruised, and traumatized?  What if we are trying to solve people being poisoned by giving them more poison?

The care of people rather it be medical care or whatever occurs within an ethical context.  Too often people who have power over others believe they operate outside of any ethical context or that their power gives them ethical standing.  It just isnt so.  The first rule of medicine is still do no harm.

And if it was treated more often as the first rule then maybe so many people would not be the victim of the efforts of the very people who say they are only trying to help.

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