Ethical Human Psychology and Psychiatry最新文献

The implementation of a recommendation by the President's New Freedom Commission (NFC) to screen the entire United States population--children first--for presumed, undetected, mental illness is an ill-conceived policy destined for disastrous consequences. The "pseudoscientific" methods used to screen for mental and behavioral abnormalities are a legacy from the discredited ideology of eugenics. Both eugenics and psychiatry suffer from a common philosophical fallacy that undermines the validity of their theories and prescriptions. Both are wed to a faith-based ideological assumption that mental and behavioral manifestations are biologically determined, and are, therefore, ameliorated by biological interventions. NFC promoted the Texas Medication Algorithm Project (TMAP) as a "model" medication treatment plan. The impact of TMAP is evident in the skyrocketing increase in psychotropic drug prescriptions for children and adults, and in the disproportionate expenditure for psychotropic drugs. The New Freedom Commission's screening for mental illness initiative is, therefore, but the first step toward prescribing drugs. The escalating expenditure for psychotropic drugs since TMAP leaves little doubt about who the beneficiaries of TMAP are. Screening for mental illness will increase their use.

While the mental health professional generally has beneficent motives and an honest belief in the DSM diagnoses assigned to clients, such diagnoses may yet be defamatory when communicated to third parties. Mental health diagnoses invariably lower the individual's reputation in the eyes of the community. At the same time, DSM diagnoses are but one out of a myriad of possible interpretive frameworks. DSM descriptors for the client's distress thus cannot be said to capture the essence of the client's personhood. When a diagnosis is published as if it captured a definitive truth about an individual psychiatric client, it is, in that important regard, inaccurate. That is, such a communication meets the criterion for a reckless disregard for the truth or an honest belief but without reasonable basis insofar as it is considered to be anything more than a working hypothesis. Hence, in certain cases, DSM labeling may constitute defamation.

This article argues that it is futile to try and treat the many serious mental disturbances now confronting society with individual psychotherapy. Only by preventing the occurrence of mental disturbance can headway be made in dealing with this source of human suffering. Prevention means confronting and ameliorating the major cause of mental disturbance: stress. The sources of stress include poverty, rampant sexism, being born unwanted, and other forms of social injustice. This article demands that those in the mental health field examine their moral and scientific beliefs and begin to take steps to change the existing unfair political and economic practices.

The field of psychotherapy has failed to live up to its promise to be a force in the continued development of democracy by aligning itself with medicine and psychiatry. Psychotherapists must recognize that those with whom they work and disseminate information to are inevitably citizens and that they are redefining citizens as mental patients. By utilizing psychiatric diagnoses, which are in effect, moral labels, psychotherapy unwittingly helps create authoritarian political structures by convincing their patients and the public that they are essentially inferior and can do nothing to change that condition. A series of recommendations are made that suggest ways for psychotherapy to free itself from institutional psychiatry and medicine and build its own "house."

No literature exists concerning the implications of using electroconvulsive therapy (ECT) in the treatment of Latinos. Given the large and increasing Latino population in the United States, the contentious history of ECT, and the possible differences in language and cultural vantage point between the typical ECT provider and Latino client, this paucity of research is worrisome. This article identifies a number of potential problems involved in multiculturally untrained service providers treating Latinos with ECT, including invalid diagnoses, an incomplete knowledge of the strengths and resiliencies of the client, and the use of ECT rather than culturally appropriate interventions. Also discussed are Latino cultural beliefs and practices salient to mental health service providers, some of the recent mandates for multiculturally informed service provision in mental health, ideas for the constructive modification of the diagnostic and treatment protocols currently guiding the use of ECT with Latinos, and needed research relevant to the issues raised.

This article reports the findings of a research study that used a critical social research methodology to review the increase in use of the diagnosis of attention deficit hyperactivity disorder (ADHD) and conceptualized the phenomenon within a theoretical framework based upon Beck's (1992, 1999) periodization of social change, the Risk Society. The study was qualitative in nature. Data were drawn from a wide range of sources including legitimating hearings, reports and studies, texts and seminal documents, field observations in schools and classrooms, and electronic discussion/bulletin board, and in-depth interviews with parents and teachers. The analysis used a critical framework to locate specific instances of claim and counter-claim and to set the historical context for understanding the "modern biological" method of intervention with children considered by parents and teachers as having ADHD. The findings of the study are structured in the context of risks. Further research will inform whether the risks become threats. Through exposure of silences, myths, contradictions and power relationships that create risks surrounding the ADHD phenomenon, it is hoped that discourse concerning the hegemonic medical model of ADHD in research and in the wider community will be further critically examined.

In this article we consider oppression in psychiatric care from a relational ethics perspective. We identify the vulnerability of psychiatric patients and the concomitant difficulties that confront medical health practitioners. We suggest that healthcare practitioners can become desensitized to systemic problems in the routine provision of care, that attention to protocols and procedural guidelines is not sufficient to reduce oppression in care, and that the discussion necessary to do so may not be generally supported within clinical environments. We conclude by proposing that the concept of fittingness may allow practitioners to recognize and resolve oppressive aspects of care in a better way and that a culture of questioning needs to be fostered within psychiatry care settings.

When researchers design an experiment to compare a given medication to another medication, a behavioral therapy, or a placebo, the experiment often involves numerous comparisons. For instance, there may be several different evaluation methods, raters, and time points. Although scientifically justified, such comparisons can be abused in the interests of drug marketing. This article provides two recent examples of such questionable practices. The first involves the case of the arthritis drug celecoxib (Celebrex), where the study lasted 12 months but the authors only presented 6 months of data. The second case involves the NIMH Multimodal Treatment Study (MTA) study evaluating the efficacy of stimulant medication for attention-deficit hyperactivity disorder where ratings made by several groups are reported in contradictory fashion. The MTA authors have not clarified the confusion, at least in print, suggesting that the actual findings of the study may have played little role in the authors' reported conclusions.

Prescriptions for psychiatric drugs to children and adolescents have skyrocketed in the past 10 years. This article presents evidence that the superior effectiveness of stimulants and antidepressants is largely a presumption based on an empirical house of cards, driven by an industry that has no conscience about the implications of its ever growing, and disturbingly younger, list of consumers. Recognizing that most mental health professionals do not have the time, and sometimes feel ill-equipped to explore the controversy regarding pharmacological treatment of children, this article discusses the four fatal flaws of drug studies to enable critical examination of research addressing the drugging of children. The four flaws are illustrated by the Emslie studies of Prozac and children, which offer not only a strident example of marketing masquerading as science, but also, given the recent FDA approval of Prozac for children, a brutal reminder of the danger inherent in not knowing how to distinguish science from science fiction. The authors argue that an ethical path requires the challenge of the automatic medical response to medicate children, with an accompanying demand for untainted science and balanced information to inform critical decisions by child caretakers.

This article suggests that psychological evaluations as a "screen for normalcy" with a view to adoption are a breach of the child's right to psychological integrity and privacy under international human rights law. A foreseeable outcome of such psychological screens, especially for the older foster child who has experienced multiple placements, is an unreliable mental health diagnosis. Normal, albeit maladaptive, potentially modifiable coping strategies arising in the context of family disruption come after the psychological screen to be labeled as an indicator of mental disorder. This, in turn, may inappropriately interfere with the child's adoption prospects. It is suggested that psychological screens for normalcy of preadoptive children represent a misuse both of psychology and psychiatry for they are motivated more by the needs and interests of social institutions involved in the adoption process rather than those of the child.