Tuesday, June 16, 2009

Political Involvement of Psychiatrists

Here's another excellent question from a visitor to the site:

Political involvement of psychiatrists: We live in a "therapeutic culture". [There] are changing sociocultural norms for what is considered normal and acceptable. Are--and should--psychiatrists be aware of the sociological and political changes occurring as a result of the millions taking antidepressants or receiving psychotherapy? Should psychiatrists take a more active role in managing forces that influence communities, given the positive therapeutic effects of unconditional positive regard, hope, trust, interpersonal connection, and belonging (some of the common factors)?
Psychiatrists as a group are extremely heterogeneous, in terms of personality style, intellectual background, and political beliefs. Those who involve themselves in administration or politics may do so in a loving attempt to help their community, but may also do so due to a need to have more influence, control, money, or self-aggrandizement (to be fair, I suppose most people would be motivated by all of these factors, to some degree). There are a lot of big egos in psychiatry, just like everywhere else.

I've often thought of the ideal role of psychiatrist (politically) as some kind of monastic figure ("Jedi-like", if I could indulge in a popular culture metaphor): serenely outside the political machine, possessing wisdom but healthily setting aside the need to exert power or control at all. This type of paradigm is in conflict with the competitive and ambitious world of politics or administration.

I do agree that we all need to be more active in informing ourselves about political concerns, and attempting to help not only individuals, but also groups, communities, or nations. And psychiatry as an organized group most definitely needs to be aware of large-scale social effects of treatments such as psychotherapy and medications.

In very dark and troubled times, or in dark and troubled parts of the world, very bad things can happen politically. The institution of psychiatry has sometimes been involved in these events. At other times, psychiatrists or therapists are themselves persecuted. It is a luxury to live in a peaceful and free nation, and we need to be vigilant to maintain social and political freedom.
Here are a few articles about this:
http://www.atypon-link.com/GPI/doi/pdf/10.1521/prev. (an essay about psychiatry in Nazi Germany)
http://www.nybooks.com/articles/16082 (an 2003 excerpt published in the New York Review of Books about psychiatry in China)


Anonymous said...

My personal feeling is Politics could benefit from psychiatric/therapeutic modeling and the more collaboration between the two fields, the better.

However, I don't believe psychiatrists should hold office. Both positions are distinct entities bounded by different rules, regulations, ethics, morals...etc.

The conflict of interest would be too great for the psychiatrist. (Especially considering the physician-hippocratic oath. )

Anonymous said...

I did not intend to delve into the dark side of psychiatry with this question, though Germany, Russia, and China were not the end of it. As recently as the occupation of Iraq and Afghanistan, and the notorious Abu Ghraib prison, psychiatry has been involved when it has come to interrogation, torture, and other inhumane treatments*.

Whether this reflects the involved psychiatrists' personality, politics and values, or something inherent to the profession of psychiatry, I do not know.

My original intention may be clarified by referring to an article by Diener and Seligman entitled "Beyond Money"**.

They suggest that policy decisions should be informed not by economic outcomes but by measures of well-being. They note that sense of life satisfaction has not improved despite continued economic development in the last decades.

I can identify with your vision though, of psychiatrist as "monastic figure...serenely outside the political machine." Personally I very much dislike the world of politics--deception, greed, and power. Yet psychiatry as an institution has such power and authority that a psychiatrist may see it as either responsibility or opportunity to give direction to this force.

At the risk of sounding irrational, I feel that the very people who need to be involved are those who detest politic's immorality and corruption!

This is a tall order indeed. I know of many people with big egos in various administrative positions, in colleges, hospitals, and government. It takes courage to be selfless amongst the selfish...and survive!

Maybe this is a matter of self-knowledge, of boundaries, of deciding what we are/not willing to do to help others, and a cost/benefit analysis.

This is a question I too struggle with, even with my relatively limited circle of power and influence.


*Miles S. Abu Ghraib: its legacy for military medicine. Lancet 2000; 364: 724-729.

**Diener, E., & Seligman, M. E. P. (2004). Beyond money: Toward an
economy of well-being. Psychological Science in the Public Interest, 5,

GK said...

There are complex ethical problems alluded to here...

I am reminded of issues in forensic psychiatry or law enforcement that come up at times, when individuals responsible for a terrible crime, or who are part of a group planning a crime, may be withholding information which, if known, could save lives.

I'm sure issues of this type have come up frequently in past wars. Strong arguments could be made on both sides of this issue, about the most ethical and just ways to handle situations of this type.

In any case, I think it is important for there to be a clear system of ethics. We must always be able to account for, and take responsibility for, our actions.

Established and clear ethical principles in global psychiatry (together with continued efforts to make the global community of psychiatrists more cohesive) may continue to help the profession to become a stronger and more positive worldwide influence, including in politically troubled areas.