The Ethics of Psychiatric Diagnosis

By Michael Robertson, MB, BS, FRANZCP; Garry Walter, MB, BS, PhD, FRANZCP

A simple view of psychiatry sees mental and physical disorders in the same realm and that the definition and categorization of mental disorder should follow the same lines as physical disorder. This position is associated with the work of Kendell and Kass. In such a view, all disorders are free of value judgments. Boorse attempted to expand on this idea by defining an organism as “healthy” if it is not diseased, which he defined as interference with normative species function. For Boorse, a disease became an illness if it was undesirable, entitled a patient to treatment, and provided a valid excuse for otherwise abnormal behavior on the part of the sufferer, such as in the adoption of the “sick role.” Such views seem to provide an impoverished account of psychiatric disorder and mental illness, prompting Wakefield to attempt a definition of mental disorders as “harmful dysfunctions” involving the failure to perform a “natural function” for which a particular physiological mechanism had evolved. Wakefield added a value judgment to this definition in stipulating that such dysfunction is undesirable. Such a definition is problematic in that “undesirability” involves a form of relativism. In trying to define dysfunction in a more universal, naturalistic sense, much of the discussion of defining “species normative functions” for humans has followed the Aristotelian notion of capacity for rational thought as being the species normative function for humans. As such, a comprehensive account of psychiatric disorder necessitates it being, in essence, a physiological failure creating an undesirable failure of the capacity for rational thought. In contrast, the anti-psychiatrists, such as Szasz, saw mental disorder as a social construct created to marginalize those experiencing “problems in living,” making psychiatry a form of social agency.

ABOUT THE AUTHORS

Michael Robertson, MB, BS, FRANZCP, is Clinical Senior Lecturer, Discipline of Psychological Medicine, Central Clinical School — University of Sydney, Australia. Garry Walter, MB, BS, PhD, FRANZCP, is Professor of Child and Adolescent Psychiatry, University of Sydney, and Area Clinical Director, Child and Adolescent Mental Health Services, Northern Sydney Central Coast Health, NSW, Australia.

Address correspondence to: Michael Robertson, MB, BS, FRANZCP: e-mail [email protected].

Dr. Robertson and Dr. Walter have disclosed no relevant financial relationships.

EDUCATIONAL OBJECTIVES

1. Assess the philosophical underpinnings of psychiatric diagnosis.
2. Describe the ethical implications of psychiatric diagnosis.
3. Review the misuse of psychiatric diagnosis in recent history.

This CME activity is primarily targeted to patient-caring physicians specializing in psychiatry. Physicians can receive AMA PRA Category 1 Credits™ by reading the CME articles in Psychiatric Annals and successfully completing the quiz at the end of the articles. Complete instructions are given subsequently. Educational objectives are found at the beginning of each CME article.

CME ACCREDITATION

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Vindico Medical Education and Psychiatric Annals. Vindico Medical Education is accredited by the ACCME to provide continuing medical education for physicians.

Vindico Medical Education designates this educational activity for a maximum of 3 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

FULL DISCLOSURE POLICY

In accordance with the Accreditation Council for Continuing Medical Education's Standards for Commercial Support, all CME providers are required to disclose to the activity audience the relevant financial relationships of the planners, teachers, and authors involved in the development of CME content. An individual has a relevant financial relationship if he or she has a financial relationship in any amount occurring in the last 12 months with a commercial interest whose products or services are discussed in the CME activity content over which the individual has control. Relationship information appears at the beginning of each CME-accredited article in this issue.

UNLABELED AND INVESTIGATIONAL USAGE

The audience is advised that this continuing medical education activity may contain references to unlabeled uses of FDA-approved products or to products not approved by the FDA for use in the United States. The faculty members have been made aware of their obligation to disclose such usage.

INSTRUCTIONS

1. Review the stated learning objectives of the CME articles and determine if these objectives match your individual learning needs. You must read each of the CME articles in this issue carefully in order to take the quiz. Do not neglect the tables and other illustrative materials as they have been selected to enhance your knowledge and understanding.
2. The cost of taking the CME quiz is $25; you must pay this fee prior to completing the quiz online.
3. The quiz questions have been designed to provide a useful link between the CME articles in the issue and your everyday practice. Read each question and choose the correct answer by checking the box next to your desired answer.
4. After you answer all questions, your quiz is graded. A score of at least 80% is required to pass
5. If you passed the quiz, you will receive by mail a CME certificate of within 4 to 6 weeks. If you failed the quiz, you may retake the quiz at another time by returning to the CME articles and then registering again for the quiz.

| | |

Ethics and Design Flaws of Humanity
Jan Fawcett, MD

Psychiatric Ethics — A Complicated Challenge
Michael Robertson, MB, BS, FRANZCP; Garry Walter, MB, BS, PhD, FRANZCP

Psychiatry in the News

 Care Ethics: What Psychiatrists have been Waiting for to Make Sound Ethical Decisions
Sidney Bloch, MD, PhD

 Neuroethics and Psychiatry: New Collaborations for Emerging Challenges
Emily R. Murphy, PhD; Judy Illes, PhD

Narrative Ethics in Psychiatry and the Literature of Youth
Karen Fisher, MB, BS; Garry Walter, MB, BS, PhD, FRANZCP; Michael Robertson, MB, BS, FRANZCP