Ethics Questions for Psychotherapy

Psychotherapy --- and more broadly, psychiatry --- is peculiarly prone to ethical problems. Its work is to restore mental and behavioral "normality." Because of this intimate, personal relation between doctor and patient, ethical questions continue to haunt the discipline, led by 20th-century writers Michele Foucault and, more pointedly, Dr. Thomas Szasz, former professor of psychiatry at the State University of New York. Szasz denies that psychiatry and psychoanalysis are part of medicine at all.

What Is Normal Behavior?

Szasz argues that psychoanalysis is based on fraud. It is fraudulent and immoral because psychiatry assumes a definition of "normality" that is then imposed on patients. Szasz holds that definitions of such things as "normal behavior" derive from society and its interests. As a result, he holds that psychoanalysis is really a form of social control that removes, medicates and sometimes imprisons those whom society sees as troublemakers. Its real targets are conflict and dissent.

What Is Mental Illness?

Szasz holds that this question is the key to everything that is ethically problematic about psychotherapy. His argument is that "normal" can refer meaningfully to organs like the heart or the lungs. "Normal" here refers to proper function: It is healthy when it does its job; it is diseased when it does not. Mental illness is not of this type. Psychotherapy deals not with brain function, which is the realm of neuroscience, but with behaviors. It is one thing to hold that the brain is chemically unbalanced because of some organic cause, another to hold that behaviors are "crazy." Therefore, psychiatry is not a part of medicine, but a form of behavior control.

What Is the Mind?

There is a clear difference between the mind and the brain. The brain is an organ; the mind is not. French philosopher Michele Foucault, in his famous 1959 work "Madness and Civilization" argues the concepts of "mind," "self" and "social function" are all social creations based on power. The mind in this field becomes a subject of the power of the doctor who is given full control over how unwanted behaviors are treated. The mind is now the subject of analysis, no different than any machine. In other words, the present concept of "madness" could only have come into existence in the industrial and scientific age.

What Is Psychotherapy?

This question brings the ethical insights of Szasz and Foucault together. Szasz holds that the brain can legitimately be treated. Foucault argues that "treatment" itself lies at the foundation of ethics in this field. Psychiatry is constructed with language --- words such as "abnormal," "pathological" or "irrational" --- and this language is created, maintained and manipulated by doctors trained to administer it. In other words, the problem with psychiatry is that its truth claims are already built into how they talk about mental illness and, just as important, how society at large speaks about mental illness. The very language of psychiatric science already contains its point of view. It is a constructed truth based on modern industrialism and individual responsibility.

References

• "Project Muse"; From Szasz to Foucault: On the Role of Critical Psychiatry; Pat Bracken and Philip Thomas; September 2010
• The Thomas S. Szasz, M.D. Cybercenter for Liberty and Responsibility: Thomas Szasz's Summary Statement and Manifesto
• The Thomas S. Szasz, M.D. Cybercenter for Liberty and Responsibility; The Shame of Medicine: The Depravity of Psychiatry

Resources

• "Madness and Civilization: A History of Insanity in the Age of Reason"; Michele Foucault; 1959