ETHICAL ISSUES AND

THE PROBLEMS OF
LABELING
Psychology 36: Abnormal Psychology

Who determines the need for

treatment?
A Familys Dilemma:
Arthur was brought to a clinic by family members because
he was speaking and acting strangely. He talked
incessantly about his secret plan to save all the starving
children in the world. His familys concern intensified
when Arthur said he was planning to break into the
German embassy and present his plan to the German
ambassador. Alarmed by his increasingly inappropriate
behavior and fearing he would be hurt, the family was
astounded to learn that they could not force him into a
psychiatric hospital.

A Familys Dilemma, Contd

Arthur could admit himselfwhich was not likely,
given his belief that nothing was wrong with him
but they had no power to admit him involuntarily
unless he was in danger of doing harm to himself
or others. Even if they sincerely believed some
harm might be forthcoming, this wasnt sufficient
reason to admit him involuntarily. The family
coped with this emergency as best they could for
several weeks until the worst of Arthurs
behaviors began to diminish.
*Arthur suffered from what is known as brief

Questions that mental health

professionals face daily:
Why wouldnt the mental health facility
admit Arthur who was clearly out of touch
with reality and in need of help?
Why couldnt his own family authorize the
mental health facility to act?

 What would have happened if Arthur had

entered the German embassy and hurt or,
worse, killed someone?
Would he have gone to jail, or would he have
finally received help from the mental health
community?
Would Arthur have been held responsible if he
hurt other people while he was delusional?

An ethical dilemma
These are just a few of the many issues that
surface when we try to balance the rights of
people who have psychological disorders
with the responsibilities of society to
provide care.
Mental health professionals must both diagnose
and treat people and consider individual and
societal rights and responsibilities.

 Systems of ethics and legal concepts

change with time and with shifting societal
and political perspectives on mental illness.
How we treat people with psychological
disorders is partly a function of how society
views these people.

Point to Ponder
Do people with mental illness need
help and protection, or does society
need protection from them?

Civil Commitment
The legal system exercises significant influence
over the mental health system.
Laws have been designed to protect people who
display abnormal behavior and to protect society.
Often, achieving this protection is a delicate
balancing act, with scales sometimes thought to
be tipped in favor of the rights of individuals and
at other times in favor of society.

 Civil commitment laws detail when a

person can be legally declared to have a
mental illness and be placed in a hospital
for treatment.
The laws protected Arthur from
involuntary commitment, but they also
put him and others at potential risk by
not compelling him to get help.

In a now classic book, Back to the Asylum, La

Fond and Durham (1992) argue that two clear
trends in mental health law are evident in recent
history in the United States:
A liberal era from 1960 to 1980 was
characterized by a commitment to individual
rights and fairness.
A neoconservative era from 1980 to the
present where the rights of people with mental
illness have been limited to provide greater
protection to society.

Criteria for Civil Commitment

Historically, states have permitted commitment
when several conditions have been met:
1. The person has a mental illness and is in need
of treatment;
2. The person is dangerous to himself or herself or
others; or
3. The person is unable to care for himself or herself,
a situation considered a grave disability.

 The government justifies its right to act

against the wishes of an individual
under two types of authority: police
power and parens patriae (state or
country as the parent) power.

Two Types of Authority

Police Power
The government takes
responsibility for
protecting the public
health, safety, and
welfare and can create
laws and regulations to
ensure this protection.
E.g., criminal offenders
are held in custody if
they are a threat to
society.

Parens Patriae Power

Applied by a state when citizens

are not likely to act in their own
best interest, e.g., to assume
custody of children who have no
living parents, or used to commit
individuals with severe mental
illness to mental health facilities
when it is believed that they
might be harmed because they
are unable to secure basic
necessities of life (a grave
disability) or because they do
not recognize their need for
treatment.
The state acts as a surrogate
parent.

Mental Illness vs. Psychological

Disorder
Mental illness is a legal concept, typically
meaning severe emotional or thought
disturbances that negatively affect an
individuals health and safety.
Mental illness is not synonymous with
psychological disorder; in other words, receiving
a diagnosis according to the DSM does not
necessarily mean that a persons condition fits
the legal definition of mental illness.

Dangerousness
Assessing whether someone is a danger to self
or others is a critical determinant of the civil
commitment process.
Dangerousness is a controversial concept to
describe people with mental illness: popular
opinion tends to be that people who are mentally
ill are more dangerous than those who are not.
This conclusion is questionable, but widespread.

 How do you determine whether a person is

dangerous to others?
How accurate are mental health
professionals at predicting who will and
who will not later be violent?
The answers bear directly on the process
of civil commitment, as well as on
protection for society.
If we cant accurately predict

 Clinicians are better at assessing the

relative risk required of the legal system
than determining dangerousness case by
case.
Stated in another way, mental health
professionals can identify groups of people
who are at greater risk than the general
population for being violentsuch as
having a previous history of both violence
and drug or alcohol dependenceand can
so advice the court.
What clinicians cannot yet do is

Patients Rights
1. The right to treatment

Also, the right to the least restrictive alternative

2. The right to refuse treatment

Has centered on the use of antipsychotic medications

3. Research participants rights

. The right to be informed about the purpose of the
research study.
. The right to privacy.
. The right to be treated with respect and dignity.

Research participants rights,

Contd
The right to be protected from physical and mental harm.
The right to choose to participate or to refuse to participate without
prejudice or reprisals.
The right to anonymity in the reporting of results.
The right to the safeguarding of their records.
These rights are particularly important for people with psychological
disorders who may not be able to understand them fully.
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