Making psychiatry moral again: the role of psychiatry in patient moral development

McConnell D, Broome M, Savulescu, J.

Journal of Medical Ethics 

Published Online First: 19 August 2022.

doi: 10.1136/jme-2022-108442

Abstract

Psychiatric involvement in patient morality is controversial. If psychiatrists are tasked with shaping patient morality, the coercive potential of psychiatry is increased, treatment may be unfairly administered on the basis of patients’ moral beliefs rather than medical need, moral disputes could damage the therapeutic relationship and, in any case, we are often uncertain or conflicted about what is morally right. Yet, there is also a strong case for the view that psychiatry often works through improving patient morality and, therefore, should aim to do so. Our goal is to offer a practical and ethical path through this conflict. We argue that the default psychiatric approach to patient morality should be procedural, whereby patients are helped to express their own moral beliefs. Such a procedural approach avoids the brunt of objections to psychiatric involvement in patient morality. However, in a small subset of cases where patients’ moral beliefs are sufficiently distorted or underdeveloped, we claim that psychiatrists should move to a substantive approach and shape the content of those beliefs when they are relevant to psychiatric outcomes. The substantive approach is prone to the above objections but we argue it is nevertheless justified in this subset of cases.

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Helping people elaborate a conception of morality has little risk of coercion and damage to the therapeutic relationship because the patient is requesting that content and is not committed to a conflicting moral position. Of course, it would be wrong to simply indoctrinate the patient so, to avoid that, the process of moral development should be patient-led as much as possible. However, if the moral views the patient gravitates towards in this process are clearly unreasonable, then the psychiatrist has an obligation to guide the patient’s views back within the bounds of reasonableness.

Psychiatrists are well placed to affect substantive moral growth. Their skill for helping people understand and elaborate their subjective worlds can reveal where the moral growth required to treat mental illness and support flourishing might be most easily achieved. We suggest a pluralist approach where the psychiatrist draws on any moral reasons, arguments or insights that help the patient achieve moral growth. In order to tailor moral reasons to the patient, psychiatrists would benefit not only from training in normative moral theories (eg, contractualism, deontology, consequentialism) but also from familiarity with a diverse range of autobiographical or fictional narratives that illustrate how different moral views are experienced and put into practice. The latter would also provide material that the psychiatrist could draw on to help the patient develop moral aspects of their own self-narrative. In the near future, the substantive approach could also benefit from pharmacotherapies, such as psychedelics, which might help patients who consent to such treatment become more receptive to new moral reasons, beliefs and emotions.

The info is here.

Predictors and consequences of intellectual humility

Porter, T., Elnakouri, A., Meyers, E.A. et al.

Nat Rev Psychol (2022). 

https://doi.org/10.1038/s44159-022-00081-9

Abstract

In a time of societal acrimony, psychological scientists have turned to a possible antidote — intellectual humility. Interest in intellectual humility comes from diverse research areas, including researchers studying leadership and organizational behaviour, personality science, positive psychology, judgement and decision-making, education, culture, and intergroup and interpersonal relationships. In this Review, we synthesize empirical approaches to the study of intellectual humility. We critically examine diverse approaches to defining and measuring intellectual humility and identify the common element: a meta-cognitive ability to recognize the limitations of one’s beliefs and knowledge. After reviewing the validity of different measurement approaches, we highlight factors that influence intellectual humility, from relationship security to social coordination. Furthermore, we review empirical evidence concerning the benefits and drawbacks of intellectual humility for personal decision-making, interpersonal relationships, scientific enterprise and society writ large. We conclude by outlining initial attempts to boost intellectual humility, foreshadowing possible scalable interventions that can turn intellectual humility into a core interpersonal, institutional and cultural value.

Importance of intellectual humility

The willingness to recognize the limits of one’s knowledge and fallibility can confer societal and individual benefits, if expressed in the right moment and to the proper extent. This insight echoes the philosophical roots of intellectual humility as a virtue. State and trait intellectual humility have been associated with a range of cognitive, social and personality variables (Table 2). At the societal level, intellectual humility can promote societal cohesion by reducing group polarization and encouraging harmonious intergroup relationships. At the individual level, intellectual humility can have important consequences for wellbeing, decision-making and academic learning.

Notably, empirical research has provided little evidence regarding the generalizability of the benefits or drawbacks of intellectual humility beyond the unique contexts of WEIRD (Western, educated, industrialized, rich and democratic) societies. With this caveat, below is an initial set of findings concerning the implications of possessing high levels of intellectual humility. Unless otherwise specified, the evidence below concerns trait-level intellectual humility. After reviewing these benefits, we consider attempts to improve an individual’s intellectual humility and confer associated benefits.

Social implications

People who score higher in intellectual humility are more likely to display tolerance of opposing political and religious views, exhibit less hostility toward members of those opposing groups, and are more likely to resist derogating outgroup members as intellectually and morally bankrupt. Although intellectually humbler people are capable of intergroup prejudice, they are more willing to question themselves and to consider rival viewpoints104. Indeed, people with greater intellectual humility display less myside bias, expose themselves to opposing perspectives more often and show greater openness to befriending outgroup members on social media platforms. By comparison, people with lower intellectual humility display features of cognitive rigidity and are more likely to hold inflexible opinions and beliefs.

The research is here.

Dear White People: Here Are 5 Uncomfortable Truths Black Colleagues Need You To Know

Dana Brownlee

Forbes.com

Originally posted 16 June 2020

While no one has a precise prescription for how to eradicate racial injustice in the workplace, I firmly believe that a critical first step is embracing the difficult conversations and uncomfortable truths that we’ve become too accustomed to avoiding. The baseline uncomfortable truth is that blacks and whites in corporate America often maintain their own subcultures – including very different informal conversations in the workplace - with surprisingly little overlap at times. To be perfectly honest, as a black woman who has worked in and around corporate America for nearly 30 years, I’ve typically only been privy to the black side of the conversation, but I think in this moment where everyone is looking for opportunities to either teach, learn or grow, it’s instructive if not necessary to break down the traditional siloes and speak the unspeakable. So in this vein I’m sharing five critical “truths” that I feel many black people in corporate settings would vehemently discuss in “private” but not necessarily assert in “public.”

Here are the 5, plus a bonus.

Truth #1 - Racism doesn’t just show up in its most extreme form. There is indeed a continuum (of racist thoughts and behaviors), and you may be on it.

Truth #2 – Even if you personally haven’t offended anyone (that you know of), you may indeed be part of the problem.

Truth #3 – Every black person on your team is not your “friend.”

Truth #4 – Gender and race discrimination are not “essentially the same.”

Truth #5 – Even though there may be one or two black faces in leadership, your organization may indeed have a rampant racial injustice problem.

Bonus Truth #6: You can absolutely be part of the solution.

As workplaces tackle racism with a renewed sense of urgency amidst the worldwide Black Lives Matter protests, it’s imperative that they approach the problem of racism as they would any other serious business problem – methodically, intensely and with a sense of urgency and conviction.

The information is here.

How to know who’s trustworthy

T. Ryan Byerly

psyche.co

Originally posted 4 Nov 2020

Here is an excerpt:

An interesting fact about the virtues of intellectual dependability is that they are both intellectual and moral virtues. They’re ‘intellectual’ in the sense that they’re concerned with intellectual goods such as knowledge and understanding; but they’re moral virtues too, because they’re concerned with the intellectual goods of others. Indeed, the moral, other-regarding features of these virtues are especially central in a way that’s different to other intellectual virtues, such as inquisitiveness or intellectual perseverance.

It is in part because of the centrality of their other-regarding dimensions that the virtues of intellectual dependability haven’t taken on a larger role in education. The reigning paradigm of what we should aim for in education is that of the critical thinker. But being a critical thinker doesn’t necessarily mean that you possess other-regarding qualities, such as the virtues of intellectual dependability.

While we might lament this fact when it comes to formal education, we can still make efforts to become more intellectually dependable on our own. And we arguably should try to do so. After all, it’s not just us who are in need of dependable guides in our networks – we need to be intellectually dependable for the sake others, too.

If we want to grow in these virtues of intellectual dependability – to become more benevolent, transparent and so on – what can we do? The following are four strategies that researchers tend to agree can help us grow in intellectual virtue.

A first strategy is direct instruction – learning about the nature of particular intellectual virtues that we hope to cultivate. Ideally, we’ll gain an account of what the virtue involves, and we might learn about the vices that oppose it. Part of the reason why direct instruction is important is that it helps to reduce our cognitive load. It gives us a framework to think through our intellectual life. It also helps us set a target to aim for.

A second strategy is to think how intellectual virtues apply in particular situations, considering what the intellectual virtue – and perhaps also its opposing vices – looks like in action. You might select some historical, contemporary or even fictional examples of people who appear to act in accordance with the virtue or its opposing vice. By encountering exemplars, you might gain a taste or sensibility for the virtue, and a person to emulate. More generally, this exercise can help you to practise evaluating scenarios in which intellectual virtues can influence behaviour. When done well, this can help you appreciate the variety of contexts in which intellectual virtues make a difference, and the different kinds of behaviour they lead to.

The info is here.