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.

The Look Over Your Shoulder: Unethical Behaviour Decreases in the Physical Presence of Observers

Köbis, N., van der Lingen, S., et al., (2019, February 5).

https://doi.org/10.31234/osf.io/gxu96

Abstract

Research in behavioural ethics repeatedly emphasizes the importance of others for people’s decisions to break ethical rules. Yet, in most lab experiments participants faced ethical dilemmas in full privacy settings. We conducted three experiments in which we compare such private set-ups to situations in which a second person is co-present in the lab. Study 1 manipulated whether that second person was a mere observer or co-benefitted from the participants’ unethical behaviour. Study 2 investigated social proximity between participant and observer –being a friend versus a stranger. Study 3 tested whether the mere presence of another person who cannot observe the participant’s behaviour suffices to decrease unethical behaviour. By using different behavioural paradigms of unethical behaviour, we obtain three main results: first, the presence of an observing other curbs unethical behaviour. Second, neither the payoff structure (Study 1) nor the social proximity towards the observing other (Study 2) qualifies this effect. Third, the mere presence of others does not reduce unethical behaviour if they do not observe the participant (Study 3). Implications, limitations and avenues for future research are discussed.

General Discussion

Taken together, the results of three experiments suggest that the physical presence of others reduces unethical behaviour, yet only if that other person can actually observe the behaviour. Even though the second person had no means to formally sanction wrong-doing, onlookers’ presence curtailed unethical behaviour while the local social utility (co-beneficiary or observer, Study 1) and the level of proximity (friend vs. stranger,Study 2) played a less important role. When others are merely present without being able to observe, no such attenuating effect on unethical behaviour occurs(Study 3).  Introducing the physical presence of another person to the rapidly growing stream of behavioural ethics research, our experiments provide some of the first empirical insights into the actual social aspects of unethical behaviour.

Humans are social animals who spend a substantial proportion of their time in company. Many decisions are made while being in the presence or in the gaze of others. At the same time, the overwhelming majority of lab experiments in behavioural ethics consists of individuals making decisions in isolation(for a meta-analysis, see Abeler et al., 2016). Also field experiments have sparsely looked at the impact of the tangible social elements of unethical behaviour (for a review, see Pierce & Balasubramanian, 2015). Nevertheless, the behavioural ethics literature emphasizes that appearing moral towards others is one of the main explanatory factor to explain when and how people break ethical rules (Mazar, Amir, & Ariely, 2008; Pillutla & Murnighan, 1995). Yet, so far behavioural research on the presence and observability of actual others remains sparse. Providing some of the first insights into how the physical presence of others shape our moral compass can contribute to the advancement of behavioural ethics and potentially inform the design of practical interventions. 

The research is here.

Direct application to those who practice independently.

Microaggression and Moral Cultures

By Bradley Campbell and Jason Manning
Comparative Sociology 13 (2014) 692–726

Here is an except:

A culture of victimhood is one characterized by concern with status and sensitivity to slight combined with a heavy reliance on third parties. People are intolerant of insults, even if unintentional, and react by bringing them to the attention of authorities or to the public at large. Domination is the main form of deviance, and victimization a way of attracting sympathy, so rather than emphasize either their strength or inner worth, the aggrieved emphasize their oppression and social marginalization. This culture shares some characteristics and conditions with the culture of dignity out of which it evolved, and it may even be viewed as a variant of this culture. It emerges in contemporary settings, such as college campuses, that increasingly lack the intimacy and cultural homogeneity that once characterized towns and suburbs, but in which organized authority and public opinion remain as powerful sanctions. Under such conditions complaint to third parties has supplanted both toleration
and negotiation. People increasingly demand help from others, and advertise their oppression as evidence that they deserve respect and assistance. Thus we might call this moral culture a culture of victimhood because the moral status of the victim, at its nadir in honor cultures, has risen to new heights.

The culture of victimhood is currently most entrenched on college campuses, where microaggression complaints are most prevalent. Other ways of campaigning for support from third parties and emphasizing one’s own oppression – from protest demonstrations to the invented victimization of
hate-crime hoaxes – are prevalent in this setting as well.

The entire article is here.