I think this list is in a summer slumber but hopefully there are still 
some reading:

This past month I taught a graduate course in health ethics for a 
master's of health administration program.  One of my own areas of 
specialization is mental health ethics, which includes the ethics of 
psychiatric diagnosis and treatment.  I have worked in community 
organizations for people with severe problems in living (e.g. 
"schizophrenia", and victims of religious and political persecution) 
and have presented papers at conferences on human rights and mental 
health.  When I went to look for materials to use in the course I was 
surprised by the assumption in many health ethics articles, some 
included in health ethics/bioethics textbooks, of the inherent validity 
or "healthiness" of psychiatric diagnosis and delineation, with 
examples of people in a "europhic or morbid phase" of "bipolar" or 
having values warped or compromised by "a severe psychiatric illness."  
Deleterious images of people who are addicted to heavy drugs also 
abound.  These kinds of perspectives, in my opinion, are harmful to the 
health interests of those who have been unfortunate enough to fall into 
continual psychiatric attention and stigmatization, such as people with 
very poor or noxious networks of support and sufferers of chronic 
trauma or victimization.

I do worry about harms falling on psychiatric users with the teaching 
of articles to health care professionals and administrators that 
present uncritically "the findings" of psychiatry.  There are pervasive 
destructive assumptions that 1) severe problems in living are primarily 
psychological, biological, and genetic--thoroughly personal--in nature, 
rather than primarily informed by relational/social/cultural factors, 
and 2) that mental illness and mental competence are diametrically 
opposed to each other (usually people don't see something like chronic 
backache, arthritis, diabetes, or itchy skin as necessarily or as a 
matter of course posing a threat to mental competence and proficiency). 
   Health care ethicists have embraced the notion that physical 
disability is socially constructed, though the notion that mental 
health disability is socially constructed has been less accepted it 
seems, though there has been some helpful work on mild-moderate 
depression and an excellent anthology by Fulford, Dickenson and 
Murray--"Healthcare Ethics and Human Values." Sometimes this can be 
because of a conflict of interest, where health care ethicists are 
friends and colleagues of psychiatrists; I have known a few health care 
ethicists in this conflict.   But I hope feminist health care ethicists 
can help more with this problem.  I am hoping to write more on this 
topic this summer.  In the meantime, if people are wanting to be 
sensitive to this issue in their own writing or anthology editing, I 
would be happy to give input from my grass roots experience.

Thanks for reading, Andrea Nicki








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