Andrea,

There is a new mental health ethics group within ASBH. We will have our second meeting this fall at the annual meeting. We have invited mental health policy experts to come speak. I hope you will join us.

My work is with the experiences of pregnant women with a history of depression. I hope to submit an R03 to NIH this fall using my pilot data. I also have new data from students at my university on unmet mental health needs.  Would love to correspond with you.

Andrea Kalfoglou
Assistant Professor
Health Administration & Policy Program
Department of Sociology/Anthropology
University of Maryland, Baltimore County

On Jul 3, 2009, at 3:09 AM, [log in to unmask] wrote:

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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