An Overview of Psychiatric Ethics

2Psychiatry and Human Rights30INTRODUCTIONIn this section I will consider the issue of the history of human rights violations by psychiatrists.The notion of human rights is a product of the Twentieth Century, which brought examples of theirviolation in the crimes of the Nazis during the 1930s and 40s. The section begins by examiningsome of the key historical events in the history of psychiatry and human rights. It then considersthe crimes of the Nazi doctors and the human rights abuses in the former USSR. The section thenexamines the history of human rights in Australian psychiatry and provides a discussion of recentcontroversies.The section is by no means comprehensive. There have been small scale human rights violations inmany other settings, including the former Apartheid regime in South Africa and numerous sporadicinstances of human rights violations in many countries. There have been concerns about thepossibility of human rights violations perpetrated by psychiatrists in present day China. This is acontroversial area and it is still unclear what the extent of the problem is. Those who are interestedin this area should refer to the Human Rights Watch website , which publishesregular updates on numerous human rights issues in relation to mental health care.Pinel and the Origins of modern psychiatryPsychiatry Pre-PinelFrom antiquity, human societies grappled with the notion of madness. Plato had distinguisheddifferent components of the soul – rational, appetitive and emotional. In Plato’s model, the rationalwas in a “chariot”, driven by the twin horses of appetite and emotion. Throughout the Middle Ages,the insane were considered to be demonically possessed, many were executed as ‘witches’.Madness was defined in pre-Enlightenment times as a form of demonic possession and those withmental illnesses were banished to abject conditions of incarceration and exclusion from society.Their confinement often involved physical restraint such as manacles or chains. The mentally ill werethe subject of ridicule or demeaning curiosity, best exemplified by the practice of allowing payingmembers of the public tour the Bethlehem hospital to enjoy the “show of Bethlehem” and poke theinmates with sticks (one penny entry, free on first Tuesday of the month). Psychiatric ‘treatments’ ofthis period included bleeding, purging, enemas and blistering. Foucault’s Madness and Civilisation 179traced the development of ‘madness’ through various eras. To Foucault, madness was not a naturalstatic occurrence, but dependent on the society in which the phenomenon occurs. At the time of theEnlightenment, madness came to be seen as the reverse of reason. Foucault described asylums asbeing the site of psychiatric power, which he defined as the asymmetric exercise of coercive force. 180Pinel’s PsychiatryPhillipe Pinel became a psychiatrist at the Hôpital Bicêtre in Paris. Pinel is considered a child of theEnlightenment, as he took the approach of the rational wisdom to the care of his patients. Ratherthan incarceration, coercive restraint and ridicule, Pinel advocated therapy involving close contactwith and careful observation of his patients. In 1798 Pinel published a classification of diseases in hisNosographie philosophique ou méthode de l’analyse appliquée à la médecine. Pinel argued that hisapproach to madness (l’aliénation mentale) was to emphasize the “moral” component of madness.