An Overview of Psychiatric Ethics

Bukovsky’s account of his treatment in various special forensic hospitals is chilling. In theearly 1960s, psychiatric prisoners were subjected to insulin coma therapy, excessive doses ofantipsychotic or barbiturate tranquilizers and unanesthetized ECT. One particular form of restraintused was the so-called “roll-ups” in which a wet canvas strip was wrapped around a patient; thestrip shrank as it dried effectively strangling the victim. Bukovsky noted that the orderlies in thesefacilities were in fact criminals who had been co-opted into the role. Bukovsky told an interviewerof the broken spirit of inmates in these facilities, whose torment continued after they were ultimatelyreleased:34“If you’re just out of psychiatric hospital it’s twice as bad because of thepsychological tension there. You’re constantly wondering if you’re normal. Eventhough you know you were diagnosed for political reasons you still watch yourself.Perhaps I am mad? Those big nobs in white coats with diplomas and professorialstatus decided I was. There must be something wrong. You keep analysingyourself, comparing yourself with others. It’s an additional burden.” 39International ResponseThe World Psychiatric Association (WPA) became aware of the malfeasance of psychiatric diagnosisand “treatment” in the USSR in 1971, after being notified by a document written by Bukovsky. Ittook six years to respond formally, although a WPA committee investigating the political abuseof psychiatry, the “Geneva Initiative on Psychiatry”, was founded in 1974. In 1977 the WPA heldits triennial congress in Honolulu. By that time the British Royal College of Psychiatrists and theAmerican Psychiatric Association had agitated for action in the case of Soviet psychiatric abuses.The WPA formally condemned the practices in the Soviet Union and similar abuses in South Africaunder the Apartheid regime and other Eastern Bloc countries.The 1977 “The Declaration of Hawaii” called for the psychiatric profession to respect patient’sautonomy and maintenance of beneficence and non-maleficence. Furthermore, it addressed issuesof informed consent, confidentiality, and provided guidelines for forensic evaluation of psychiatricpatients and involuntary treatment. There was also an obligation for psychiatrists not to “misuse”their professional skills. Particular reference was made to the use of involuntary treatment in theabsence of psychiatric disorder. By 1982, the Soviets faced expulsion from the WPA, and voluntarilywithdrew to save face. Soviet psychiatric practices were abandoned in the face of Gorbachev’sglasnost and perestroika.The USSR was readmitted to the WPA in 1989.Aboriginal Mental Health and Human RightsEarly Influences in Indigenous Mental HealthRacist attitudes towards indigenous Australians were evident in early writings of Australianpsychiatry. Aborigines were characterised as “crude and simple, childish and devoid of reasoning,and often sexual and animal in nature” and as such “Aboriginal insanity was interpreted as the mostexaggerated expression of their innate primitiveness and savagery”. 186 Apart from the modernisinginfluences of Norton Manning, the emergence of serious consideration of the unique issues ofAboriginal mental health are credited to the psychiatrist John Cawte. 187,188 In addition to meticulousethnographic studies, Cawte’s work placed Aboriginal mental health in the context of the tensionbetween old and new world influences. 189 Indigenous mental health emerged as a substantive areaof expertise internationally due to the wave of decolonisation after World War II and a dedicatedWorld Health Organisation report into the mental health of Indigenous peoples. 190Themes in Aboriginal HistoryThe relationship between Aboriginal and white Australia has been perpetually traumatic. The arrivalof white settlement in Aboriginal Australia resulted in dispossession of traditional lands, degradationof Aboriginal culture and a sporadic program of murder, all of which have been equated with thegenocides of other native populations by Europeans in the Nineteenth Century. 191 As Kiernan notesin his world history of genocide: