An Overview of Psychiatric Ethics

“normal” member of that culture placed in another) would be deemed “mentally ill” in the view ofcultural relativism. This explains the position that delusions, for example, must be beliefs inconsistentwith the person’s culture. In clinical practice, such a perspective requires that the clinician be awareof the need to see the patient’s experience in the context of their particular culture. In other words,the question must be “how would a typical member of this group view this situation?”54Alienism and Mental HygieneThe term “alienism” refers to the 19th Century view in Western psychiatry that persons sufferingfrom mental illness were thought to be “alienated” from society and themselves. This view derivedpredominantly from the study of mentally disordered offenders and the assumed relationshipbetween mental illness and criminality. In forensic settings, psychiatrists were termed “alienists”.Mental hygiene is defined as the process of “preserving the mind against all incidents and influencescalculated to deteriorate its qualities, impair its energies, or derange its movements”. 394 The mentalhygiene approach addressed all factors in society which may be injurious to mental health. Themovement gained prominence in post-war Western psychiatry and reached its peak in the work ofAdolph Meyer in the USA.Colonial and Post-Colonial PsychiatryThe trauma of cultural displacement and the legacy of colonisation are critical in conceptualisingthe mental health of indigenous populations. Under colonial rule, psychiatry was often co-optedinto the subjugation of indigenous populations, such as in French Algeria. Frantz Fanon’s book TheWretched of the Earth 395 highlighted how European psychiatry functioned in a colonial setting toalienate the colonized population from their society by forcing a questioning of identity through theEuropean psychiatric prism.Fanon, like Che Guevara, was a medical practitioner and revolutionary. In addition to hisrevolutionary politics, Fanon pursued a project of reform in the psychiatric profession in Algeria,creating a dialectic of psychiatrist or street fighter. 396 Indeed, Fanon’s double life as a colonial-erapsychiatrist and as an Algerian Front de Libération Nationale (FLN) activist has invited much criticismin revisionist views of his life. His most recent biographer refers to his reputation as a “talentedhater”, 397 and other critics cannot look past his complicity in FLN atrocities, such as bombings andsabotage. 398Fanon identified colonial psychiatry in Algeria as Eurocentric and as exerting a hegemonic culturalinfluence upon the population as a perpetuation of the “colonizer-colonized” dynamic. The culturalestrangement and institutionalized racism brought about by Eurocentric psychiatry creates a senseof “the Other” in the colonized population, forcing them to constantly question “Who am I?” Whilstmuch of the psychiatric material in Fanon’s other works, The Wretched of the Earth 395 and BlackSkin, White Mask 399 was co-written and possibly anecdotal, 400 his main contribution to the field ofpsychiatry was the requirement of a “common culture” between psychiatrist and patient. 401 Fanonreformulated Lacan’s notion of méconnaissance 402 to the alienation of the colonized Other fromcultural, social and political elements, through a process of internalizing injustice. 403 Fanon rejectedEurocentric psychiatry as it presented a means of conforming to the “psychology of the colonized”.Madness was therefore sociogenic in Fanon’s view, and so psychiatric treatment, in the tradition ofPinel, took place in psychiatric institutions that functioned as institutions of social change. Indeed,Fanon has been described as a “social psychiatrist driven by humanism to unmask inhumanity”. 396Even in post-colonial societies, there are remnants of alienist themes in psychiatric institutionswhich have evolved largely as recreations of those of the previous colonizing power. 404 One possibleinstance of this are the “Culture Bound Syndromes”, including such diagnoses as “amok” found inthe Malay culture, and “uqamairineq” among the Yupik Eskimos. Culture-bound syndromes are seenas “folk illnesses” in which changes of behaviour figure prominently. 405 The phenomenon of “amok”,found in Malaysia and Indonesia, involves a person (usually male) exhibiting a deranged state ofagitation and hostile aggression, often leading to destruction of property. From the perspective ofthe person’s culture, such behaviour is viewed as being within the bounds of normal behaviour. Inthe era of British colonial rule, and its associated psychiatric institutions, such behaviour representedgrounds for involuntary psychiatric treatment. Thus a Western pathologizing of a normal behaviourrepresented an example of the use of psychiatry as a process of exerting social control. The