Ethical problems of modern psychiatry and research of the human psyche

The successes and possibilities of biotechnology in the field of control and management of brain activity today are truly fantastic. This is extravagant, fortunately, not proven brainwashing of people with the help of psychotropic radiation; and “lie detectors” that have already become familiar and routine, making it possible to “read other people’s thoughts” and receive information about a person’s subjective experiences. These are the procedures of neuro-linguistic programming (NLP), with the help of which a model of successful psychotherapy is formed, using the method of changing the text and its impact on a person.

At the same time, despite great achievements, the field of psychiatry remains one of the most complex and problematic in modern medicine. Some researchers explain this, in particular, by its traditional predilection for the so-called linear principle, according to which every mental illness has the same causes, manifestations, course, outcome (i.e. one cause gives the same effect). Such “rigidity” in the formulation of a clinical diagnosis is poorly justified, because it is impossible not to take into account the factor that not only the physical and spiritual properties of individuals are unique, but also the manifestation and course of the disease in individual patients. Departure from unilinearity and turning to theories of random processes will lead, according to some experts, to the renewal of psychiatry , because the concept of the disease will be probabilistic , and its course in some cases will be fundamentally unpredictable. In psychiatry, the concept of free will will become relevant, which will entail a change in the judgment about the “norm” and pathology, blurring the boundaries between them. Orientation to a specific person – according to the fundamental principle of medicine “to treat not the disease, but the patient ” – will help to avoid ” ethical distortions ” (“hyperdiagnosis” or “presumption of the disease”).

Certain ethical dangers are fraught with psychosurgical intervention in the patient’s life. This is the possibility of a subjective, arbitrary approach to the choice of an object and methods of treatment. This is the danger of expanding the scope of psychosurgical manipulations. Indications for them may be not only criminal behavior, but also, for example, the “hyperactivity syndrome” in children (folly, disobedience, unstable behavior), as well as mass demonstrations and outbreaks of violence, diagnosed as “brain diseases”, to which it is necessary to apply mass surgical (or other psychotropic) intervention. The consequences of such approaches are not difficult to imagine. Therefore, many experts in the field of psychiatry propose to impose a moratorium on certain areas of psychosurgical research. These include, for example, lobotomy operations, which in the United States alone underwent more than 50 thousand people who eventually became disabled (the author of the lobotomy, Nobel Prize winner Dr. Egas Monis was almost shot dead by his own patient, driven to despair by his condition). It is no coincidence that the outstanding English neurosurgeon P. Harper at one time refused to continue research in the field of lobotomy. Similar results are also obtained by the method of implanting electrodes into the human brain, developed at the Institute of the Brain by Academician N. Bekhtereva. Providing a stimulating, suppressing, switching off effect on the emotional and mental activity of a person through the electrodes can completely change the structure of the personality, producing aggressiveness, sadness, fear, carelessness, etc. in it.

Thus, many biotechnologies associated with advances in neurophysiology and microsurgery of the brain, as well as in the field of psychiatry in general, are fraught with certain dangers in their application, because often their end result is not just a correction and modification of behavior, but radical changes in the essence of the human personality. These hazards include:

– the use of psychiatry for political and social purposes to correct the behavior of “socially dangerous persons”;

– the possibility of a complete rebirth of the personality as a result of partial intervention (for example, the impact on the pleasure center in order to cure drug addiction is fraught with the suppression of creative activity and initiative);

– experimental studies of the psycho-emotional state of a person against his will as a violation of human rights – an invasion of his intimate world;

– the use of psychotropic techniques not for medical, but for social purposes: “happiness through electrodes”, manipulation of people’s minds for political and other purposes, the use of NLP to achieve success, etc.

It is obvious that modern biotechnologies in the field of psychiatry carry a huge number of ethical problems, which do not so much receive a specific resolution, but rather give rise to new questions that remain “open” as before.

One of the most difficult ethical problems of psychiatry is the moral side of the attitude towards patients . The formation of the attitude of society towards the mad as to sick people began only in 1793, when the French doctor F. Pinel for the first time (!) Removed the chains from them, thereby raising them to the dignity of the sick. He advised them to use various “fatherly” means (care, patronage, affection, indulgence, edification, exhortation), just to subdue the patient, win his trust. However, it was also allowed to use some measures of constraint – “straitjacket”, temporary isolation. Only 50 years later, the English doctor D. Conolly excludes any measures of constraint in relation to the mentally ill: “No constraint.” However, until the middle of the twentieth century. forced hospitalization of the mentally ill was considered an unshakable norm, based on the ethical traditions of the medical profession and moral feelings of mercy, humanity, and responsibility.

In the 50s. 20th century in Western countries, the “crisis of psychiatric hospitals” begins – a movement that proposes the expansion of treatment for mental patients without isolation from society. In 1954, a committee of WHO experts on mental health determined the hospitalization of socially dangerous mental patients through the courts as a procedure that was humiliating for them and their relatives. Since the 60s. in Western psychiatry, the deinstitutionalization of the treatment of mental patients is actively carried out – the rejection of the need for their hospitalization. This was due to the fact that placing them in a hospital “for the unconditional benefit of the mentally ill themselves” turned out for many of them to a long-term (and even lifelong) stay-imprisonment in it. Other negative aspects of hospitalization were also noted: the loss of social activity by patients, the breakdown of social ties, emotional isolation, etc. In the US, the movement for “psychiatry without a hospital bed” has led to massive closures of public psychiatric clinics. True, the new system was unable to provide qualified medical care to the most severe contingent of mental patients, therefore, in the United States, softer forms of psychiatric care have been developed – partial hospitalization, psychiatric care in general hospitals, etc.

In the 60s. in Europe, and then in America, even more dramatic events unfolded around psychiatry. We are talking about the “anti-psychiatrist” movements, which claimed that there are no mental illnesses, just like the mentally ill, that a psychiatric diagnosis is a social “label”, that psychiatry is not a science, and psychiatrists are not doctors. The “anti-hospital” and “anti-psychiatric” movements led in the 70s and 80s. to revolutionary changes in psychiatry: the social context of the provision of psychiatric care began to be determined by the idea of u200bu200bprotecting the civil rights of the mentally ill. Social exclusion, unjustified restriction of rights, contemptuous or dismissive attitude, other forms of humiliation of the human dignity of the mentally ill – all this began to be subject to moral and legal assessment and regulation.

One of the main problems in the provision of psychiatric care remains involuntary treatment. Today, hospitalization of a patient by the decision of a psychiatrist without the consent of him or his relatives is carried out only if the patient poses an immediate danger to himself or others. This is the paradigm of protecting and guaranteeing the civil rights of persons suffering from mental disorders . At the same time, the principle of “informed consent” of the patient to any intervention in the sphere of his health (hospitalization, appointment of studies or any means of treatment) acquires the following aspects in psychiatry. First, the patient must be provided with complete and comprehensive information, including answers to all his questions, about his disease, diagnosis and prognosis, duration of treatment and the risk associated with the use of especially dangerous types or methods of treatment. Secondly, obtaining the consent of the patient after informing him is the responsibility of the doctor; consent to clinical experiments in psychiatry require additional guarantees for the protection of the rights of the mentally ill. Thirdly, “informed consent” is the right of competent patients, their consent must be voluntary and informed, i.e. obtained without threats, violence or deceit.

However, in psychiatry, the voluntariness of treatment and the patient’s right to refuse it carries serious contradictions. On the one hand, this right is here also a generally recognized ethical and humanistic value and a legal norm corresponding to generally recognized international standards. On the other hand, the application of this norm in the provision of psychiatric care makes the problem of danger that some mentally ill people may pose to themselves and others. This raises another ethical aspect associated with the functions of a psychiatric hospital, consisting primarily in the provision of medical care to patients, taking into account their civil rights, and not only in the isolation of dangerous mental patients.

At the same time, inpatient psychiatry sometimes countered madness, insanity, and irrational behavior as therapeutic means with “cruel, sometimes deadly treatment” – massive bloodletting, strong souls, cold baths, etc. In 1935, a lobotomy operation was performed for the first time, which subsequently revealed severe complications. In the 1930s, shock methods of treating mental disorders began to be widely used, causing serious complications: fractures of long bones (!), dislocations of the lower jaw, etc. In modern conditions, abandoning the “straitjacket”, hospitals have switched to using some patients with large doses of narcotic drugs, potent psychotropic drugs. This is nothing more than “chemical constraint”, which often leads to serious iatrogenic complications. There is a problem of protecting patients from overtreatment .

The problem of the clinical status of such a field of psychiatry as narcology is relevant, which implies an attitude towards a person suffering from alcohol or drug addiction as a sick person who experiences the disorganization of social life caused by the disease more acutely than even violations of body functions. As a rule, in addition to health problems, mental disorders, personality degradation, they have various social problems. Such patients lose the ability to communicate normally with workmates, family relationships are disrupted, qualifications are lost, offenses are committed that result in a criminal record, job loss, inactivity, inability to manage one’s time, finances, etc. However, these patients usually do not realize the severity of their illness, resist, avoid the treatment process.

Modern principles of treatment of patients with alcoholism and drug addiction are largely focused on the mobilization and activation of the patient’s reserves, primarily on the psychological capabilities of his personality. In these conditions, the attitude of others towards these patients becomes especially important. At the same time, the attitude in society towards those suffering from alcoholism and drug addiction remains complex and tense. Our beliefs and values, life experiences, interactions with others, the emotional component that sometimes defines our relationships more than knowledge of factual information, all tend to cause people who use drugs or alcoholism to viewed as immoral, weak-willed, sinful and incurable.

Such a negative attitude hinders productive work with these people and affects them: such patients often tend to “fall out” of the treatment process, their illness can relapse. This leads to the belief that all who abuse alcohol or drugs have a poor prognosis in terms of recovery, which in turn prevents them from getting the help they need. Barriers in working with these people, therefore, are:

Pessimism – the belief that the treatment of people suffering from addiction is a hopeless thing;

moralizing – when users of psychoactive substances or these substances themselves are considered as a vice, and their use is a shameful act;

· stereotyping – it is believed that the abuse of alcohol or psychoactive substances is more common for some segments of the population than for others;

neglect, ignoring – non-recognition of the fact that alcohol and other drug addictions are a disease that needs treatment.

It must be remembered that a person who abuses psychoactive substances is the same person, only in trouble. And if he has at least some resources and stability, he is ready to respond to even small psychotherapeutic influences, especially at an early stage of addiction, which can lead to positive results.

Therefore, the tactful intervention of relatives and friends, early diagnosis, benevolent counseling and clarification of the circumstances in which some people develop addiction will increase the effectiveness of assistance to drug addicts. Relationships that provide such a patient with a sense of dignity and self-respect, guarantee him personal security and non-disclosure of information, contribute to their inclusion in the treatment process, give rise to optimistic expectations for the future.

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