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| PERSPECTIVE/VIEWPOINT |
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| Year : 2019 | Volume
: 1
| Issue : 1 | Page : 33-35 |
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Social psychiatry: The ethical challenges
Fernando Lolas
Secretary, World Association of Social Psychiatry; Department of Psychiatry, Faculty of Medicine, Interdisciplinary Center for Studies in Bioethics, University of Chile, Santiago, Chile
| Date of Submission | 15-May-2019 |
| Date of Decision | 16-Jun-2019 |
| Date of Acceptance | 16-Jun-2019 |
| Date of Web Publication | 27-Sep-2019 |
Correspondence Address:
Prof. Fernando Lolas
Department of Psychiatry, Faculty of Medicine, Interdisciplinary Center for Studies in Bioethics, University of Chile, Santiago
Chile
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/WSP.WSP_2_19
Considerations on the ethical challenges facing social psychiatry are based on the fact that it is an academic and applied endeavor harmonizing different forms of knowledge stemming from diverse sources, with different epistemic traditions. The field requires careful analysis of linguistic uses, distinguishing between public, international, and global health research and practice. Ethical imperatives extend from sound research practices to reasoned application of knowledge, advocacy, and counseling.
Keywords: Bioethics, global health, international health, public health
How to cite this article:
Lolas F. Social psychiatry: The ethical challenges. World Soc Psychiatry 2019;1:33-5 |
| Challenges Are Both Technical and Ethical | |  |
Challenges for the field of psychiatry in future are not only technical but also ethical. We need not only more information and more knowledge but also better knowledge. Moreover, above all, knowledge on how to use knowledge.
Knowledge is not only information but also it is organized, structured, information, with a social implication or applicability. The differing forms of organizing data and information lead to different rationalities and disciplines. In order to gain insights from different perspectives, a meta-knowledge (knowledge on how to gain and apply knowledge in a prudent way) is needed.
This meta-knowledge, which brings together expertise and prudence (Metis or tekhné and phónesis) is what we have come to call bioethics, meaning to imply the dialogical foundation of ethical reflection and use for the sake of a better social environment.[1]
| The Meaning of Social | | |
Speaking of social psychiatry, the term social has different meanings.
On the one hand, it is used in opposition to individuals. What is valid in individual health may or may not be true for communities, groups, and societies. The challenge resides in defining what is a group and to infer from the occurrences at group level what may or may not happen to individuals. Epidemiology, the study of prevalence and incidence of events in larger aggregates of human persons, may offer clues to the prevention of disease and promotion of good habits. In ethical analyses, the rights of the group may sometimes be in opposition to the rights of individuals. In addition, several forms of inequity (lack of access to healthcare, unfair distribution of resources, and poverty) may have consequences for individual well-being.
Another usage of the term social in the context of medicine and healthcare refers to a view complementary to that of the hard sciences, physiology, and biochemistry. It emphasizes the need to consider all those influences that may affect the state of health in a given population or individuals that are rightly considered preconditions for well-being: economic stability, forms of government, and public policies. The necessary consideration of these dimensions brings to light that human beings do not exist in a vacuum but are always dependent on other human beings. They are relational beings. As important as bodily metabolism is social equilibrium and meaning. In this sense, social refers to all those contributions stemming from a reasonable appraisal of the sciences of the human (or Geisteswissenschaften, in Dilthey's sense).
It is important to note, however, that those epistemological contributions from disciplines other than the biological do not differ from these only in the nature of data or the experimental proof of sound information. Their epistemic difference lies more in the conception of the object of study, in the form in which constructs are formed and studied and in the motivations for their study. The social and human sciences deal with embodied meaning and with the causes and results of human interactions.
This is where ethical reflection should be placed. Instead of considering ethics as a mere addendum to the hard facts of empirical science, it really contains the motivation for an integrative study of human relations based on the dialog between persons and between rationalities. It has also relevance for the construction of a historical and applied reason, giving adequate room for experiencing cultural differences that may impinge on the ways people live, suffer, and die. The causes and expression of illness, disease, and sickness are modeled after ways of living and ways of expressing. The Lebenswelt of different peoples finds expression in differing forms of feeling well, falling ill, and expressing suffering. To tackle these dimensions, as complementary to the physiological-biochemical rationality, demands not only to consider other forms of data gathering processes. It entails the necessity of assuming a different attitude to what knowledge really means. It demands, aside from consideration of big numbers, an empathic attitude toward differences in world conceptions (Weltanschauungen), otherness, and cultural expectations.
| Ethics in the Context of Population-Based Studies | | |
Ethics, as a linguistically elaborated description and justification of moral behavior, is always social, by definition. Moreover it is always local. Many wrongful decisions are taken if a unique world view is imposed. Not only Western values and standards are useful. Social psychiatry expands its ethical commitment to respectful consideration of other world views, considers the nature of beliefs, examines the pathogenic and pathoplastic influences of societal structure, social change, and forms of governance.[2]
It is essential to reflect on the many levels in which the dialogical ethics needed for social psychiatry can be developed. First, the field is replete with designations that may need analysis.
For instance, the expression public health – and its extension to public mental health – alludes to the organized efforts of communities to tackle challenges to the well-being of their members by means of research data, regulations, and value-based actions. Here, the tensions between individuum and group may be apparent. While tradition and custom may help in orienting reasonable action, some degree of coercion may sometimes be needed to implement measures. A teleological or consequence-based ethical analysis must complement notions based on conviction or belief.
The expression “international health” is taken sometimes to imply that models of healthcare, successful in some countries, may be extended to others without further analysis or change. This attitude is reminiscent of those early days of the science of anthropology, where experts from civilized countries went to faraway places to observe “natives” and collect curious information to compare with their own living standards. It has a flavor of colonialism and ethical imperialism, taking for granted that what is good for scientifically minded societies should be good for everyone on earth. Ethics in this field should prevent abuse of “solutions” that have no real relevance in other societies.
When speaking of global health, people are usually reminded that standards of care, access to resources, and healthcare practices, if not equal everywhere, should at least be compatible with a humane and satisfactory life for all people. The emphasis may be placed on equitable access to civilization instruments and devices and to the attainment of the best possible conditions for people irrespective of their place in the world. The ethical stance, in the sense of duties toward others, is apparent. This emphasis notwithstanding, care should be exercised when indicating courses of action and making recommendations.
The plea for a bioethical underpinning of the field of social psychiatry is not only good rhetoric. It means taking seriously the dialogical character of social practices, the complex constitution of personal and societal well-being and the foundation of research and care n justified belief and sound empiricism.[3]
| A Roadmap for Ethics in Social Psychiatry | | |
Must contain at least the following aspects:
- A realization that knowledge is obtained by different means and approaches, and that human groups differ in their realization
- A sound harmonization between empirical data and interhuman relations
- An analysis of belief, custom, and tradition in the way societies conceptualize well-being, illness, sickness, and disease
- A consideration of persons in the social role of patients as partners in the process of healing and curing, respecting privacy and confidentiality
- A strong advocacy attitude toward inequalities, inequities, and suffering irrespective of geographical determinants, race, religion, or ethnicity
- An approach that considers both personal integrity of researchers and health-care givers and the consequences of decisions taken by policymakers and health authorities
- Caution in the dissemination of research findings, avoiding stigmatization of populations, and preventing discrimination
- Permanent analysis of public concerns and appropriate advocacy of vulnerable populations and persons
- Commitment to public education and information that may improve dialog and partnership
- Adequate identification of sources of conflicts of interest when conducting research, applying knowledge, or informing the public.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Lolas F. Bioethics. Moral Dialogue in the Life Sciences. Santiago de Chile: PAHO Bioethics Program and Editorial Universitaria; 1999.  |
| 2. | Lolas F, Quezada A, Rodríguez E, editors. Investigación en Salud. Dimensión Ética. (Health Research. Ethical dimensions). Santiago de Chile: Centro Interdisciplinario de Estudios en Bioética, Universidad de Chile; 2006. |
| 3. | Lolas F. Bioethics and psychiatry: A challenging future. World Psychiatry 2002;1:123-4. |
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