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Madness versus badness: the ethical tension between the recovery movement and forensic psychiatry

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Abstract

The mental health recovery movement promotes patient self-determination and opposes coercive psychiatric treatment. While it has made great strides towards these ends, its rhetoric impairs its political efficacy. We illustrate how psychiatry can share recovery values and yet appear to violate them. In certain criminal proceedings, for example, forensic psychiatrists routinely argue that persons with mental illness who have committed crimes are not full moral agents. Such arguments align with the recovery movement’s aim of providing appropriate treatment and services for people with severe mental illness, but contradict its fundamental principle of self-determination. We suggest that this contradiction should be addressed with some urgency, and we recommend a multidisciplinary collaborative effort involving ethics, law, psychiatry, and social policy to address this and other ethical questions that arise as the United States strives to implement recovery-oriented programs.

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References

  1. Lerman, P. 1985. Deinstitutionalization and welfare policies. American Association of Political and Social Science 479: 132–155.

    Article  Google Scholar 

  2. Grob, G.N. 1992. Mental health policy in America: Myths and realities. Health Affairs 11: 7–21.

    Article  Google Scholar 

  3. Frank, R., and S. Glied. 2006. Better but not well: Mental health policy in the United States since 1950. Baltimore, MD: The Johns Hopkins University Press.

    Google Scholar 

  4. U.S. Department of Health and Human Services. 1999. Mental health: A report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services.

    Google Scholar 

  5. Corrigan, P.W., K.T. Mueser, G.R. Bond, R.E. Drake, and P. Solomon. 2008. Principles and practices of psychiatric rehabilitation: An empirical approach. New York: The Guilford Press.

    Google Scholar 

  6. Solomon, P. 2004. Peer support/peer provided services underlying processes, benefits, and critical ingredients. Psychiatric Rehabilitation Journal 27: 392–403.

    Article  Google Scholar 

  7. U.S. Department of Health and Human Services. 2009. National consensus statement on mental health recovery. U.S. Department of Health and Human Services. http://mentalhealth.samhsa.gov/publications/allpubs/sma05-4129. Accessed 12 August 2009.

  8. Davidson, L., M. O’Connell, J. Tondora, T. Styron, and K. Kangas. 2006. The top ten concerns about recovery encountered in mental health system transformation. Psychiatric Services 57: 640–645.

    Article  Google Scholar 

  9. Davidson, L., M.J. O’Connell, J. Tondora, M. Lawless, and A.C. Evans. 2005. Recovery in serious mental illness: A new wine or just a new bottle? Professional Psychology: Research and Practice 36: 480–487.

    Article  Google Scholar 

  10. Jacobson, N., and D. Greenley. 2001. What is recovery? A conceptual model and explication. Psychiatric Services 52: 482–485.

    Article  Google Scholar 

  11. Mulligan, K. 2003. Recovery movement gains influence in mental health programs. Psychiatric News January 10.

  12. Anthony, W. 1993. Recovery from mental illness: The guiding vision of the mental health service system in the 1990s. Psychiatric Rehabilitation 16: 12–23.

    Google Scholar 

  13. Rogers, J.A., M.J. Vergare, R.C. Baron, and M.S. Salzer. 2007. Barriers to recovery and recommendations for change: The Pennsylvania consensus conference on psychiatry’s role. Psychiatric Services 58: 1119–1123.

    Article  Google Scholar 

  14. Engel, G.L. 1980. The clinical application of the biopsychosocial model. American Journal of Psychiatry 137: 535–544.

    Google Scholar 

  15. Szasz, T. 1964. The myth of mental illness: Foundations of a theory of personal conduct. New York: Harper & Row.

    Google Scholar 

  16. American Psychiatric Association. 2009. The principles of medical ethics with annotations especially applicable to psychiatry, Rev. ed. American Psychiatric Association. http://www.psych.org/MainMenu/PsychiatricPractice/Ethics/ResourcesStandards/PrinciplesofMedicalEthics.aspx. Accessed 17 September 2009.

  17. Perlin, M.L., ed. 1999. Mental disability law: Cases and materials. Durham, NC: Carolina Academic Press.

    Google Scholar 

  18. Appelbaum, P.S. 1994. Almost a revolution: Mental health law and the limits of change. New York: Oxford University Press.

    Google Scholar 

  19. Hamann, J., R. Mendel, R. Cohen, S. Heres, M. Ziegler, M. Bühner, and W. Kissling. 2009. Psychiatrists’ use of shared decision making in the treatment of schizophrenia: Patient characteristics and decision topics. Psychiatric Services 60: 1107–1112.

    Article  Google Scholar 

  20. American Association of Psychiatry and the Law. 2005. Ethics guidelines for the practice of forensic psychiatry. American Association of Psychiatry and the Law. http://www.aapl.org/ethics.htm. Accessed 23 September 2009.

  21. Appelbaum, P.S., and T.G. Gutheil. 2007. Clinical handbook of psychiatry and the law, 4th ed. Philadelphia: Lippincott, Williams & Wilkins.

    Google Scholar 

  22. Aneshensel, C.S., and J.C. Phelan. 1999. Handbook of the sociology of mental health. New York: Kluwer Academic/Plenum Publishers.

    Google Scholar 

  23. U.S. Department of Health and Human Services. 2003. President’s New Freedom Commission on Mental Health: Achieving the promise: Transforming mental health care in America. Final report. Rockville, MD: U.S. Department of Health and Human Services.

    Google Scholar 

  24. Sadler, J.Z. 2005. Values and psychiatric diagnosis, international perspectives in philosophy and psychiatry. New York: Oxford University Press.

    Google Scholar 

  25. Fulford, K.W.M. 1989. Moral theory and medical practice. Cambridge: Cambridge University Press.

    Google Scholar 

  26. Murphy, D. 2006. Psychiatry in the scientific image. Cambridge, MA: The MIT Press.

    Google Scholar 

  27. Lieberman, J.A., R.E. Drake, L.I. Sederer, A. Belger, R. Keefe, D. Perkins, and S. Stroup. 2008. Science and recovery in schizophrenia. Psychiatric Services 59: 487–496.

    Article  Google Scholar 

  28. Ware, N.C., K. Hopper, T. Tugenberg, B. Dickey, and D. Fisher. 2008. A theory of social integration as quality of life. Psychiatric Services 59: 27–33.

    Article  Google Scholar 

  29. Hillbrand, M., and J.L. Young. 2008. Instilling hope into forensic treatment: The antidote to despair and desperation. Journal of the American Academy of Psychiatry and the Law 36: 90–94.

    Google Scholar 

  30. Wexler, D. 2008. Rehabilitating lawyers: Principles of therapeutic jurisprudence for criminal law practice. Durham, NC: Carolina Academic Press.

    Google Scholar 

  31. Boorse, C. 1982 [1976]. What a theory of mental health should be. In Psychiatry and ethics, ed. R.B. Edwards. Buffalo: Prometheus Books.

  32. Sedgwick, P. 1973. Illness—Mental and otherwise. Hastings Center Studies 1: 19–40.

    Article  Google Scholar 

  33. Appelbaum, P.S. 2007. Clinical practice. Assessment of patients’ competence to consent to treatment. New England Journal of Medicine 357: 1834–1840.

    Article  Google Scholar 

  34. Appelbaum, P.S., C.W. Lidz, and R. Klitzman. 2009. Voluntariness of consent to research: A conceptual model. Hastings Center Report 39: 30–39.

    Article  Google Scholar 

  35. Drane, J.F. 1985. The many faces of competency. Hastings Center Report 15: 17–21.

    Google Scholar 

  36. Jefferson, A.L., S. Lambe, D.J. Moser, L.K. Byerly, A. Ozonoff, and J.H. Karlawish. 2008. Decisional capacity for research participation in individuals with mild cognitive impairment. Journal of the American Geriatrics Society 56: 1236–1243.

    Article  Google Scholar 

  37. Raad, R., J. Karlawish, and P.S. Appelbaum. 2009. The capacity to vote of persons with serious mental illness. Psychiatric Services 60: 624–628.

    Article  Google Scholar 

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Acknowledgements

The authors thank Michael P. Williams, Esq. and Kenneth J. Weiss, MD, as well as our anonymous reviewers, for their valuable feedback and suggestions.

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Authors and Affiliations

  1. Center for Bioethics, University of Pennsylvania, 3401 Market Street, Suite 320, Philadelphia, PA, 19104-3308, USA

    Claire L. Pouncey

  2. School of Social Policy and Practice, Center for Bioethics, University of Pennsylvania, 3701 Locust Walk, Philadelphia, PA, 19104-6214, USA

    Jonathan M. Lukens

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  1. Claire L. Pouncey
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  2. Jonathan M. Lukens
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Correspondence to Claire L. Pouncey.

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Pouncey, C.L., Lukens, J.M. Madness versus badness: the ethical tension between the recovery movement and forensic psychiatry. Theor Med Bioeth 31, 93–105 (2010). https://doi.org/10.1007/s11017-010-9138-9

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