Through a glass, darkly: ethics of mental health practitioner-patient relationships in traditional societies

ABSTRACT

Assumptions about the universality of ethics and the use of dominant ethical frameworks of mental health care may obscure the differences and contextual realities in traditional societies. The ‘culture’ of the encounter between the mental health practitioner and the patient can be viewed through three dominant perspectives; paternalism, autonomy and reciprocity. Culture strongly influences how persons construct and negotiate their autonomous identities and the concept of relational autonomy may be more relevant in traditional societies like India. In this article, research studies and practitioner viewpoints are brought together to highlight the debates related to patient-practitioner communication, confidentiality and disclosure, informed consent and decision-making capacity, involuntary admissions and discharge processes, use of covert medication, advance directives and cultural influences on the definition of professional boundaries. Understanding the complex interplay of cultural beliefs and processes, culturally embedded practitioner value systems, economics, social justice paradigms and existing mental health care systems in traditional and resource-poor societies can provide a deeper understanding of the ethics of mental health care. A view of reality as interpretative and contextual can enhance our understanding of the ethical playing field in mental health care in both traditional and modern societies.

KEYWORDS:

• Ethics
• mental health care
• traditional societies
• culture
• relational autonomy

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes on contributors

Dr. Poornima Bhola is an Additional Professor of Clinical Psychology. Her keen interest in ethical questions is reflected in her involvement in teaching, training and research concerning the ethics of practice. She is a member of ethics committees and has co-edited a book on ethics. Her areas of interest include psychotherapy processes and training, psychiatric rehabilitation, personality disorders and youth mental health.

Dr. Santosh Chaturvedi is a Dean of Behavioural Sciences and Professor of Psychiatry. His areas of interest include Consultation Liaison Psychiatry, psychiatric ethics and psychiatric rehabilitation. He has been a member of ethics committees and is currently the Member Secretary of the Institution's Research Ethics Committee.