Medical Ethics: A Very Short Introduction by R. A. Hope

Author:R. A. Hope [Hope, R. A.]
Language: eng
Format: epub
Tags: Medical, Ethics, Philosophy, Ethics & Moral Philosophy
ISBN: 9780192802828
Google: PeoRDAAAQBAJ
Publisher: OUP Oxford
Published: 2004-09-23T18:29:44.275278+00:00

Chapter 6

Inconsistencies about

madness

43rd day of April in the year 2000: Today we celebrate a most illustrious event! Spain has a king. He has been found. I am this king . . . Now everything has been revealed to me. I see it all as clearly as my own hand. But before this, I don’t know why, before I seemed to see everything through some sort of fog. I think this all can be explained by the ridiculous idea people have that the brain is in the head. Nothing of the kind: it is carried by the wind from the direction of the Caspian Sea.

(Gogol, Diary of a Madman, 1835)

In 1851 Dr Samuel Cartwright published an article in the New Orleans Medical and Surgical Journal describing the mental illness of drapetomania (quoted in Reznek, 1987). This was an illness from which Negro slaves suffered: it was manifest by a tendency to run away from their white masters.

In 1952 the first edition of the US Diagnostic and Statistical Manual of Mental Disorders was published. This is the main US

classification of mental illness. Homosexuality was listed as a mental disorder and its status was confirmed in the second edition of the manual in 1968. In 1973 there was debate in the American Psychiatric Association as to the medical status of homosexuality. By a small majority the Association voted to remove homosexuality from the list of mental disorders.

75

The classificatory system of disease that is used in most of Europe, including the UK, is the International Classification of Diseases. The current edition includes fetishism as a mental disorder. This is described as:

Reliance on some non-living object as stimulus for sexual arousal and sexual gratification. Many fetishes are extensions of the human body, such as articles of clothing or footwear. Other common examples are characterised by some particular texture such as rubber, plastic or leather.

The diagnosis of fetishism can be made if the person experiences recurrent intense sexual urges and fantasies involving such objects, if he acts on these, if the preference has been present for more than six months, and if the object is the most important source of sexual stimulation. Will fetishism still be classified as a mental disorder in 20 years’ time?

The social and ethical values that lie behind the diagnosis and Medical Ethics

classification of mental disorders have been under attack since the anti-psychiatry movement in the 1960s. What we count as ‘healthy’

or ‘unhealthy’ sometimes reflects our value commitments, and these can, and should, be challenged. Although the question of what is a mental illness can raise deep and difficult problems, I am going to put these to one side. Some conditions, such as schizophrenia, do render people out of touch with reality, and cause suffering, to such an extent that I will take for granted that these conditions are the proper concern of the medical specialty of psychiatry. What I want to examine in this chapter are the different standards used in enforcing treatment and secure accommodation for those with and without mental disorder.

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