Ethics and psychiatric knowledge

E K Ledermann

I agree that a medical biological model of mental illness is not appropriate. According to the Critical Psychiatry Network the rejection is based on the importance of primary social, cultural, economic and political contexts. I accept that these contexts are important if we want to understand why some people feel ill, but wish to develop the theme that ‘patients must be engaged with their beliefs and preferences’ stated by Dr. Phil Thomas in his introductory essay for the Critical Psychiatry Network.

In the foreword to my book Mental Health and Human Conscience, The true and the false self (Avebury 1984), Dr David Lamb maintains that "Dr. Ledermann argues that morality lies at the core of medical practice and that a philosophical understanding of a libertarian moral framework is essential to psychiatric therapy." He holds that the subject of the book is "the point at which medicine and philosophy coincide: the moral requirement for sound health and a meaningful existence. The problems of human freedom, conscience, self-confidence, examined within this book, fall within the province of psychiatry." (ibid, pp vii,viii). These quotations show that I agree with Dr. Thomas when he insists that "strong ethical philosophical perspectives are essential for psychiatric knowledge".

So my philosophical theory, rather than reducing the mental state to a biological model, engages with it through an ethic based on freedom. This ethical freedom involves an acceptance of responsibility and of guilt if we fail to accept the voice of our conscience.

In my book Medicine For The Whole Person (Element 1997) I quote a paper, published in the British Journal of Psychiatry by P Mason and G Wilkinson: "The prevalence of psychiatric morbidity in Great Britain’ (January 1996, Vol. 168, pp1-3). According to these authors in England, Scotland and Wales "14 per cent of adults had a neurotic health problem, women far more often than men … The most common neurotic symptoms were fatigue (27%), sleep problems(25%), irritability (22%) and worry. These patients were labeled as suffering from "mixed anxiety and depressive disorder, followed by "generalized anxiety disorder". According to the same article alcoholics number 4.7% of the population and 2.2% suffer from drugs dependency. According to another publication, issued by the Medical Research Council called Mims Magazine Weekly (September 1993) "Two million children are mentally ill in this country, there is a clear link between mental health problems in parents and in their children". In my book I call the chapter where these figures are quoted: "Social Spiritual Malaise."

Drugs are not the answer for these millions and it is affirmed that "medicine (and its patients) must be liberated from the hedonistic ethic which only recognizes striving for pleasure (ibid. p 162). In my book Mental Health and Human Conscience: The true and the false self I refute hedonism. Hedonism has a psychological basis and Freud is a powerful influence, arguing that man’s ultimate aim is pleasure, experienced in sexual union. But "people who strive for pleasure deceive themselves. Pleasure and happiness are fundamentally difference. … The state of happiness eludes him who is motivated by pleasure, as the pleasure gets stale and he feels disillusioned. By avoiding situations which do not entail pleasure, but are burdensome or painful, the hedonist deprives himself of the possibility of gaining the state of happiness which results from having acted in accordance with one’s conscience without a selfish aim.

"Misled by the conviction that striving for pleasure will bring happiness, an ethic has been formulated according to which man ought to strive for pleasure. This is the message of ethical hedonism which is fallacious as the psychological form." (ibid pp 132-4)

Convincing people of the fallacy of hedonism and of the truth of an ethic of conscience is for me a supreme task of applying "a strong ethical perspective", postulated by Dr Thomas.