Mental Patient: Psychiatric Ethics from a Patient’s Perspective (Basic Bioethics)

✍ Scribed by Abigail Gosselin

• Publisher: The MIT Press
• Year: 2022
• Tongue: English
• Leaves: 309
• Category: Library

✦ Synopsis

A philosopher who has experienced psychosis argues that recovery requires regaining agency and autonomy within a therapeutic relationship based on mutual trust.

In Mental Patient, philosopher Abigail Gosselin uses her personal experiences with psychosis and the process of recovery to explore often overlooked psychiatric ethics. For many people who struggle with psychosis, she argues, psychosis impairs agency and autonomy. She shows how clinicians can help psychiatric patients regain agency and autonomy through a positive therapeutic relationship characterized by mutual trust. Patients, she says, need to take an active role in regaining their agency and autonomy—specifically, by giving testimony, constructing a narrative of their experience to instill meaning, making choices about treatment, and deciding to show up and participate in life activities.

Gosselin examines how psychotic experience is medicalized and describes what it is like to be a patient receiving mental health care treatment. In addition to mutual trust, she says, a productive therapeutic relationship requires the clinician’s empathetic understanding of the patient’s experiences and perspective. She also explains why psychotic patients sometimes feel ambivalent about recovery and struggle to stay committed to it. The psychiatric ethics issues she examines include the development of epistemic agency and credibility, epistemic justice, the use of coercion, therapeutic alliance, the significance of choice, and the taking of responsibility. Mental Patient differs from straightforward memoirs of psychiatric illness in that it analyses philosophic issues related to psychosis and recovery, and it differs from other books on psychiatric ethics in that its analyses are drawn from the author’s first-person experiences as a mental patient.

✦ Table of Contents

Contents
Acknowledgments
Introduction
1. Psychosis
Introduction
Mental Patient: A Word about Terminology
The “Mental” in “Mental Patient”: Mental Illness
Psychosis
Disorganization and Loss of Agency
Conclusion
2. Autonomy
Introduction
Autonomy
Autonomous Choice
Psychotic Constraints on Autonomy
Respecting the Choices of Psychotic Patients
Increasing Autonomy
Conclusion
3. Patient
Introduction
Medicalization of Mental Illness Experience
Medicalization, Power, and Vulnerability
Being Sick
The Patient Identity
Agency, Autonomy, and Treatment
Conclusion
4. Trust
Introduction
Building Relationships of Trust
What Patients Trust in Their Clinicians
What Clinicians Trust in Their Patients
Therapeutic Alliance
Incompetence and Coercive Treatment
Encouragement to Trust
Conclusion
5. Empathy
Introduction
Empathizing with Psychotic Patients
What Hallucinations Can Sometimes Be Like
Empathy
The Role of Empathy in Developing Autonomy
The Role of Empathy in Clinical Care
Empathy and Compassion
Empathy and Compassion of the Patient
Conclusion
6. Testimony
Introduction
Patient Testimony
Power, Privilege, and Credibility
Uptake
Conclusion
7. Meaning Making
Introduction
The Mental Patient as an Epistemic Agent Engaged in Practices of Meaning Making
Conditions for Meaning Making in Therapy
Personal Narratives
Larger Narratives of Mental Illness
Settling on Larger Narrative Frameworks
Epistemic Trust
Conclusion
8. Choices
Introduction
The Choice to Take Medication as Prescribed
Factors in Choosing to Take Medication
Difficulties with Choosing to Take Medication as Prescribed
Choices
Taking Responsibility
Conclusion
Conclusion
Notes
1. Psychosis
2. Autonomy
3. Patient
4. Trust
5. Empathy
6. Testimony
7. Meaning Making
8. Choices
Conclusion
Bibliography
Series Editors
Index