TOPICAL SECTION DESCRIPTIONS

• Access and Autonomy in Mental Health Care Financing

• Coercion and Compulsion

• Crime, Moral Responsibility, and Mental Disorders

• Eudaimonia & the Goals of Psychiatry 

• Freedom and Digital Universes

• Free Will, Psychiatric Genetics & Molecular Neuroscience

• Meaning and Mental Health

• Progress & Purpose in Cross-Cultural Mental Health Care

• Psychiatry and Politics: Repression, Expression, or Digression?

• Self, Other, Freedom, and Mental Health

• Therapies, Ideologies, and Liberation

• Values and Psychiatry

Access and Autonomy in Mental Health Care Financing

While the United States continues its movement towards a free-market approach to mental health care, other countries and societies have approached th eproblem of paying for mental health care in other ways. This section addresses clinician and patient freedom in selecting care, a problem compounded by th eexplosion of information about mental health care as well as the proliferation of alternative therapies for mental disorders. Particular topics for this section may include, but not be limited to: (1) Comparison of the moral advantages and disadvantages, with respect to human freedoms, of particular mental health care systems across societies; (2) Social or cultural studies of the relation between at-large cultural values and the freedoms of clinician and/or patient; (3) Ethical consideration of the proper balance between individual interests and social interests regarding mental health care.

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Coercion and Compulsion

Choice, voluntariness, and coercion have long been controversial themes for psychiatry and freedom. In what ways do mental disorders constrain personal freedoms? What should be institutional and social responses to mental illness? For many countries, the morality of involuntary hospitalization and involuntary treatment remains a core issue of public policy. What makes involuntary treatment or hospitalization a moral public policy? Is such a policy universally applicable? If so, why, and if not, what social conditions might prohibit coercive seclusion or treatment? What is the responsibility of the international community regarding abuse of involuntary seclusion or treatment?

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Crime, Moral Responsibility, and Mental Disorders

The “mad” vs. “bad” debate epitomized in the 1960's by authors like Szasz, Laing, Scheff, Foucault, and Goffman is overdue for reconsideration. In light of “millennial” neuroscience, cognitive psychology, behavioral genetics, and contemporary psychiatry, the question of human responsibility and human freedom is even more poignant today as technical possibilities for manipulation of the brain, mind, and personality have expanded. What are the implications for criminal and other varieties of responsibility when the old distinctions between choice, compulsion, impulse, autonomy, ambivalence, and freedom are blurred?

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Eudaimonia & the Goals of Psychiatry

In some ways, this topic is the most fundamental of the conference. How does, or should, psychiatry contribute to human flourishing? Is the task of psychiatry the furtherance of particular kinds of human freedom, and if so, which ones? Can notions of freedom alone sustain a justification for mental health treatment? What role does human freedom play in the goals of psychiatry?

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Freedom and Digital Universes

The explosive growth of communications technology poses new problems for mental health and freedom. People can communicate with each other cheaply and with relatively little expense. While the Internet has made the world smaller, it has also enabled increasingly narrow groups of people to communicate privately and to the exclusion of others. Ideological groups can simultaneously globalize and particularize their views, fostering increasingly closed and self-referential communications – a “paranoid” network. So the ‘Net poses possibilities for both constraining ideological freedoms and expanding them. What does the potential for virtual identities do for actual human identity? The Internet and availability of esoteric information has already had its influence on the doctor-patient
relationship, where increasingly patients can be more informed about their particular disorder than their physicians. Because the traditional source of clinician power, the knowledge differential, is being eroded, there is a need to rethink the role of physician power, treatment relationships, and clinician/patient autonomy. Indeed, the virtual paradigm poses its own challenges to empirical research and research ethics.

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Free Will, Psychiatric Genetics & Molecular Neuroscience

Advances in psychiatric genetics and molecular neuroscience have both opened up new opportunities for understanding psychopathology but also provoked the re-asking of classical questions for sciences of the mind: What is mental causation? What purposes does a scientific explanation serve? How do the findings of contemporary neuroscience and behavioral genetics influenced notions of free will? How should psychiatry present its new understandings to policymakers, scholars in other disciplines, and the public?

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Meaning and Mental Health

Conventional conceptions of mental health include concepts of choice, responsibility, and purpose, all concepts relevant to human freedom. What does it mean to have, or exhibit, “mental health”, and what does it mean to lose a personal freedom to a mental disorder? Recent developments in psychiatry around the world have suggested expanding the domain of mental health to include domains of the self such as spirituality, the developmental life cycle, positive psychology, and transpersonal dimensions. What would be the implications of embracing these domains under the mental health rubric?

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Progress & Purpose in Cross-Cultural Mental Health Care

Progress in mental health care is taken for granted within Western biomedical paradigms, but what constitutes progress in other, nontechnological societies is not so obvious. What are the ethical, methodological, and practical difficulties with using Western psychiatric concepts in third-world or other non-endemic settings? Reference to “progress” in a field often presupposes the purpose of the field, and the purposes of mental health care in diverse societies cannot be taken for granted. To what ends are the efforts of cross-cultural psychiatry applied? This question suggests a number of potential directions for this section, including: (1) Consideration of the compatibility of the values between the host culture and Western biomedical ones (2) Political or ideological implications of exporting Western psychiatric practices into traditional cultures (3) Epistemic questions concerning the applicability of mental health concepts from one culture into another.

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Psychiatry and Politics: Repression, Expression, or Digression?

This section addresses tripartite facets of psychiatry and politics. The first concerns the notion of political identity and political freedom in individuals. What do political beliefs and ideologies have to do with mental health or illness? The second aspect concerns the political aspects of psychiatric practice. In the post-Cold War era, concern about political abuse of psychiatry has shifted focus from Eastern Europe to countries scattered all over the world. What roles should the world mental health community assume in monitoring and acting on this problem? On what criteria might abuse or neglect by psychiatry be based? How should clinicians and the public monitor abuse of psychiatry in their own “back yards”? The third aspect concerns the role of political considerations in developing psychiatric knowledge. What role, if any, do politics play in psychiatric science? What role SHOULD politics play in psychiatric science?

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Self, Other, Freedom, and Mental Health

How might the relations between self hood and community be cast for the purposes of mental health theory and treatment? How might concepts of self and other shape notions of mental health therapy? What does “freedom” mean in the context of psychiatric therapies? What is the proper balance between psychiatry as medical treatment and psychiatry as a moral therapy for social ills?

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Therapies, Ideologies, and Liberation

Contemporary neuroscience has led us into the realm of drug therapies for mild to severe mental disorders with fewer side effects and toxicities. Moreover, deeper understanding of neural mechanisms for temperament, personality, and emotional regulation have led to the potential for psychopharmacological personal enhancement, extending “therapy” beyond that of treating disease, disorder, and disability, to the realm of enhancement or medicalizing personal achievement. These advances in knowledge bring novel epistemic and ethical problems to psychiatry, as well as new spins on old dilemmas. What are the proper goals of psychopharmacological treatment? Are there “down-sides” to pharmacological enhancement? How can we distinguish disorder from non-disorder when “treatments” are much the same? Is the use of drugs for self-enhancement a liberation, an enslavement, or some other mode of freedom?

The “Freud” and the “Science” Wars both have suggested that psychotherapy and science arise from particular ideological interests. Can psychotherapy transcend such political ramifications, and if so, how? What are the proper roles for the psychotherapies – to facilitate adaptation to the [political] status quo (a la Freud), to foment political change, or neither? Many of the questions of therapy vs. enhancement posed by the Psychopharmacology and Liberation section above could be equally posed for the psychotherapies.

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Values and Psychiatry

As the influence of formal diagnostic manuals like the ICD or DSM spread, increasing questions arise about the meaning of classification, the proper use of classification, and credible processes for classifying mental disorders. Should mental disorder classifications be scientific taxonomies modeled after biological taxonomy? Should they be heuristic guides embedded in the clinical praxis? Should they serve particular administrative, fiscal, or political interests? If so, which interests, and by whose authority? These questions among others are central ones as psychiatric diagnosis enters the new century characterized by genetic and neuropharmacological innovations.

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