Читать книгу Ethics in Psychotherapy and Counseling - Kenneth S. Pope - Страница 59

State and provincial licensing confers power. Licensed professionals can do things that people without a license cannot. With patients’ consent, surgeons can cut human beings wide open and remove internal organs, anesthesiologists can drug clients until they are unconscious, and some therapists can recommend or administer mind or mood altering drugs to clients, all with the law’s authorization. People will take off their clothes and willingly (well, somewhat willingly) submit to all sorts of indignities during a medical examination. They let physicians to do things to them that they would not dream of letting anyone else do.

Similarly, clients will open up and allow us as therapists to explore private aspects of their thoughts, feelings, and social lives, including their history, fantasies, hopes, and fears. Clients will tell us their most guarded secrets, material shared with literally no one else. We can ask questions off-limits to others. States and provinces recognize the importance of protecting clients against the misuse of this power to violate privacy. Except in certain instances, we are legally required to keep confidential what we have learned about clients through the professional relationship. Holding private information about our clients gives us power.

Through licensing, governments also invest us with the power of state-recognized authority to affect our clients’ lives. We have the power to make decisions (subject to judicial review) about our clients’ civil liberties. In some cases, we have the power to determine whether a person constitutes an immediate danger to the life of someone else and should be held against their will for observation or treatment. Alan Stone (1978), professor of law and psychiatry at Harvard University and a former president of the American Psychiatric Association, noted that in the 1950s the United States incarcerated more of its citizens against their will for mental health purposes than any other country, and that the abuse of this power later led to extensive reforms and formal safeguards.

The state has sometimes used the power of involuntary hospitalization to enforce social injustice. For example, in 1958, Black pastor and civil rights activist Clennon King “tried in vain to enrol at the all-White University of Mississippi” (Negro pastor pronounced sane, demands Mississippi apologize, 1958, p. 3). State troopers took him to a mental health institution where he was imprisoned against his will. Where he had been committed was kept secret from everyone for 48 hours. After being confined in the mental health institution for 12 days, he was released when a panel of 17 doctors declared him sane. He regained his freedom only to face charges of disturbing the peace by trying to enrol in an all-White university and resisting arrest. He said, “My only fear of jail is what might happen to me in that jail—the authorities are the only ones who have threatened me” (Negro pastor pronounced sane, demands Mississippi apologize, 1958, p. 3).

In the 1940s and 1950s, the government of Quebec falsely diagnosed 20,000 Canadian children as mentally ill and imprisoned them in psychiatric institutions to enable the misappropriation of government funds (Boucher et al., 2008; Clément, 2016; Duplessis orphans seek proof of medical experiments, 2004). The children became known as the Duplissis Orphans, named after Mauric Duplessis, who governed as Premiere of Quebec for five non-consecutive terms between 1936 and 1959. These are only a few of the countless examples in which the field of mental health and therapists have acted in unjust ways causing harm to vulnerable populations, and engendering distrust in the mental health system.