Therapy & Ethics
To the Editor:
Dr. Farber’s essay [“Psychoanalysis & Morality,” Nov. '65] points up an important issue. . . . Although Freud attempted to disassociate himself from a consideration of the relationship of ethics to psychoanalysis, the passage of time has proven the necessity for recognizing the implications of the psychoanalytic system for moral conduct. . . .It is doubtful, however, that these issues will be objectively and truthfully confronted unless the therapist first clearly defines his responsibilities. He cannot evade the commitment . . . to a patient who, by his very coming to him is appealing for help in making decisions. To thrust the burden back upon the patient is a denial of professional responsibility. . . .
To resort, on the other hand, to the manipulation of behavior employed in the various conditioning techniques, as described by Dr. London, assigns the therapist . . . the role of an omniscient authority who, almost by definition, violates the integrity of his patient’s personality. . . .
The answer seems to lie in a therapy that is carried out by well-trained persons . . . who accept their responsibilities seriously and recognize that an individual who seeks psychological help deserves, by that very fact, amounts of support appropriate to the severity of his illness. It is the responsibility of the therapist to provide this support, without projecting his own problems onto the patient or manipulating him. . . .
To the Editor:
. . . Dr. Farber did not mention one type of psychiatric worker of interest to the public—the industrial psychiatrist. . . .
If we grant that the psychiatrist’s task is to help the patient adjust to his environment, the question becomes: how are we to tell when the patient is functioning better? . . . For the industrial psychiatrist who sees no moral content to his work . . . the answer is a simple one: when the patient is functioning more efficiently, channeling all his energies into efforts to please his superiors.
But the industrial psychiatrist who takes it upon himself to help determine the morality of various courses open to the bothered worker/patient assumes a heavy load indeed. The patient did not seek him out as a private practitioner. Moreover, he has ties to the same corporation as does the worker/patient, which makes it impossible for him to transfer the burden of moral choice to an impersonal market which will grant or deny what the patient seeks. . . .
There are extreme illustrations of the moral problems facing an industrial psychiatrist unwilling to transfer moral responsibility to a managerial bureaucracy: what about the industrial psychiatric diagnostician who recommends to a patient lengthy psychoanalysis as a means of dissolving suicidal impulses while adjusting to a distasteful work situation . . . when a change of job might actually be a quicker way out of the impasse? What about an industrial psychiatrist who uses the secretly-recorded results of polygraph examinations, for example, which some managements require. . . . And what if his diagnosis then determines whether the worker/patient will be given or denied the psychiatric sacrament—i.e., psychiatric concurrence in promotion, assignment overseas, the key to the executive washroom, etc? Dr. Szasz’s old-fashioned regard for the patient’s preferences in sitting up or lying down seem to have been left far behind by these advances in applied behavioral science. . . .
Winston Ascham Brent
To the Editor:
. . . If Dr. Szasz’s “autonomy” is as inhuman and perverse as Dr. Farber implies, we are all in grievous trouble. And of course we are, whether or not for the reasons either doctor assigns.
Articles like Dr. Farber’s give us both the reminder and the hope that open and serious debate can rescue our thinking from desuetude . . . and parochialism.
(Dr.) J. B. Smith
Beverly Hills, California
[Further correspondence on Mr. Farber's article will appear in our April issue.]