Ethics, power and faustian pacts

Renowned psychologist Dr Mary Pipher has handed back her American Psychological Association presidential award in protest at the organisation’s refusal to ban participation in US military interrogations which some deem to be torture under the Geneva Convention.

However, the whole issue of psychologists participation in government interrogations shadows a significant, but little mentioned, change in the status of psychologists in the medical establishment.

Fifty years ago, clinical psychologists were little more than test technicians who provided information for psychiatrists to interpret.

During the last decade, clinical psychology training has become equally, if not more, arduous than medical training, and psychological interventions have been shown to be highly effective.

Consequently, psychologists are now being considered on a par with physicians in many organisations. For example, psychologist-led mental health and brain-injury teams are increasingly common.

This change in status is being increasingly reflected in the law. In the UK’s 2005 Capacity Act, psychologists are now able to sign assessments concerning someone’s mental competence to make a contested decision, something that was previously reserved for medical doctors.

The recently approved UK Mental Health Bill is likely to allow psychologists, rather than just psychiatrists, to take a lead in ‘sectioning’ people – i.e. detaining them if they’re deemed a risk to themselves or others owing to mental illness.

In the the US military, and in some US states, psychologists are now able to prescribe medication, previously the sole domain of physicians, and the APA is pushing for the extension of these rights.

Not all psychologists are of a same mind on these issues, and many see these changes as much as a ‘poison chalice’ as as benefit.

In many ways, psychologists and psychiatrists are a ‘good cop, bad cop’ double act in mental health. Psychiatrists can forcibly drug and detain people, while psychologists can tut and scowl with the patient and continue to work collaboratively to improve their mental state.

Of course, patients may be a lot less willing to work with psychologists if they’ve played a role in their detention or forcible medication.

Internal debates aside, the fact that the US Government is quite happy to rely on psychologists, rather than physicians, for their interrogation practices is testament to a general change in status.

Contentious issues concerning a potent mix of economics, ethics and power balance shifts are common for physicians, who are used to governments wanting to give or take responsibilities away from them to suit their political agenda or latest reform plan.

In contrast, these sorts of ethical dilemmas are relatively new for psychologists.

What makes this an interesting time, is that psychology is in a transition period where lots of legal changes are being made to solidify their responsibilities.

This makes the profession much more susceptible to influence by government, and it will be interesting to see how these issues play out, of which the debate over military interrogations is perhaps only an early skirmish.

Link to interview with Dr Mary Pipher.

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