email page print pageAll Topic Reviews
50 Signs of Mental IllnessA Beautiful MindA Beautiful MindA Bright Red ScreamA Casebook of Ethical Challenges in NeuropsychologyA Corner Of The UniverseA Lethal InheritanceA Mood ApartA Research Agenda for DSM-VA Slant of SunA War of NervesAbnormal Psychology in ContextADD-Friendly Ways to Organize Your LifeAddiction Recovery ToolsAdvance Directives in Mental HealthAggression and Antisocial Behavior in Children and AdolescentsAl-JununAlmost a PsychopathAlterations of ConsciousnessAm I Okay?American ManiaAmerican Psychiatric Publishing Textbook of Neuropsychiatry and Clinical NeurosciencesAn American ObsessionAngelheadAnger, Madness, and the DaimonicAnthology of a Crazy LadyApproaching NeverlandAs Nature Made HimAsylumAttention-Deficit Hyperactivity DisorderAttention-Deficit/Hyperactivity DisorderBeing Mentally Ill: A Sociological Theory Betrayal TraumaBetrayed as BoysBetter Than ProzacBetter Than WellBeyond AppearanceBeyond ReasonBinge No MoreBiological UnhappinessBipolar DisorderBipolar DisorderBipolar Disorder DemystifiedBlack-eyed SuzieBlaming the BrainBleeding to Ease the PainBluebirdBlueprints Clinical Cases in PsychiatryBody Image, Eating Disorders, and ObesityBorderline Personality DisorderBrain Circuitry and Signaling in PsychiatryBrave New BrainBreakdown of WillBrief Adolescent Therapy Homework PlannerBrief Child Therapy Homework PlannerBrief Therapy Homework PlannerCalm EnergyCassandra's DaughterCaught in the NetChild and Adolescent Treatment for Social Work PracticeChildren Changed by TraumaChronic Fatigue Syndrome (The Facts)Clinical Handbook of Psychological DisordersClinical Manual of Women's Mental HealthCognitive Theories of Mental IllnessCommonsense RebellionCommunity and In-Home Behavioral Health TreatmentComprehending SuicideConcise Guide to Child and Adolescent PsychiatryConquering Post-Traumatic Stress DisorderConscience and ConvenienceConsciousnessConsole and ClassifyContesting PsychiatryCoping With TraumaCopshockCrazy for YouCrazy in AmericaCrazy Like UsCreating HysteriaCritical PsychiatryCruel CompassionCultural Assessment in Clinical PsychiatryCulture and Mental HealthCulture and Psychiatric DiagnosisCultures of NeurastheniaDaddy's GirlsDante's CureDarwinian PsychiatryDaughter of the Queen of ShebaDaughters of MadnessDeinstitutionalization And People With Intellectual DisabilitiesDelivered from DistractionDepression In Later LifeDepression SourcebookDepression-Free for LifeDescriptions and PrescriptionsDestructive Trends in Mental HealthDevil in the DetailsDiagnosis: SchizophreniaDiagnostic and Statistical Manual of Mental Disorders DSM-IV-TRDirty Filthy Love DVDDisorders Of DesireDisrupted LivesDissociative ChildrenDivided MindsDr. Andrew Weil's Guide to Optimum HealthDr. Weisinger's Anger Work-Out BookDSM-IV SourcebookDSM-IV-TR CasebookDSM-IV-TR in ActionDSM-IV-TR Mental DisordersE-TherapyEccentricsElectroshockEmergencies in Mental Health PracticeEmergency PsychiatryEmotional and Behavioral Problems of Young ChildrenEmotions and LifeEmpowering People with Severe Mental IllnessEssential PsychopharmacologyEssentials of Cas AssessmentEssentials of Wais-III AssessmentEthics and Values in PsychotherapyEthics in Mental Health ResearchEthics in Psychiatric ResearchEthics, Culture, and PsychiatryEverything In Its PlaceFamily Experiences With Mental IllnessFatigue as a Window to the BrainFear of IntimacyFinding Iris ChangFinding Meaning in the Experience of DementiaFlorid StatesFolie a DeuxFor the Love of ItForensic Nursing and Multidisciplinary Care of the Mentally Disordered OffenderFountain HouseFrom Madness to Mental HealthFrom Trauma to TransformationGandhi's WayGender and Its Effects on PsychopathologyGender and Mental HealthGenes, Environment, and PsychopathologyGetting Your Life BackGracefully InsaneGrieving Mental IllnessHandbook of AttachmentHandbook of DepressionHandbook of Self and IdentityHealing the SplitHerbs for the MindHidden SelvesHigh RiskHope and DespairHow Clients Make Therapy WorkHow People ChangeHow to Become a SchizophrenicHow We Think About DementiaHughes' Outline of Modern PsychiatryHumanizing MadnessHysterical MenHystoriesI Hate You-Don't Leave MeI Never Promised You a Rose GardenI Thought I Could FlyI'm CrazyImagining RobertImpulse Control DisordersIn Others' EyesIn Two MindsInsanityIntegrated Behavioral Health CareIntegrative MedicineIntegrative Mental Health CareIntuitionJust CheckingKarl JaspersKissing DoorknobsKundalini Yoga Meditation for Complex Psychiatric DisordersLaw and the BrainLaw, Liberty, and PsychiatryLegal and Ethical Aspects of HealthcareLiberatory PsychiatryLife at the BottomLife at the Texas State Lunatic Asylum, 1857-1997Life Is Not a Game of PerfectLithium for MedeaLiving Outside Mental IllnessLiving with AnxietyLiving With SchizophreniaLiving with SchizophreniaLiving Without Depression and Manic DepressionLost in the MirrorLove's ExecutionerLoving Someone With Bipolar DisorderMad in AmericaMad TravelersMad, Bad and SadMadhouseMadnessMadness at HomeMadness in Buenos AiresManaged Care ContractingMandated Reporting of Suspected Child AbuseManic Depression and CreativityMary BarnesMasters of the MindMeasuring PsychopathologyMedia MadnessMedicine As MinistryMelancholy And the Care of the SoulMemory, Brain, and BeliefMental HealthMental Health At The CrossroadsMental Health Issues in Lesbian, Gay, Bisexual, and Transgender Communities Mental Health MattersMental Health Policy in BritainMental Health Policy in BritainMental Health Professionals, Minorities and the PoorMental IllnessMental Illness and Your TownMental Illness, Medicine and LawMental SlaveryMindfulness in Plain EnglishModels of MadnessMothers Who Kill Their ChildrenMozart's Brain and the Fighter PilotMultifamily Groups in the Treatment of Severe Psychiatric DisordersMuses, Madmen, and ProphetsMyths of ChildhoodNapkin NotesNeural MisfireNew Hope For People With Bipolar DisorderNight Falls FastNo Enemies WithinNolaNormalNot CrazyNovember of the SoulOf Two MindsOn Being Normal and Other DisordersOn Our Own, TogetherOn The Stigma Of Mental IllnessOrigins of Human NatureOut of Its MindOut of the ShadowsOvercoming Compulsive HoardingPathologies of BeliefPathways through PainPersonal Recovery and Mental IllnessPersonality Disorder: Temperament or Trauma?Pillar of SaltPoints of ViewPoppy ShakespearePosttraumatic Stress DisorderPsychiatric Cultures ComparedPsychiatric Diagnosis and ClassificationPsychiatric Genetics and GenomicsPsychiatric Illness in WomenPsychiatrists and Traditional HealersPsychiatryPsychiatry and ReligionPsychiatry in SocietyPsychological Dimensions of the SelfPsychology and the MediaPsychopathia SexualisPsychopathologyPsychopathyPsychotic DepressionQuitting the Nairobi TrioRaising a Moody ChildRapid Cognitive TherapyRebuilding Shattered LivesReclaiming Soul in Health CareReclaiming the SoulRecollection, Testimony, and Lying in Early ChildhoodRecovery from SchizophreniaRecovery in Mental IllnessRedressing the EmperorRelational Mental HealthRemembering TraumaRepressed SpacesResearch Advances in Genetics and GenomicsRestricted AccessRethinking the DSMReviving OpheliaRewarding Specialties for Mental Health CliniciansSaints, Scholars, and Schizophrenics: Mental Illness in Rural IrelandSchizophreniaSchizophrenia RevealedSchizophrenia: A Scientific Delusion?Self-Determination Theory in the ClinicShunnedShynessSigns of SafetySilencing the VoicesSlackjawSocial Cognition and SchizophreniaSocial Inclusion of People with Mental IllnessSoul Murder RevisitedSounds from the Bell JarSpeaking Our MindsSpontaneous HealingStop PretendingStraight Talk about Psychological Testing for KidsStranger Than FictionStreet CrazyStudy Guide to the DSM-IV-TRSurviving Manic DepressionSurviving SchizophreniaSurviving SchizophreniaTaking Charge of ADHD, Revised EditionTaking the Fear Out of ChangingTalking Back to PsychiatryTarnationTeen LoveTelling Is Risky BusinessTelling SecretsThe Age of InsanityThe American Psychiatric Press Textbook of PsychiatryThe American Psychiatric Publishing Textbook Of Child And Adolescent PsychiatryThe Anger WorkbookThe Anorexic SelfThe Behavioral Medicine Treatment PlannerThe Betty Ford Center Book of AnswersThe Bipolar ChildThe Bipolar Disorder Survival GuideThe Body in PsychotherapyThe Borderline Personality Disorder Survival GuideThe Broken MirrorThe Burden of SympathyThe Cambridge Medical Ethics WorkbookThe Case for Pragmatic PsychologyThe Center Cannot HoldThe Chemical Dependence Treatment Documentation SourcebookThe Chemical Dependence Treatment PlannerThe Child and Adolescent Psychotherapy Treatment PlannerThe Clinical Child Documentation SourcebookThe Clinical Documentation SourcebookThe Complete Adult Psychotherapy Treatment PlannerThe Condition of MadnessThe Construction of Power and Authority in PsychiatryThe Couples Psychotherapy Treatment PlannerThe Criminal BrainThe Cultural Context of Health, Illness, and MedicineThe Day the Voices StoppedThe Death of PsychotherapyThe Depression WorkbookThe Difficult-to-Treat Psychiatric PatientThe Early Stages of SchizophreniaThe Employee Assistance Treatment PlannerThe Employee Assistance Treatment PlannerThe Epidemiology of SchizophreniaThe Essential Family Guide to Borderline Personality DisorderThe Essentials of New York Mental Health LawThe Ethical WayThe Evolution of Mental Health LawThe Explosive ChildThe Fall Of An IconThe Fasting GirlThe Forensic Documentation SourcebookThe Forgotten MournersThe Gift of Adult ADDThe Good EaterThe Green ParrotThe Healing Power of PetsThe Heart of AddictionThe Heroic ClientThe Insanity OffenseThe Invisible PlagueThe Last Time I Wore a DressThe Limits of Autobiography The LobotomistThe Madness of Our LivesThe Mark of ShameThe Meaning of AddictionThe Meaning of MindThe Medical AdvisorThe Mind/Mood Pill BookThe Most Solitary of AfflictionsThe Mozart EffectThe Naked Lady Who Stood on Her HeadThe Older Adult Psychotherapy Treatment PlannerThe OutsiderThe Pastoral Counseling Treatment PlannerThe PDR Family Guide to Natural Medicines & Healing TherapiesThe Places That Scare YouThe Plural SelfThe Problem of EvilThe Psychology of Religion and CopingThe Quiet RoomThe Real World Guide to Psychotherapy PracticeThe Right to Refuse Mental Health TreatmentThe Rise of Mental Health NursingThe Roots of the Recovery Movement in PsychiatryThe Savage GirlThe Self-Help SourcebookThe Talking CureThe Trick Is to Keep BreathingThe Unwell BrainThe Virtuous PsychiatristThe Way of TransitionThe Wing of MadnessThe Wisdom in FeelingTheoretical Evolutions in Person-Centered/Experiential TherapyTherapy's DelusionsTheraScribe 3.0 for WindowsThis is Madness TooThoughts Without a ThinkerThrough the Looking GlassTo Have Or To Be?Toxic PsychiatryTransforming MadnessTraumaTraumatic PastsTraumatic Relationships and Serious Mental DisordersTreating Affect PhobiaTreating Chronic and Severe Mental DisordersTreating Self-InjuryTreatment and Rehabilitation of Severe Mental IllnessTreatment Plans and Interventions for Depression and Anxiety DisordersTwinsUnderstanding and Treating Violent Psychiatric PatientsUnderstanding Child MolestersUnderstanding DepressionUnderstanding ParanoiaUnderstanding the Stigma of Mental IllnessUnderstanding Treatment Without ConsentUnholy MadnessUnspeakable Truths and Happy EndingsUsers and Abusers of PsychiatryViolence and Mental DisorderVoices of MadnessVoices of RecoveryVulnerability to PsychopathologyWarning: Psychiatry Can Be Hazardous to Your Mental HealthWashing My Life AwayWhen History Is a NightmareWhen Someone You Love Is BipolarWhen the Body SpeaksWhen Walls Become DoorwaysWitchcrazeWomen and Borderline Personality DisorderWomen and Mental IllnessWomen Who Hurt ThemselvesWomen's Mental HealthWrestling with the AngelYou Must Be DreamingYour Drug May Be Your ProblemYour Miracle Brain
In Two Minds is an excellent
casebook of tough ethical problems in mental health. It aims to provide a thorough discussion of a number of
perspectives on a variety of cases.
There are fourteen main cases discussed, with several other shorter
examples scattered through the book.
The first section, consisting of two chapters, sets out the tools of
the trade, explaining some of the basics of philosophy and the particular
approach the authors take. Their
central claim is that issues of value are pervasive in psychiatry, and thus
psychiatric ethics has a broader scope than more traditional medical ethics. They organize their cases around the stages
of the clinical process: the proper scope of psychiatry, diagnosis, etiology,
treatment, prognosis, and teamwork and the organization of services. The final chapters look at teaching and
research ethics. The book includes some
comical cartoons to illustrate some of the main points, and there is a reading
guide to the literature at the end of each chapter. Each case has a commentary
by a practitioner as well as its own list of articles and books referred to in
its discussion. The authors emphasize
the importance of understanding the point of view of patients, and steer
between the extremes of a rigid medical model and a radical
antipsychiatry. They do not insist on
any particular methodology, but rather are inclined to use whatever approach
might be helpful in a given situation.
They often argue that conceptual analysis can be a helpful tool in
understanding the issues at hand.
Given that this is really the only
book of cases in psychiatric ethics that is currently in print, it has no
serious competition. It sets a high
standard for any future competitors, in its broad ranging discussion of the
philosophical issues raised by clinical experience. It is worth listing the cases:
35-year-old solicitor with a ten-month-old baby who
previously had postnatal depression and now wants to put her baby up for
53-year-old man with a learning disability with fecal
impaction due to chronic self-neglect.
42-year-old man with hallucinations, delusions and
strong suicidal feelings who says he has nothing to live for.
35-year-old woman with a history of repeated hospital admissions
who makes it very difficult for people to help her.
Middle-aged African-American lawyer whose religious
experience may be interpreted as psychosis.
42-year-old woman who is depressed and suicidal but
refuses admission to hospital.
27-year-old woman with genetic disorder who acquires an
odd belief about her psychotherapists sexual attitudes towards her.
38-year-old man with history of inveterate drug and
alcohol abuse becomes the principal carer for his three daughters.
69-year-old woman with Alzheimers disease who refuses
help from social services but is a burden to her neighbors.
15-year-old boy requests genetic testing for
54-year-old man who is depressed and suicidal is due to
be released from hospital but he may be a danger to his sons.
Man in his early forties with paranoid schizophrenia
and a history of indecent assaults who is reluctant to continue with his
79-year-old man with Alzheimers disease; should he be
allowed to return home after being hit by a car?
15-year-old boy suffers repeated psychotic breakdowns
but his father refuses treatment for him.
The cases are described in good detail for a page or two and
then the subsequent discussion takes several more pages. Naturally, one of the central themes is the
competency and autonomy of an individual and the rights of psychiatrists to
impose treatment. They raise a wealth
of important considerations, including the definition of mental disorder, the
responsibility of agents for their actions, the criteria for rationality, the
scientific basis of psychiatry, the rights of patients, the notion of the
patients true wishes, the dangers in predicting dangerous behavior, and the
responsibilities of research scientists towards their subjects. The authors bring in not only ethical
theory, but also philosophy of mind, personal identity, methodological
considerations, and epistemology.
Strangely, there is almost no discussion of the nature of freedom of the
will and the question of whether alcoholics and drug users are responsible for
their actions. This is a missed
opportunity, and is especially odd given that Fulford has elsewhere argued that
the best way to understand mental illness is a failure of action, and one of
his central examples concerns addiction.
Nevertheless, through their sustained argument throughout the book, the
authors succeed in their aim to show that psychiatric ethics as they practice
it is philosophically richer and more challenging than traditional medical
ethics, although they dont give any reason to suppose that medical ethics
could not be more philosophically interesting.
(Indeed, since the authors are also co-editors of Healthcare Ethics
and Human Values: An Introductory Text with Readings and Case Studies
(2002), it is likely they believe that medical ethics can become
There are however, some significant
limitations to this text. Most
obviously, it is very much devoted to a British context. The authors are British and all the
practitioner commentaries are by British clinicians. When legal issues are raised, the only law
covered, with a couple of exceptions, is British. This makes the book far less useful to a wider international
readership, and it all but rules it out as a possible textbook for teaching
psychiatric ethics in North America or the rest of the world. It also means that it does not deal with
some of the problems that are specific to the US. It is striking that the book includes no cases that concern the
ethical quandaries faced by psychiatrists when trying to get the best care for
patients with no or inadequate coverage from health insurance or managed care
providers. Indeed, with only fourteen
main cases covered, the book leaves many kinds of difficult cases
undiscussed. There are no cases of
children with depression, attention deficit hyperactivity disorder, or conduct
disorders with schools or parents demanding that they be placed on medication,
or refusing to allow them to be treated.
Neither does the book include sustained discussion of patients
threatening their doctors with violence, nor of doctors becoming sexually or
romantically involved with their patients.
While some of the cases are of parents who may be unable to carry out
their parental responsibilities or may even be a threat to their children, none
of them includes sexual abuse.
Another limitation of the book is
that while it provides excellent discussion of its cases covering both the
philosophical issues and the practical details, its less clear whether readers
will find it easy to use the book as a manual to help find the correct answer
to difficult cases. Of course, this may
be asking too much of a casebook. As
much as readers may wish for an algorithm for deciding the right course of
action given any ethical dilemma, this is simply not possible in most
cases. The philosophical issues are
simply too complex and our ethical knowledge is too uncertain for simple
answers to be available. Nevertheless,
the authors could have provided more in the way of a decision-making framework
to help clinicians work through difficult cases. Furthermore, it would be helpful to not only discuss the
philosophical complexities, but the difficulty of acting in the face of the uncertainty
of philosophical knowledge and the contingency of philosophical beliefs. One of the central problems in real life
cases is how to proceed when those responsible for decision-making consider the
facts with great care, deliberate long and hard about what to do, and yet still
disagree amongst themselves about what is best.
Even with these limitations, In
Two Minds is still an excellent resource for those interested in
psychiatric ethics. It is the natural
choice for a textbook for courses on this topic in Britain, and it could be
used for similar courses in the US and other countries if it were supplemented
by other readings or information relevant to the country in question. Highly recommended.
2002 Christian Perring. All rights reserved.
Ph.D., is Chair of the Philosophy Department at Dowling College, Long Island.
He is editor of Metapsychology Online Review. His main research is on
philosophical issues in psychiatry. He is especially interested in exploring
how philosophers can play a greater role in public life, and he is keen to help
foster communication between philosophers, mental health professionals, and the