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Talk is cheap: diverse dignities at the centre of mental disorder

It may be fairly easy to say that the dignity of a person in the domain of psychiatry should be respected. Justification is easy to find. For example, the South African Constitution proclaims ‘everyone has inherent dignity and the right to have their dignity respected and protected.’

When simply a pretence, this kind of talk is obviously cheap. But pretence isn’t the only reason behind such statements. Cheap talk presents as a gap between a principle and its practice. In paying lip-service to the principle, ‘respect’ becomes a mere token of respect rather than the real McCoy, with that being the action of holding the dignity of the person in high regard. And before prematurely thinking of course, I do that, recognise the taxing challenges in doing so.

I highlight here two major challenges in the practice of holding the dignity of a person in high regard: recognising the effects mental disorder has on one’s dignity, and accounting for the diversity of ways in which mental disorder is evaluated as dignified and undignified.

We can list a few potential but well-known effects of mental disorder on one’s dignity. When someone is depressed, that person usually undervalues his or her self-worth and dignity. A person in a manic episode often overvalues his or her worth and dignity, sometimes to a delusional extent. Some deeds in mania and psychosis such as sexual indiscretions, indiscriminate spending, and grossly disorganised behaviour bring the indignities of shame, embarrassment and humiliation for the family and the patient (sometimes only after recovery). Fears about the indignities of embarrassment and humiliation are at the core of social anxiety disorder/social phobia. Families and society do sometimes respond to the manifestations of mental disorder in undignifying ways – such as laughter, jokes, rejection, condescendence, etc. – even if merely trying to deal with the psychological threat of also being afflicted by mental disorder.

Presuming these effects on one’s dignity, even flagging some of them, might seem to undermine the very respect for dignity I’m advocating. One’s dignity is after all not necessarily affected when suffering from mental disorder. However, failing to recognise them when they are indeed present, is worse, for it precludes accounting for them in restoring dignity. The action of holding in high regard the dignity of a person suffering from mental disorder thus includes the pursuit of restoring dignity when so affected. Crucial in determining an appropriate course of action is to identify in whose view the dignity of the person is so affected: the patient, the family, the community, the practitioner, and/or the society at large.

The second major challenge I highlight in the practice of holding the dignity of a person in high regard is to account for the differences among people, families, and communities in evaluating what is dignified and undignified. Surely, we share values by which almost anyone would concur something is dignified or undignified. Holding the dignity of a person in high regard is itself a shared value. But ethically sound practice should also account for a range of diverse values in a given context. For example, an applicant to the High Court in South Africa argued a few months ago that he should be assisted by his physician to commit suicide, for the excruciating pain he was suffering was undignified, and therefore in breach of his constitutional right to dignity. Not everyone, however, considers the suffering of excruciating pain as undignified. Many people have attested to the dignity with which they have endured, or have seen others endure, suffering.

Accounting for both diverse and shared values in what counts as dignified and undignified goes some way, but to hold the dignity of a person in high regard in the domain of psychiatry requires that the values, shared and diverse, that are not principally about dignity, are accounted for too.

Featured image credit: Photo by Foundry. CC0 Public Domain via Pixabay.

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