with growing success; but success is by no means invariable. There is thus a
growing, but far from complete, understanding of when these treatments work. It
is presumably not in dispute that they should not be used for conditions for which
there is no evidence of success, or persisted with for a patient for whom a treat-
ment has now been tried and has failed. But what general objection to their use
might there be?
Two have been put forward: that they only tackle the symptoms and not the
underlying problem, and that they are inherently invasive and manipulatory and
hence degrading. But neither of these seems to work as an overall objection. The
first may be true, but can be met by pointing out that to ease the symptoms is to do
at least some good, sometimes a great deal, and that the symptoms may need to be
relieved before the patient can begin to tackle the underlying problem. A clinically
depressed person may have excellent reasons for being depressed and much to be
depressed about, but the depression may need to be lifted by medication or even
ECT before they are able to do anything about the social or personal causes of their
depression.
The second argument, that it is inherently wrong to try to alter a person's mental
state by these physical means rather than by rational argument, has more force.
But it may be met by pointing out that the proper use of physical treatments #it is
not disputed that these can be misused) is to remove obstacles to rational thinking
which are themselves often ± though perhaps not always ± either physical in origin
or made worse by the current state of the brain or nervous system. To use drugs to
end the hearing of voices or the experience of hallucinations or of sudden
frightening changes in perception is to restore the opportunity to be rational, not to
take it away. Similar considerations apply to behaviourist treatments, in places
where they are still used; if they are working, and if the aim is to free a person from
behaviour patterns and habits that interfere with rational choice ± such as
alcoholism or compulsive gambling ± it is hard to see what objection there can be
to their use.
The ethics of psychotherapy are more complicated. As far as I know, no
objections have been raised to psychotherapy in general, but objections have
certainly been raised to particular forms of psychotherapy and particular ways of
carrying it out. The basic objection is to covert manipulation; there may be lip-
service to the idea that the therapist is being non-directive and non-judgemental
but nevertheless there can be considerable concealed pressure from the therapist,
or, in group therapy, from the whole group, to adopt certain views and ideas. The
extreme case of this concerns the retrieval of buried memories; there is still an
unsolved problem, regarding supposed memories of child abuse, as to when a
genuine trauma has been recalled and when false ideas have been planted in the
client's mind.
The existence of these various problems has the following consequences. There
seems to be no form of treatment, of those currently used, that is in principle
ethically unacceptable. But equally any form of treatment can be used in an un-
ethical way, which in the context of mental illness typically means a manipulative
way. Also, any form of treatment may be wrong for a particular patient, always or at
aparticular time. This creates two obligations for the nurse. First, to administer
treatment, in any form, not only with sensitivity and humanity, as is always
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