Letters to the Editor
Re: Psychiatry in the Nazi Era
Dear Editor: About the time that Dr Seeman's paper was being reviewed, we published a similar review called AFirst Do No Harm: The Role of Psychiatry in Nazi Germany@ (1). We would like to contribute to the discussion about the extent to which basic principles that supported the disciplinary matrix in the Nazi era influence our current activity. We would also like to discuss the tools we can use to reduce the risk of getting caught in the continuum of abuse suggested by Kleinman (2). We believe that continuous education focusing on ethical aspects of our actions can help us in this task. The goals of social sciences and epistemology are essential tools to reach a comprehensive understanding of our job.
Dudley and Gale say that attitudes of psychiatrists toward patients sometimes resemble the stereotypical attitudes of societies toward marginal groups (3). Within this framework, nonstigmatization only makes sense within an ambitious program that takes into account the disparities within our discipline. It is worth analyzing the situation of minorities within society, as well as their exclusion. Biological psychiatry neutralizes these aspects by disregarding diversities and minimizing the influence of the social component in our work (4).
Not following certain scientific trends supported by “prestigious knowledge” makes psychiatrists feel left out of the evolution of their specialty. In other words, academic groups or scientists connected to such trends as psychopharmacology are more varied and powerful and have a greater number of followers than those connected to such marginal trends as history, anthropology, or epistemology. Within this framework, it is essential to examine how programs for the congresses of our associations are prepared.
In her paper, Dr Seeman wonders how future historians will portray us and whether someone will be able to ensure today’s science will not turn into myth in few a years (5). We agree with her that this is crucial. We should not forget that experiments and programs carried out by Nazis were not prepared by insane people but by major figures of German psychiatry (3,6).
With regard to the connection between the discipline and the political and economic context that Seeman so aptly questions, we believe that this increases when psychiatrists take on the role of managers. Reflection becomes essential to prevent the disregard of ethical and professional imperatives by institutional policies in which patients' needs are not the focus. Often, what is advantageous for society is not in the best interest of individual patients.
With these issues in mind, we believe that the ideal of a scientifically objective clinician must be reworked. Objectivity in psychiatry must be grounded in a clear definition of which value judgments are to be used in scientific processes and which should be used to ensure that all decisions we make are ethical. The task is difficult and it will take a long time, but personal reflection and self-criticism are the first steps toward scientific objectivity (7).
With these concerns, and to learn about our particular context, we recently conducted fieldwork on the ethical aspects of psychiatric practice in Argentina, recently published in Vertex (8).
References
1. Pieczanski P, Blanco MF, Ragusa A, Matusevich D, Finkelsztein C. Primero no daZar: el rol de la psiquiatría durante la Alemania Nazi. An. Psiquiatría 2004;20(1):36–40.
2. Kleinman A. Rethinking psychiatry: from cultural category to personal experience, 1st ed. New York (NY): The Free Press; 1988. p 77–107.
3. Dudley M, Gale F. Psychiatrists as a moral community? Psychiatry under the Nazis and its contemporary relevance. Aust N Z J Psychiatry 1998;32:242–51.
4. Cohen CI. Overcoming social amnesia: the role for a social perspective in psychiatric research and practice. Psychiatr Serv 2000;51(1):72–8.
5. Seeman MV. Psychiatry in the Nazi era. Can J Psychiatry 2005;50:218–25.
6. Lerner BH, Rothman DJ. Medicine and the Holocaust: learning more of the lessons. Ann Intern Med 1995;122:793–4.
7. Rudner R. The scientist qua scientists makes value judgments. In:Klemke ED, Wyss Rudge D, Kline AD, editors. 3rd ed. Buffalo (NY): Prometheus Books; 1998. p 492–8.
8. Pieczanski P, Matusevich D, Ragusa A, Goyos E, Finkelsztein C. Ethical aspects of psychiatric practice in Argentina: a survey. Vertex. 2005;16:228–36.
Pedro Pieczanski, MD
Daniel Matusevich, MD
Buenos Aires, Argentina
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