Dialogues in Philosophy
Mental and Neuro Sciences

Dialogues in Philosophy, Mental and Neuro Sciences

The official journal of Crossing Dialogues
Volume 12, Issue 2 (December 2019)


Ethics of the therapeutic relationship in psychiatry
Gaspare Vella
Ethics is considered in the complex context of that specific human relationship which is the relationship between the psychiatrist and his patient. Ethics is here conceived as strictly linked to the issue of personal freedom and defined as the “possibility of the possibility”.
In the relationship with his patient, the psychiatrist has to consider two different orders that require a different approach at the ethical level too. Indeed, it is different if the phenomena presented by the patient pertain to the somatic-endogenous or to the psychogenic order.
In the first case symptoms are facts linked by a cause-effect relation, while in the second one the psychogenic phenomena have to do with the order of motivations, of meaningful connections.
These two orders require a different relational approach and different techniques to be applied, different but used in the same setting. Moreover, often the two orders are interconnected in the same patient, for example when a shift from the endogenous to the psychogenic order occurs, in cases in which the antidepressants are improving depressive symptoms. The emergence of the psychogenic level changes the nature of the therapeutic relationship, requiring the psychiatrist to change accordingly in order to cooperate with the patient on the basis of shared values and respect of free choice.
ethics, psychiatry, psychology, psychopathology, freedom
Dial Phil Ment Neuro Sci 2019; 12(2): 79-82