Disciplinary Note

Order, the Moral Life and Mental Health Treatment

John R. Peteet

Associate Professor, Department of Psychiatry, Harvard Medical School

This discussion of the moral order is germane to my current work on the psychiatrist’s role in the patient’s moral life. While value neutrality on the part of a therapist is generally recognized to be a myth, explicit discussion of the moral dimension of clinical work is uncommon. This stems in part from the individualistic orientation of much Western treatment, in part from concerns to avoid moralistic judgment, and in part from the difficulties of attempting a “tense consensus”.

The ”Fourth Wave” on Growth and Flourishing in Mental Health #

Biggar’s Theology Brief on Order is helpful in clarifying the place of human goods as the basis of moral laws because while psychiatry remains focused more on pathology than on mental health, a number of “Fourth Wave” approaches aim to enhance growth and flourishing, making more possible the identification of human goods. Examples include gratitude and forgiveness- promoting therapies that grow out of the positive psychology movement, and meaning-centered and dignity-conserving therapies designed to help the seriously medically ill. Perhaps if these goods can be seen to guide how we ought to envision a life well lived, clinicians will be less likely to slide into moral subjectivism when they encourage patients to act on the basis of their values, and even become more open to theological resources for grounding and fostering them.

Accountability as a Virtue in Psychiatric Treatment #

Furthermore, while subjection to authority is a challenging notion for many clinicians who daily see how human authority has been abused, this Brief provides models for considering how structure and hierarchy can be compatible with creative freedom. This is consistent with recent work on accountability as a virtue, which refers to the welcoming of one’s responsibilities both to others and for their impact on others. Accountable people are open to input from others in legitimate roles, take responsibility for their own attitudes, thoughts, emotions and actions, and work to improve or correct their responses to have a positive impact. Psychiatric treatment often aims to correct disordered forms of accountability, including difficulties with empathy and self-regulation. Both the process of treatment and the practice of professionalism depend on relationally responsible accountability. Accountability to legitimate authority is an overlooked complement to healthy autonomy.

Finding versus Making Meaning in Mental Health #

Finally, the perspective that moral and other orders are “out there,” rather than only internally and subjectively generated, can provide a useful corrective to the tendency of much existentially and spiritually oriented care to encourage “making” rather than “finding” meaning.

Further Reading #

Mumford J. Therapy beyond good and evil. The New Atlantis, Spring, 2022; 28-38. https://www.thenewatlantis.com/publications/therapy-beyond-good-and-evil The author argues from his experience as a patient that a non-judgmental psychology is failing patients who need to hear hard truths.

Peteet JR. Doing the Right Thing: An Approach to Moral Issues in Mental Health Treatment. Washington, D.C.: American Psychiatric Publishing, Inc. 2004. Explores the nature of psychiatry as a moral enterprise and the clinician’s role in addressing problems in moral functioning.

Peteet JR. A fourth wave of psychotherapies: moving beyond recovery toward well-being. Harv Rev Psychiatry. 2018;26(2):90-95. Considers emerging treatment approaches focused on human growth and flourishing.

Peteet JR, Witvliet CVO, & Evans CS. Accountability as a key virtue in mental health and human flourishing. Philosophy, Psychiatry, & Psychology,2022; 29(1), 49-60. Explores the importance of healthy accountability in mental health treatment and professionalism.