I have written in the past about a person’s state of mind being potentially a decision rather than a biological fact. There are people who truly manage to convert their eyeglasses from gray to rose-colored. It astonishes me, in factת how two people can so differently experience the exact same set of events. I want to be clear that this is not some hidden comment about how we should react to acts of terror or the state of the world. I am talking about the very personal feelings that an individual can have, and how these personal feelings are interpreted by the public.
Just in my last blog post, I spoke of a future that truly will be a paradise on earth. Will people still be sad in this future world? Will there still be depressed patients, when arguably, there is nothing to be depressed about? If in fact, every form of depression can be linked to a particular region in the brain, then it should eventually be possible to alter our cerebral chemical levels and to create a feeling of joy in anyone who seeks mental health care. Is this considered really dealing with the problem, or just applying a high tech bandaid?
What will be the role of psychiatrists and psychologists when people can safely and reliably eliminate any negative personal feelings with a pill? I am talking about a kind of treatment that will have, for all intents and purposes, no side effects and no degree of addiction. Will it be important to understand why a person has become sad or angry or depressed or suicidal or homicidal, when all of these emotions can be wiped away with an easy to swallow capsule?
My focus throughout my blog posts has primarily, and actually almost exclusively, been about general health care to the exclusion of mental health care. But many of the same problems that exist with a family doctor assessing a patient, also exist when a qualified professional assesses the mental status of a patient. How often does a psychiatrist, or more so a community-based psychologist or social worker, consult with another professional before making a critical diagnosis? Do these professionals make use of EMRs and other clinical assist tools to document and diagnose and track patients?
Sometimes, these diagnoses can be life-changing. If an air traffic controller is deemed to be depressive, he/she can lose his job and potentially never get it back. If any individual speaks to a mental health care professional and shares their deepest secrets, that could very well be interpreted as a danger to oneself or others, how does that mental health care professional accurately assess the true danger? And please respect the fact that a mental health care professional could inadvertently allow a very dangerous person to cause serious damage if the personal secrets are not properly addressed.
One of the reasons I have come to write about this, has to do with an article I read today in the paper, where a clearly dangerous individual was deemed unfit to be tried in court, due to psychiatric illness. Had the same individual been under treatment by a mental health care specialist, would that have changed the homicidal outcome? This individual, like many others today, is actually very open about their extreme views. And once again, I want to clarify that this is not a secret jab at any particular religious group, political viewpoint or the like. One could argue that any one of us is a ticking time bomb, and the only difference between living a normal life versus “going postal”, is circumstances and/or opportunity.
I imagine that one could summarize this as a very simple question: does a person have the inherent right to have “crazy” thoughts? In the future, when we have the ability to scan the brain and determine if a person is having what future societies define as “crazy”, will this alone be considered a criminal offense that requires the patient to take medication or even undergo surgery to banish the unacceptable thoughts? This is the foundation of the book and movie “Minority Report”. If we know that a person is going to commit a crime or act in a way that is socially unacceptable, do we have the right to preempt this even if it means incarcerating an individual for a crime that they have not yet committed?
This actually is the ultimate test of privacy rights, as technology becomes more and more interventional. Imagine walking down the street, and your embedded chip warning you that the gentleman who just passed you had a sexually aggressive fantasy about you. Does the man or woman who is a target of this fantasy have the right to report this? Is this considered within the realm of a normal psyche? With all due respect to the mental health community, there is really no data on this because technology still really cannot read minds. But this time is coming. Unfortunately, decision-makers will wait until decisions about such issues are forced upon them, even though these technologies and their ethical questions are going to soon exist.
I personally have a very simple motto which I share with anyone concerned about hacking and infringements on personal privacy and security – there is no such thing as privacy and security in this day and age. Of course, there is a multi-billion-dollar industry that is entirely focused on protecting our privacy and security [and these are different things]. But someone who truly wishes to learn every detail about another individual can usually do so, sometimes without using technology at all. Our greatest protection against others poking into our lives, is a simple fact that the vast majority of us are boring. The vast majority of us do not live lives that draw the interest of others. But once an individual or a government decides that they want to know everything about you, it is really only a question of time and money until every dark secret is exposed.
What I am asking is whether our thoughts should remain our personal domain no matter how advanced technology becomes? Should there be draconian laws against anybody ever using technology to reach into our brains, in a similar way that people steal Wi-Fi signals as they pass by your house?
My personal feeling about this is very simply, yes – our thoughts should always remain our own. If our behaviors reflect thoughts that are potentially dangerous to others, then I personally have no qualms about challenging the given individual about those behaviors. If a person has a thought about harming another and if that person begins to stalk the target, then this is clearly an offense. But as long as the perpetrator keeps his or her thoughts to themselves, I personally feel that this domain should be respected.
Now comes the question – when such a potential perpetrator shares these personal thoughts with a professional mental health care worker, is there an inherent relinquishing of privacy rights in doing so? Is a mental health care worker allowed to say that the thought of harming another is enough to incarcerate an individual, or force them into a closed psychiatric ward?
I don’t pretend to have the ultimate answers to these very difficult questions. I will say that in my personal experience, thoughts of actually harming others are quite common. A lot of people experience very negative stimuli, such as being harmed by a physician, or assaulted by a friend and so on. And a significant number of these people will have very drastic thoughts and even dreams about how they would like to seek retribution. There is a reason why superhero movies, TV shows and cartoons are so popular.
At the moment, many people are not aware of the fact that mental health care workers have a responsibility to report cases where there is a serious concern as to personal harm and/or harm to others. So, if someone is having nightmares that include harming themselves and others, a mental health care worker could potentially decide that such a person must be taken away by the police or by psychiatric services. Once this happens, the damage to the person’s psyche and personal reputation can be irreparable.
So once again, let me say that there must be a line drawn in the sand that states that a person’s thoughts are his or her own. The question is where exactly that line should be drawn – more to the discretion of the patient or more to the welfare of the public.
Thanks for listening