Thank you for the kind comment! I’m glad this helped you take a fresh perspective! One of the hardest parts of receiving mental healthcare is wondering what your providers think of about you while poking around your head. It’s important to me to try to convey to my patients that even though I can’t know exactly how it feels to be them, I will believe what they tell me about their experience, and use that information to make the very best choices I can in caring for them.

Thanks for the kind comment!

Questions about what makes an individual, and competing motivations between the conscious and subconscious, were some of the things knocking around my head while writing this, and I'm glad to hear you feel there's significant questions to be asked there.

In regard to waiting being less ethical, I agree with you, I think we have a moral responsibility to do what we can while we can do it, which is the reason I currently work in psychiatry, imperfect a science as it is. That said, the difference between a world with less suffering, and a world free from suffering, will come down largely to advances in our theories of mind, so while we shouldn't pause psychiatry to study the mind, the study of the mind should really be asking more and better questions.

Thank you, I really appreciate that. Thanks for caring about the good fight.

I have very mixed feelings about ECT. Although I've seen it help many patients, I've also seen it induce near-catatonic states and mood swings in more patients than I would like. There is also limited research on the long-term effects of ECT and whether or not ECT actually provides enough long-term relief from symptoms to be worth the discomfort and physical and psychological risk.

Ketamine and Propofol have, in my opinion, a better cost-benefit ratio, and I like that they don't induce a seizure-like response in the brain. Recent research on consciousness would seem to suggest that altering the structure of the brain under anesthesia, when the consciousness is not able to access it, may be very disorienting and uncomfortable for the consciousness.

Furthermore, advances in consciousness research have allowed development of techniques like Transcranial Magnetic Stimulation, which are much less invasive, although in my opinion inducing an electromagnetic current in the brain by any form is like using a hammer to adjust your rearview mirror.

I think unusual conscious experiences and fresh ways of looking at the world allow the consciousness to participate in positive reorganization of neural networks, which is one of the reasons I think psychotherapy and introspection are such important parts of psychiatric treatment. Medication and other physical treatments can correct the wiring, but if you repair a computer and then only download viruses all day, the computer won't last long. Retraining patterns of thought is just as important as reorganizing neural pathways.

These are just my opinions, and have nothing to do with the particulars of my job or the policies of my hospital.

I feel I can empathize with your last sentence there. At the psych hospital where I work, in the US, I care for many patients who have been involuntarily committed. Although I have deep ethical concerns about many practices in American psychiatry, and the American Mental Health Court system, people only become committed to the hospital's care after they have fallen through every safety net and crack in society, of which there are desperately few to begin with. This is the best we have, at the moment, but I see a large part of my life's work as the fight toward a better, more ethical, more compassionate system.

Along these lines: it's not uncommon to see people who are floridly psychotic or display a serious inability to care for themself be legally committed to the care of the hospital involuntarily, or to have guardianship assigned to a relative or other legal guardian. In these cases, a simple question raises grave concerns: what if the person with legal guardianship secretly but potently hates the person for whom they are enabled to make medical decisions?

No matter how well we understand neuroscience, I imagine conscious inner privacy will remain an ethical issue for a very long time. I cannot directly access another person’s consciousness, I cannot know for myself what the experience they are having feels like to have. I can only infer things about their experience from various sources of data. If some quantum-informational theories of consciousness are correct, inner privacy may be a fundamental law of information in the universe, so I think this issue will remain salient for quite a while.

I think you raise a great point. A patient who feels at war within themselves will not achieve peace by killing some part of themselves, and so often the course we take in psychiatry is exactly what you suggest, integrating things rather than trying to kill or remove them. For example, some patients on inpatient units I have worked on find the experience of being physically or chemically restrained to be enjoyable for some reason or another, and have learned how to create situations in which there is sufficient danger to the patient or others that hospital policy requires restraints. The clinical course for these patients involves 1) attempting to limit situations where an escalation to restrain is possible, and 2) attempting to understand and modify the motivations of this behavior, in order to allow the patient to obtain the emotional gratification they get from restraint, from other sources. If this desire for restraint is not acknowledged as part of the problem, however, the patient will continue to behave dangerously in order to be repeatedly restrained.

There’s a book called The Mask of Sanity by Harvey M. Cleckley which was one of the first to compare the appearance of psychopathy between different psychopaths. The book is from 1941 and so obviously quite outdated, but Cleckley’s metaphor of a mask remains quite relevant. Many ASPD patients I’ve worked with have described feeling as though they are constantly wearing a mask, or as though they are a mask with nothing behind it. I.E. if the constructed character they present to the world were removed, they would have no internal frame of reference at all. It follows, then, to ask ask to whom the suffering belongs: the psychopath, or the mask?

Thanks for the insightful comment. I think you’ve summed up my experience working in psych as well. Because it would be totally wrong to assume patients are lying from the get-go, the provider simply has to do the best they can, providing informed consent and prompting self-reflection where possible, and allow the patient to assume some responsibility for giving the information they give and requesting the treatment they do. There are of course some conditions, such as munchausen’s, in which self-report of symptoms is intentionally deceptive, and in my experience the medical system is still pretty unprepared to detect and diagnose these types of issues, and it was around these types of problems that I designed the thought experiment. I really don’t have a specific clinical course I’m arguing for, because I think we simply need to learn more about the mind before our diagnostic tools will improve to a significant degree.

This is one of this most difficult issues we are investigating at the moment, I think. Recent developments in neuroscience are forcing more and more scientists to consider panpsychist-like perspectives. The more things to which we ascribe experience, the more we need to consider whether or not we are causing those things experiences of suffering.

This is a thought experiment I wrote to encourage discussion of ethical issues in medical science, particularly in the field of psychiatry in the treatment of personality disorders. I have worked in this field in different capacities of direct patient care for years now, and will for the rest of my life, so I feel my development of this thought experiment is based on genuine ethical issues I have observed.

The 9 analysis questions following the thought experiment relate to Ethics of Medicine, as well as Philosophy of Science topics such as theories of mind.

This thought experiment intends to argue that novel conceptual frameworks in the theory of mind are needed to understand the experience of mental illness, before sound ethical decisions can be made.

I hope this is appropriate for submission to this sub, but if not, please let me know, and I'll remove it.