Answer the questions with the following link below. Here are the Questions for Discussion Board: 1.

  

Answer the questions with the following link below. Here are the Questions for Discussion Board: 1. Some people are not consciously aware when they have a psychological disorder. Under what circumstances is it ethical to involuntarily treat such people? 2. Rachel’s father has severe schizophrenia; he has experienced several episodes of psychosis, but is unaware of his disorder. As her father does not know he has a disorder, he does not see the necessity for treatment. Rachel wants to respect his autonomy but feels that treatment is the best option and that he is unfit to make an objective decision about it. Is there a treatment that would be least compromising of his autonomy?Please follow these directions below while answering:Posting thoroughly answers question(s) and includes several supporting details/examples from the week’s readings/posted materials. Posting shows critical thinking and a deep understanding of the concepts.
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Chapter 15: Psychological Treatments
On Ethics
Involuntary Treatment for Mental Disorders
Suppose you are hurrying to class one winter morning, slip on some ice, fall, and sprain
your ankle. You may not realize that your ankle is sprained, but you know you are
injured. Another student offers to help you to the infirmary and you gladly accept.
However, if you were suffering from anosognosia, a condition caused by a brain disease
or injury to the parietal lobe, you would not know you were injured. People with this
condition may have quite dramatic impairments, such as paralysis and blindness, but are
unaware of their problems. For example, Tony Rosato, a Canadian actor and former
Saturday Night Live cast member, denied that he had any mental health problems, in spite
of clear evidence that he had Capgras syndrome.
Approximately 50 percent of individuals with schizophrenia and 40 percent of
individuals with bipolar disorder are unaware of their disorder. Unlike anosognosia, in
which a parietal lobe defect can be seen on a brain scan, however, there are currently no
objective markers for unawareness of mental disorders. This failure to recognize a
disorder is the most common reason why people with these diagnoses do not take their
medication, often resulting in worsening of symptoms and increased likelihood of
victimization, homelessness, joblessness, incarceration, rehospitalization, and violent acts
against others and themselves. In addition, if a person is not treated, the disorder may
progress to the point where it is no longer treatable; research has shown, for example, that
delaying treatment for schizophrenia causes the disorder to become more severe and less
responsive to treatment.
Many family members have been frustrated trying to get help for relatives who are
unaware of their own disorders, refuse treatment, and deteriorate, often ending up
homeless. Community members have been frustrated by their inability to help the
Psychology  in  Your  Life,  2e  
 
©W.  W.  Norton  &  Company  
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homeless, who, depending on the state, legally may have the right to refuse treatment.
Should people who are unaware of their own mental disorders be treated even if they do
not want to be?
We do not force treatment on people with medical problems, even if their reasoning for
rejecting treatment is illogical. Treating mental disorders is even more of an ethical
quagmire, mainly because we do not understand many of the disorders completely. As
discussed in Chapter 14, the neural underpinnings of depression, bipolar disorder, and
schizophrenia are still being studied. Diagnoses are based on behaviors, not on blood
tests, and those behaviors may have different origins and be open to various
interpretations. In addition, a minority of both psychologists and psychiatrists do not
agree that many mental disorders have biological bases; instead, they explain them as
emotional reactions to negative life circumstances, stress, or acute trauma. Until research
can prove direct causation of mental disorders by biologic processes and can uncover the
mechanisms that cause and can treat them, these practitioners believe any involuntary
treatments violate an individual’s right of self-determination.
Safety is also an ethical issue. Even if a diagnosis is agreed upon, treatments vary in side
effects, costs, and effectiveness. When a person is treated involuntarily, who should
determine what treatments to use—the family (if there is one), the physician, the
community, the government? The optimal treatment as seen by the community or
government may be the most cost-effective one, whereas the optimal treatment for the
individual may not be. Ethicists also worry that if individuals are threatened with
involuntary treatment, they will be less likely to seek treatment when they need it or may
be reluctant to continue it once they have started.
Studies done from the ethical standpoint of fairness and justice suggest a different
treatment modality. A sense of fairness and “being heard” can matter almost as much as
treatment pressures. Therefore, any treatment must respect the person with the disorder
and treat the person fairly. One such treatment, which has proved highly effective and has
markedly decreased rehospitalizations, involves offering patients a contract in which they
Psychology  in  Your  Life,  2e  
 
©W.  W.  Norton  &  Company  
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receive a small amount of money or gift certificates for compliance with treatment. This
cognitive-behavioral technique, in which positive or healthy behavior is reliably and
clearly rewarded, may be perceived as coercion or as exploitation of poor patients.
However, the majority of patients do not consider the practice coercive and understand
that, unlike involuntary treatment, they can turn it down.
What would you do if your sibling or parent, for example, were experiencing psychotic
episodes but was unaware of having a disorder and refused medical evaluation or
treatment? Would you consider it ethical to respect your relative’s autonomy and do
nothing, or would you force him or her to go for treatment? What if they had been
arrested for aggressive behavior while in the midst of a psychotic episode? What if your
mother was living homeless on the street and being victimized?
Psychology  in  Your  Life,  2e  
 
©W.  W.  Norton  &  Company  
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Ethics Discussion Questions
1. Some people are not consciously aware when they have a psychological disorder.
Under what circumstances is it ethical to involuntarily treat such people?
Concepts to Consider

Psychotherapy (p. 540): Psychotherapy is an umbrella term for the treatments that
aim to alter disordered thoughts and behavior. There are various branches of
psychotherapy, which are each appropriate for treating different disorders:
psychodynamic therapy, humanistic therapy, behavior therapy, cognitive therapy,
group therapy, and family therapy.

Biological therapies (p. 544): Some psychological disorders stem from abnormal
biological processes. Psychotropic medications are used to change mental
processes by altering neurochemistry in the brain. Anti-anxiety drugs,
antidepressants, mood stabilizers, antipsychotics, and stimulants are used to treat
a variety of psychological disorders.

Alternative treatments (p. 545): Psychotherapy and psychotropic medication are
sometimes ineffective. In extreme cases, electroconvulsive therapy (ECT),
transcranial magnetic stimulation (TMS), and deep brain stimulation (DBS) are
used to treat disorders.

Psychological disorders (p. 551): The broad categories of psychological disorders
include anxiety disorders, obsessive-compulsive disorders, depressive disorders,
bipolar disorders, and psychotic disorders.

Anosognosia: People who have anosognosia have a damaged parietal lobe, which
renders them unable to recognize mental disorders and physical injuries.

Safety: When people are unaware that they have a psychological disorder, they
put themselves and other people at risk.

Autonomy: People should be able to maintain their psychological and physical
integrity by making their own decisions about treatments.
Psychology  in  Your  Life,  2e  
 
©W.  W.  Norton  &  Company  
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2. Rachel’s father has severe schizophrenia; he has experienced several episodes of
psychosis, but is unaware of his disorder. As her father does not know he has a
disorder, he does not see the necessity for treatment. Rachel wants to respect his
autonomy but feels that treatment is the best option and that he is unfit to make an
objective decision about it. Is there a treatment that would be least compromising
of his autonomy?
Concepts to Consider

Electroconvulsive therapy (ECT) (p. 545): This form of therapy involves
administering an electrical current via electrodes on the scalp, which can produce
a seizure. It has been used to treat depression and schizophrenia.

Schizophrenia (p. 551): Schizophrenia is a psychotic disorder, which affects
motor abilities, cognition, and perception.

Psychotropic medication (p. 560): Conventional antipsychotics reduce the
positive symptoms (e.g., hallucinations) of schizophrenia. Atypical antipsychotics
work on the level of neurotransmitters and are effective in reducing positive and
negative symptoms (e.g., lack of empathy).

Behavior therapy (p. 562): Social and behavioral problems associated with
schizophrenia are best addressed using behavioral therapy in addition to
psychotropic drugs.

Prognosis (p. 562): People who have schizophrenia typically experience multiple
psychotic episodes. For some people the disorder gets worse as they age, but for
most people diagnosed with schizophrenia, their symptoms lessen over time.
Psychology  in  Your  Life,  2e  
 
©W.  W.  Norton  &  Company  

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