BOOKS
R.D. Hinshelwood (1997) Therapy or Coercion: Does Psychoanalysis Differ from Brain-Washing? London: Karnac Books.
From my entry into the psychiatric profession in the mid-1960s and the influence then of ‘anti-psychiatry’, I had felt a nagging discomfort about the ethics of professional paternalism. In psychiatry this entails compulsory admission and treatment (including ECT) of very vulnerable people who ar deemed to lack the necessary self-determining motivation towards themselves, their lives, or anything else very much. In the last papers listed, I was reaching for the principles of ethics which might emerge from a psychoanalytic understanding of the unconscious aspects of the person, of the self, and of relationships. My approach was based on the capacity for minds to exchange experiences and functions, unconsciously, so that functions of one mind can be usurped by another. Such exchangeable ethical functions are particularly guilt and responsibility. Distortions of the sense of self and identity arise from primitive phantasies, notably projective identification following a splitting of the self/ego, and a loss of parts then seen as others, not oneself. It is a curious and deeply unconscious process which is never taken into account in the philosophical literature on ethics and moral philosophy. Ethical responsibility must be to care for persons such that they remain themselves as much as possible, and this applies both to professional care, as well as to general ethics. Despite the removal of responsibility for themselves that the compulsory admission of people to a mental hospital entails, the long term aim must be to restore that self-responsibility at the earliest moment and in the gentlest way.
JOURNAL ARTICLES
R.D. Hinshelwood (1990) Therapy or coercion: a clinical note on personal change in a therapeutic community, International Journal of Therapeutic Communities 11:53-59.
This develops the issue commenced in the 1985 paper on group cohesiveness/ It is a forerunner try-out of the underlying idea in the above book published seven years later. The fluidity of mental functions passing from one mind to another implies a powerful unconscious mode of coercing others without their fully realising it. So, it raises the issue of how much does the therapeutic community succeed by coercing its members into new behaviours, and indeed into seeing themselves in ways acceptable to the community.
R.D. Hinshelwood (1995) The social relocation of personal identity, Philosophy, Psychology, Psychiatry 2: 185-204.
Philosophy has many accounts of identity and individuality. The account of projective identification given in 1946 shows it as an influence on experiences and mental functions projected into others or coming from others interpersonally. This paper develops the themes of two papers in 1989 on social possession, and on communication flow in the Section on ‘What are Organisations’) and it connects with the concern described in the 1990 paper on coercion. Personal identity can be corrupted, distorted, and fragmented by the dynamics of the social group in which a subject exists at any particular moment. A persons sense of himself is a much more fluid experience than is usually granted in contemporary Western society.
R.D. Hinshelwood (1997) Primitive mental processes: psycho-analysis and the ethics of integration. Philosophy, Psychology, Psychiatry 4: 121-143.
This follows the previous paper on identity and links the vicissitudes of identity to the primitive mechanisms, and unconscious phantasies of introjection, projection, splitting, and identification.
CHAPTERS IN EDITED BOOKS
R.D. Hinshelwood (2000) In Donna Dickenson and Bill Fulford (eds) In Two Minds: A Casebook of Psychiatric Ethics. Oxford: Oxford University Press.
In this academic textbook on psychiatric ethics, I wrote a chapter on the loss of a patient’s autonomy, responsibility and authority. It is of necessity when hje/she avoids the pains of reality. Frequently the patient colludes with off-loading their responsibility because it relieves a burden of of thinking and judging their own actions. However this prescribes an ethics in which the autonomy and personal responsibility is transferred on only a temporary basis, to be returned to the patient, as appropriate and with support of course.
R.D. Hinshelwood (2004) Clinical and institutional relations to personal identity. In Chris Heginbotham (ed) Philosophy and Psychopathology: An Exploration of Personal Identity in Mental Disorder. Aldershot: Ashgate Publishing.
This invited Chapter focussed on considerations of ethical care under the conditions of identity in clinical work and care institutions. It thus followed on, and generally summarised the work of the texts above on identity and ethics.
R.D. Hinshelwood (2005) A psychoanalytic perspective on confidentiality: the divided mind in treatment. In Christein M. Koggrl, Allannah Furlong and Charles Levin (eds) Confidential Relationships: Psychoanalytic Ethical, and Legal Contexts. New York: Rodopi Press.
In this chapter, I make the claim that confidentiality is more than a legal matter, it is therapeutic. In the correct setting there is permission for unconscious aspects of the personality, impulses and relationships to emerge towards conscious insight. Can ethical approval be given for the research into the unconscious mind which by definition demands not to be known or broadcast, even within the subject. Can a responsible permission be granted by the conscious mind?
R.D. Hinshelwood (2015) Projection and introjection: The uses of paternalism, and its abuses. The Oxford Handbook of Psychiatric Ethics (Edited by John Z. Sadler, K. W. M. Fulford, and Werdie (C.W.) van Staden). Oxford: OUP. Available online at: https://www.oxfordhandbooks.com/view/10.1093/oxfordhb/9780198732372.001.0001/oxfordhb-9780198732372-e-34
Psychiatry staddles both a neuropsychological medical approach and a careful listening in to the person’s own experiences in so far as they can speak them. This implies different ethical principles. On one hand the psychiatrist is the scientific authority how the patient addresses for the expertise available; on th other had the patient, and his unconscious carry the authority, as best they can for conveying the troubling experiences of anxiety and confict and their avoidance. It can be a risk that faced with the complexity of this double-task, the psychiatrist will retreat into the simpler role of the consulted expert who takes full responsibility for diagnosis and treatment in the medical model. For many patients there I a relief in letting someone else take responsibility for intolerable states of mind, by projecting their personal authority into the ‘expert’