Conflicting Value Systems And Therapeutic Intervention
Abdul Basit PhD

Over the past two decades, the mental health field has expanded its scope enormously, and it continues to do so at a rapid rate.  It has assimilated drug abuse, the violence of the youth, unrest in universities, the problems of blacks and the poor and the aged, and many types of antisocial behavior.  Mental health experts are eager to point out such problems as appropriate targets for their intervention, and are willing to offer solutions.

As we go on extending the definitions of mental illness and labeling an increasing number of people as 'disturbed', thus transforming people into patients, we are constantly confronted, whether we realize it or not, with the problem of values.  We define a certain sort of behavior as 'disturbed' and as needing to be changed by therapeutic techniques; that judgment certainly cannot be made without considering one value system as superior to another.

Ultimately, then, we must come to terms with the problem of values.  Do we really know what constitutes a good human being?  What do we consider to be the good life?  Are the traditional value systems good, or should one believe in situation ethics?  The problem becomes more complicated when we realize that not only is there no consensus on values but the different value systems are themselves rapidly changing from year to year.

Consequently one cannot help wondering how people in the mental health field, with their various value systems, decide what is good or bad for their patients.  Studies have suggested that  "Therapists consider patients improved who begin to resemble them in their style of life, in their values, and in their interests." (1)  The question is: How much deviance or disturbance is tolerable or even healthy, and who decides?  And: How do mental health practitioners determine the relative merits of different value systems?

To anticipate the accusation that I am raising issues just for the sake of arguments, or discussing problems that have no immediate relevance, let me give just a few examples.

The parents of a 13 year old girl were stunned when they found a small plastic bag of marijuana in her dresser drawer.  She was not going to school, and she wore jeans that they considered not only sloppy but dirty.  She also stated openly that she did not believe in God and Christianity, and that few people do anyway.  After some blunt confrontations with her parents she refused to eat and drink, and was confined to her room.

When the girl was seen by a psychiatric treatment team, the members' opinions were divided; some said that her parents were too rigid and wanted to force her to accept their values; others felt that she must be a nut to be so anti-religious and anti-social.  The team leader, a psychiatrist, finally gave his verdict that the girl was not depressed or anxious and should be free to choose her way of life, that her parents had no right to force her to accept worn-out traditional values.

Or take the case of an 18 year old boy who has been raising hell in school because he thinks the teachers are autocratic, and are mainly interested in strengthening a monolithic bureaucratic set-up in which students have no choice about what and when and how they want to learn.  He was labeled 'disturbed' and the parents sought psychiatric help.  The professional staff were again divided:  some felt strongly that "All that the boy needs is discipline."

Consider the 40 year old female patient who firmly believed in prayer; staff members indirectly told her that she was still resorting to her early infantile attitude about God as the magic-worker.  Or take the case of the 20 year old unmarried girl whose doctor considered her promiscuity pathological, even though he said clinicians should not be moral arbiters.

Those are not medical problems, and not strictly psychiatric problems, but are social and cultural issues that are directly related to value systems.  A psychiatrist is not like a physician who treats a physical disorder, dealing only with the illness regardless of the patient's social, cultural and religious background.  If someone is suffering from pneumonia, the doctor treats only the pneumonia, and is not concerned with whether the patient is religious or atheistic, or is doing things that are radical or antisocial.

But that separation does not apply in psychiatry.  We are dealing with human behavior, evaluating whether a patient's behavior is right or wrong, good or bad, healthy or sick, progressive or retrogressive, useful or dangerous.  In doing so, we are called on to function in roles for which we have not been adequately trained.

We are continuously involved with the problem of values, but since there is no consensus of values among professional staff, among patients, or in the community, and the values themselves are rapidly changing, there is a pressing need to study closely the ethical implications of any therapeutic intervention.

From this brief discussion, a few issues clearly emerge.  If we persist in transforming an ever-increasing number of people into patients and asking then to change their behavior, and even their values, are we not obliged to show how society, as well as the individuals concerned, would benefit?  If we are right in regarding certain behavior as 'disturbed', what value system will we use as a standard toward which the behavior be changed?

If we impose our own value systems on the other staff as well as on the patients, are we not engaged in a kind of brainwashing?  And finally, if there is no consensus of values among professional staff, are we not giving double messages to patients and exposing them to uncertainty and confusion?  As a patient once remarked: "We are told so many different things by so many different people that we do not know what to believe."

It is morally incumbent upon us to thoroughly examine how much we contribute to patients' confusion by imposing our moral values on them, and to question our assumptions about the therapeutic virtues of those values.

However, we need to emphasize that despite cultural differences and conflicting value systems, there are universal factors in human behavior that link all humanity, called "Psychic Unity."  Generally, experienced clinicians maintain an open stance and are flexible in applying theories to situations.  One must, however, avoid those therapists who rigidly adhere to a single theoretical system and whose cultural backgrounds are less diverse than the population they serve.  But most therapists these days have received training in multi-cultural counseling.  Research has consistently shown that seasoned therapists are usually effective with most type of patients and they tend not to impose their value system on their clients.

(1)   H. L. Lennard and A. Bernstein, "Dilemma in Mental Health Program Evaluation" American Psychologist, Vol 26, March 1971, p. 308

Abdul Basit PhD, is a Research Associate at University of Chicago, Illinois

published article: Hospital and Community Psychiatry.  A Journal of the American Psychiatric Association.  Vol 24  Number 3   March 1973