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date: 22 January 2020

Abstract and Keywords

Psychiatry straddles a medical approach to the mentally ill, and a dynamic approach to the experiences of severely disturbed people. One consequence of this is that ethical principles apply in different ways. The understanding of processes known as introjection, projection, and splitting seriously disrupt the functioning of a person and his ability to make adequate, responsible decisions. Severe mental illness can be regarded as the disruption of a moral agent, and in a sense treatment has to focus on the resumption of those functions that enable the person to take responsibility again. This chapter explores the ethics of the person’s loss of his personal functioning. Paternalism does not have a free rein, and needs to be carefully used as it supplants autonomy. Over-extended paternalistic care leads to excessive depletion of the patient, and was apparent in the old mental hospital as it still is in contemporary community care as specific organizational dynamics.

Keywords: introjection, projection, splitting, paternalism, autonomy, moral agent, severe mental illness, organizational dynamics

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