Through a glass, darkly: ethics of mental health practitioner-patient relationships in traditional societies

ABSTRACT Assumptions about the universality of ethics and the use of dominant ethical frameworks of mental health care may obscure the differences and contextual realities in traditional societies. The ‘culture’ of the encounter between the mental health practitioner and the patient can be viewed through three dominant perspectives; paternalism, autonomy and reciprocity. Culture strongly influences how persons construct and negotiate their autonomous identities and the concept of relational autonomy may be more relevant in traditional societies like India. In this article, research studies and practitioner viewpoints are brought together to highlight the debates related to patient-practitioner communication, confidentiality and disclosure, informed consent and decision-making capacity, involuntary admissions and discharge processes, use of covert medication, advance directives and cultural influences on the definition of professional boundaries. Understanding the complex interplay of cultural beliefs and processes, culturally embedded practitioner value systems, economics, social justice paradigms and existing mental health care systems in traditional and resource-poor societies can provide a deeper understanding of the ethics of mental health care. A view of reality as interpretative and contextual can enhance our understanding of the ethical playing field in mental health care in both traditional and modern societies.