I am a lecturer in biomedical ethics and law, primarily interested in the ethical and philosophical issues of psychiatry. I have a background in bioethics, social science, psychology and biology. I also host and co-edit a website psychiatricethics.com which features articles and multimedia on a wide range of issues in psychiatry, neuroethics and bioethics.
For several years I have been researching the ethical and philosophical issues raised by self harm and its treatment. In particular, I have been concerned with the ethical questions which arise when doctors or nurses allow patients to self harm in psychiatric hospitals. I first encountered this issue when it was reported in the British press that patients were being allowed to self cut in some NHS hospitals. For example, one inpatient was allowed to keep a piece of glass in a locked draw in her room and use it to cut her knees.
My work on self harm has had an empirical component. I conducted qualitative interviews and focus groups with patients, doctors and nurses. In the interviews we explored people’s motivations and intentions when they self harm and possible consequences of allowing people to injure themselves in hospital. This was the first study conducted of its kind. Drawing on the data, I argued that allowing self harm is permissible in the short term if there is a low probability of serious physical damage or death and the patient can engage with therapeutic strategies designed to manage their distress in alternative ways in the future.
In my research I am predominantly interested in investigating the ways in which harm minimisation may function to enhance patient autonomy. This idea is of course controversial. Many people find the idea of allowing patients to self harm in medical institutions at best counter intuitive and at worst sickening and morally wrong. However, I argue that in certain circumstances patients should be allowed to self harm. This idea involves understanding, at a deeper level, concepts such as autonomy and harm as well as asking what the function of psychiatric practice ought to be. At a very simple level, allowing patients to self harm in controlled conditions with the supervision of medical staff reduces the risk of patients causing themselves more severe injury. At a deeper level allowing self harm may actually foster better relationships between the professional and the patient and in time provide a more substantial chance that patients will recover. Someone may self injure to relieve intense distressing emotions and thoughts. The harm acts as a release providing temporary respite from distress. People who self harm often feel that their life is out of their control. They value the fact that they are free to do what they want to their own body. In these circumstances, allowing injury can prevent conflict between the staff and the patient and minimise the risk of hidden uncontrolled injury. As one nurse I interviewed said,
“[I]t’s worse to keep jumping on people, putting everybody else at risk and kind of that’s probably more traumatic, it’s so damaging to the relationship we have with people”
Alternatively, allowing injury can help establish trust and open the door to a dialogue about the patient’s distressing emotions rather than focusing on physical injury.
Following my earlier research, I am currently looking at the philosophical issues raised by the emotions in relation to psychiatry and self harm. In particular, the way in which disgust affects our moral judgments towards people who self injure and practices that tolerate it. Disgust often works as a barrier between society and psychiatric patients, doctors and their patients and also patients and themselves. Of course, what disgust is and what it ought to mean is a complex philosophical issue that draws on psychological research. Disgust still plays a prominent role in the formation of law and policy. My research questions whether disgust should hold any moral weight or underpin moral and legal judgments.
More information about my research can be found at my website psychiatricethics.com. The website, co-edited with the philosopher A. M. Calladine, already hosts a number of articles by contributors such as Neil Levy, Katrina Sifferd and Nancy Nyquist Potter. Topics range from issues in neuroethics such as consciousness and responsibility to the ethical issues of coercive treatment. The website is intended as a forum for debate between academics, students and the general public. It also functions as an educational resource for students studying bioethics, featuring videos and podcasts on psychiatry and ethics. If you would like to contribute to the site please contact me using the contacts page on the website.