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ABSTRACT: Psychiatric labeling has been the subject of considerable ethical debate. Much of it has centered on issues associated with the application of psychiatric labels. In comparison, far less attention has been paid to issues associated with the removal of psychiatric labels. Ethical problems of this last sort tend to revolve around identity. Many sufferers are reticent to relinquish their iatrogenic identity in the face of official label change; some actively resist it. New forms of this resistance are taking place in the private chat rooms and virtual communities of the Internet, a domain where consumer autonomy reigns supreme. Medical sociology, psychiatry, and bioethics have paid little attention to these developments. Yet these new consumer-driven initiatives actually pose considerable risks to consumers. They also present complex ethical challenges for researchers. Clinically, there is even sufficient evidence to wonder whether the Internet may be the nesting ground for a new kind of identity disturbance. The purpose of the present discussion is to survey these developments and identify potential issues and problems for future research. Taken as a whole, the entire episode suggests that we may have reached a turning point in the history of psychiatry where consumer autonomy and the Internet are now powerful new forces in the manufacture of madness
KEYWORDS: autonomy, bioethics, identity, Internet, mental illness, psychiatry
There appears to be a new psychiatric phenomenon emerging in the private chat rooms of the Internet, a novel syndrome that revolves around identity. At the same time, there are important ethical obstacles that prevent psychiatrists and bioethicists from studying that phenomenon. The two themes are inextricably linked. Psychiatry needs to study the phenomenon, but studying it poses complex ethical problems. The purpose of the present discussion is to describe the putative new syndrome and the ethical challenges involved in studying it.
The syndrome seems to be a sort of "madness for identity." Its defining feature is a refusal by some psychiatric patients to relinquish the iatrogenic identity provided by their medical diagnostic labels. In one way, there is nothing new about the existence of refusals of this type; they probably go back to the dawn of psychiatry. But there is another way in which the refusals we are concerned with are novel. This is...