Navigating Uncertain Terrain: Risk of Abuse or Misuse of Psychiatric Epistemic Power in the Face of Uncertainty Without Ethical Reflexivity and Regulation

Abstract

In this study, we examine the complex interplay between psychiatric epistemic power and its institutional applications through the phenomenon of “diagnosis removal” in Turkey. Within the constraints of limited mental health legislation, psychiatric diagnostic categories serve both as markers of risk and as administrative constructs that can be erased when convenient, presenting paradoxical challenges for healthcare providers and patients alike. Through a systematic analysis of case studies and theoretical frameworks, we explore how bureaucratic authorities can misuse psychiatric diagnoses in employment contexts. The study reveals a significant paradox where psychiatric expertise is simultaneously invoked and challenged, potentially undermining both therapeutic relationships and legal rights. This situation arises from a regulatory vacuum in mental health legislation, further exacerbated by a harm-based approach to mental health issues rather than a rights-based one. Key findings demonstrate how the institutional handling of psychiatric diagnoses creates a treatment disincentive effect, where individuals avoid seeking mental health care due to employment concerns. The analysis also reveals how concept creep and harm-based morality contribute to the misappropriation of psychiatric knowledge in administrative contexts. These findings highlight the urgent need for comprehensive mental health legislation that balances individual rights with public health concerns while protecting the integrity of psychiatric practice from institutional misuse, particularly in employment contexts.

1. Introduction

Psychiatry, in addition to being a medical discipline, has a unique position within medicine as it deals with the nature of human beings in relation to social and psychological factors (Gaebel et al. 2010). Given psychiatry’s comprehensive approach, addressing the biological, psychological, and social dimensions of the human being, it is not surprising that the problem sets encountered are inherently complex. In addition, psychiatry represents an important epistemic power in its relationship with the subjects it deals with. Although physicians, as practitioners of practical action, strive to exercise this power as neutrally as possible, they still have the potential to overstep boundaries in interactions with various stakeholders or be exploited by different social forces for instrumental purposes. For this reason, the epistemic position of psychiatry and its social meaning have been a subject of debate from time to time (Tekin and Bluhm 2019). In addition, developments in the field of medicine and technology and emerging new diagnostic categories, while benefiting the individual and society, also bring problems such as overmedicalization. Such developments also pave the way for health professionals to face new (and sometimes exaggerated) burdens. This is accompanied by the abdication of responsibilities by governments and social institutions, which, as some authors argue, should take primary responsibility for many issues (Hofmann 2022). All of this may involve the risk that the discipline of psychiatry, which represents an important influence in terms of social relations with its epistemic position, may be misused due to epistemic difficulties.

In this context, it is crucial for psychiatry to critically reflect on its epistemic power and social position—both as a discipline and in the actions of individual psychiatrists. By psychiatric epistemic power, we refer to the authority and legitimacy granted to psychiatric knowledge within social, legal, and administrative frameworks. This power derives from psychiatry’s status as a medical specialty, offering unique insights into human behavior and mental functioning. In addition, legal regulations can also serve as important regulators of the ethical use of this epistemic power. Such regulations can also ensure that third parties are aware that the arbitrary use of the epistemic aspect of psychiatry can eventually be to the detriment of the individual, society, and institutions such as medicine. In sum, there is an important need for an ethical awareness of the epistemic power of psychiatry and its possible internal and external abuses at individual, institutional, and societal levels. In this article, we explore a case that enables us to examine various aspects of the relationship between psychiatry, the individual, and society. This case serves as a compelling example of the ambiguous application of psychiatry’s epistemic power. Our objective is to highlight and ethically analyze the explicit and implicit ethical and ontological risks associated with this ambiguity.

This article examines a specific case in Turkey where psychiatric diagnoses are both requested for employment processes and can simultaneously be “removed” through bureaucratic mechanisms. This paradoxical situation reveals how psychiatric knowledge can be misused in administrative contexts, even against the intentions of psychiatrists themselves. This article is structured as follows: First, we outline our methodological approach to analyzing the phenomenon. Next, we present findings on the diagnosis removal phenomenon in Turkey and its practical implications. Then, we examine these findings through the frameworks of psychiatric epistemic power, concept creep, and harm-based morality. Finally, we conclude with recommendations for regulatory frameworks to better safeguard individual rights and professional integrity.

2. Method

We employ a case analysis approach to examine the “diagnosis removal phenomenon” in Turkey as an illustrative example of how psychiatric knowledge is used in institutional contexts.

Our methodology incorporates multiple analytical perspectives. First, we examined the factual context of the diagnosis removal phenomenon by analyzing key documents, including official statements from the Psychiatric Association of Turkey (2024a, 2024b), relevant regulations from the Republic of Turkey Ministry of Health (1998), and decisions from the Personal Data Protection Authority (2020). This allowed us to establish the practical significance and scope of the issue. Second, we applied established theoretical frameworks to interpret this phenomenon. Fulford et al.’s (1993) critical approach to the ethical implications of psychiatric diagnoses provided a foundation for understanding how psychiatric diagnostic categories can be misused by institutional actors. We focused on three key theoretical concepts in our analysis: (a) Psychiatric epistemic power: The authority and influence that psychiatric knowledge carries in social, administrative, and legal contexts. (b) Concept creep: The expansion of psychiatric and psychological terms beyond their clinical origins into administrative and social domains (Haslam 2016). (c) Harm-based versus rights-based approaches: The tension between approaches that prioritize risk prevention versus those that center individual rights and autonomy.

Finally, we examined the implications of this case study by analyzing how the absence of comprehensive mental health legislation in Turkey creates a regulatory vacuum impacting both psychiatric practice and patient rights. We considered how this contrasts with jurisdictions that have established mental health laws with clear protections against discrimination, highlighting the consequences of this legislative gap.

Through this multi-faceted approach, we sought to understand both the specific manifestations of the diagnosis removal phenomenon and its broader implications for psychiatric practice, patient rights, and mental health policy in contexts without rights-based mental health legislation.

3. Requests by People with Psychiatric Diagnoses to Have Their Diagnoses Removed: An Interesting Example from Turkey

The diagnosis removal phenomenon in Turkey represents a significant practical challenge for the psychiatric profession. According to recent statements from the Psychiatric Association of Turkey (2024a, 2024b), psychiatrists nationwide are facing a significant increase in patient requests to remove psychiatric diagnoses from medical records. This organization has deemed the issue important enough to establish a dedicated task group to address it. While precise national statistics are not yet available due to the recent emergence of this phenomenon, preliminary reports indicate that urban psychiatric clinics may see multiple such requests (Psychiatric Association of Turkey 2024b).

The central issue revolves around the impact of psychiatric knowledge on employment opportunities. In Turkey, numerous employers, especially in public sectors like law enforcement, the military, civil service, and education, consistently require health board reports that incorporate psychiatric evaluations as part of their hiring processes. Aydin et al. (2021) reported that psychiatrists often encounter patients who request the removal of their diagnosis due to employment-related concerns. This represents a substantial practical problem, not merely a theoretical concern. The real everyday life phenomenon that we address concerns how the epistemic power of psychiatry (or the epistemic power attributed to it) affects work–life or job application processes, which represent an important dimension of the world of individuals with a psychiatric diagnosis. In this context, the main problem is that individuals with a psychiatric diagnosis are made the object of intense questioning by employers (public or private) in the world of work and especially in job application processes. However, in terms of the current health discourse in close relation to human rights, it is a basic expectation that individuals with mental problems or mental illness should not be marginalized or stigmatized and should participate in social life (United Nations 2007). In this respect, reducing stigmatization and participating in social life also contribute to an increase in the search for treatment and enable patients or individuals with mental illness to access more appropriate treatment and assistance. Thus, reducing the stigmatization of individuals with mental illness is one of the important agendas of many countries and international organizations in terms of human rights (World Health Organization 2021). On the other hand, in Turkey, a relatively populist practice has emerged wherein the bureaucratic discourse defines the right of patients to “remove their diagnosis” (without any detailed regulation). This situation appears to place the individuals who seek psychiatric help and receive a diagnosis in conflict with the clinicians striving to provide assistance (Aydin et al. 2021). However, in the clinical context, the collaboration between the psychiatrist and the patient, or the individual seeking help for a shared objective, aligns with the fundamental ethos of medicine (Pellegrino and Thomasma 1981).

In fact, considering our background in psychiatry and ethics, we assert that we see the phenomenon of diagnosis removal can be viewed as an appropriate and rights-based practice when the necessary conditions are met. This is in line with the rights defined in the Turkish Patient Rights Regulation. Article 17 of the Patient Rights Regulation states that “The patient may request that incomplete, ambiguous and erroneous medical and personal information in the records of health institutions and organizations be completed, explained, corrected and made in accordance with the final health status and personal status”. (Republic of Turkey Ministry of Health 1998). However, despite all of these positive meanings, we would like to point out that the practice of “diagnosis removal” in Turkey reveals deep systematic problems in the real life of patients.

We can briefly summarize the factual context that prompted our consideration as follows: As issues surrounding the privacy of personal data gain increasing importance, individuals facing challenges in job application processes due to their psychiatric conditions are turning to the Personal Data Protection Authority. In response, the Authority, referencing the relevant Ministry, has indicated that not all requests can be assessed, particularly highlighting concerns related to public security stemming from mental health issues. The Personal Data Protection Authority provided justification for this statement. However, the Ministry of Health (partially justified) stated that patients can request the deletion of inadvertently incorrect diagnoses. However, for this purpose, a regulation was issued stating that the relevant physician should manage the process (Personal Data Protection Authority 2020). Consequently, individuals who had problems with job application processes and had some form of psychiatric diagnosis in the past were intensively confronted with psychiatrists.

The main problem with this phenomenon, especially in the case of psychiatric problems, is that the requests actually go beyond an (inadvertent) error correction request. One of the main problems that psychiatrists face in their daily experiences is the risk that many people who have problems with job application processes may apply to psychiatric outpatient clinics with a request to have their current diagnoses removed, which may cause medical problems (Psychiatric Association of Turkey 2024b). In fact, this issue was directly addressed on the agenda of the Psychiatric Association of Turkey, and a task group was established. In the statement made by the Psychiatric Association of Turkey on the subject, it was noted that individuals, particularly those who wish to avoid complications in job application processes, often seek to have their diagnoses removed. Furthermore, these requests sometimes involve threats and harassment directed at psychiatrists (Psychiatric Association of Turkey 2024a). Indeed, many psychiatrists experience problems in their daily practice regarding this issue (Aydin et al. 2021). Therefore, it is noteworthy that psychiatric diagnostic categories, which are intended to promote the well-being of patients based on psychiatric diagnoses, are accepted by employers, including bureaucratic authorities. This acceptance reflects an acknowledgment of the epistemic authority of psychiatry, as diagnoses are perceived as a genuine issue in the employment process. This has been effectively underscored by the practice commonly referred to as the right to “erase the diagnosis”. In this context, it is possible to say that what was initially recognized as a right, on the contrary, involves the risk of further marginalizing psychiatric conditions or diagnoses.

The main problem here is that individuals with psychiatric diagnoses are approached with an ethos of “protection from harm” rather than a rights-based approach. In Turkey, nearly all psychiatric diagnoses are treated as problematic in evaluation processes for certain professional groups. This reflects a systematic approach centered on “protection from harm” rather than rights protection. We hypothesize that a bias toward harm prevention shapes these evaluation practices. The reason for this is that many institutions, especially public institutions, ask for medical board reports that include psychiatric evaluations in job application processes. During these evaluations, physicians inevitably refer to previous diagnoses.

As a result, individuals with a diagnosis perceive the removal of their diagnosis as a means to avoid the potential negative interpretation of psychiatric problems within the framework of existing legislation. It is predicted that, in the long run, this bias will adversely affect help-seeking behaviors rather than reducing stigma and increasing the social acceptance of individuals with mental problems. This can be considered to be significantly related to the absence of a rights-based mental health act.

This phenomenon demonstrates that it is crucial to develop policies that enable patients to participate in both diagnosis and treatment processes and reduce their stigmatization. Otherwise, “pretending that there is no diagnosis”, which may have a beneficial aspect to the individual, is the product of an evaluation that is far from being a problem solver.

We believe that the issues identified in our case study in Turkey can be elucidated through several fundamental theoretical concepts. In this context, it can be argued that the ambiguous transition of psychological concepts into everyday language facilitates the misuse of epistemic power. In addition, it is possible to mention the significant effect of protection from a harm-based orientation rather than rights-based approaches. In fact, while it is challenging to establish a direct connection with existing legal regulations, the absence of rights-based protections for individuals with mental health issues contributes to the emergence of a de facto discriminatory process against these individuals. One of the most typical examples of this is the problematization of the decision-making capacities of almost all individuals over the age of 65 by notaries referring them to psychiatrists without any legal grounds regarding their daily affairs. However, the issue of discrimination against elderly individuals is considered an area that should be evaluated on the basis of rights and should not be discriminated against, especially in many countries with mental health laws (Yıldız 2018). A similar situation is the social acceptance of discourses based on conditions such as complete mental well-being, especially in order to enter public or some specialized jobs. In this context, it is ironic that many individuals are required to submit health report requests, including psychiatric evaluations, during job application processes. In the following section, the abuse of the epistemic power of psychiatry, the effects of the expanded use of psychiatric concepts, and the impact of harm-based ethical approaches in these and similar cases will be discussed.

4. Discussion

At the outset of the discussion, it is important to clarify the context in which the phenomenon of diagnosis removal occurs in Turkey. In fact, health board reports, including psychiatric evaluations, are mandated for job applications across many fields. Thus, paradoxically, the challenges faced by disciplines such as psychiatry, despite the recent acknowledgment of the right to “remove a diagnosis”, represent a profound contradiction. In other words, the phenomenon of de-diagnosis in Turkey reveals a complex paradox in the relationship between psychiatric epistemic power and its institutional implementation. This paradox exemplifies what Hofmann (2022) refers to as the expanding moral space of medicine, where medical authority is both summoned to fulfill its duty (or provide assistance) and simultaneously challenged in ways that may undermine its fundamental ethos (Hofmann 2019, 2022). Hofmann’s analysis is particularly relevant for psychiatry, where the expansion of medical authority into social and institutional spheres creates unique challenges. This expansion, while potentially useful in recognizing broader health needs, can lead to what Hofmann called “moral expansion” (Hofmann 2022). Thus, it can lead to a situation in which medical concepts go beyond their therapeutic purpose and become administrative and social control mechanisms.

In Turkey, this expansion is evident in the fact that psychiatric diagnoses have become both potential risk markers and somehow erasable concepts. In other words, the patient who seeks psychiatric support from the physician subsequently demands that the physician erase this diagnosis when faced with inquiries from employers (both public and private). In our opinion, such a problematic situation arises due to the bureaucracy’s and employers’ sloppy reading of diagnoses as “risk signs”, which includes all psychiatric diagnoses.

The legal implications of this situation are particularly important in the context of human rights and health law. The absence of comprehensive mental health legislation in Turkey has created a regulatory vacuum in which administrative practices can override both clinical decisions and patient rights. This is intensified by the fact that almost every psychiatric problem in Turkey is somehow seen as a problem in job application processes or is associated with significant concern about it. Ultimately, this gap in legal protection for individuals with mental health issues starkly contrasts with jurisdictions that have established mental health laws, where the rights of these individuals are safeguarded by clear legal frameworks (World Health Organization 2021).

It is important to note that while appropriate legal frameworks are needed, we recognize that mental health laws themselves can sometimes be used to limit rights even when designed to protect them. History shows that laws ostensibly created to safeguard vulnerable populations can be misused by authorities (van Voren 2010). Therefore, our emphasis is on human rights-sensitive practices rather than merely establishing laws. Any regulatory framework must carefully balance protection with respect for autonomy and include robust safeguards against potential misuse.

The situation in Turkey illustrates how the absence of robust legal protections can result in practices that, although seemingly aimed at safeguarding individual rights through mechanisms like de-diagnosis, can ultimately undermine both patient care and professional integrity. The most typical example of this is when individuals with a psychiatric diagnosis demand (sometimes forcibly) that physicians declare that they have inadvertently misdiagnosed them. While this may appear to be a right for the patient, it is crucial for everyone to ask what is actually happening legally and morally in light of this phenomenon. In our view, one of the contradictions evident in this situation is that, on one hand, there is an emphasis on the importance of mental health, with claims that individuals experiencing mental distress do not receive adequate support and that efforts are being made to find solutions. On the other hand, people who have visited a psychiatrist or received support at any point in their lives often encounter difficulties in their job applications. When they voice their concerns about this, rather than addressing the underlying systemic issues, they are reminded of their right to “remove the diagnosis”. It is reasonable to hypothesize that this will not reduce entrenched systematic discrimination.

In our opinion, the institutionalized handling of psychiatric diagnoses in Turkey, outside of mental health professionals, demonstrates how psychiatric epistemic power can be misused against the will of psychiatric professionals. This misuse occurs within what some authors describe as the social contract between medicine and society but extends beyond traditional boundaries into what might be termed a legal-administrative domain (Cruess and Cruess 2011). The current situation involves psychiatric information being requested for risk assessment and made to appear erasable by administrators in a simplistic and ill-considered manner. This has created a distorted relationship that jeopardizes both therapeutic relationships and legal rights. This situation demonstrates that psychiatrists, ethicists, medical philosophers, and lawyers should work together to raise awareness about the ways in which psychiatric diagnostic categories are explicitly or implicitly misused, especially by bureaucratic authorities.

The workplace discrimination faced by individuals with psychiatric diagnoses in Turkey is not merely theoretical but has practical manifestations in several sectors, particularly in the security and armed forces. As Aydin et al. (2021) argue, the mental health of those who will use a gun during duty is important both for the risk of self-harm and for public safety. However, the regulations designed to ensure this safety create significant barriers for individuals with any history of psychiatric treatment.

These regulations create a significant treatment disincentive effect. Individuals who need psychiatric support often avoid seeking help due to concerns about future employment prospects, particularly in security and armed service positions. This avoidance leads to untreated mental health conditions and potentially more serious issues after individuals begin serving in sensitive positions (Aydin et al. 2021). This situation has the effect of limiting individuals’ personal rights and reinforcing the stigma associated with psychiatric treatment. As a result, individuals must choose between seeking necessary care and maintaining employment opportunities. The practical consequence of these regulations is the phenomenon we are examining—individuals with past psychiatric diagnoses seeking to have those records removed to overcome employment barriers. This practice demonstrates how administrative requirements designed with public safety in mind can inadvertently undermine both individual rights to treatment and potentially public safety itself by discouraging appropriate mental health care.

A particularly worrying aspect of this phenomenon is its potential long-term impact on access to, and the quality of, mental health services. The perception of psychiatric diagnoses as something that should or can be erased for administrative convenience sends a problematic message to society regarding the legitimacy of mental health services. This results in what is known as a treatment disincentive effect, wherein individuals who could benefit from psychiatric treatment refrain from seeking it due to apprehensions regarding potential future employment or social repercussions (Ashcroft et al. 2014). This effect is particularly troubling from a public health and human rights perspective because it can disproportionately affect vulnerable populations who already face barriers to accessing mental health services (United Nations 2007; World Health Organization 2021).

The legal framework surrounding this issue requires careful consideration. Although patient rights legislation in Turkey, including Article 17 of the Patient Rights Regulation in Turkey, provides for the correction of medical records (Republic of Turkey Ministry of Health 1998), the interpretation and application of these rights in psychiatric contexts, as revealed by the present case may be contrary to both individual and public health interests. This necessitates what the United Nations Convention on the Rights of Persons with Disabilities (2007) calls a rights-based approach to mental health services, where protection against discrimination is balanced with access to appropriate care and treatment. The Convention explicitly addresses employment discrimination in Article 27, which acknowledges the right of persons with disabilities to work on an equal basis with others. It prohibits discrimination based on disability in all matters related to various forms of employment (United Nations 2007). This would require employers to make reasonable accommodations and prohibit using health status, including psychiatric diagnoses, as a basis for exclusion unless directly relevant to essential job functions. As Galderisi et al. (2024) note, the Convention shifts the focus from risk prevention to capacity building and supportive environments, challenging the harm-based approaches that currently dominate mental health policy in current psychiatric practice, including in Turkey.

In the context of Turkey, it can be asserted that this balanced approach is confined to legislation, with no rights-based practices evident in reality. Consequently, the strong demand from patients to eliminate psychiatric diagnoses may seem to be a primary reflex adopted by them. This scenario leads patients to view access to treatment as secondary to the challenges they may encounter during job applications. As a result, this situation poses a dual risk of discrimination and harm for patients, while physicians attending to them confront a significant moral dilemma regarding these demands (Aydin et al. 2021; Yıldız and Arda 2024; Kılınçel et al. 2021). Currently, issues such as malpractice concerns also play a fundamental role in physicians’ justification of their actions (Kaya and Erkal 2024; Liang et al. 2022). Therefore, concerns about erroneous diagnoses or meeting the demands related to these issues may trigger malpractice concerns and related problems, such as burnout.

The problematic spread of psychiatric concepts into administrative fields can be understood through what Haslam (2016) calls “concept creep”. This term describes how psychiatric and psychological concepts expand beyond their clinical origins to encompass broader phenomena in everyday life. For example, an issue that was previously seen as a simple problem in daily life may be reclassified as a psychiatric concern when viewed through a clinical lens, often with significant consequences for the individual (Haslam 2016).

In Turkey, this expansion has created a situation where psychiatric diagnoses function simultaneously as medical information and administrative barriers, particularly in employment contexts. The result is what legal scholars would call a “conflict of rights” (Martinez-Zorrilla 2011): the right to non-discrimination in employment directly conflicts with the right to accurate medical records and appropriate healthcare. Resolving this conflict requires a rights-based approach that prioritizes both access to mental healthcare and protection from discrimination, rather than the current harm-prevention focus that sacrifices individual rights to avoid perceived risks.

Taking into account the case and the discussion to date, it is important to note the relationship between psychiatric diagnoses and concepts such as risk or harm, which play a significant role in the emergence of such problems. In our opinion, this is largely due to the absence of a comprehensive mental health law in Turkey. In addition, the impact of the frequent conflation of mental health issues with concepts such as dangerousness and risk in existing legal regulations is also apparent. This creates a problematic legal and ethical framework in which harm-based morality dominates administrative decision-making processes, and potential risks are prioritized over individual rights and treatment needs (Haslam et al. 2020). This prioritization reflects broader societal trends in what Haslam calls the horizontal expansion of concepts of harm and raises important questions of proportionality and discrimination in administrative law (Haslam et al. 2021; Haslam 2016). The current approach is interesting in that individuals both have a psychiatric diagnosis and attempt to have it removed. However, it is often overlooked that psychiatric diagnoses or any medical diagnosis in its social context often privilege patients to access certain opportunities (treatment, therapy, sometimes rest, etc.) (Rogers and Pilgrim 2014). However, the discourse surrounding psychiatric issues, framed through the lens of risk and harm as evidenced in our case, may compel patients to disengage from the system or seek assistance through alternative channels. This tendency is linked to the cognitive theoretical framework of psychiatric problems at both the social and individual levels (Flusberg et al. 2023; Haslam 2005). In essence, this means the isolation of patients. In particular, this must not lead to a situation of discrimination or exclusion from a different perspective while mentioning the benefits of discourses on early diagnosis and the importance of access to psychiatry in terms of public and individual health (Galderisi et al. 2024).

From an ethical and legal standpoint, the solution does not lie in the facilitation of de-diagnosis; rather, it is in the development of comprehensive anti-discrimination protections that allow individuals to seek mental health care without the fear of future consequences. This approach is consistent with international human rights standards and can better serve individual and public health interests. In this regard, legislators and various professionals operating within this domain must engage in introspection regarding the essence and ramifications of their endeavors, extending beyond the present moment to encompass future projections.

5. Conclusions

Our analysis of Turkey’s diagnosis removal phenomenon reveals critical insights into the complex challenges facing psychiatric practice in contemporary institutional contexts. This case exemplifies how the absence of comprehensive mental health legislation can lead to paradoxical situations in which psychiatric epistemic power is both invoked and undermined, potentially harming both individual patients and public health interests.

Our investigation highlights three key conclusions. First, the institutional management of psychiatric diagnoses in Turkey illustrates how psychiatric epistemic authority can be misappropriated by bureaucratic entities, even in the absence of direct intent from psychiatric professionals. This misuse often occurs through the expansion of psychiatric concepts beyond clinical contexts, particularly in administrative and employment settings. Second, the current approach to managing psychiatric diagnoses in employment contexts reveals a problematic prioritization of harm-based moral reasoning over rights-based approaches. This prioritization has created a system in which individuals must choose between seeking mental health care and maintaining employment opportunities, effectively undermining both therapeutic relationships and access to care. Third, the case highlights the urgent need for regulatory frameworks that protect individual rights and professional integrity in psychiatric practice. Such frameworks must balance the legitimate needs of various stakeholders while preventing the misuse of psychiatric knowledge in administrative contexts.

In the future, this analysis is anticipated to indicate the necessity for some fundamental reforms in the governance and practice of mental health. A fundamental aspect of these reforms concerns the formulation of a comprehensive mental health legislative framework that is explicitly designed to safeguard individuals against discrimination while concurrently delineating the appropriate utilization of psychiatric information. While regulatory frameworks are essential, we emphasize that they must be carefully designed with explicit protections against potential misuse. The focus should remain on rights-based approaches that balance protection with autonomy, rather than frameworks that could inadvertently reinforce discrimination under the guise of protection. Such a framework should incorporate key principles from the UN Convention on the Rights of Persons with Disabilities, particularly Article 27 on employment and work and Article 22 on respect for privacy regarding personal, health, and rehabilitation information (United Nations 2007). As Gooding (2013) argues, the Convention provides a transformative blueprint for addressing systemic discrimination by shifting from substitute decision-making paradigms toward supported decision-making frameworks that maintain autonomy while providing necessary protections. The legislative framework should be complemented by the implementation of robust mechanisms to challenge discriminatory practices while maintaining clinical integrity. The creation of clear guidelines for the appropriate use of psychiatric knowledge in administrative contexts is also crucial, as is the establishment of protections that ensure that administrative practices do not deter access to mental health services. The findings of this study have broader implications for understanding how psychiatric epistemic power operates in institutional contexts and the importance of ethical reflexivity in preventing its misuse. The case study under consideration serves as a crucial reminder that protecting the integrity of psychiatric practice requires constant vigilance against the subtle ways in which institutional processes can corrupt its fundamental therapeutic mission.

Future research in this area should focus on collecting systematic empirical data on the prevalence of diagnosis removal requests and their impact on treatment-seeking behaviors. While the current analysis relies on available statements from professional organizations and legal documents, a more comprehensive understanding would benefit from direct surveys of both psychiatrists and individuals affected by these practices. Additionally, comparative studies examining how other countries with similar sociocultural contexts but stronger mental health legislation manage the tension between employment rights and mental health stigma could provide valuable insights for policy development in Turkey. We intend to pursue such empirical research to substantiate further the patterns identified in this analysis and to develop more targeted policy recommendations.

Author Contributions

Conceptualization, A.Y. and B.A.; methodology, A.Y. and B.A.; formal analysis, A.Y. and B.A.; resources, A.Y. and B.A.; writing—original draft preparation, A.Y. and B.A.; writing—review and editing, A.Y. and B.A.; supervision, B.A. All authors have read and agreed to the published version of the manuscript.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

No new data were created or analyzed in this study. Data sharing is not applicable to this article.

Conflicts of Interest

The authors declare no conflict of interest.

Footnotes

Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

References

Ashcroft, Rachelle; Silveira, Jose; Rush, Brian; McKenzie, Kwame. Incentives and Disincentives for the Treatment of Depression and Anxiety: A Scoping Review. The Canadian Journal of Psychiatry; 2014; 59, pp. 385-92. [DOI: https://dx.doi.org/10.1177/070674371405900706]

Aydin, Sare; Batmaz, Sedat; Aslan, Esma Akpinar; Celikbas, Zekiye. Evaluation of the Procedures of People Applying to the Psychiatry Outpatient Clinics to Remove Their Past Diagnosis. Dusunen Adam: The Journal of Psychiatry and Neurological Sciences; 2021; 34, pp. 392-93. [DOI: https://dx.doi.org/10.14744/DAJPNS.2021.00162]

Cruess, Sylvia R.; Cruess, Richard L. Medicine’s Social Contract with Society: Its Nature, Evolution, and Present State. Psychiatry’s Contract with Society: Concepts, Controversies, and Consequences; Bhugra, Dinesh; Malik, Amit; Ikkos, George. Oxford University Press: Oxford, 2011; pp. 123-46.

Flusberg, Stephen J.; Dellavalle, Michael; Thibodeau, Paul H. How Metaphor and Political Ideology Shape Lay Theories of Mental Disorders. Journal of Social and Clinical Psychology; 2023; 42, pp. 293-322. [DOI: https://dx.doi.org/10.1521/jscp.2023.42.4.293]

Fulford, Kenneth W. M.; Smirnov, A. Y. U.; Snow, E. Concepts of Disease and the Abuse of Psychiatry in the USSR. The British Journal of Psychiatry; 1993; 162, pp. 801-10. [DOI: https://dx.doi.org/10.1192/bjp.162.6.801] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/8330112]

Gaebel, Wolfgang; Zielasek, Jürgen; Cleveland, Helen-Rose. Psychiatry as a Medical Specialty: Challenges and Opportunities. World Psychiatry; 2010; 9, pp. 36-38. [DOI: https://dx.doi.org/10.1002/j.2051-5545.2010.tb00265.x]

Galderisi, Silvana; Appelbaum, Paul S.; Gill, Neeraj; Gooding, Piers; Herrman, Helen; Melillo, Antonio; Myrick, Keris; Pathare, Soumitra; Savage, Martha; Szmukler, George . Ethical Challenges in Contemporary Psychiatry: An Overview and an Appraisal of Possible Strategies and Research Needs. World Psychiatry; 2024; 23, pp. 364-86. [DOI: https://dx.doi.org/10.1002/wps.21230]

Gooding, Piers. Supported Decision-Making: A Rights-Based Disability Concept and its Implications for Mental Health Law. Psychiatry, Psychology and Law; 2013; 20, pp. 431-451. [DOI: https://dx.doi.org/10.1080/13218719.2012.711683]

Haslam, Nick. Dimensions of Folk Psychiatry. Review of General Psychology; 2005; 9, pp. 35-47. [DOI: https://dx.doi.org/10.1037/1089-2680.9.1.35]

Haslam, Nick. Concept Creep: Psychology’s Expanding Concepts of Harm and Pathology. Psychological Inquiry; 2016; 27, pp. 1-17. [DOI: https://dx.doi.org/10.1080/1047840X.2016.1082418]

Haslam, Nick; Dakin, Brodie C.; Fabiano, Fabian; McGrath, Melanie J.; Rhee, Joshua; Vylomova, Ekaterina; Weaving, Morgan; Wheeler, Melissa A. Harm Inflation: Making Sense of Concept Creep. European Review of Social Psychology; 2020; 31, pp. 254-86. [DOI: https://dx.doi.org/10.1080/10463283.2020.1796080]

Haslam, Nick; Tse, Jesse S. Y.; Deyne, Simon De. Concept Creep and Psychiatrization. Frontiers in Sociology; 2021; 6, 806147. [DOI: https://dx.doi.org/10.3389/fsoc.2021.806147] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/34977230]

Hofmann, Bjørn. Expanding Disease and Undermining the Ethos of Medicine. European Journal of Epidemiology; 2019; 34, pp. 613-19. [DOI: https://dx.doi.org/10.1007/s10654-019-00496-4]

Hofmann, Bjørn. Managing the Moral Expansion of Medicine. BMC Medical Ethics; 2022; 23, 97. [DOI: https://dx.doi.org/10.1186/s12910-022-00836-2]

Kaya, Burak; Erkal, Emre. Evaluation of Malpractice Fear, Burnout, and Spiritual Well-Being among Physicians in Turkey: A Descriptive Study. Journal of Religion and Health; 2024; [DOI: https://dx.doi.org/10.1007/s10943-024-02168-4]

Kılınçel, Oğuzhan; Erzin, Gamze; Kılınçel, Şenay; Senol, Sevin Hun; Ceylan, Deniz; Acar, Murat; Capraz, Necip. Profile of Young Psychiatrists: A Cross-Sectional Survey Study from Turkey. Turkish Journal of Clinical Psychiatry; 2021; 24, pp. 278-87. [DOI: https://dx.doi.org/10.5505/kpd.2021.15428]

Liang, Fei; Hu, Shu; Guo, Youqi. The Association between Fear of Malpractice and Burnout among Chinese Medical Workers: The Mediating Role of Legal Consciousness. BMC Psychiatry; 2022; 22, 358. [DOI: https://dx.doi.org/10.1186/s12888-022-04009-8]

Martinez-Zorrilla, David. The Structure of Conflicts of Fundamental Legal Rights. Law and Philosophy; 2011; 30, pp. 729-49. [DOI: https://dx.doi.org/10.1007/s10982-011-9112-3]

Pellegrino, Edmund D.; Thomasma, David C. A Philosophical Basis of Medical Practice: Toward a Philosophy and Ethic of the Healing Professions; Oxford University Press: New York, 1981.

Personal Data Protection Authority. Summary of the Decision of the Personal Data Protection Authority of 06/02/2020 and Number 2020/93 on ‘Complaints Regarding the Correction/Deletion of Past Health Data’. 2020; Available online: https://www.kvkk.gov.tr/Icerik/6875/2020-93 (accessed on 24 December 2024). (In Turkish)

Psychiatric Association of Turkey. About the Request for Removal of a Previous Psychiatric Diagnosis. 2024a; Available online: https://psikiyatri.org.tr/3891/gecmise-yonelik-psikiyatrik-tani-sildirme-talebi-hakkinda (accessed on 5 January 2025). (In Turkish)

Psychiatric Association of Turkey. Meeting with the Law Office Regarding the Request for Removal of Past Psychiatric Diagnosis. TPD Bülteni; 2024b; 27, 50.(In Turkish)

Republic of Turkey Ministry of Health. Regulation on Patient Rights. 1998; Available online: https://www.mevzuat.gov.tr/mevzuat?MevzuatNo=4847&MevzuatTur=7&MevzuatTertip=5 (accessed on 24 December 2024). (In Turkish)

Rogers, Anne; Pilgrim, David. Mental Health Work and Professions. A Sociology of Mental Health and Illness; 5th ed. Rogers, Anne; Pilgrim, David. McGraw-Hill Education: New York, 2014; pp. 107-23.

Tekin, Şerife; Bluhm, Robyn. Introduction to Philosophy of Psychiatry. The Bloomsbury Companion to Philosophy of Psychiatry; Tekin, Şerife; Bluhm, Robyn. Bloomsbury Academic: London, 2019; pp. 1-17.

United Nations. Convention on the Rights of Persons with Disabilities. 2007; Available online: https://www.ohchr.org/en/instruments-mechanisms/instruments/convention-rights-persons-disabilities (accessed on 10 December 2024).

van Voren, Robert. Political Abuse of Psychiatry—An Historical Overview. Schizophrenia Bulletin; 2010; 36, pp. 33-35. [DOI: https://dx.doi.org/10.1093/schbul/sbp119]

World Health Organization. Guidance on Community Mental Health Services: Promoting Person-Centred and Rights-Based Approaches; World Health Organization: Geneva, 2021; Available online: https://iris.who.int/handle/10665/341648 (accessed on 15 December 2024).

Yıldız, Abdullah. To Be 65 Years Old in Turkey: Is It the End of Being an Individual and Competent?. Turkish Journal of Bioethics; 2018; 5, pp. 117-25. (In Turkish) [DOI: https://dx.doi.org/10.5505/tjob.2018.89410]

Yıldız, Abdullah; Arda, Berna. Being a Psychiatrist in the Evaluation Process of a Gun License Report: Morally Challenging Experience—A Qualitative Study from Turkey. Psychiatry, Psychology and Law; 2024; 31, pp. 873-95. [DOI: https://dx.doi.org/10.1080/13218719.2023.2222401] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/39318883]