Coercive Therapy in East and West: A Brief Review

By Firoozabadi, Ali; Bahredar, Mohammad Jafar | Iranian Journal of Psychiatry, April 1, 2009 | Go to article overview

Coercive Therapy in East and West: A Brief Review


Firoozabadi, Ali, Bahredar, Mohammad Jafar, Iranian Journal of Psychiatry


The physician-patient relationship has undergonene significant changes in recent decades in Western countries. Taking a client-centered approach, society has given more autonomy and freedom to patients. The patient is regarded as a consumer who is looking for the best and most scientific approach and is free to choose among different methods of treatment. The role of the physician is only a guiding role. On the other hand, in Eastern countries, we still experience a parent-child relationship in therapeutic settings. Eastern patients expect direct advice from their physicians, and the family has an important role in decision-making. An approach which is considered coercive in Western countries could still be a useful and acceptable one in Eastern cultures. The main goal of the authors in this paper is to compare different attitudes towards this issue in Eastern and Western cultures..

Keywords: Cross-cultural comparison, Physician-patient Relation, Paternalism

Iran J Psychiatry 2009; 4: 44-45

Western and Eastern countries are not in a similar stage of growth and development. Western countries are in the postmodern era which is characterized by a reaction against the Age of Reason, and its fundamental principles are rationalism, materialism, and reductionism. Postmodern philosophers attack the enlightenment concept of truth and reject any mettanarative. All claims of proof or truth are attacked with suspicion. Science has expanded its boundaries to include different validation processes, perspectives and types of knowledge. In particular, it requires scientific expertise to meet public concern. On the other hand, in pre-modern societies, the individual is not recognized as an independent entity ; and people behave in a collective manner. The self is not autonomous but is connected to an in-group , and directs its energy towards achieving group rather than personal goals. Priority is given to interpersonal responsibilities rather than to justice and individual rights (1).

Under the influences of economic development and the emphasis on human autonomy and independence, social relationships have become more and more consumer centered. Quality replaces truth as an ongoing principle. These changes lead to an unnecessary generalization that shows its effect on the physician-patient relationship. We have a democratization of medicine, including psychiatry with emphasis on a patient-centered approach. The idea that clinical goodness has to do with treating a patient's illness as the patient defines it is at the heart of the postmodernist trend of defining medical knowledge and skill by what the consumer demands. In the

postmodern mind, scientific discovery is a social process rooted in discourse among the scientific community.

It has been said that coercive treatment is acceptable only on two conditions:1) If the patient cannot make an autonomous decision about the treatment ; and 2) if the treatment is in the patient's authentic interest (2). "Autonomy is expressive of who you are. Being autonomous and being someone are tightly connected" (2). As Ganzini and Lee (3) said: "An inauthentic decision is not a truly autonomous one". Beachamp and Childress (4) suggested that the basic conditions for an action to be autonomous are: 1) Intentional; 2) Carried out with an understanding of the situation; 3) Done without controlling influences. Thomas Schramme maintains that coercion does not only consist of actions that ignore the actual choice of a person, but also of threats that determine the free formation of his will and are against the autonomous will of the patient. Patients can be coerced into doing something or giving consent to certain actions by means of external sources. ( 5).

In this paper, we suggest that in both Western and Eastern culture, autonomy is still an unattainable goal due to different causes. Coercive treatment cannot be separated from coercive society. Hence, we have to consider different systems of coercion instead of taking in to account non-coercive treatments. …

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