Preprint Patient objectification in psychiatry, 2026, Sakakibara

[Dolphin]

Patient objectification in psychiatryの表示

jxiv.jst.go.jp

Patient objectification in psychiatry
Eisuke Sakakibara1

Abstract

Psychiatry is characterized by several distinctive features: (1) it sometimes provides treatment against a patient’s willor preferences; (2) it intervenes in patients’ minds through physico-chemical means, such as psychotropic medication; (3) it treats patients’ utterances not as reports of facts but as signs of illness; and (4) it may attribute patients’ inappropriate words or actions to mental disorder, thereby exempting them from responsibility ordinarily borne by a moral agent. This paper reexamines the ethical unease inherent in these psychiatric practices through the lens of patient objectification and investigates the conditions under which such objectification may be justified.

Within feminist theory, objectification has been analyzed as a multifaceted phenomenon encompassing at least ten aspects, including instrumentality, denial of autonomy, inertness, fungibility, violability, ownership, denial of subjectivity, reduction to body, reduction to appearance, and silencing. Building on this framework, this paper examines objectification in medicine more generally by distinguishing four domains: decision-making, therapeutic intervention, information gathering, and the psychological defense of medical staff.

Psychiatry likewise involves patient objectification across these domains. However, because the symptoms of mental disorder extend into capacities central to agency—namely beliefs, emotions, and actions—psychiatric objectification stands in especially strong tension with respect for persons. Nevertheless, it cannot be regarded as uniformly impermissible. Mental disorders can impair the capacities that underpin personhood, and psychiatry aims at treating such impairments. Objectification can therefore be justified when it is undertaken for the patient’s benefit, supported by sufficient justification, and restricted to the minimum necessary extent.

Keywords:anti-psychiatry; disorders of agency; involuntary treatment; objective attitude; personhood

 

[Utsikt]

Objectification can therefore be justified when it is undertaken for the patient’s benefit, supported by sufficient justification, and restricted to the minimum necessary extent.

In theory, probably, but the author doesn’t seem to spend any time deliberating to what extent we can know if the interventions are beneficial to the patient, and if we have sufficient evidence of benefit for the interventions that are normally used.

 

[Jonathan Edwards]

In theory, probably, but the author doesn’t seem to spend any time deliberating to what extent we can know if the interventions are beneficial to the patient, and if we have sufficient evidence of benefit for the interventions that are normally used.

Yes, but that applies to all medicine maybe. A good psychiatrist will make fair decisions about things like this. I have seen it in action and the way it can be lifesaving. A bad psychiatrist will be lazy and get things wrong. Same for physicians.

But the whole narrative here seems to me very naive.

"These four cases share a common feature: in each, the psychiatrist fails to treat the patient fully as a person and instead treats the patient, in certain respects, as a thing."

As if people didn't treat each other like things all the time and as if the concept of 'person' actually holds water in the way implied. The quoting of Kant shows how simple-minded it all is. Most people get to understand the tensions between interests in personal relations fairly early on in their teens.

The reality of major mental illness is that it blows apart any analysis of this sort. I think it is insulting to people with mental illness to turn their problems into political chips like this, to be honest.

 

[Dolphin]

Third, the synecdochal relation may be compromised when patients experience subjectively distressing symptoms despite the absence of objectively identifiable abnormalities. In conditions such as chronic fatigue syndrome and fibromyalgia—where pathophysiology remains poorly understood and diagnosis relies largely on patients’ reports—physicians may regard patients’ complaints with suspicion, sometimes assuming fabrication or exaggeration (Blease et al. 2017; Buchman et al. 2017). Yet, as the adage “absence of evidence is not evidence of absence” reminds us, equating the absence of objective findings with the dismissal of patients’ subjective experiences constitutes a morally problematic form of objectification.

 

[Jonathan Edwards]

"physicians may regard patients’ complaints with suspicion, sometimes assuming fabrication or exaggeration (Blease et al. 2017; Buchman et al. 2017). Yet, as the adage “absence of evidence is not evidence of absence” reminds us, equating the absence of objective findings with the dismissal of patients’ subjective experiences constitutes a morally problematic form of objectification."

Surely, the error here is subjectification - assuming that you know what this 'person' is really feeling when in fact you have got the person wrong. What the physician should do is objectify. To have an evidence base for the natural history and treatment response profile for human beings who report in this way without any assumption about what is going on inside their heads and to act in an objective manner accordingly.

 

[Trish]

Third, the synecdochal relation may be compromised when patients experience subjectively distressing symptoms despite the absence of objectively identifiable abnormalities. In conditions such as chronic fatigue syndrome and fibromyalgia—where pathophysiology remains poorly understood and diagnosis relies largely on patients’ reports—physicians may regard patients’ complaints with suspicion, sometimes assuming fabrication or exaggeration (Blease et al. 2017; Buchman et al. 2017). Yet, as the adage “absence of evidence is not evidence of absence” reminds us, equating the absence of objective findings with the dismissal of patients’ subjective experiences constitutes a morally problematic form of objectification.

This shouldn't even need to be mentioned in a paper about psychiatry, given that ME/CFS is not a psychiatric disorder. By including it, they imply ME/CFS is the business of psychiatry, and the problem is that about objectifying/subjectifying. The problem is they should never be seeing us in the first place.