Paul McHugh, Professor Emeritus at
Johns Hopkins University, enjoys a little bit of controversy. He likes to poke
and prod at some of the shibboleths, or even the sacred cows of psychiatry, and
he is not afraid to stir the possum, as some would put it. This collection of
essays and opinion pieces continues this arc of interest and addresses some of
the most contentious points in current debate. He is not averse to calling our
attention to what he believes are the emperor’s new clothes, but he is
sometimes hard to classify. On occasion he seems to be coming from the Right
(he has sat on Bush’s Presidential Council for Bioethics and the U.S.
Conference of Catholic Bishops Review Panel on Sexual Abuse of children by
clergy), on others from another direction altogether. He may be asking to be
judged by his critics rather than his friends.

The essays that make up this
collection have been written over the last 15 years and cover current
commentary, such as an essay concerning the Terri Schiavo case, entries into
the psychology of public events, such his piece entitled "A psychiatrist
looks at terrorism", general pieces on the state of the art or those with
a longer perspective, such as his eloquent foreword to an edition of Karl
Jaspers’ General Psychopathology in which he talks quite movingly of the
contribution Jaspers has made to the understanding of the human experience. He
ventures into psychiatric history and even offers his own take on the tragedies
of Shakespeare, and reckons he would have made fine psychiatrist if he hadn’t
been so busy elsewhere. The essays have been published in a variety of forms,
from newspaper columns to academic journals to serious and weighty books. And
it is perhaps the range and scope of the essays that make them so intriguing.

No one would read the collection
and agree with every point, but in almost every essay there are points of
contention and argument that make the reader stop and revaluate a previous
opinion. McHugh is not one for floating with the tide of consensus. Like many a
maverick, and it may not be entirely unfair to call him that, he will move from
position to position across the ideological spectrum according to the issue at
hand. He will cause nods of agreement and scowls of disapproval in equal
measure, often by the same person, sometimes within the same paragraph. For
example, he takes the libertarian psychiatry of Thomas Szasz to task for its scorn
of sincere efforts to help those severely afflicted by mental illness – he
regards such an approach as arrogant and trivializing. Szasz is criticized for
allowing, even condoning, the suffering of individuals if they do not wish for
treatment. Then he will argue, with equal passion, that Terri Schiavo should
not have been allowed to die even if she did have irreparable brain damage, may
have been in a persistent vegetative state and may have expressed an opinion
some years previously. It may be suggested that what McHugh sees as the common
link is the welfare of the patient, and the primary responsibility of all
health care workers to preserve the dignity of that.

Thus, he has little time for grand
theorizing. He is one psychiatrist who is glad to see the crumbling of the
Freudian empire (although as an American he may have been more afflicted by
this than most), and sees the world through pragmatic and empirical eyes. "What
do we know?" he would ask. "And what do we know we don’t know?"
Finally, "What do we presume?" He is cautious of what he calls ‘spectral
evidence’ and recognize that psychiatry is by no means a perfect science and is
as prone to fads, fashions and the same pure daftness as any other field of
human endeavor.

McHugh seems to have learnt the
meaning of hubris. Indeed, as he details many of the fads and fashions that
have bedeviled psychiatry, from the interpretation of Freudian theory as
somehow empirical rather than poetic, or the anti-psychiatry movement that may
have had some cause to draw attention to the overconfidence of the discipline,
or the vogue for sex change surgery to the pandemic of repressed memories of
abuse, he only wishes that psychiatrists and others would "do no harm"
rather be filled with the impervious certainty of the righteous. He argues that
the harm caused by these moments of overconfidence – and he does believe that
they harmed many people – came not from malice, but from hubris. That alone may
be reason enough for reading McHugh. You may not agree, but he should make you
think.

© 2006 Mark Welch

Mark
Welch, Ph.D. Assistant Professor in the Faculty of Nursing at the University of
Alberta, Edmonton, Alberta and Co-Director of the PAHO/WHO Collaborating Centre
for Nursing & Mental Health.

Categories: Ethics, Philosophical