Mental illness poses particular ethical challenges for public life, and one of the specific challenges is the issue of when ought we disclose mental illness being suffered by another person. On the surface, the answer ought to be never. Such disclosure will normally constitute a breach of privacy, may stigmatize a person, and, most importantly, may also damage a person who is already vulnerable. However there may be more complex factors and circumstances where it may be appropriate to disclose the fact that a person is suffering from a mental illness.
One circumstance wherein it may be appropriate to disclose that a person is suffering from a mental illness is where it can reasonably be assumed that the mental illness will impact upon how a person functions in a role of responsibility within an organization. Often it is not obvious that a person is suffering from a mental illness which impacts upon his or her functioning. Further, it may not be obvious to the person him or herself that he or she is suffering from an impaired judgment due to the illness. Lack of self-knowledge is often part of the impairment.
Another obvious circumstance where disclosure may be appropriate is where there has been some form of prior self-disclosure by the person involved. Such self-disclosure may be unwitting, but it is still arguable that once a person identifies him or herself as suffering from a mental illness, then in certain contexts the person waives the right to privacy. This doesn’t entirely deal with the problem of the vulnerability of those suffering mental illness, and the possibility that further identification of such persons as suffering from mental illness may further damage them.
Strangely, the duty of care towards those suffering from mental illness can be argued to support some limited disclosure of the fact that a person is suffering from a mental illness. Within any organization, there is either an implied or explicit duty of care to protect those with mental illness, and continuing to work within an organization may place a person at risk. Moreover, it may be difficult to exercise the duty of care if those in authority don’t know a person is suffering from mental illness. And those suffering themselves from mental illness are not always fully aware of how their illness may be impacting upon them.
Similarly, there is a responsibility within organizations to assist those with mental illness to participate fully in the life of the organization. This can involve putting in place support mechanisms, or making special allowances for the fact that a person is suffering from mental illness. However it may be difficult to achieve this if one doesn’t know that a person is suffering from a mental illness, and thus the need for disclosure.
The duty of care also applies to protecting the general population of an organization. If a person suffering from a mental illness is prone to engage in bullying or aggressive conduct towards others, as part of his or her mental illness, then it is arguable that those in authority within an organization have a responsibility to prevent this from happening. Further, if his or her negative behaviour towards others is reasonably foreseeable, then those within the organization have a responsibility to prevent the bullying or aggressive behaviour from occurring. If a person knows that a key person in an organization suffers from a mental illness which tends to make him or her aggressive, then it is arguable there is a responsibility to disclose this.
Mental illness and the political process pose special challenges. In Australia, there is an implicit recognition that it might not be appropriate for those with mental illness to be involved in the political process, namely through Section 93(8) of the Commonwealth Electoral Act (1918), which indicates those of “unsound mind” ought not to be on the electoral roll. As it is a pre-requisite for election to parliament that a person must be on the electoral roll, the above provision thus also functions to exclude those of “unsound mind” from election to parliament. Section 93(8) has been the subject of some criticism by mental health advocates, although it does stand as an indicator of the historic caution we have towards allowing those with mental health issues into positions of power and responsibility in politics, and even in the decision-making process.
Of course, in discussing mental health and public life, one needs to recognize that many of the great political and moral leaders of the world suffered, at times, from debilitating depression, perhaps the most common of contemporary mental illnesses. In politics, Abraham Lincoln and Winston Churchill both suffered from deep depression. The theologian Dietrich Bonhoeffer and civil rights campaigner Martin Luther King Jr also suffered, at times, from depression. If we exclude those with mental health issues from our public life, we may well impoverish that same public life.
Clearly mental health is an area with many moral and ethical complexities. One may well argue that the key element in any discussion needs to be compassion, although what this means in practice is not always clear. One of the encouraging signs is that there now seems to be more public discussion regarding mental health, and the stigma regarding mental illness seems to be diminishing. This may well assist in encouraging a mature discussion about mental health and public life, including the key of issue of when and how mental illness needs to be disclosed.
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