Here the therapist tries to explore the (not so straight forward) needs of the clients..
~ by Dr Ravindra Agrawal
Not so ethical conversation…the unanswered questions
For any psychiatrist , a patient in complete remission and back to full range of functioning is a mark of work satisfaction.
Sunita ( name changed) is a 38 year old lady who gives me the reasons to qualify for above. She was married at the age of 28 yrs and the stress of marital duties unmasked her schizophrenia 2 years into her marriage. This resulted in her being scorned and abused. She did not get any support resulting in her illness becoming worse. There followed serious of hospitalizations culminating in her husband divorcing her.
Post returning to her parents, Sunita began to get proper, consistent treatment and support. She recovered rapidly; has been in full remission for past 4 years. She now is also employed.
About 6 months ago She expressed about her desire to remarry. She was forthcoming that she longs for companionship and was trying to convince her parents who were hesitant, for they remembered the wretched life she had to undergo in her previous marriage. I, on my part was supportive of the decision if her would-be husband is made well aware of her illness and is willing to support her if she needs help. I emphasized to her parents that a loving and supportive partner can indeed help improve her quality of life further. Thus satisfied they all began to look for a suitable groom for her
Recently, Sunita informs me that she has found a 42 year old gentleman Ramesh (name changed) whom she wishes to marry. Ramesh visited her house along with his family and they too have expressed their agreement for this match.
However, there was a catch!
Sunita has decided not to inform Ramesh about her illness. She says that if she informs them about her mental illness, they may back off and change their mind. She says that she is not prepared to stay single anymore and wants to get married anyhow.
I put forth an ethical argument that this will amount to dishonesty to Ramesh as it may affect his life significantly. She was countered this by saying that Ramesh was still single despite being 42 years old. Additionally, she has done her own background check on him and has come to know that he drinks everyday. There may be problems in his life or about him, which he is not telling her. It is quiet possible that he will get drunk and beat her. She did not feel that by not telling him about her mental illness she is doing anything wrong.
When I asked her whether she is able to envisage what may happen if they come to know about she having withheld this important information or what if she has a relapse; she replied that she is prepared to face the consequences. Even if it means that her Ramesh may decide to leave her (as in her previous marriage), she is willing to take that risk in return to a few months of companionship.
She further went on to say that if I can guarantee that he will not break the marriage she is happy to bring him to me to tell him about her illness.
What should do I do now? or
What should any psychiatrist or mental health professional do in such circumstances?
Should we take the high moral ground and insist on what is right here?
But then what is definition of what is right?
Should we expect our clients to do what is ideal even when the society in which we and our patients live is not ideal and is full of stigma towards mentally ill?
I did do a quick online search to look for any literature on my ethical predicament but was able to only find many (valuable) articles of legal aspects of one of the partner having mental illness, on one’s ability to marry and whether there are valid grounds for annulment of marriage on the basis of insanity. I couldn’t find much data on ethical aspects and on what we psychiatrists should do when faced with such situations when a patient under our treatment is intent on not disclosing his/ her mental illness to the would be spouse.
Is there a mandatory obligation on the mental health professional to disclose for the sake of another person whose life may get irreversibly affected?
Should this be the sole discretion of the client and our duty is to provide the right information irrespective of the decision taken?
P.S. The above questions are meant to highlight the maturity of thoughts required in the mental health discourse. There are perhaps no right or wrong answers. The therapist needs to be open minded to keep client's need in perspective.