Ethics Commentary

A doctor whose practice may threaten the well-being of his patients must surely be reported to the proper authorities. But the case of Dr. G opens up some deeper issues. Dr. G can legitimately be understood as a clear case of mental illness, but there is another possible view of what is going on, that he has had a religious experience. With respect to Dr. G’s fitness to practice, psychiatrists will have rather different responsibilities depending on which of these views of his experiences they take. A difficulty that has to be faced in cases like that of Dr. G is how to make the distinction between mental illness and religious experience, and beyond that, to what extent society can make room for both.

It is understandable that the psychiatrist and other health workers who come into contact with this patient would think he has a psychosis and would want him to take anti-psychotic medication. What else are they to think of this man who hears voices (one of the possible diagnostic criteria for schizophrenia), which have become more frequent and insistent over time, and now seem to be exercising control over his actions (another of the possible diagnostic criteria for schizophrenia) — commanding him to walk along the expressway and telling him that he will one day be a saint? This pattern of behaviour must surely be very familiar to them, from their textbooks and to some extent in their day-to-day practice, though no doubt the details vary from patient to patient.

In Dr. G’s case, much about what has happened — and perhaps ought to happen — fits in with the practices of major societal institutions such as the police and the health authorities, and fits well with patterns of behaviour witnessed before and which professionals have been trained to recognise and to respond to. Moreover, the “mental health” response is a well-practised one, and one which, I would venture to say, has done much good in the lives of many, and may perhaps do much good in the life of Dr. G, for example by enabling him to return to his usual life and practise as a doctor.

But are these the only possible reactions in Dr. G’s case — and are they the right ones? One need not subscribe to any kind of scepticism in general about mental illness to raise questions about the standard reactions of police and health services in a case such as this. To understand Dr. G’s actions, one could appeal, instead, to another familiar enough pattern — though it is perhaps rather weakly represented in more secular forms of modern thinking — into which Dr. G’s sort of behaviour may also fit. The idea of someone receiving a revelation from God and altering their whole life is a common enough trope of religious teaching. In the Christian tradition, Jesus’ disciples were plucked, as it were, from their various ordinary lives — fishermen becoming fishers of men — and seemingly overnight they took on a new life. There was something in the voice of Jesus which called to them, and which convinced them of its authority.

An interesting case, with some parallels to that of Dr. G, is reported by Maurice O’Connor Drury. From 1947, Drury practised as a psychiatrist (Danger of Words: xxviii),¹ but had earlier been a philosophy student of Wittgenstein, and retained a strong relationship with him up until the philosopher’s death in 1951. Here is the case as he introduces it:

Mr. D was sixty-seven years of age, a retired civil servant, a man of great piety who devoted his retirement to prayer and works of charity. His wife had no sympathy for what she regarded as a morbid religiousness. One morning at Mass he heard the words of the Gospel: ‘Go and sell all that thou hast and give to the poor and thou shalt have treasure in heaven, and come and follow me.’ These words spoke to him like a command. And straightaway he left the church, putting all the money that was on him into the poor-box at the...