When we figure medical practice as warfare, an individual clinician may be either a dutiful combatant or a conscientious objector. The rhetorical structure of this choice means that clinicians may exercise their consciences by loyally joining or disloyally exiting the medical ranks' battle against disease. But there are alternatives to loyalty and exit, and within psychiatry, these alternatives have transformed clinical services. In the 1970s, gay activists successfully resisted the American Psychiatric Association's characterization of homosexuality as a mental illness. In the 1940s, Mennonite nonresisters created the Mennonite mental health movement as a noncoercive alternative to standard psychiatric care. These gay activists and Mennonite volunteers opened communal alternatives to violence. When clinicians pursue nonviolent conflict about contested medical practices, they practice with the integrity that develops out of engaging in moral dialogue. Medicine becomes something more than a war in which individuals serve or to which they object: instead, it becomes a prudential set of practices that advance through principled disagreements and that expand the imagination of clinicians as they respond to the vulnerability of the people they meet as patients.


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pp. 434-451
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