Comment by rubbingalcohol | Hacker News Reader

Comment by rubbingalcohol | Hacker News Reader

When I was a kid, I had a psychologist who ratted out many of the things I told him, supposedly "in confidence," to my parents. It was a deceptive abuse of doctor-patient confidentiality , and I promptly stopped talking to him when I found out he had deceived me.

In general, I would say "no." It's never okay for a psychologist to deceive their patients, or to experiment on people without their knowledge. Talking to a professional about mental health issues puts a person in a vulnerable position. When a psychologist abuses that vulnerability, it is an extreme betrayal that would make it less likely for the patient to be able to open up to anyone else about their issues, thus obstructing their ability to receive mental health treatment in the future.

Performing psychological experiments on people without their knowledge could similarly aggravate underlying psychological issues, with potentially serious consequences. This is some Nazi doctor-level shit.

Mental health issues are in some ways more problematic than physical health issues, because culturally we don't take them as seriously as "real" diseases. Too often our medical system treats mental health issues as a moral inadequacy, not a health issue. The fact that we even think twice about the question posed in the OP shows how seriously messed up our priorities are.

> It's never okay for a psychologist to deceive their patients

This is not true, as there are certain cases where doctor/patient confidentiality is explicitly allowed to be breached - if you credibly threaten the practitioner or other people, then the duty of care changes. If you credibly threaten to murder someone, then a mental health staffer is entirely within their rights to breach your confidence.

Your own situation you describe, of course, does not appear to be one of those cases.

He's not talking about the current status of the law. The law has absolutely zero to do with right and wrong. He's talking about morality. He seems to believe that if you agree to help someone with their mental problems, that you shouldn't turn around and betray their trust for ANY reason -- that's the only way any real trust can be developed. I tend to agree.

If someone said "you can trust me, except for this laundry list of things you can say in which case I'll have you locked in a cage and force you to take medication against your will" would you trust them? Because that's the reality of every conversation with a psychologist currently -- it's just not made explicit.

I said 'duty of care', not 'law'. If you credibly threaten the practitioner or third parties, then morality most definitely says you should protect those people from harm. I mean seriously, make the moral comparison: break someone's trust or let someone get maimed or die.

To put it bluntly, it's stupid to demand a practitioner ignore credible threats (stress credible) against their own life, in favour of some weirdly puritan moral theory. Practitioners are people too, with their own lives, loves, and foibles... and, frequently, their own mental illnesses. They're not any more disposable than the patients they treat. Just because you're interested in helping someone doesn't mean that you commit to do so even unto your own death.

> If someone said "you can trust me, except for this laundry list of things you can say in which case I'll have you locked in a cage and force you to take medication against your will" would you trust them?

Psychologists can't prescribe medicine or force detention - you're tilting at a windmill here. Psychiatrists can do both, though with some limitations on how they can detain. Similarly, credible threats are hardly a 'laundry list'.

When you see a psychiatrist or psychologist they must not say "anything you tell me is confidential". They must say (something like) "I'll treat everything you say as strictly confidential, although their are some important exceptions. I have a legal duty to report child abuse; and if I think you pose a risk of harm to another person I have to divulge that".

This allows confidentiality within the law and does not deceive the patient.

You are now just arguing just to argue. Your response is irrelevant to the discussion.

It's not clear to me that your experience was unethical. As parents are the legal guardians of kids, where is the responsibility -- to the adult, or to the child?

Your third paragraph is very hyperbolic and taints the otherwise reasonable points I believe you made.

I would say that the the responsibility of the psychologist (and all doctors) is to their patient, which in this case is the child. That does not necessarily mean that it is unethical to disclose what was said to the parents, as doing so may be in the best interest of the child.

However, there is a significant second order concern with violating confidentiality. In future instances, the child may be less willing to speak "in confidence" with a psychologist.

Reply on news.ycombinator.com