A Dangerous Method

Books and Media between government coercion and setting limits tween governmental intervention and individual on state power, and by partnering with other liberties. Each discussion concludes with recom- stakeholders in the public health system. mendations for future public health measures. In this book, Gostin examines complications In his discussion of the right to refuse treat- that occur when government strives to prevent in- ment, Gostin describes the elements of informed jury and disease or to enhance the public’s health. consent that are necessary to initiate treatment. He notes that the government may opt to per- Embedded in this concept is the patient’s right to suade, use incentives, or sometimes compel indi- refuse treatment, but the right is not absolute. A viduals and businesses to promote health and summary of case law contains exceptions to the safety standards in the interest of public safety. He right to refuse treatment in special circumstances, contends that this power and obligation form the such as inmates in corrections systems and men- basis of public health law. tally ill defendants who are adjudicated incompe- The book is organized into four major parts: tent to proceed with trial. Public health justifica- Conceptual Foundations of Public Health Law, tions for mandatory treatment are set forth, Law and the Public’s Health, Public Health and including preservation of health and life and pre- Civil Liberties in Conflict, and The Future of the vention of harm to others. Public’s Health. In Part 1, Gostin explains his the- The text is dense with case studies, tables, dia- ory and definition of the field of public health and grams, photographs, and summaries that will assist offers a systematic evaluation of public health reg- the reader who seeks to research specific topics in ulation. In Part 2, he describes and discusses legal greater detail. There are over 200 pages of notes concepts of constitutional, administrative, tort, connected with the chapters, as well as an extensive and global health law. In Part 3, he provides a bibliography and list of the court cases referred to representative sample of public health practices, as in the text. This book is timely, given the current well as the conflicts with individual rights and in- debate regarding national health care and the con- terests, and in Part 4, he gives his vision of the flict between mandatory participation and indi- future of public health law. vidual choices. Public Health Law is a comprehen- The author covers a host of public health topics, sive work that represents a major contribution to including infectious disease (HIV, pandemic in- the public health policy literature. fluenza, severe acute respiratory syndrome (SARS), and anthrax), vaccination, and quaran- References tines. Bioterrorism is reviewed as a matter of pub- 1. Daubert v. Merrell Dow Pharmaceuticals, Inc., 509 U.S. 579 (1993) lic health and national security. The roles of inter- Howard H. Sokolov, MD national treaties and multiple international health New Albany, OH organizations, such as the World Health Organi- zation, World Trade Organization, and United Disclosures of financial or other potential conflicts of interest: None Nations, are described. Several public health topics may be of interest to health care professionals, including litigations related to tobacco, obesity, firearm prevention, and product liability. The A Dangerous Method: Ethics at duty to warn people who unknowingly have been the Dawn of Modern Psychiatry exposed to HIV is of particular interest to forensic Screenplay by Christopher Hampton. Directed by David psychiatrists, as are confidentiality, privilege, and Cronenberg. Produced by Jeremy Thomas. A German/ the Health Information Protection and Portability Canadian co-production distributed by Universal Pictures Act (HIPAA). Concise commentaries are provided (Germany/Austria), Lionsgate (UK), Sony Pictures Classics about civil commitment, the right to refuse treat- (US), BIM (Italy), and Mars (France). Released in the ment, and Daubert1 requirements for expert wit- United States November 23, 2011. 94 minutes. ness testimony. In these discussions, the author examines each problem, summarizes the current David Cronenberg’s movie, A Dangerous Method,is legislative and regulatory guidelines regarding based on Carl Jung’s historically known sexual en- each one, and often outlines relevant conflicts be- tanglement with his patient, Sabina Spielrein. The Volume 40, Number 2, 2012 299 Books and Media portrayals of Jung (Michael Fassbender), Sigmund ratory assistant when they were not having sessions, Freud (Viggo Mortensen), and Spielrein (Keira and eventually ended in a sexual relationship, which Knightly) are especially compelling to anyone who the director unfortunately depicts as (possibly) heal- has an interest in this critical phase of modern psy- ing for the obviously oedipalized Spielrein. The chiatry’s birth. The storyline provides little action, boundary-transgressing Jung is depicted as a but is a thoughtful biography of Jung and his strug- wounded healer (a common motif in movies and in gles with Freud and with himself. Beautifully filmed real life), stultified by an empty marriage to a far too in Germany and Austria, the movie records the con- young, uninteresting, and unexciting woman, and straints of the Victorian age with the tightness of a restrained by Victorian mores that approved of libido straightjacket. only in service of childbearing. Poor Carl. No won- Cronenberg, in bringing out the complex forces at der he eventually has his own nervous breakdown, as work between Jung and Freud, imagines their rela- related in the film’s epilogue. tionship on the basis of the correspondence between The habit during that era of colleagues’ analyz- them. Thus, the fictional interpretation of the basic ing each other—their dreams, affairs, and career well-known facts of the events feels authentic. The choices—is shown in the relationship between letter-writing motif, which is used in visuals through- Jung and Freud. The co-counseling exchange of out the film, is both crafty and symbolic, suggesting insights and information, typical during the nas- the creation of something important as the story un- cent days of psychoanalysis, is especially portrayed folds. That something is psychoanalysis. in Jung’s work with another patient (and also col- Set against the background of Jung’s developing league), Ottos Gross. Gross’s libertine libido, and then deteriorating relationship with Freud, the which Jung is trying to tame, stimulates and story follows Spielrein’s progression from a regressed broadens Jung’s own, propelling his attraction to- and barely functional hysteric, treated by Jung, to a ward the brilliant, unbridled, and alluring Spiel- newly minted physician, Jung’s lover, and eventu- rein. Like Gross, she is Id personified. Once given ally, a psychoanalyst herself! free reign, Jung’s libido drives him to indulge in As a teacher of ethics, I have often pointed to affairs with colleagues for years to come. certain Hollywood movies as exemplars of unethical Jung’s bursting through traditional ethics bound- behavior by psychiatrists, particularly in the films’ aries with a degree of sexual liberation more familiar treatment of boundary ethics. Their plots are inven- to modern audiences foreshadows his eventual tran- tions, however, and knowing that the characters and scendence of Freud’s strict world view. Freud was stories are only fictional provides a bit of comfort. trying to be as conventional as possible by adhering Not so with A Dangerous Method. The danger to to the values of science. Jung’s move toward mysti- which the title refers is Jung’s unconscionable breach cism and ideas such as the collective unconscious is of ethics. rendered as almost heroic, leaving old, ossified Freud The early ethics in the pioneering era of the talking literally paralyzed on the floor in one scene. Modern cure were challenged by the likelihood that one’s audiences are as likely to celebrate Jung’s pioneering patient might become one’s colleague and co-author New Age genius as they are his freeing of the libido in in a few years, and vice versa. The traditional model the natural pursuit of sexual freedom. Freud is shown of the doctor-patient relationship had already been policing boundaries, but the boundaries with which established, with appropriate sexual boundaries. he is almost fanatically obsessed involve protecting Freud is shown reacting negatively to the initial ru- the edifice of his new psychoanalytic theories and mors that Jung might have been erotically involved methods. with his Russian hysteric patient, whom he treated at Unlike portrayals of psychiatrists in other movies, his Burgho¨lzi clinic (idyllically and beautifully ren- this depiction of the seminal psychiatrists’ weak- dered by the cinematography). Jung, however, was nesses and ethics transgressions cannot be dismissed unprepared for the effect that the intimacy of this as fictional. The lives of these founding fathers, who new method of revealing the inner psychic life could are known by name and reputation to most film- have on the treatment relationship. That energy pro- goers, demonstrate that what we do as psychiatrists is pelled him down a boundary black hole. It started so essentially human. We may be as fraught with with his asking his patient, Spielrein, to be his labo- weaknesses and vulnerabilities as any of our patients. 300 The Journal of the American Academy of Psychiatry and the Law Books and Media They can literally become we and we they. This pros- enable informal discussions with numerous col- pect demands extra care, discernment, and consulta- leagues and formal consultations with ethicists and tion in the conduct of the delicate and sometimes ethics committees, we can do better. intense psychiatric treatment relationship, when we use our own potentially dangerous method. Jung had Mark S. Komrad, MD Freud to consult about the Spielrein matter, but Towson, MD Freud’s response produced only guilt in Jung, not Disclosures of financial or other potential conflicts of interest: Chair of behavioral restraint.

Load more