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Personality
Personality Judgments and Holy Secrets
What does confidentiality have to do with judging?
Posted September 27, 2010
Recently I've been thinking about instances when judging personality is an inherently dangerous or bad activity (background here).
When I say that making a personality judgment is dangerous, I am considering judgments in three contexts. My recent focus has been on a given judgment that a mental health professional might make in the media about a public figure. That discussion has relevance, I believe, to making judgments of others in everyday life, and also has some implications for judging patients in treatment.
A key concern of professional ethics codes regarding judging others has to do with preserving a patient's (or client's) rights to confidentiality. Although this rarely pertains to public figures, because comments about politicians and celebrities are rarely based on an actual treatment situations, confidentiality is an issue worth considering. Even in everyday situations, after all, we may find ourselves wondering if we should repeat information we have heard about someone.
Among physicians, violating a patient's confidentiality has been regarded as a matter to be avoided -- and dangerous and threatening, as well -- for millennia.
Ancient Greek physicians may first have defined the rules of confidentiality when they instituted the Hippocratic oath, an oath professional physicians recited and which states in part:
Whatever I hear or see in the course of my professional duties (or even outside the course of treatment) regarding my patients is strictly confidential and I will not allow it to be spread about. But instead, will hold these as holy secrets.
Keeping these holy secrets private was regarded both then and today as key to successful medical practice. Expert practitioners know that they have an immense advantage in helping someone if they can begin with a reasonable understanding of their patient's activities, relationships, and life issues. Doctors and other healers work to earn the trust of their patients so that the patients will share with them any information relevant to providing an accurate diagnosis.
A physician who considered whether her patient had contracted a sexually-transmitted disease might discard the hypothesis if her patient denied any sexual activity. Yet, if the patient had engaged in risky sexual practices but was afraid to confide in her physician, she could misdirect her own treatment. A clear respect for confidentiality is needed to allow for such sharing between patient and doctor.
This concern for confidentiality is found in the Ethics Codes of both APAs (the American Psychiatric Association and American Psychological Association) - and it is key to day-to-day practice.
Needless to say, it would be a grave ethical violation indeed to share private information from one's consulting room with the public, without prior approval of one's client. A portion of the American Psychiatric Association's Rule 7.3 (the Goldwater Rule) puts it this way:
...it is unethical for a psychiatrist to offer a professional opinion [to the media] unless he or she has conducted an examination and has been granted proper authorization for such a statement.
The "authorization for such a statement" might occur, for example, if a celebrity authorized his physician or psychologist to acknowledge that he has a Substance Abuse Disorder, so as to explain to the public the celebrity's erratic behavior, and his treatment at a rehabilitation center.
The Ethics Code of the American Psychological Association, too, lays out the psychologists' adherence to protecting Privacy and Confidentiality. Section 4.01 states, for example, psychologists, "...have a primary obligation and take reasonable precautions to protect confidential information obtained through or stored in any medium," while recognizing limits imposed by their employer or the law.
The limits of the law, incidentally, are that psychologists and psychiatrists must report certain statements by clients to the responsible authorities, despite the confidential relationship, if those statements indicate that a client is engaged in the abuse of a child or elder, for example, or about to victimize someone as part of a serious crime.
As a matter of curiosity, the only counselors exempt from this reporting requirement, to my knowledge, are Catholic priests hearing confession. The Church instructs that priests hearing confession are required under the Seal of Confession (see the Catholic Encyclopedia entry) never to reveal anything said to them. They may seek counsel about what they have heard, but without identifying the individual who said it. In the United States, the Seal of Confession is often regarded as protected by the separation of Church and State, and therefore as in a somewhat different category from other forms of confidentiality, although the exact legal obligations of priests vary from state to state. Church law, however, is strict in this regard, as I understand it, and a member of the clergy might find himself caught uncomfortably between the laws of Church and State.
To return to judgments of personality by mental health professionals, violating confidentiality is surely a practice to be avoided except in those rare instances where the law requires an official report. For most of us in our private lives, repeating information we have received in confidence when making judgments of another person is a problematic practice as well, and so although legal issues usually are not relevant, the wise person weighs the reasons for any such sharing very carefully.
As for public comments about, say, our elected officials, confidentiality usually does not enter into the matter. If a journalist were to ask Professor X her opinion of President Obama's mental health there is no presumption that Professor X has treated the President. Rather, such a question implicitly asks: "Do you, as a professional with expert knowledge of human psychology, have insights or observations about President Obama that might inform the rest of us?"
Given no violation of confidentiality, is there still something inherently problematic about answering such a question from a journalist? It could be, as some have argued, that mental health professionals' judgments are particularly troublesome and should not be shared with the public. The other view is that withholding such judgments creates troubles of a different kind. I will continue to consider these issues in future posts.
Notes
The quote from the Hippocratic oath is from the translation at: http://www.iep.utm.edu/hippocra/
I also referred to Goodman, K. (2008, January). Privacy, confidentiality, law and ethics. Northern Florida Medicine Supplement, www.DCMSonline.org) for this post.
The quote from 7.3 of the Ethics Code of the American Psychiatric Association was from:
http://www.psych.org/mainmenu/psychiatricpractice/ethics/resourcesstand…
\The quotes from the American Psychological Association Ethics Codes are from:
http://www.apa.org/ethics/code/index.aspx
The material on the Seal of Confession is from the Catholic Encyclopedia.
Copyright © 2010 John D. Mayer
