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This book explores the moral lives of mental health clinicians serving the most marginalized individuals in the US healthcare system. Drawing on years of fieldwork in a community psychiatry outreach team, Brodwin traces the ethical dilemmas and everyday struggles of front line providers. On the street, in staff room debates, or in private confessions, these psychiatrists and social workers confront ongoing challenges to their self-image as competent and compassionate advocates. At times they openly question the coercion and forced-dependency built into the current system of care. At other times they justify their use of extreme power in the face of loud opposition from clients. This in-depth study exposes the fault lines in today's community psychiatry. It shows how people working deep inside the system struggle to maintain their ideals and manage a chronic sense of futility. Their commentaries about the obligatory and the forbidden also suggest ways to bridge formal bioethics and the realities of mental health practice. The experiences of these clinicians pose a single overarching question: how should we bear responsibility for the most vulnerable among us?

Background Ethical decision-making in child and adolescent psychiatry (CAP) is inherently complex, shaped by developmental vulnerability, evolving autonomy, and competing responsibilities to patients, families, and the legal system. Clinicians often face moral dilemmas when navigating adolescent confidentiality, parental authority, and mandatory reporting duties, especially in high-stakes or culturally sensitive contexts. As large language models (LLMs) enter clinical settings, their potential to support ethical reasoning remains underexplored, particularly outside Western paradigms. This study qualitatively investigates how different LLMs provide ethical, legal, and emotional guidance to clinicians facing ethically challenging scenarios in CAP, situated within Turkiye’s sociocultural and legal landscape. Method A scenario-based qualitative design was employed. Three expert-developed case vignettes reflecting ethically charged dilemmas, such as adolescent autonomy, parental conflict, and confidentiality, were submitted to the three LLMs (ChatGPT 4.0, Gemini 2.5 Flash, and GROK 3). Responses were analyzed using content and thematic analysis to identify key patterns of ethical-legal reasoning, alongside discourse analysis to examine tone, empathy, and cultural sensitivity. Two researchers, with backgrounds in CAP and medical ethics, conducted independent coding and reached consensus through a reflexive, interdisciplinary approach. Results All LLMs addressed core ethical principles (autonomy, non-maleficence, beneficence, and justice) and referenced Turkish legal frameworks such as the Child Protection Law, Patient Rights Regulation, and mandatory reporting obligations, situating their guidance within the national regulatory context. They also differed in their engagement with sociocultural sensitivities: GROK 3 emphasized therapeutic communication and relational trust, Gemini 2.5 Flash applied a highly structured, rule-based style focused on procedural compliance, while ChatGPT 4.0 provided concise and practical suggestions. Despite thematic overlaps, these varying approaches shaped how effectively the models aligned with Turkiye’s clinical realities. Notably, LLMs frequently acted as “thinking companions,” offering ethical and legal justifications while leaving interpretive responsibility with clinicians. Conclusion LLMs in CAP hold promise not only as cognitive aids but also as emotionally attuned, context-sensitive companions in ethical decision-making processes. Their effectiveness depends not just on algorithmic precision but also on explainability, empathy, and cultural alignment. Rather than replacing clinician judgment, LLMs may serve to ease emotional burden, enhance therapeutic reflection, and foster ethically sound care in complex, high-pressure situations.

There is growing international resistance to the oppressiveness of psychiatry. While previous studies have critiqued psychiatry, Psychiatry Disrupted goes beyond theorizing what is wrong with it to theorizing how we might stop it. Introducing readers to the arguments and rationale for opposing psychiatry, the book combines perspectives from anti-psychiatry and critical psychiatry activism, mad activism, antiracist, critical, and radical disability studies, as well as feminist, Marxist, and anarchist thought. The editors and contributors are activists and academics - adult education and social work professors, psychologists, prominent leaders in the psychiatric survivor movement, and artists - from across Canada, England, and the United States. From chapters discussing feminist opposition to the medicalization of human experience, to the links between psychiatry and neo-liberalism, to internal tensions within the various movements and different identities from which people organize, the collection theorizes psychiatry while contributing to a range of scholarship and presenting a comprehensive overview of resistance to psychiatry in the academy and in the community. Contributors include Simon Adam (University of Toronto), Rosemary Barnes University of Toronto, Peter Beresford (Brunel University), Bonnie Burstow (University of Toronto), Chris Chapman (York University), Mark Cresswell (Durham University), Shaindl Diamond (York University), Chava Finkler (Memorial University), Ambrose Kirby (therapist in private practice, Brenda A. LeFrançois (Memorial University of Newfoundland), Mick McKeown (University of Central Lancashire), Robert Menzies (Simon Fraser University), China Mills (Oxford University), Tina Minkowitz (World Network of Users and Survivors of Psychiatry), Ian Parker (University of Leicester), Susan Schellenberg, Helen Spandler (University of Central Lancashire), and AJ Withers (York University). A courageous anthology, Psychiatry Disrupted is a timely work that asks compelling activist questions that no other book in the field touches.

The most influential critique of psychiatry ever written, Szasz's classic 1974 book revolutionized thinking about the nature of the psychiatric profession and the moral implications of its practices.

Background Most studies are inclined to report positive rather than negative or inconclusive results. It is currently unknown how clinicians appraise the results of a randomized clinical trial. For example, how does the study funding source influence the appraisal of an RCT, and do positive findings influence perceived credibility and clinical relevance? This study investigates whether psychiatrists’ appraisal of a scientific abstract is influenced by industry funding disclosures and a positive outcome. Methods Dutch psychiatrists were randomized to evaluate a scientific abstract describing a fictitious RCT for a novel antipsychotic drug. Four different abstracts were created reporting either absence or presence of industry funding disclosure as well as a positive or a negative outcome. Primary outcomes were the perceived credibility and clinical relevance of the study results (10-point Likert scale). Secondary outcomes were the assessment of methodological quality and interest in reading the full article. Results Three hundred ninety-five psychiatrists completed the survey (completion rate 45%). Industry funding disclosure was found not to influence perceived credibility (Mean Difference MD 0.12; 95% CI − 0.28 to 0.47, p?) nor interpretation of its clinical relevance (MD 0.14; 95% CI − 0.54 to 0.27, p?). A negative outcome was perceived as more credible than a positive outcome (MD 0.81 points; 95% Confidence Interval (CI) 0.43 to 1.18, p?), but did not affect clinical relevance scores (MD -0.14; 95% CI − 0.54 to 0.27). Conclusions In this study, industry funding disclosure was not associated with the perceived credibility nor judgement of clinical relevance of a fictional RCT by psychiatrists. Positive study outcomes were found to be less credible compared to negative outcomes, but industry funding had no significant effects. Psychiatrists may underestimate the influence of funding sources on research results. The fact that physicians indicated negative outcomes to be more credible may point to more awareness of existing publication bias in the scientific literature.

All human behaviour is, ultimately, a moral undertaking, in which each situation must be considered on its own merits. As a result ethical conduct is complex. Despite the proliferation of Codes of Conduct and other forms of professional guidance, there are no easy answers to most human problems. Mental Health Ethics encourages readers to heighten their awareness of the key ethical dilemmas found in mainstream contemporary mental health practice. This text provides an overview of traditional and contemporary ethical perspectives and critically examines a range of ethical and moral challenges present in contemporary ‘psychiatric-mental’ health services. Offering a comprehensive and interdisciplinary perspective, it includes six parts, each with their own introduction, summary and set of ethical challenges, covering: fundamental ethical principles; legal issues; specific challenges for different professional groups; working with different service user groups; models of care and treatment; recovery and human rights perspectives. Providing detailed consideration of issues and dilemmas, Mental Health Ethics helps all mental health professionals keep people at the centre of the services they offer. Section 1: Ethics and Mental Health 1. Ethics: In Search of the Good Life Phil Barker 2. The Keystone of Psychiatric Ethics Phil Barker 3. Who Cares Any More, Anyway? Phil Barker Section 2: The Professional Context 4. The Psychiatrist Duncan Double 5. The Mental Health Nurse Tony Warne, Sue McAndrew and Dawn Gawthorpe 6. The Social Worker Shula Ramon 7. The Clinical Psychologist Lucy Johnstone 8. The Therapist Phil Barker 9. The Occupational Therapist Lesley Brady 10. The Chaplain Kevin Franz Section 3: Care and Treatment 11. Psychiatric Diagnosis Phil Barker 12. Professional Relationships Vince Mitchell 13. Restraint Brodie Patterson 14. ECT and Consent Phil Barker 15. Medication Austyn Snowden Section 4: The Human Context 16. Acute care Jan Horsfall, Michelle Cleary, Glenn E Hunt and Garry Walter 17. Forensic Care Tom Mason 18. Addictions Jeffrey Schaler 19. Younger people in mental health care Tim McDougall 20. Older people in mental health care Elizabeth Collier and Natali Yates-Bolton 21. Race and culture Suman Fernando 22. Suicide John Cutcliffe and Paul Links Section 5: Legal Issues 23. Mental Health Law in England and Wales Tony Warne and Sue McAndrew 24. Mental Health Law in Ireland Denis Ryan and Agnes Higgins 25. Mental Health Law in Scotland Robert Davidson 26. Advance Directives Jacqueline Atkinson 27. The Insanity Defence and Diminished Responsibility Tom Mason Section 6: Ideologal Issues 28. Talk about Recovery Poppy Buchanan-Barker 29. Illusion, Individuality and Autonomy Craig Newnes 30. Ethics - The Elephant in the Room Phil Barker Phil Barker is a psychotherapist in private practice and a Director of Clan Unity International, a mental health recovery consultancy. He is also Honorary Professor in the Faculty of Medicine, Dentistry and Nursing, University of Dundee, UK. ‘I was personally fairly familiar with and committed to the underlying thesis and found much that resonated with my values. That is, the essence of ethical practice is a lot about values, but values demonstrated rather than merely espoused. After reading this text, I felt better able to articulate the issues and found myself recommending it (or particular chapters) to students. It deserves a wide readership, as it will surely assist people to develop ethical sensitivity and importantly to ponder the important questions that confront anyone working within mental health services.’ – Journal of Psychiatric and Mental Health Nursing 'Well written, accessible and thought provoking...if you are undertaking any study that stimulates discussion around the working practices of your profession, a great deal of what it contains will be relevant despite the mental health emphasis.' – MIDIRS 'Represents a considerable addition to the literature in this field.' – Nursing Ethics