My adult granddaughter has longstanding mental-health and substance-abuse issues, with little success from multiple treatments. Her psychiatrist seems to be trying various medications, some of which require careful monitoring and are risky for women of childbearing age. My grandchild is not responsible about taking meds properly, getting lab work done or using birth control. I know her doctor can’t discuss her case with me, but would it be wrong for me to voice my concerns, given the potential risks? — Name Withheld
From the Ethicist:
In general, a psychiatrist will know if patients aren’t keeping on top of their blood work and other safety requirements — the lab results will typically be sent to their office. Still, nothing stops you from sharing your concerns with the doctor. Just keep in mind that a responsible psychiatrist may feel that patients have the right to know about communications regarding their care. If she later learned you contacted the doctor without her knowledge, after all, she could feel that a paternalistic alliance was formed behind her back. So assume that your message may be shared with her. Your right to voice concerns doesn’t come with a right to confidentiality — and what feels like protection to you may feel like betrayal to her.
A Bonus Question
My 12-year-old son, a seventh grader, was found watching pornography on his iPad. When investigating where he got the link to this site from, we found it had been sent by a friend in their chat.
While we now have implemented parental controls and had a conversation about this with our son, we don’t know if we should inform the parents of this other child about what’s happened. We saw that the link came through their chat, but we can’t tell for sure whether his friend saw it, too, or just forwarded it. We have no idea what the parents know, or how we would even approach the topic with them, or how well it would go over with them if we did.
The easiest thing would be to forget about the whole situation and move on. But we feel that may be morally regrettable. — Name Withheld
From the Ethicist:
Parents are always measuring their children’s progress to make sure they aren’t lagging behind. As you remind us, though, there are areas where their lagging behind would suit us just fine. What’s unusual about the situation you describe, I’m afraid, is just that your son was caught. To judge from several studies, he’s at the age when American youth, on average, first view pornography. In her 2021 book ‘‘Pornography and Public Health,’’ Emily F. Rothman, a public-health expert at Boston University, notes that an interest in sexual imagery at that age makes sense, developmentally speaking.
Part of what’s so valuable about Rothman’s book is that she’s upfront about the conflicting or equivocal nature of much of that research; people who make confident declarations about the consequences of viewing porn are apt to have a very partial view of the findings. In general, the empirical evidence about participatory online media is notoriously messy and contested. It can encourage teenagers to eat laundry pods; it can also let young climate activists know that they’re part of a global movement. Still, Rothman is clear that online porn is a lousy form of sex ed. Though parental controls can be helpful, the fact that porn mostly doesn’t belong to the genre of cinéma vérité is something to convey in health classes, and in your version of the parental ‘‘birds and bees’’ conversation.
It sounds as if you don’t know the other parents well and can only guess whether their response will be supportive and educative, or defensive and punitive. Nor can you predict the repercussions it might have on your son’s friendships. The situation, as you describe it, is concerning; but it’s not a calamity. For all these reasons, I’d focus on your son, doing your best to maintain open channels of communication with him, and to be ready to discuss any questions he may have. This isn’t a crisis that calls for immediate intervention with the other family. It’s a developmental milestone that calls for appropriate guidance — something best handled within your family, ideally with equipoise, a sense of humor and a willingness to talk things through.
Readers Respond
The previous question was from a reader whose sister was receiving therapy from someone with a dual practice. He wrote: “My sister began seeing a therapist after some tension between her and her husband reached a near-breaking point. At first I was happy to hear she was taking steps to address the situation. But she recently explained that her therapist is also a self-described ‘spiritual medium,’ who told my sister she had ‘three spirits’ following her, and that she was carrying unresolved baggage from a past life. The ‘therapist/medium’ also offered to check her home for ghosts and expel any that were found. When I told my sister that this all sounded alarming and inappropriate for a mental-health professional, she responded, ‘Well, I like it.’ She’s considering asking the ‘therapist/medium’ to ‘put her in touch’ with our father, who died almost two decades ago. I worry that someone who has earned my sister’s trust is now taking advantage of it. Should I do more than casually offer up my concerns?”
In his response, the Ethicist noted: “In a range of cases, what predicts a patient’s improvement is simply having a good connection with a therapist. Basically, talking with someone you trust and find sympathetic can be helpful. Notice too how many therapeutic models ask us to imagine the psyche as divided among contending entities. A practitioner of internal-family-systems therapy might teach patients to conceptualize distress in terms of parts or subpersonalities of the self (e.g., ‘exiles’ and ‘firefighters’), while your sister’s therapist relocates the problem to an external set of forces. But is it possible that the experience of healing could be similar if your sister gets better at managing her emotions and finds ways to move forward? I’m not equating the work done by trained, credentialed therapists with what mediums do. Your sister’s therapist, who’s evidently both, could be breaching ethical codes that mental-health professionals are meant to abide by. Especially if she’s charging extra for her ghost-busting, exploitation may well enter the picture.” (Reread the full question and answer here.)
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The short answer is: I totally agree with the Ethicist on this one. I have had experiences both personal and through encounters with “readers” or mediums. I run the other way from anyone who says I am “cursed.” There are many ethical and honest and capable mediums out there, but there are also a lot of charlatans, and this is their hook. They prey on peoples’ fears. — Deborah
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Although the Ethicist’s advice is very sound (as always!), he might have lent more credence to the reality of life on the “other side” if he were better apprised of the very good evidence for it. — Charley
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As a mental health therapist, I can assure you that this arrangement is unethical because it features a dual relationship. This therapist is encouraging a secondary relationship of “ghostbusting” by offering to provide this service at her client’s home. Regardless of whether she intends to charge for this service or not, it remains a dual relationship. If the letter writer’s sister wants that service, that’s fine, in which case the therapist should refer her to a different spiritual medium to do so. I’m not stating that the Ethicist’s example of Internal Family Systems (IFS) is incorrect. However, IFS is an evidence-based therapeutic approach, as are many other therapeutic methodologies. I also agree that much of a client’s improvement is dependent upon a good therapeutic relationship. However, this therapist is unethical and should be reported to her state’s licensing board. — Janet
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I have a Ph.D. in psychology and the best therapist I have ever gone to was both a licensed counselor and a devoted practitioner of shamanism. Did I believe in what she told me about the spirit world? Not so much — but it didn’t matter. There was something about just going with it that allowed me to stop overanalyzing things, approach the world more metaphorically and heal. The letter writer should let the sister do what works for her. — Jennifer
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The lines between faith, mysticism and therapy can be very, very blurry. If the letter writer’s sister feels that she benefits from seeing her “therapist/medium,” who are we to judge? In all of these cases, most of the benefit comes from having the patient talk through their troubles. Of course, if the “therapist/medium” seeks unusual financial gains, that’s a game changer. — Rick
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I always enjoy the insights that the Ethicist brings and the way he thinks through a problem. I would like to push back against one thought here, though, that I think is a false equivalency. I don’t think that the therapeutic practice of helping one conceptualize one’s feelings or behaviors as facets of one’s personality by giving those facets a name, such as “exile” or “firefighter,” is equivalent to what the therapist in question is doing. I don’t think you are expected to believe that there is a literal firefighter inside you, whereas the therapist in question is making a literal (and unfounded) claim about reality, and expecting the patient to believe it. I think that practices based on unfounded truth claims, while not necessarily damaging, have a higher probability of being damaging to a patient. — Steve
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I find hubris in both the question and response. I’m a natural psychic who has spent 25 years honing this ability through extensive training. Mediumship does not belong to some incredulous or demented margins; it can be practiced ethically by individuals trained through empirical standards to address the uncanny and perplexing phenomena beyond our five-sense world. — Andrea
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