Ethics Rounds

In January APA journal Psychology, Public Policy & Law sponsored a symposium "Overcoming the Stigma of Disability" at the University of Miami School of Law. Two speakers, Elyn Saks, JD, and Bruce Winick, JD, talked about personal and professional aspects of having a disability. (In the interests of full disclosure, I have published with Professor Saks and Professor Winick and they are personal friends.) The purpose of the program was to help overcome the debilitating effects of stigma by presenting two role models whose lives demonstrate that disability need not be a barrier to high achievement.

Both Elyn and Bruce have made significant contributions to psychology. Elyn is a chaired professor at the University of Southern California Law School, who also teaches at the USC Medical School Institute of Psychiatry and Law and is an advanced research candidate at the New Center for Psychoanalysis in Los Angeles. She writes broadly and prolifically on mental health from legal, clinical and ethical perspectives. Bruce, a professor of law and professor of psychiatry and behavioral sciences at the University of Miami, is a founder of the movement "Therapeutic Jurisprudence," which examines how the law, legal systems, and legal processes can be structured to promote mental health. Both participated in "Overcoming the Stigma of Disability" as scholars with enormous subject matter expertise. They also participated as individuals with disabilities. Elyn was diagnosed with schizophrenia shortly after she began her studies at Yale Law School. Early in his academic career, Bruce was diagnosed with retinitis pigmentosa, a degenerative visual disability.

Elyn and Bruce spoke poignantly about how they hid their disabilities from colleagues. A friend of Bruce's warned him not to let his faculty know: a budding legal scholar going blind would not be a good candidate for tenure, he was told. Shortly after her first psychiatric hospitalization Elyn disclosed her mental illness in a professional setting. The reaction was swift and unambiguous: She was no longer welcome. The two learned early on that disclosing a disability could be a career ending move.

The symposium invited participants to discuss their own responses to stigma based upon disability. One particularly encouraging response was the recent formation of a national law student organization, the National Association of Law Students with Disabilities, dedicated to supporting law students with disabilities in their legal careers. I found the discussion about this organization an excellent example of turning emotions into action.

An opportunity for reflection

The symposium offered a rich opportunity to reflect on the ethical aspects of stigma and disability within psychology. "Stigma" traces its roots back to the Greek and means a "mark." Stigma, a mark with a pejorative taint, silences the communication "I have unique needs that require consideration." Stigma is a barrier to voicing one's needs. Stigma is therefore antithetical to the very spirit of psychology.

The Ethical Principles of Psychologists and Code of Conduct (2002) addresses the ethical aspects of disability in two ways. First, the code encourages psychologists to be "aware of and respect" differences based upon disability and mandates psychologists to obtain the relevant competencies when an understanding of a disability is necessary for the effective implementation of their services.

Principle E: Respect for People's Rights and Dignity

Psychologists respect the dignity and worth of all people, and the rights of individuals to privacy, confidentiality, and self-determination… Psychologists are aware of and respect cultural, individual, and role differences, including those based on age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language, and socioeconomic status and consider these factors when working with members of such groups …. (emphasis added).

2.01 Competence

(b) Where scientific or professional knowledge in the discipline of psychology establishes that an understanding of factors associated with age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language, or socioeconomic status is essential for effective implementation of their services or research, psychologists have or obtain the training, experience, consultation, or supervision necessary to ensure the competence of their services, or they make appropriate referrals (emphasis added).

In addition to these affirmative actions that the Ethics Code encourages and requires psychologists to take, Ethical Standards 3.01 and 3.03 prohibit discrimination and harassment based upon disability. In addressing the ethical aspects of disability, the Ethics Code thus calls upon psychologists to understand and respect differences based upon disabilities, to obtain the required competencies when understanding a disability is relevant to the effective implementation of services, and to refrain from discrimination and harassment based upon a disability. Becoming aware of disabilities and responding appropriately have central roles in our ethics.

The field of psychology faces a challenge: To examine openly and honestly the role of stigma among psychologists. How many like Elyn Saks and Bruce Winick are there within the ranks of psychology, at an early stage in their careers and afraid to come out to their professional colleagues? How much talent is wasted and energy expended keeping disabilities hidden because of the stigma attached to a mental health professional struggling with a mental illness? How many students with a physical disability are discouraged from pursuing psychology training because they fear a training program either won't understand their needs or won't be committed to providing reasonable accommodations?

For those of us on training faculties, how disability-friendly is our program? If we are unsure how to answer this question, what resources are available to help us find out? As a faculty, do we view a student or applicant with a disability more as an opportunity to expand our awareness about disabilities, or as an imposition on our time and resources? We can be sure that students with disabilities have a keen awareness of faculty attitudes and behaviors. The Americans with Disabilities Act is highly relevant to these issues, but as psychologists we know that attitudes and beliefs are powerful in creating safe and nurturing environments.

At times, a disability will interfere with a psychologist's work-related duties. Ethical Standard 2.06 obligates psychologists to respond to their own situation appropriately:

2.06 Personal Problems and Conflicts

(a) Psychologists refrain from initiating an activity when they know or should know that there is a substantial likelihood that their personal problems will prevent them from performing their work-related activities in a competent manner.

(b) When psychologists become aware of personal problems that may interfere with their performing work-related duties adequately, they take appropriate measures, such as obtaining professional consultation or assistance, and determine whether they should limit, suspend, or terminate their work-related duties.

Psychological associations with colleague-assistance programs can be excellent sources of support. An association's working relationship with the licensing board can be invaluable. Stigma is nonetheless likely to explain a significant part of the variance regarding whether an intervention with a particular psychologist is successful. Self-care and caring for others within our profession are, ironically, some of the least well developed aspects of ethics in psychology.

Stigma silences. In the face of stigma, it is enormously difficult for individuals with disabilities to voice their needs. Psychologists help people speak about their experiences, challenges, and pain. As we help our clients and others with whom we work deal with the stigma they may face, let us be likewise attentive and sensitive to the stigma experienced by our colleagues, the psychologists and psychology students with whom we work side-by-side each day.

Stephen Behnke, PhD, JD, directs APA's Ethics Office. APA's Office on Disability Issues in Psychology, directed by Anju Khubchandani, is an excellent resource to help psychologists think about the questions posed in this column. You may reach her by e-mail.

'Ethics Rounds' now available as CE

Previously published "Ethics Rounds" columns have been converted into CE programs.