When Should a Psychiatrist Refuse to Treat a Patient?

If you were a psychiatrist assigned by the government to make torturers feel better about their lives, what would you do? That's not a rhetorical question. Back in the 1950s, the psychiatrist and philosopher Frantz Fanon was forced to answer that question, in his own life.

Photo: Algiers, 1960. By Nicolas Tikhomiroff

These days Fanon is known for his groundbreaking work chronicling political resistance movements in Algeria in the 1950s and 60s. Many people first encounter him as the author of the powerful 1952 book Black Skin, White Masks, about how blacks were treated under colonialism in Africa and the Caribbean — a situation which Fanon witnessed firsthand, growing up in a black middle-class family in Martinique in the 1930s.


But in the 1940s, Fanon was a young, idealistic psychiatrist. He'd just finished his college education in France, and in the early 1950s he began working in a French hospital in Algeria. This was during the height of the anti-colonial resistance movement, where Algerians were trying to push out the French colonial government. Known as the Front de Libération Nationale (FLN), or National Liberation Front, these protesters were routinely attacked by French troops, as well as imprisoned and tortured.

Fanon had already published Black Skin, White Masks, partly in response to ignorance about the black experience he'd encountered in France. But he had never been in the middle of war where white colonial troops were literally smashing the heads of brown people who wanted simply to reclaim their own country. At first, Fanon continued to do his job at the hospital. But more and more often, he found that the patients seeking his psychiatric help were suffering from traumas of war.

Fanon has written a lot about these patients, but one story always stuck with me. A man came to him, complaining of depression, suicidal thoughts, and violent urges. The man was obviously in great distress, and was deeply afraid that his feelings were going to get so powerful that he was going to start hurting his family. In fact, that fear was what had finally driven him to seek Fanon's help. When Fanon inquired what the man did for a living, he replied that he worked for the government, interrogating members of the FLN. The man was a torturer. Fanon knew immediately what was causing the man's psychological troubles. Obviously his job was turning him from a loving father into someone violent, someone even this interrogator was afraid of becoming.


So Fanon had a choice to make. He could use the tools of the burgeoning science of psychiatry to help this man feel better about torturing people. Or he could decide that the problem the man suffered wasn't within the purview of science to fix. It was a moral problem. This man was being evil, and his suffering could only be eased if he stopped engaging in evil behavior.


Fanon does not record the exact words he spoke to this man. But we do know that shortly thereafter, he quit his fancy job at the French hospital in Algeria. He never worked for the French again. For the rest of his life, Fanon devoted himself to chronicling the psychological and philosophical experiences of people who chose to resist government oppression in Algeria and elsewhere in Africa.

Undoubtedly, Fanon's real story begins after he left that hospital — it was the start of his career as a philosopher whose work is still extremely influential.


But I always find myself thinking back to that moment right before Fanon quit his job. He looked into the eyes of that torturer, a man who was obviously in pain, and decided not to help. Maybe Fanon thought that this patient's depression wasn't a sign of sickness — instead, it was a healthy sign of resistance to a sickness in that man's world. Or maybe Fanon thought, as I suggested earlier, that the man's problem was related more to evil than mental illness.

Either way, Fanon did not believe that a person who tortured other people should feel better about himself. Fanon's choice allows us to think about something that people in the sciences and healthcare often confront at some point in their lives. Where will they draw the line between what science can do, and what it should do?


Sure, Fanon could have treated that guy. Maybe he could have taught him to compartmentalize his feelings, focus on positive imagery — or, hell, maybe over years he could have even convinced the guy to finally quit his job torturing Algerians. But Fanon didn't want to use his education and skills to help a man whose problem, after all, stemmed from the fact that he was paid to injure and kill people who didn't obey the government. Regardless of whether this man was treatable, Fanon decided not to treat him.

Not everyone faces such a stark decision. Maybe an engineer is given the opportunity to build an amazing device that could be used to hurt people. Maybe a doctor is told to give preferential treatment to people who pay out of pocket rather than using health insurance. Maybe a new graduate is offered a job using her Ph.D. in geology to find oil deep beneath a sea habitat.


Or maybe they're in a situation very much like Fanon's, where they're told to help people feel better psychologically about a world where white police officers can kill black people under extremely suspicious circumstances, and yet never even stand trial for it. Let's dispense with the subtleties, shall we, and just stare that fact in the face.

All of us have those moments when we have to draw a line. We can use our knowledge to help people feel better about doing bad things. Or we can admit there is a moral realm that stands outside rationality, outside science, and outside our quest for perfect understanding. In that moral realm, we judge our own actions not by numbers of patents filed or Nobel Prizes won. Instead, we judge based on what we think will make the world a better place. And that's hard. You can't quantify it.


You can only decide.

Annalee Newitz is the editor-in-chief of io9 and this is her column. She's the author of Scatter, Adapt and Remember: How Humans Will Survive a Mass Extinction. Follow her on Twitter, or email her.


Share This Story

Get our newsletter