Psychiatric Ethics in an Authoritarian State: Bearing Witness and Respecting Persons

Join the 18th Annual JCB Jus Lecture with Dr. Dominic Sisti.

This lecture examines how psychiatric practice can be shaped and distorted during periods of political instability. Dr. Sisti explores why bearing witness and protecting dignity remain central ethical responsibilities in mental health care today.

Bioethics is entering a period of profound instability. Many of its foundational commitments — autonomy, consent, justice assume a stable liberal order that is rapidly eroding. In this context, psychiatry’s authority, diagnostic tools, and coercive powers become particularly susceptible to misuse.

In this lecture, Dr. Sisti traces both historical and contemporary examples of psychiatric practices being co-opted by political forces from drapetomania and abuses within Soviet psychiatry, to racialized schizophrenia diagnoses, “excited delirium,” and the Trump Administration’s Executive Order on homelessness. Although framed as a response to an urgent social issue, the Trump EO ultimately weaponizes medical language to justify forced removal and heightened coercion. Through these cases, Dr. Sisti argues that psychiatric ethics and clinicians themselves must recommit to bearing witness, upholding human dignity, and resisting institutional cooptation.

This is a timely and essential conversation for clinicians, ethicists, policymakers, trainees, and anyone concerned about the future of mental health care.