The dominance of technological paradigms within psychiatry creates moral and ethical tensions over how to engage with the interpersonal narratives of those experiencing mental distress. This paper argues that such paradigms are poorly suited for fostering principled responses to human suffering, and proposes an alternative approach that considers a view of relationships based in feminist theories about the nature of caring. Four primary characteristics are presented which distinguish caring from technological paradigms: a concern with the particular nature of contexts, embodied (...) practice, the dialogical basis of caring and the existential basis of caring. From this we explore the role of the moral imagination and our ability, through narrative, to acknowledge, engage with and bear witness to the injustices that shape the lives of those who suffer. This, we argue, is at the heart of caring. Clinical implications are discussed, including an exposition of the importance of narrative in recovery from trauma and distress. Narrative Psychiatry, The Sanctuary Model of care, and Soteria, are outlined as examples of this type of practice. (shrink)

This article draws on Ellul’s analysis of propaganda in understanding propaganda in the helping professions. Key in such an analysis is the interweaving of the psychological and sociological. Contrary to the discourse in mission statements of professional organizations and their codes of ethics calling for informed consent, competence of professionals and taking advantage of research findings, in everyday practice we find a variety of avoidable lapses, including decontextualized problem framing, bogus claims concerning risks, accuracy of assessment measures, and effectiveness of (...) interventions. Perhaps most troubling is obscuring the causes of human problems, for example, framing problems-in-living such as anxiety, alienation, and loneliness that result from living in a technological society as brain disorders, so mystifying the causes of distress. (shrink)