Advocacy and Corruption in the Healing Professions

In looking at the professions one does well, I think, to hold to the old religious distinction between the ministerial and the prophetic. One should not assume, as many do, a simple polarity in which the sciences are inherently radical or revolutionary and the healing professions intrinsically conservative. The professions must minister to people, take care of them, and that is a relatively conservative process. But there are prophets who emerge from the healing ministrations of the professions—Freud is a notable example—with radical critiques and revolutionary messages. Moreover, even 'pure scientists' (in biology or physics, for example) spend most of their time ministering to the existing paradigm, doing what Thomas Kuhn (1962) calls 'normal science,' and strongly resist the breakthrough that is inevitably charted by the prophets among them. There are ministerial and prophetic elements in both the healing professions and the sciences.

But one must also distinguish between the professions, which have profound value in their capacity for continuity and renewal, and professionalism, the ideology of professional omniscience, which in our era inevitably leads to 'technicism' and the model of the machine. The necessity for such a distinction becomes painfully clear if one looks at the situation that prevailed for psychiatrists in Vietnam. I want to take that situation as a starting point for a broader discussion of these dilemmas and their moral and conceptual ramifications. For the fact is that, in such extreme situations, the professional may be no better able than his soldier-patient to sort out the nuances of care and professional commitment on the one hand, and moral (or immoral) action on the other.

Central to my view of the present predicament of the professions is the psychology and the spirit of the survivor. The concept of the survivor derives in my work from the study I did in Hiroshima a little more than ten years ago (Lifton, 1968, ch. 12) and has b