Nietzsche's Genealogy of Morality and the changing boundaries of medicine, psychiatry and psychiatric and mental health nursing practice: a slave revolt?

Accessible summary • The boundaries of medical and psychiatric and mental health nursing practice appear to be changing in recent years • These changes include a move towards more inclusive health care practices that recognize common physical and mental corporeality • This may suggest an inversion of the values that were previously held as good or bad The main constructions in Nietzsche's On the Genealogy of Morality (1994) are employed in order to explore the changes in mental health care that have been recently taking place. Characterized by boundaries that define the objectivity of scientific method, the biological stratum or the area of concern (disease and the disembodied being) and the professional distance that is maintained in the healthcare encounter, the noble morality of contemporary allopathic (Western) mental health care practice appears to be being challenged, in an act of ressentiment, by the slave morality of society, inverting values and beliefs that have previously been held. Mental health care paternalism may be in the process of giving way to consumer sovereignty, patient participation in decision making and the re‐discovery of the embodied being at the centre of the healthcare encounter. Nietzsche warns that the dominance of slave morality and the inversion of moral values (what was a quality that was held by the nobles and regarded as good) – that is, objectivity and mental health care paternalism – becomes bad; and what was a quality held by the slaves and regarded as bad – subjectivity – becomes good, may ultimately be detrimental to the advancement of society.