Presentation Information
[SY-84-02]Eyes That Seek Eyes: From Paternalism to Autonomy
Grant Contest2
*Karen Yanit De León Valdez (Universidad de Monterrey (UDEM)(Mexico))
Keywords:
Autonomy,Dignity,Relational psychiatry,Doctor-patient relationship,Paternalism
The most striking difference I observed in my psychiatric training between Mexico and France lies in the gaze. In France, I encountered a horizontal gaze between clinicians and patients—one that fosters collaborative, reflective, and autonomous decision-making. This gaze acknowledges the patient as a subject, capable of participating actively in their own care.
In contrast, in Mexico, there remains a noticeable tendency toward paternalism, where the patient is often infantilized. The clinician is positioned as an authority who “knows best,” while the patient is expected to comply—frequently without the opportunity to express their preferences or to assume an active role in their treatment. This dynamic is often mirrored in the patient’s perception of the clinician as an omnipotent figure, responsible not only for treatment but for resolving existential dilemmas. In such cases, the patient may abdicate their own agency, locating both power and responsibility outside themselves.
In this presentation, I will explore the paradoxes that emerge when clinicians attempt to fulfill the role of the omnipotent caregiver, as well as the tensions and resistance that arise when we strive to return agency to the patient.
I propose that a more sustainable and ethical therapeutic relationship depends on seeing the patient face to face. This horizontal gaze implies more than eye contact—it is an epistemological and relational stance. It invites us to engage with the patient’s concerns, to co-construct meaning, and to accompany them as they take responsibility for their own care and well-being.
In contrast, in Mexico, there remains a noticeable tendency toward paternalism, where the patient is often infantilized. The clinician is positioned as an authority who “knows best,” while the patient is expected to comply—frequently without the opportunity to express their preferences or to assume an active role in their treatment. This dynamic is often mirrored in the patient’s perception of the clinician as an omnipotent figure, responsible not only for treatment but for resolving existential dilemmas. In such cases, the patient may abdicate their own agency, locating both power and responsibility outside themselves.
In this presentation, I will explore the paradoxes that emerge when clinicians attempt to fulfill the role of the omnipotent caregiver, as well as the tensions and resistance that arise when we strive to return agency to the patient.
I propose that a more sustainable and ethical therapeutic relationship depends on seeing the patient face to face. This horizontal gaze implies more than eye contact—it is an epistemological and relational stance. It invites us to engage with the patient’s concerns, to co-construct meaning, and to accompany them as they take responsibility for their own care and well-being.