Journal of Health Care and Research

Journal of Health Care and Research

Hiroshi Bando^1,2iD*, Akiyo Yoshioka¹, Masahiro Bando^1,2, Yu Nishikiori^1
1New Elderly Association (NEA) Tokushima, Tokushima, Japan
²Tokushima University and Medical Research, Tokushima, Japan

Corresponding Author: Hiroshi Bando ^{ORCID iD}
Address: Tokushima University /Medical Research, Nakashowa 1-61, Tokushima 770-0943, Japan.
Received date: 15 August 2025; Accepted date: 18 September 2025; Published date: 24 September 2025

Citation: Bando H, Yoshioka A, Bando M, Nishikiori Y. Human Dignity Consisted with Internal and External Dignity in Mental Healthcare. J Health Care and Research. 2025 Sept 24;6(2):52-54.

Copyright © 2025 Bando H, Yoshioka A, Bando M, Nishikiori Y. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium provided the original work is properly cited.

Keywords: Human Dignity, Mental Healthcare, Patient-Centered Approach, Internal and External Dignity, Human Rights Revolution

Abbreviations: PCC: Patient-Centered Approach

Abstract

Human dignity has been important and in discussion for long in mental healthcare and related regions. Historically, the human rights revolution has emerged from the Universal Declaration of Human Rights. The dignity can be explained from two separate sources of internal and external dignity. They are self-respect (how I see myself), and respect from other people (how others see me) with related government, country, and community, and so on. The medical team would propose applicable perspectives as human dignity, dignity for identity, dignity of excellence, and attributed dignity. Further crucial factors are valuable for respect, empathy, communication, and autonomy.

Commentary

As a whole, human dignity has been crucial and important from various points of view [1]. It has been broadly recognized as a moral concept and basic human rights, which relate to mental healthcare. However, the actual status of the dignity, rights, and equality of mental healthcare service has been violated to some degree by forced medical practice and discrimination from the biomedical recovery human model.

It is desirable for the concept of dignity to transcend vague moral and ethical concepts and for mental health services to be provided in accordance with the needs of service users. This will lead to the implementation of standard operating guidelines [2]. This process will ensure that all users are empowered. With this goal in mind, it will be necessary to consider appropriate mental health care methods, devise training methods for medical staff, accumulate experience in peer work, and consider how to link actual experience to improvements.

From a recent historical point of view, the human rights revolution has emerged from the Universal Declaration of Human Rights [3]. When we observe the process of elaboration on the related words and phrases, the syntax will be worthwhile for predominance of dignity to right. The word “dignity” would be clearly societal importance and vital individual, in which both include large energy to protect in daily life for sustaining the dignity. The concept “dignity” is likely to have two factors, where one is internal aspect (how I observe myself) and another is external aspect (how others observe me). If the dignity of individuals or groups is consistently violated, their health will be seriously affected. When dignity is violated, the negative impact on mental, psychological, physical, and social well-being is so great that it is already recognized around the world.

As a matter of fact, dignity can be explained for two separate sources. The first is internal dignity, which is self-respect (how I see myself), and another is external dignity, which is respect from other people (how others see me). These dynamic processes have existed constantly with various related internal and external factors. The external dignity includes a variety of factors from outside. They are from people around, related government, laws in the country, and the community. It can be illustrated in (Fig-1). The dignified self would be required for both aspects. Since self-respect is always dynamic and changing, generalized dignity would be dynamic. The definition of dignity may be enhanced or undermined by the situation of identified dignity in the person. It is changed by aging, disease, impaired function, and by other people around [4]. The concept of dignity can be characterized by the situation that the person is observed from others around. Among these, ‘not being observed’ may involve the condition where he is not heard or acknowledged from people around him. When a person can have inner and outer dignity, he can live his life with hope and pride.

Fig-1: Various factors of internal and external dignity in mental healthcare

In the area of mental healthcare professional (HCP) ethics, crucial importance of dignity has been widely recognized as one of the moral concepts. It is also applied in the fields of world mental healthcare services, health care policy, and patient experience protocols, which were proposed by the latest guidance of the World Health Organization (WHO) and also the United Nations (UN). Furthermore, the stigma and related continuous use of practices has caused the violations of human rights in mental healthcare [5]. Among WHO member countries, only 38% of them prepared the mental health plan or policy which would be fully covered with human rights. In the case of higher income countries, only 43% of them are satisfied with them. Further, 40% of them do not include the effective independent authority to manage mental health facilities, where international human rights exist with enough compliance situation [5].

As a moral perspective, dignity has been inherent in human beings and inalienable. In other words, humans can enjoy simply by the existence on the earth. For an intrinsic human quality, the dignity has been acknowledged and shared between human beings. The dignity means both of being what I am and the recognition of existence among others [6]. Currently, social and medical situation in the developed countries has been aged or aging world. Consequently, various stakeholders should address the adequate care of the older people with careful concern. Furthermore, the problem of loss or lack of personal dignity has been often associated with social and medical unstable situation of decreased function and mobility impairment [7].

On the other hand, the word ‘dignity’ has been a polysemic technical term which may be a useless concept by some ethicists. In order to protest this thought, medical personnel team propose applicable 4 perspectives for more accurate definition against such thought. They are i) human dignity, ii) dignity for identity, iii) dignity of excellence, and iv) attributed dignity. Concerning dignity for aged people, the importance of human dignity and solicitude will be discussed. These perspectives will bring applicable friendship, respect, and dignity of them, by providing each elderly ethical and geriatric care physically and psychologically. For communicating the elderly, a patient-centered approach (PCC) has been effective for adequate management [8]. It may facilitate empathy, active listening, cultural competent care, and useful decision-making. When aiming to the dignity of mental health, 4 points will be valuable, which are respect, empathy, communication, and autonomy.

In summary, the human rights revolution was developed formerly, and recent perspectives on human dignity for mental health in the medical field were described. It has become an important problem with the increasing elderly population across the world. We will pay attention to PCC and keep some factors for the elderly, such as respect, empathy, communication, and autonomy.

Commentary

The authors have read and approved the final version of the manuscript. The authors have no conflicts of interest to declare.

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