Monday, 22 February 2010

Review of Psychiatry as Cognitive Neuroscience

There is a review of Matthew Broome and Lisa Bortolotti's Psychiatry as Cognitive Neuroscience : Philosophical Perspectives  in Psychological Medicine. I'm pleased that my chapter at least gave the impression of using psychiatry to inform philosophy. Whilst my aim, I am not sure how true it actually was.

Psychological Medicine, 40 (2010). doi:10.1017/S0033291710000103 Psychiatry as Cognitive Neuroscience : Philosophical Perspectives. Edited by M. R. Broome and L. Bortolotti (Pp. 382; £34.95; ISBN 978-0-19-923-8033). Oxford University Press: Oxford. 2009. 
Psychiatry as Cognitive Neuroscience is a collection of consistently high-quality chapters addressing a variety of conceptual issues regarding the role that the cognitive neurosciences can play in psychiatry. Best described as a work of interdisciplinary philosophy, the book has a broader appeal than it would were it primarily an attempt to construe scientific psychiatry as a type of cognitive neuroscience. One feature of the book that may be of special interest to psychiatrists and psychologists is that the individual chapters focus on specific psychiatric conditions. Psychotic and delusional states are prominent, but addiction, personality disorders and memory disturbances also receive attention.
As befitting a diverse collection, the chapters have a variety of goals. Philosophical analysis is used to better conceptualize psychiatric symptoms, but information about psychiatric conditions is also used to advance philosophical understanding. Lynn Stephens and George Graham’s chapter on what is ‘pathological ’ in compulsions exemplifies the former approach. Tim Thornton in particular uses psychiatry as a tool for making progress on philosophical problems.
Schizophrenia and/or delusions are addressed in chapters by Richard Samuels, John Campbell, Philip Gerrans, Dan Lloyd, Shaun Gallagher, Keith Frankish, Anne Aimola Davies and Martin Davies, as well as the editors themselves. One of the interesting themes running throughout the book involves the exploration of phenomenology and cognitive neuroscience – especially with respect to delusions. Many thinkers have criticized the DSM and ICD categories for being too heterogeneous to support the discovery of underlying biological mechanisms. A similar argument is given here, namely, that a more accurate phenomenological understanding of psychopathology might provide a better map for discovering underlying pathological processes. Alternatively, as noted by Matthew Ratcliffe, information about underlying mechanisms might also contribute to an improved phenomenological analysis. Over the course of several chapters, a good case is made for the proposition that a significant potential exists for jointly reformulating our understanding of both disturbed consciousness and the nature of biocognitive mechanisms.
The contributors support using information from the cognitive neurosciences to advance the psychiatric knowledge base, but they generally do not advocate making the cognitive neurosciences the sole paradigm for scientific psychiatry. Here is where careful philosophical analysis offers an important contribution. Focusing the philosophical lens on specific scientific theories makes it clear that there are crucial background assumptions and normative considerations that (a) cannot be reduced to cognitive neuroscience and (b) are essential to our understanding of psychiatric disorders. As might be expected, this viewpoint is consistent with the general perspective of the editors Broome and Bortoliti in their own work.
There are valuable ideas in the book for anyone with an interest in the conceptual problems of psychiatry. Some of the more engaging chapters actually deal less with neuroscience per se. These chapters include Rachel Cooper on the science versus pseudoscience distinction, and Hanna Pickard on personality disorders as both Szasian and ‘ valid. ’
The two chapters prior to the editors’ epilogue are ‘big idea’ chapters that address psychiatric disorders, moral theory and the cognitive neurosciences. Written by Iain Law and Jeanette Kennett and Steve Matthews, they explore whether major depressive disorder is associated with compromised virtue/character and the implications that dissociation and amnestic symptoms might have for moral responsibility. Both claim that psychiatric symptoms result in reduced moral capacities.
These final chapters underscore a conclusion that readers are likely to draw as a result of carefully working through the various contributions, specifically, that thoughtful analyses like those offered throughout the book helpfully challenge us to think more deeply about science and psychiatric disorders.