Thursday, 12 May 2011

Outline for a potential short course on the philosophy of psychiatry

Charlotte Blease is teaching a five week x two hour course on What is psychiatry? over at Queens University Belfast. That prompts me to ask what I would teach, preferably - in my daydreams - in a room at the Castle Green Hotel in Kendal with access to Alexander’s Bar afterwards.

To be taught over five weeks of 90 minute sessions with meditative musing, over a pint, afterwards.

1) What’s special about psychiatry?
Psychiatry bridges some key divides. It crosses between mind and brain, understanding and explanation, individuals and their particular experiences and patterns in populations, bio-medical facts and values.
Modern psychiatry – arguably! – began with Karl Jaspers’ work a century ago and so this session examines his attempt to balance the ‘brain mythologies’ of his time with understanding. This leads on to both a model of phenomenology, to explore the ‘what it is likeness’ of experiences, and empathy: our shared access to how one experience leads to another. But is understanding really distinct from explanation? And do we need empathy to understand one another?

Reading: extract from Jaspers.

2) Szasz, anti-psychiatry and the reality or otherwise of mental illness
Whilst Jaspers combined philosophical and psychiatric interests, the recent focus (in the anglo-american world) on the philosophy of psychiatry has been in response to arguments against psychiatry from anti-psychiatrists. Thomas Szasz seems to advance two sorts of argument for the merely mythic status of mental illness. Are they persuasive? What else might they highlight about the nature of mental illness?

Reading: extract from Szasz and Kendell

3) Is mental illness value laden and does it matter if it is?
The debate about the reality of mental illness seems to turn on differences of opinion about the presence of values in psychiatric diagnosis. But, according to Bill Fulford’s analysis, the real issue is the status of physical illness. If illness, whether mental or physical, is essentially evaluative, why is there so much more debate about mental illness? And is Fulford right that there cannot be a value-free account of dysfunction based on whizzy evolutionary theory?

Reading: extract from Fulford

4) The DSM, reliability and validity and the loss of sadness
A key element of psychiatry is diagnosis of mental illness based on a classification or taxonomy. Since the WW2, the main aim of this has been ‘reliability’ which is a measure of how much clinicians agree in making the same diagnosis of the same condition. But recently, the concern has shifted to validity. Does psychiatric classification gets things right, does it cut nature at the joints? How could we begin to answer that question? One particular issue of recent debate is the boundary between sadness and depression. Is there a danger of pathologising what is an everyday, if regrettable, condition?

Reading: extract from Horwitz and Wakefield

5) Psychiatry and the relation of mind and brain
Since Jaspers’ day, our knowledge of the relation of mind and brain or mind and underlying biology has increased dramatically. But how much does this help with deciding what is and is not mental illness?

Reading: extract from Fulford et al.