The new philosophy of psychiatry

Natalie Banner and I published a review of 7 of the books in the OUP book series, International Perspectives in Philosophy and Psychiatry, in the South Africa based free access electronic journal Philosophy, Ethics, and Humanities in Medicine a few months ago. We've had a reply, I see. The main focus of disagreement seems to be that whilst we saw grounds for optimism in the various new developments in the field (including the book series, the journal PPP, the internal conference series, my own institute at Uclan etc), the reply sees only grounds for pessimism in the thought that philosophy has 'left the building' of psychiatry.

Having had some experience of teaching medical students at Warwick (one of whom once said: "Your course is hard because we're not used to thinking; in a year's time we can be GPs following NICE guidelines and we'll never need to think again") I can see how a philosophical sensitivity may not be high on many young psychiatrists' agendas trying to pass exams and get on. In truth, this is part of what the WPA programme on psychiatry for the person is reacting to /against. But I still prefer to see some good in a popular reaction amongst other psychiatrists against the absence of philosophy in practice. Perhaps the growth of interest in philosophy by psychiatrists in the UK at least (note the rapid growth of the RCP philosophy group) is a grass roots reaction against the pressures towards scientism in some areas of clinical practice.

The World Psychiatric Association Institutional Program on Psychiatry for the Person

I’ve just been to a three day conference organised by the World Psychiatric Association to attempt to come up with practical ideas for their Institutional Program on Psychiatry for the Person.

Juan Mezzich, President of the WPA has been pushing both the idea of comprehensive diagnosis and the idea of an ‘Idiographic (Personalised) Diagnostic Formulation’ for the last couple of years and wants there to have been progress made during his term of office. But I had some sense of the difficulty from the way that preliminary discussion of basic ideas expanded to leave very little time for actually trying to draft some kind of guidance or protocol or whatever.

One interesting sign of the difficulty was this. Robert Cloninger presented a scientific model of factors which both promote positive mental health and also protect against mental illness (although one of his more interesting general points was that these do not simply stand in a reciprocal relationship). But he got considerable criticism from part of the audience, especially Richard Williams, for somehow ignoring the person.

Over coffee he (Cloninger) expressed indignation over the fact that, surely, he was putting the person at the heart of things. It seemed to me that the underlying contrary worry was that a ‘psychiatry for the person’ should concentrate on placing patient or service user voices at the heart of things and thus adding even a scientifically well grounded theory of personality – couched obviously in analysts’ rather than agents’ categories – didn’t address that issue.

There were a couple of other themes: much disagreement on the value of making formal diagnoses at all for a high proportion of mental health care; and also at least some suggestion that the real challenge the service user movement was offering to psychiatry was to take the pathology out of conceptions psychopathological experience. Who knows what will actually come of the work, though.

Journal acceptances and rejections

Having finished books this year and last (the co-authored Oxford Textbook of Philosophy and Psychiatry and a single authored Essential Philosophy of Psychiatry), I’ve decided to concentrate on writing papers for a bit. It means I can be rather more flexible in subject matter and it means that the proof reading and amateur copy editing stage is more ‘little and often’. So far one paper - ‘Why the idea of framework propositions cannot contribute to an understanding of delusions’ - is due to come out in Phenomenology and the Cognitive Sciences and another, on idiographic judgement, is being considered by Medicine, Health Care and Philosophy.

But, of course, submitting papers to journals brings with it inevitable rejections. I’ve just had a pure philosophy paper on McDowell and Wittgenstein turned down which is hard not to take personally. So I need to look at the reasons for rejection and think whether to resubmit it to the same journal (they expressed mild interest in that) or another. But it’s best to put it to one side for a couple of days first to get a bit more objectivity.

Folk psychology

The reading group at the Philosophy Department at Lancaster University – one stop up the railway line from Preston – is reading Matthew Ratcliffe’s (expensive) book ‘Rethinking Commonsense Psychology’. Although we’ve just read the first two chapters which are basically preparatory, the idea that talk of ‘folk psychology’ by philosophers and cognitive scientists isn’t the harmless shorthand it is taken to be is interesting. It makes me feel guilty about all the times I’ve just used the phrase without thinking.

It also seems to me to be plausible that philosophers have over-intellectualised mutual understanding. In a paper written with Bill Fulford, Richard Gipps argued a few years ago that accounts of delusion suffered the same fault.

But because he aims to argue against all versions of folk psychology (including accounts in which folk psychology is a theory which is only tacitly known), Ratcliffe has a tricky case to make. He will have to argue that his favoured approach, which draws on a phenomenological tradition, not only is a better description of the surface of human practices but also of the underlying generalities. We’ll see.

At the last meeting one student expressed the worry that so far we’d given the author ‘a kicking’. It is strange - but obvious on reflection - to think that the philosophical culture of respecting authors precisely by criticising them might seem alien to newcomers to it.