When philosophers have applied their minds to mental illness, their aim has sometimes been to highlight the shortfalls and inconsistencies in prevalent concepts of the nature of mental disorders. At worst, this has led to the view that mental illness has no real existence and that it serves only as a means of stigmatising and excluding those who do not conform to expected patterns of behaviour. Although this has often been interesting and illuminating, it has been of little help to those of us who have to understand and treat those with mental illness. It has certainly not led to any reduction in the demand for psychiatric services. However, the approach in this book is refreshingly pragmatic and free of ivory-tower scepticism. As a result, it demonstrates the important contribution that philosophers can make when they accept the reality and complexity of mental illness.
This contribution is one that is becoming of increasing importance with developments in neuroscience, such as brain imaging and molecular genetics, as applied to mental illness. Science is able to investigate normal and abnormal mental functioning in ways that are becoming increasingly fine-grained. This is throwing into sharp relief puzzles about the interface between brain disturbance and abnormal experience. It also emphasises the need for scientists to have a clear concept of what it is that they seek to investigate before they begin the process of framing testable hypotheses. One psychopathological phenomenon that is discussed at length in this book is delusions. Are these top-down, the products of disturbed information-processing, or bottom-up, an immediate, non-inferential experience? Or is the deluded patient better regarded as inhabiting an alternative reality in which abnormal ideas arise in the context of a more pervasive disturbance of how the world is perceived? The experiments that are performed and the ways in which results are interpreted will depend on the answers that are given to questions such as these.
Matthew Broome and Lisa Bortolotti have assembled a stellar cast of contributors to this volume. They bring together philosophy and neuroscience in an attempt to give an account of psychopathology that is more detailed and penetrating than the standard descriptions and definitions. The quality of the writing and analysis is uniformly excellent without becoming inaccessible to a clinical readership. The combination of rigorous conceptual analysis and neuroscience will take psychiatry in new directions in future years. This book offers an important route map to that future.
John Callender Consultant Psychiatrist, Royal Cornhill Hospital, Aberdeen AB25 7ZH, Scotland, UK. Email: jscall@doctors.org.uk
