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Published online by Cambridge University Press:  02 January 2018

Matthew R. Broome
Matthew R. Broome*
Affiliation:
Warwick Medical School, University of Warwick, Coventry, UK, email: [email protected]
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The Psychiatrist , Volume 37 , Issue 9 , September 2013 , pp. 310 - 312
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This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Copyright © Royal College of Psychiatrists, 2013

Philosophy of psychiatry

There has been a rapid growth of publications in the philosophy of psychiatry over the past 10 years, not least due to the highly successful International Perspectives in Philosophy and Psychiatry series from Oxford University Press. In this article, I will focus on monographs, textbooks and edited collections, as well as a few helpful internet resources, but unfortunately I will not be able to cover the papers published in journals in this area. Even given this exclusion, there are a large number of publications, and I have listed those I have found personally most useful. They are divided by either area of philosophy or branch of psychiatry. With the increasing complexities of our work as clinicians, conceptual approaches are needed more than ever, and I hope that this brief survey will serve as a starting point for any psychiatrist who wishes to explore the philosophical complexities of our practice.

Classics

Philosophical consideration of mental illness occurs throughout history and in many of the works of the greatest philosophers, from Plato and Augustine to Wittgenstein and Heidegger. Yet, it is with Jaspers and his General Psychopathology, Reference Jaspers1 first published 100 years ago, that a systematic attempt was made to think about studying the mind in illness and its relationship with neuroscience. Arguably, this book launched phenomenological psychiatry, a movement that is still very much active. In the latter half of the 20th century it was psychiatry and medicine themselves, their relation to mental illness and stance towards those with putative psychiatric diagnoses, that came into focus. Szasz’s The Myth of Mental Illness, Reference Szasz2 Foucault’s A History of Madness Reference Foucault3 and The Birth of the Clinic, Reference Foucault4 together with Laing’s The Divided Self Reference Laing5 all attacked the perceived default medical model, albeit from different perspectives and with different goals. Clare’s Psychiatry in Dissent Reference Clare6 remains a well-reasoned and clear counterpoint.

Textbooks

Many of the themes introduced by Jaspers, Szasz, Foucault and Laing regarding medicalisation, styles of treatment, understanding and explanation, responsibility and politicisation are core topics for contemporary philosophy of psychiatry. At present, there are several very good textbook overviews of the subject, all of which discuss these topics, among others. Thornton’s Essential Philosophy of Psychiatry Reference Thornton7 and Graham’s The Disordered Mind Reference Graham8 are excellent single-author textbooks and these authors, joined by Fulford, offer the larger Oxford Textbook of Philosophy and Psychiatry. Reference Fulford, Thornton and Graham9 Finally, Radden offers an edited collection surveying the field in The Philosophy of Psychiatry: A Companion. Reference Radden10

Philosophy of science and classification

One of the main drivers for my interest in philosophy was in thinking about the validity and meaning of my own scientific empirical work in early psychosis and schizophrenia. How should we study these disorders? Is there a single method for a science of psychiatry? What does neuroscience offer us? Many of these questions are present in the work of Jaspers, but with the advent of increasing sophistication in research, the influence of international classification systems, the breach between subjective reports of illness and scientific accounts, a laudable goal seemed to be to reconcile, if possible, different explanatory frameworks and perspectives on distress and disorder. These concerns prompted my own Psychiatry as Cognitive Neuroscience: Philosophical Perspectives, Reference Broome and Bortolotti11 co-edited with Bortolotti. Bolton & Hill’s Mind, Meaning, and Mental Disorder Reference Bolton and Hill12 is an influential book that offers a reconciliation between meaning-based interventions, such as psychotherapy, with biological processes. Cooper’s excellent Psychiatry and Philosophy of Science Reference Cooper13 allows us to see psychiatry as a complex discipline, reliant on a collection of sciences, and Murphy’s Psychiatry in the Scientific Image Reference Murphy14 offers a detailed and powerful discussion of the notion of mental illnesses in terms of what they are and how they should be studied and classified. Bolton examines contemporary discussions of disorder, with reference to prominent interlocutors and the DSM-5 development, in What is Mental Disorder?. Reference Bolton15 Ghaemi’s The Rise and Fall of the Biopsychosocial Model Reference Ghaemi16 critiques a contemporary approach to reconciling explanatory models and argues for a psychiatric eclecticism. Useful and important papers on the scientific study of psychiatry can be found in two volumes of papers edited by Kendler & Parnas, Philosophical Issues in Psychiatry. Reference Kendler and Parnas17,Reference Kendler and Parnas18

Phenomenology and psychopathology

Since Jaspers’ work, the phenomenological approach has been a major thread in the philosophy of psychiatry. Spiegelberg’s Phenomenology in Psychology and Psychiatry Reference Spiegelberg19 is a good historical overview with many of the key texts being found in The Maudsley Reader in Phenomenological Psychiatry. Reference Broome, Harland, Owen and Stringaris20 Important recent books utilising phenomenology in psychiatry include Ratclffe’s Feelings of Being, Reference Ratcliffe21 Stanghellini’s Disembodied Spirits and Deanimated Bodies, Reference Stanghellini22 and Matthews’ Body-Subjects and Disordered Minds. Reference Matthews23 Cutting’s excellent Principles of Psychopathology Reference Cutting24 and his more recent A Critique of Psychopathology Reference Cutting25 examine psychopathology informed by cognitive neuropsychology and by philosophy, utilising insights from Bergson and Scheler among others. I would also highly recommend the philosophically rich intellectual biography of the young R.D. Laing, Beveridge’s Portrait of the Psychiatrist as a Young Man, Reference Beveridge26 as an intriguing account of Laing’s development as an existential-phenomenological psychiatrist and psycho-therapist. Carel’s moving and important Illness, although exploring health problems in general, focuses on the experience of illness, and of life, of the person with health problems. Reference Carel27

Delusions and schizophrenia

As with phenomenology, the problem of delusions and the experience of psychosis has been a key feature of philosophy of psychiatry and perhaps served as one of the main ways through which academic philosophy has come to psychiatry. Important texts include Sass’ Madness and Modernism Reference Sass28 and his The Paradoxes of Delusion. Reference Sass29 Graham’s When Self-Consciousness Breaks Reference Graham30 and Coltheart & Davies’ Pathologies of Belief Reference Coltheart and Davies31 both examine key psychotic experiences philosophically but with a detailed grasp of neuropsychological accounts of psychopathology. Reconceiving Schizophrenia, edited by Chung and colleagues, Reference Chung, Fulford and Graham32 is an excellent collection of essays and Woods’ brilliant The Sublime Object of Psychiatry Reference Woods33 broadens the debate by examining conceptions of schizophrenia not only in psychiatry and philosophy, but in wider cultural theory, too. One of the most important works on delusions is Bortolotti’s Delusions and Other Irrational Beliefs, a book that examines the core features of delusions in relation to other mental states, demonstrating that many non-delusional beliefs are not so rational and delusions often differ in degree, rather than kind, from other, non-pathological, beliefs. Reference Bortolotti34 Radden’s On Delusion is another excellent monograph exploring delusions in philosophy, psychiatry and psychology, and offering a cultural context. Reference Radden35

Depression, dissociation and dementia

Although psychosis, and delusions in particular, features highly in the philosophy of psychiatry literature, other disorders have stimulated philosophical reflection. Radden’s The Nature of Melancholy Reference Radden36 is an anthology of readings about depression, and her Moody Minds Distempered Reference Radden37 is a contemporary examination of depression and sadness. The eminent philosopher Ian Hacking has written Rewriting the Soul Reference Hacking38 and Mad Travellers, Reference Hacking39 which examine multiple personalities and fugue states respectively, as well as memory and historically located disorders. Hughes’ Thinking Through Dementia Reference Hughes40 and his co-edited Dementia: Mind, Meaning, and the Person Reference Hughes, Louw and Sabat41 are both rigorous philosophical explorations of issues arising through considering dementia as patients, carers, clinicians, policy makers and researchers. Failures of memory and autobiographical narration are explored by Hirstein in Confabulation: Views from Neuroscience, Psychiatry, Psychology and Philosophy. Reference Hirstein42

Psychopharmacology and psychotherapy

The interventions we offer are also an area of philosophical reflection. Stein’s marvellous Philosophy of Psychopharmacology Reference Stein43 draws on cognitive neuroscience and evidence-based medicine to examine the role of psychotropics in how we view ourselves as people and psychiatric disorders, as well as the idea of enhancement. Moncrieff’s The Myth of the Chemical Cure Reference Moncrieff44 critiques some conceptualisations of psychiatric disorders as discrete neurochemical states that can be ameliorated by putatively precise and specific drug agents. Wollheim’s Freud Reference Wollheim45 is a masterpiece by a sympathetic professional philosopher and Lear’s Freud Reference Lear46 is a more recent philosophical account of Freud’s work, as Tauber’s Freud: The Reluctant Philosopher. Reference Tauber47 Gardner’s Irrationality and the Philosophy of Psychoanalysis Reference Gardner48 argues that Freudian and Kleinian accounts of the mind are powerful ways to understand failures of rationality. Brakel’s Philosophy, Psychoanalysis and the A-rational Mind Reference Brakel49 and Unconscious Knowing and Other Essays in Psycho-Philosophical Analysis Reference Brakel50 both examine psychoanalytic practice and concepts philosophically. A key text examining the psychotherapeutic role of the physician in psychiatry remains the Zollikon Seminars of Heidegger & Boss. Reference Heidegger and Boss51

Ethics and responsibility

Two important strands of philosophy of psychiatry are how clinicians and wider society should treat those with mental illness, and whether those with mental illness are accountable for their actions, either morally or legally. Green & Bloch offer An Anthology of Psychiatric Ethics Reference Green and Bloch52 as well as an edited volume of more contemporary essays, Psychiatric Ethics. Reference Bloch and Green53 Dickenson & Fulford’s In Two Minds: A Casebook of Psychiatric Ethics is a collection of practical problems, with different commentators and perspectives. Reference Dickenson and Fulford54 Callender’s superb monograph, Free Will and Responsibility: A Guide for Practitioners, Reference Callender55 charts both the science and philosophy of morality and free will and how these in turn relate to illness, blame and treatment. Responsibility and Psychopathy, Reference Malatesti and McMillan56 edited by Malatesti & McMillan, examines these issues more specifically in psychopathy. Radoilska’s edited Autonomy and Mental Disorder Reference Radoilska57 looks at the role of choice and decision-making in mental illness.

Websites

Important online resources can be found on the Royal College of Psychiatrists’ Philosophy Special Interest Group website (www.rcpsych.ac.uk/workinpsychiatry/specialinterestgroups/philosophy.aspx), and a very useful resource, collecting conferences and publications in philosophy and psychiatry, is the International Network for Philosophy and Psychiatry website (http://inpponline.org). The Maudsley Philosophy Group contains details on current projects as well as links to audio recordings from speakers (www.maudsleyphilosophygroup.org). The Critical Psychiatry Network can be found at www.criticalpsychiatry.co.uk. The journal Philosophy, Psychiatry, and Psychology can be browsed online and is a great source of papers published in the area (http://muse.jhu.edu/journals/ppp/). For those new to philosophy, and who may enjoy podcasts, ‘The History of Philosophy without any gaps’ (www.historyofphilosophy.net), ‘Philosophy Bites’ (www.philosophybites.com) and the philosophy episodes of ‘In Our Time’ (www.bbc.co.uk/radio4/features/in-our-time/archive/philosophy/all) all offer great introductions to key philosophers and topics.

Concluding remarks

With 2013 comes the centenary of the publication of Jaspers’ General Psychopathology and, as well as conferences being organised internationally, several high-impact publications have been published. These include Stanghellini & Fuchs’ One Century of Karl Jaspers’ General Psychopathology, Reference Stanghellini and Fuchs58 Fulford and colleagues’ Oxford Handbook of Philosophy and Psychiatry Reference Fulford, Davies, Gipps, Graham, Sadler and Stanghellini59 and The Routledge Companion to Philosophy of Mental Disorder, Reference Gerrans and Hohwy60 edited by Gerrans & Hohwy. As these books evidence, the cross-disciplinary field of philosophy and psychiatry continues to grow and develop. Thinking and reading in this area can have the potential to help us all become more reflective, aware of the limitations and strengths of our discipline, and ultimately, better doctors and psychiatrists.

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