Tuesday 17 August 2021

Problems of Living

Today's post is by Dan Stein (University of Cape Town) who writes about his new book, Problems of Living (Elsevier, 2021).

It seems to me hard to practice psychiatry without asking some key “big questions”, both about the nature of the mind (and mental illness) in particular, and about the nature of life (and mental suffering) in general. More than a decade ago I published a volume, Philosophy of Psychopharmacology, in which I addressed some of the “hard problems” faced by mental health clinicians, with a particular focus on philosophical issues raised or addressed by advances in psychiatric medication. 

This year I’ve published my second volume at the intersection of psychiatry and philosophy, Problems of Living, in which I look at a range of “hard problems” raised by life as a whole, with a particular focus on philosophical issues raised or addressed by advances in the cognitive-affective sciences including psychology and neuroscience.

I view my approach in both of these volumes is “integrative” in a number of ways. First, I often spell out debates in the psychiatric or philosophical literature, and then take a “middle way” that I see as drawing on the best points made by the protagonists in the debate. 

Second, in thinking through the “big questions” and “hard problems”, I draw on a range of disciplines, including not only philosophy, but also psychiatry, psychology, and neuroscience. 

Third, I often juxtapose authors from different times and places; Aristotle, Spinoza, Hume, Dewey, Jaspers, and Lakoff are amongst my favourites, perhaps precisely because each covered so many different areas, bringing together different disciplines, with a wisdom and practical judgment that remains relevant.

Dan Stein

I can imagine that a registrar in psychiatry, working in the trenches, and swotting neuroscience for exams, might well shrug his or her shoulders in response to this all, perhaps even rolling their eyes at the disjuncture between intellectual pretension and clinical reality. 

Similarly, an individual suffering from a mental disorder, that perhaps has not responded successfully to modern interventions, may be less interested in conceptual niceties, than in psychiatry making practical progress. 

On the other hand, for a philosopher doing cutting-edge work in metaphysics or epistemology, this volume doesn’t cut the mustard; it lacks the rigour that sophisticated philosophy requires. And for the hard-nosed neuroscientist, the excursions made by the volume into brain research may similarly smack of over-simplification.

But perhaps this is a space worth holding: stepping back far enough from clinical realities to try to contribute to work on the “big questions” and “hard problems”, but not stepping back so far as to lose touch with key concerns for clinicians and patients working and living at the coalface. 

And I’d also like to hold a space that tries to make a contribution, but that doesn’t necessarily offer resolution: the thing about the “big questions” and “hard problems” is that there isn’t necessarily a single best answer, these involve “essentially contested” constructs and issues, which don’t give way to simple solutions, but which entail complexity and wickedness, and which it is therefore crucial to keep discussing.

Philosophy of Psychopharmacology argues that psychiatry is precisely the sort of field that should on the one hand acknowledge its own fallibility, while at the same time try to make a positive difference - even though we have still so much to learn about the brain-mind and its disorders, and even though our interventions are far from ideal. 

Problems in Living argues that any answers to the problems of living can only be partial and tentative, but that we should nevertheless persist in trying to live meaningful lives – even though we have still so much to learn about human nature and the world, and despite life’s apparent absurdity. Taken together they argue that it’s key to find a balance between overly optimistic Panglossian views of psychiatry and of life, and unremittingly pessimistic perspectives, and to keep moving forwards - as best we can - with each.

1 comment:

  1. Thanks for this prof.I am beginning to realise that psychiatry can not be practised without seriously attempting to address these hard philosophical questions.A reductionistic approach seems to me overly simplistic and unsatisfactory.


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