Tuesday, 10 January 2023

Participatory Interactive Objectivity in Psychiatry

Today's post is by Şerife Tekin at University of Texas at San Antonio on her recent paper “Participatory Interactive Objectivity in Psychiatry” in Philosophy of Science.

Şerife Tekin 

As evident from the compelling body of scholarship featured in the Imperfect Cognitions blog, the last decade has been a very exciting time to be doing philosophy of psychiatry. What has been even more exciting for me, as a philosopher who has long been promoting the view that giving uptake to the first-person perspectives and testimonies of individuals diagnosed with mental disorders is necessary for enhancing rigorous research and ethical clinical practices, is the increased philosophical interest in thinking about how to include service users/ patients/ex-patients/survivors into enhancing research. 

As can be seen, for example, from the line-up of speakers and their abstracts, in a recent conference organized by Sam Fellowes on “Philosophically Analysing the Role of Service Users in Psychiatric Research,” I am delighted that this topic is garnering a lot more interest and attention from scholars and service users in the field. While we still have a lot of work to do to convince psychiatric research and clinical treatment circles, I am encouraged to see the increased collaboration between philosophers and the service users to push this approach forward.

In “Participatory Interactive Objectivity in Psychiatry,” I focus specifically on the creation and revision processes of the Diagnostic and Statistical Manual of Mental Disorders (DSM), a document produced by the American Psychiatric Association (APA) that identifies the properties of mental disorders and thereby guides research, diagnosis, treatment, and various administrative tasks. 

I challenge the exclusion of patients  from epistemic practices, through a historical overview of the DSM development since its inception in 1952. (I use the word "patient" to refer to the individual who is in a position of need due to the distress she is experiencing and who seeks help from a professional to address her condition. I recognize that “patients” are not homogenous, and some prefer being referred to as service-user/survivor/ex-patient. For my purposes in this article, I use these terms interchangeably.) 

I respond to the objections provided by the APA on the inclusion of patients in the DSM creation process, on the grounds that it would impede psychiatry’s scientific aspirations for arriving at objective knowledge. I argue that there are epistemic – rather than exclusively social/political – reasons for including individuals with first-person experiences in the DSM revision process. Service users/patients/ex-patients/survivors are indispensable resources to enhance psychiatric epistemology, especially in the context of the crisis, controversy, and uncertainty surrounding mental health research and treatment. 

My argument unfolds as follows. 

  • First, I outline the development process of the series of DSMs. 
  • Second, I examine the APA’s position that the inclusion of patients in the DSM’s epistemic practices would impede psychiatry’s goal to be objective. 
  • Third, I demonstrate that the notion of objectivity operant in the APA’s statements is insufficiently developed, and it leans heavily towards a logical positivistic understanding of what science is and how it can be objective.
  • Fourth, I develop an alternative approach to thinking about objectivity in psychiatry, Participatory Interactive Objectivity (PIO), according to which patients’ inclusion is necessary for objectivity in psychiatry. 

PIO takes cues from feminist epistemology, feminist philosophy, and science and technology studies, and promotes the idea that knowledge about mental disorders must be generated by a community of experts, including those with training-based expertise and those with experience-based expertise (e.g., Longino 1990, Collins and Evans 2002, Douglas 2004, Solomon 2015, Wylie 2015, Whyte 2018, Bueter 2021, Gagné-Julien 2021). Engagement between different kinds of experts would allow a diversity of standpoints to go through a process of transformative criticism, enhancing objectivity while also increasing public trust in the DSM.

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