Today's post is by Sam Wilkinson (University of Exeter) on his recent book Philosophy of Psychiatry: A Contemporary Introduction (2023, Routledge).
Year-on-year, as my module was tweaked and improved, largely thanks to feedback from my students, it occurred to me (wrongly, as it turns out) that it would be relatively straightforward to turn said module into a textbook. And that’s what I’ve done - eventually!
Like the module itself, the textbook is divided into two parts, which reflect two quite different enterprises that fall under the category “philosophy of psychiatry”.
The first enterprise involves philosophical scrutiny of psychiatry, with “psychiatry” here including both psychiatric practice and psychiatric research. The second involves philosophical engagement with the psychiatric phenomena themselves. In light of this, Part 1 is called “Philosophy of Psychiatric Practice and Research” while Part 2 is called “Philosophy and Psychopathology”.
After an overarching introduction entitled “What is philosophy of psychiatry and why does it matter?” (Chapter 1), Part 1 begins by reflecting on the purview of psychiatry (Chapter 2), addressing different approaches to the nature of mental illness, including challenges to its very existence and, by extension, to the legitimacy of psychiatry as a discipline. Then, Chapter 3 addresses issues surrounding the “medical model” and whether psychiatry ought to proceed via diagnosis.
Chapter 4 (“Mental illness, moral responsibility, and the boundaries of the person”) addresses questions about the way in which psychiatric conditions can impact on our autonomy, moral responsibility and sense of self. Different views about this can be seen as either tangential or central to questions about the fundamental nature of mental illness. (Viewed as central, to say that someone suffers from mental illness is, in part, to say that they are a passive victim of a condition.)
The role of culture in our thinking about pathology is addressed in Chapter 5, with religion as a salient test case. One important distinction here is between the context of formation and the context of evaluation. The former denotes the way in which culture may impact on the presence or prevalence of certain problematic phenomena, whereas the latter denotes the way in which culture impacts on the way in which certain phenomena are evaluated as pathological or otherwise. These two often interact in interesting ways.
The final chapter of Part 1 (Chapter 6) applies thinking in philosophy of science on the nature of explanation to the issue of scientific explanation in psychiatry. What is it to properly scientifically explain a phenomenon of psychiatric interest? A broad family of “pragmatic” views is presented in a particularly sympathetic light.
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| Sam Wilkinson |
Part 2 can be more swiftly summarized. It goes through various phenomena of psychiatric interest, trying to shed light on what they are and what philosophical issues they raise. So, Chapter 7 examines schizophrenia, and some important controversies that arise when thinking about that concept, and how that concept is not simply a different concept, but a different kind of concept, from that of psychosis. Building on this, Chapters 8 and 9 examine voice hearing and delusions, respectively. The former touches on various issues, including the nature of perceptual experience and inner speech. The latter touches especially on the nature and norms of belief.
Chapters 10 and 11 discuss depression and addiction. One of the big challenges surrounding depression concerns how we are to delineate depression as a clinical phenomenon. In turn, addiction raises fundamental questions about the nature of motivation, rationality and internal conflict.
The final chapter concerns my hopes and predictions for the future of the discipline. This involves discussion of i) overlooked phenomena that have received some philosophical scrutiny but would benefit from more (e.g. PTSD, personality disorders), ii) mental health in the digital age, iii) the exciting field of computational psychiatry, iv) approaches to mental health that might be called “externalistic”, and v) innovative approaches to psychiatric discourse.
Finally, I’d like to say a bit about how the book is written and its aims. Clearly one thing that lecturers avoid is a straight-up presentation of the canonical literature (“So-and-so said such-and-such”). What I’ve tried to do, with this book, is introduce each topic in an intuitive and relatable way that makes it clear what philosophical itches there are to scratch. That way, when the existing work is presented, the reader can see what exactly it is in the service of.