Why psychiatry needs philosophy (and vice versa) Tim Thornton, Professor of Philosophy and Mental Health INNOVATIVE THINKING FOR THE REAL WORLD

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1 Why psychiatry needs philosophy (and vice versa) Tim Thornton, Professor of Philosophy and Mental Health

2 Plan What is the relation of philosophy and psychiatry? The most obvious candidate is oppositional. That is philosophy is either criticism or defence of psychiatry against other external critics. Szasz criticism of mental illness as an example. Szasz argument can be blocked but suggests conceptual tensions internal to mental healthcare. This suggests a better model of the relation: psychiatry has an internal relation to philosophy because it raises intrinsic philosophical puzzles. 2

3 A motivating worry When one discipline examples another it is typically either debunking or uncritically validating. Philosophy of psychiatry as criticism / defence. Cf sociology of science. Cf history of epidemiology. These are external views of the object discipline. Instead: philosophical reflection is part of psychiatry. 3

4 The history of philosophy of psychiatry Karl Jaspers (General Psychopathology 1913) switched between philosophy and psychiatry. Since then little UK/USA philosophy of psychiatry until recently. Rebirth inspired by 1960s Anti-Psychiatry (Cooper, Foucault, Laing and perhaps Szasz). Hence tempting then to see philosophy as the handmaid to Anti-Psychiatry, a critique of psychiatry. Or as a defence of psychiatry against its opponents. 4

5 Philosophy as a defence of psychiatry Jennifer Hansen There Are No Philosophers in Foxholes! But Maybe There Should Be... [Hansen 2007]. Association for the Advancement of the Philosophy of Psychiatry symposium. Hansen describes teaching a student - Samantha whose mother was battling with bipolar disorder and whose cousins are psychiatrists. Samantha blurted out: You see, it is these silly debates that piss off real psychiatrists. No wonder psychiatrists don t respect philosophers!... [T]he psychiatrists she had been talking to pointed out to her, over and over again, that mental illness was real, that psychiatry was a science, and therefore, any debates over classification or the reality of mental illness was wasted breath. [ibid: 2] 5

6 Philosophy as a defence of psychiatry Philosophers, in their mind, were pseudo-scientists getting tangled up with unsolvable metaphysical questions... In particular, Samantha found Thomas Szasz s work offensive; it was, in fact, her disgust with his claim that mental illness is not real that predisposed her to agree with her cousin s colleagues [ibid: 2] Hansen suggests: The hope is that philosophers and psychiatrists can form a partnership to counteract the growing critics of the field. Philosophers can play a useful role in clarifying conceptual confusions, demonstrate the weakness of some of the arguments made against psychiatry, and the flawed nature of the critics assumptions. [ibid: 4 italics added] 6

7 Is criticism or defence the only role for philosophy of psychiatry? Must philosophy be either pro- or anti- psychiatry? No: philosophical issues arise directly from the nature of mental health care, conceptions of illness and service user experiences. Visible even in Szasz anti-psychiatric arguments. o An argument from circularity and from different underlying norms. 7

8 Szasz key argument against mental illness The concept of illness, whether bodily or mental, implies deviation from some clearly defined norm. In the case of physical illness, the norm is the structural and functional integrity of the human body What is the norm, deviation from which is regarded as mental illness? This question cannot be easily answered. But whatever this norm may be, we can be certain of only one thing: namely, that it must be stated in terms of psychological, ethical, and legal concepts [Szasz 1972: 15] 8

9 Szasz key argument against mental illness Yet the remedy is sought in terms of medical measures that it is hoped and assumed are free from wide differences of ethical value. The definition of the disorder and the terms in which its remedy are sought are therefore at serious odds with one another [ibid: 15] Since medical interventions are designed to remedy only medical problems, it is logically absurd to expect that they will help solve problems whose very existence have been defined and established on non-medical grounds. [ibid: 17, italics added] 9

10 Exercise Here s the argument: 1. Mental and physical illnesses answer to different norms (bodily function vs social / ethical / legal). 2. Because mental illness answers to a different norm it cannot be treated using physical medicine, or medically more generally. 3. Hence mental illness (as something can be so treated, rather than as life problems) is a myth. Is this a good argument? How could we question the first premise? And the second? 10

11 Responding to Szasz argument Perhaps mental illnesses are identified as whatever causes the symptomatic effects, described in value-laden terms? But if psychiatric healthcare is essentially value laden, doesn t that undermine its objectivity? Hence further lines of inquiry: o Which values are in play? o What kind of subjectivity / objectivity do they possess? o What implications does being value-laden have for scientific taxonomy? o Whose values matter for recovery? o Why is there anti-psychiatry but not anti-cardiology? 11

12 These questions are Conceptual in nature. They are not empirical. They are not externally politically imposed but internally generated by the very nature of mental health and illness. They are philosophical. And hence philosophy is continuous with psychiatry. 12

13 What is philosophy? Philosophers are philosophers not because they have common aims and interests (they don't), or common methods (they don't), or agree to discuss a common set of problems (they don't), or are endowed with common faculties (they aren't), but simply and solely because they are taking part in a single continuing conversation. [Rorty 1979: 411] Which conversation? o What is the good and the true? o What is reality? o Is knowledge possible? Philosophy as an a priori method eg conceptual analysis. 13

14 Other conceptual questions in psychiatry Is there a plausible general account of a disorder? Could any account of disorder serve as a benchmark for contentious putative disorders? Can any alternative to criteriological diagnosis such as idiographic or narrative formulation aspire to validity? Is there any coherent alternative to getting better as the aim of mental healthcare? Is RDoC reductionist and does it matter to the subject matter of mental healthcare? Why does incapacity justify coercion? What kind of mental state is a delusion? 14

15 Karl Jaspers General Psychopathology 1913

16 The Oxford Handbook of Philosophy and Psychiatry 2013

17 The OUP International Perspectives in philosophy and psychiatry 2002-

18 Philosophy, psychiatry and psychology 1994-

19 Courses PHILOSOPHY AND MENTAL HEALTH, MA/PGDIP/PGCERT This distance learning course aims to develop a better understanding of psychiatry, and mental health care through analysi

20 Moral The conceptual / philosophical complexities of mental healthcare are not all externally politically imposed but internally generated. Addressing them is a distinct activity: not empirical inquiry on the same level. It requires reflection / abstraction / argument. But despite differences of method, the results cannot by isolated from a fuller understanding of mental healthcare. Not an optional extra. Perhaps: If not of narrow training, then a feature of healthcare education. As educators we need to be (inter alia) philosophers. 20

21 References Hansen, J (2007) There Are No Philosophers in Foxholes! But Maybe There Should Be... Association for the Advancement of Philosophy and Psychiatry Bulletin 14: 1-2 Rorty, R. (1979) Philosophy and the Mirror of Nature, Oxford: Blackwell Szasz, T. (1972) The Myth of Mental Illness, London: Paladin

22 ANY QUESTIONS?