Getting Personal in the Philosophy of Psychiatry: Broadening Our Minds … and More (original) (raw)
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The Crisis of Present-Day Psychiatry: Regaining the Personal
The Crisis of Present-Day Psychiatry: Regaining the Personal , 1999
(The following is the second of two articles adapted by the authors from lectures given at the University of Zurich upon their receiving the 1998 Dr. Magrit Egnér-Stiftung prize-Ed.) Present-day psychiatry has fallen into crisis because of the severe limitations of its conception of the person and, as a result, its conception of the patient. It objectifies the patient in a number of ways: 1) It lacks a conception of normality and consequently perceives most aspects of the patient's life in pathological terms; 2) It reduces the patient's problems to a list of pathological symptoms; 3) It tends to conceive of these symptoms as having primarily biological causes; and 4) Its methods of treatment are pharmacological and behavioral. Because of this reductionism, psychiatry fails to distinguish between healthy and pathological features of human life. It fails to view the pathological aspects of patients' lives within the larger context of their personalities and sociocultural milieus. It fails to consider adequately the psychological and social factors that cause and maintain each patient's problems. Finally, it fails to employ treatments that address whole people living daily in their sociocultural worlds. Yet this reductionism does alert us to important components of human life. To express our point as generally as possible: it alerts us to the anthropological fact that human beings are, in many respects, objects. Although the reductionist conception of the patient does, because of its limitations, signal the loss of the personal, our attempt to regain the personal must incorporate the object-like components of human existence that reductionism pinpoints. Because human beings are, in certain respects, objects, a full conception of people must not disregard this object-like-ness but must rather situate it within the broader philosophical context in which it rightfully belongs.
Essential Philosophy of Psychiatry
The British Journal of Psychiatry, 2008
This is an important book. The author entitles it an 'essay' , an apt term for a sharply focused but extended examination of the question. It is not a review, but an argument; but the argument analyses much that has previously been said about the subject. Bolton is ideally placed to write such a piece, being a philosopher, clinical psychologist and researcher. He also co-directs a Masters programme on the 'Philosophy of mental disorder'. Bolton notes that the question has a curious status: 'barely visible yet of widespread importance'. Clinicians may pay little regard to it in day-today practice, but the implications for social exclusion are major. Particularly troubling is the role of 'values' , as opposed to facts, in determining what mental disorder is. The essay starts by examining the assumptions underlying the diagnostic manuals, including some major recent critiques, such as that of Horwitz & Wakefield. 1 Bolton then asks what the bio-behavioural sciences now have to tell us about the phenomena. This is a valuable discussion, particularly the claim that Jaspers' celebrated dichotomy between 'understanding' and 'explanation' should be superseded by a more inclusive concept of 'intentional causality'. This encompasses biological and psychological processes construed within the context of evolutionary design, and can lead to coherent 'pluralistic' accounts of causes. Then on to the claim that mental disorders could be 'natural facts'. The strongest case is Wakefield's, who argues that mental disorders are harmful disruptions of psychological functions designed by evolution. This receives a sympathetic hearing, but is not endorsed because many proposed 'functions' are hypotheses, not facts, and are hugely pervaded by social meaning. So we cannot escape a critical role for 'values' in defining mental disorder. The social aspects of mental disorder are then examined, much influenced by Foucault. Bolton's view of the implications of 'post-modernism' is that uncertainty about 'boundaries' presents the necessity for a range of 'stakeholder' voices to be heard and to be reconciled. Bolton finally settles on a pragmatic view of mental disorder-complex, often messy agreements based on judgements of 'distress or disability' that lead to a perceived need for treatment. This does not help in relation to interventions to protect the public, which he argues should be regulated by human rights protections, not definitions of mental disorder. Sadly, this is unlikely to work in practice. The book is clearly organised and is written in an engaging style. The reader need not fear abstruse philosophical analysis. Anyone with an interest in the subject would do well to read the book-and that should include all clinicians.
Towards real persons: Clinical judgement and philosophy of psychiatry
South African Journal of Psychiatry, 2007
Abstract: One of the motivations for the new philosophy of psychiatry is the need to understand changing ideas in mental health care. In the last century, changes in both physical and biological theory prompted work in philosophy of physics and philosophy of ...
Politix, 2017
Many studies of psychiatry share the same methodological and theoretical assumption:namely, to show that the reality of mental illness—both its definition and treatment—is social, always involves challenging the construction of its subject through psychiatry, and that to focus on one dimension of this reality, psychiatric or social, inevitably leads to neglect of the other. The establishment of this mutually exclusive relationship between social and psychiatric issues produces a “dualist” approach, in which the role of social sciences is to distinguish between what psychiatry claims to do—identify and treat mental health problems—and what it actually does—social control, normalizing deviance, moralizing a social class, or serving as an instrument of power over the education system. This article aims to distance itself from these dualistic approaches by challenging the mutually exclusive relationship between the social and the psychiatric, as well as the competitive relationship between the social sciences and psychiatry that it produces. This challenge is based on an approach that highlights tensionsinternal to the activity as a point of entry to the study of psychiatry. It attempts to describe a specific type of tension: ontological tension. This refers to the way in which professionals respond, in practice and under given circumstances, to the issue of the ontological indeterminacy of the problems they face. This article aims to reveal the ontological tension between psychiatric and social issues that is at work in the practices of diagnosing and treating problematic behaviors and individuals. It seeks to show that the question of the ontology of the problem, and specifically the ontological problem of the border between the psychiatric and the social, is faced by psychiatry professionals themselves and that this question, aligned with institutionalized professions, raises key issues regarding the practical division of labor and shared responsibility for a situation.
Cox J, Gray A, 2009. Psychiatry for the person
Purpose of review This review considers much recent work focused around the Psychiatry for the Person Programme of the World Psychiatric Association. Yet we have also considered the wider medical context, based on recent publications familiar to us in the fields of ethics, religion, spirituality and person-centred medicine as well as ‘medicine of the person’ as developed by Tournier. Recent findings There is an urgent need for evaluative outcome studies of person-centred care, including the narratives of service users, rigorous scientific methods and new conceptual models; and for a reformulation of the bio-psychosocial model to incorporate new knowledge in the neurosciences, philosophy, anthropology, ethics and theology. Summary We suggest that a biosocial/psychospiritual (BSPS) approach to relationship-based healthcare should be more actively considered.
Psychiatry, philosophy and the self
Current Opinion in Psychiatry, 2005
The aim of this article is to investigate psychopathology in order to illuminate the nature of personal identity. Predominantly, the authors reviewed here defend a more robust version of the narrative self against Dennett's claim that narrative self is ultimately a useful fiction. Authors explore the limit case of dissociative identity disorder in order to explore how apt an embodied, socially interactive and autonomous narrative self is for addressing legal and moral paradoxes intertwined with establishing personal identity. Psychiatric practice should embrace therapeutic approaches that restore the unity inherent to the capacity to narrate a life.
Psychiatry and the mental patient: an uneasy relationship
2010
The second half of the 20 th century has witnessed major changes in the way mental health care in the Western countries has been organized and provided for people suffering from mental illness. Deinstitutionalization and community care became common terms used to define a policy that aims to shift the locus of psychiatric care from large mental hospitals and custodial institutions into community. Deinstitutionalization of psychiatric care requires an empowering approach towards the mentally ill individuals and their capabilities to lead a self-dependent life in the community. Such an approach implies accepting the mentally ill health-care service users as credible individuals capable of taking responsibility for their actions and life. The aim of this article is to examine psychiatric conception of mental illness, treatment and the psychiatric encounter. The presentation largely draws upon analysis of Lithuanian psychiatric texts, although some foreign psychiatric literature is also used. The article starts with an introduction of a changing situation of the mental patient and proceeds to the analysis of the psychiatric discourse. The author argues that by conceptualizing mental illness as pathology located within the functioning of the individual body that affects the ability of a sick individual to apprehend the reality and to retain critical insight towards one's health problem, psychiatric discourse may reproduce paternalistic approach towards the mentally ill individuals even in the deinstitutionalized settings. Such an approach may have certain implications for the individuals' ability to lead an independent life in the community.