At first blush it is an odd idea to
have a "proactive textbook" as the editors announce. A textbook is
more often seen as a compendium of received wisdom, an overview, a digest of
the field. It is often said that textbooks are outdated before they are
written. So something is quite different about a book that propounds to develop
or even begin to define an area of scholarship.

In recent times there has been not
only a growing interest in the interface of philosophy and psychiatry (as this
website testifies), but also a recognition that this something that every
advanced student should consider. Indeed, philosophy courses are becoming part
of the British MRCPych examinations (for those wishing to qualify as
psychiatrists) and in a number of Nursing programs at Masters and PhD level. This
is not just an abstract concept, but a very real investigation of the
implications, for example, of the move from Positivism to a Post-modern world. But
this book is neither solely a philosophy text, nor a psychiatric one. It moves
between the two, occupying that ill-defined land that is neither and yet is
both; attempting all the time to bring out the history, relevance, links and
interdependence of ideas. But, it does so using, in the main, a case study
approach, with appropriate exercises, study notes and self-test questions for
the student as well as the more casual reader. It gives useful reading guides
and synopses and is thoroughly well indexed. It also comes with a CD of 179
seminal readings that are referred to throughout the text, and in this way it
could be very usefully employed as a course text for students in a variety of
fields.

It is presented in five parts. Part
One deals with general core concepts and "puts people’s individual
experiences of mental distress and disorder on an equal footing with the
generalized knowledge and skills of professionals" (italics in the
original so we are meant to notice them). It considers the historical context
of mental health practice, and asks, with good reason, "What is
psychiatry? What is anti-psychiatry? What is disorder? What can philosophy have
to say about this?" Sometimes it seems that psychiatry is as psychiatry
does; sometimes it appears to have an agenda. Sometimes there is a fallacious
syllogism, and sometimes there is analytic rigor. The key arguments of writers
such as Jaspers and Szasz are similarly introduced, both for their fundamental
positions and also for the questions they pose for daily living. What should be
done when a person complains, for example, of feeling so worthless as to be
contemplating suicide?

Part Two is a philosophical history
of psychopathology and "brings empathetic understanding to subjective
meaning back into clinical assessment alongside causal explanations". It
begins a brief history of mental disorder, and continues with the issues of
phenomenological understandings. It attempts to tease apart a series of
binaries such as value/fact, illness/disease, unnatural/natural causes,
moral/physical therapies, hermeneutics/brain imaging,
anti-psychiatry/psychopharmacology. It also, interestingly, draws one tradition
through Plato and Christianity and another through Hippocrates and Islam. And
then we end up with the DSM.

Part Three is concerned with the
philosophy of science and mental health to enrich our understanding of
observational science to show "the importance of subjectivity and judgment
(including clinical judgment) based on tacit knowledge alongside
objectivity and induction … based on explicit knowledge". By this time the
material is getting dense and complicated, and it is to be hoped that the
reader has taken a break. Freud, a major figure throughout, and his idea of
philosophical fieldwork, is of central importance, not just because he truly
wanted to see psychoanalysis accepted as a science, but also because his work
is almost the touchstone of all later theorizing. It is suggested that much of
late 20^th and 21^st century psychiatry and philosophy is a
reaction to Freud. What, it is posed, is data? What is observation, what is
interpretation? Can they be distinguished and does it matter anyway? The
influence of Logical Positivism and diagnostic categories and practice, and the
debates concerning hypothetical particles and unobservables in physics add to a
heady mix of doubt and speculation.

Part Four doesn’t get much clearer
as it broaches the problems of values and ethics in mental health. It
introduces the idea of Value-Based Practice. It covers the key concepts in
bio-ethics, and some of the issues raised by having laws in these areas. What
does it mean to have compulsory treatment? Are we back to the anti-psychiatric
position of an illness compared with problems with living? What does consent
mean? At what point may it be justifiable to override a person’s rights in this
way? What can philosophical discourse say to us here? The recent events
concerning euthanasia, ‘rational suicide’ and forced caesarean births are
broached at this point, but not explored thoroughly. Nor is the issue of
deliberate infection by HIV positive persons; but perhaps that is not a
psychiatric concern.

The fifth section looks at the
philosophy of mind and mental health. In many ways this returns us to our point
of departure. What exactly is the mind? What is the mind and what is the body?
Is a disorder of the mind a disorder of the body or not? The section revisits
many of the concepts outlined in previous chapters, and many of the familiar
names reappear as the circle closes. How to know what is going on in someone’s
mind, how to understand the individual experience of identity, how to enter
into the world of another become principal concerns.

In conclusion it should be said
that this is a very fine, deeply impressive addition to both psychiatric and
philosophical literature, as well as forging an identity of its own. It has
admirable clarity and speaks much good sense. It moves at a steady pace and the
large number of reflective exercises helps a reader negotiate difficult
terrain. It will be of great value to students (both new and continuing) of a
number of disciplines and many of its concerns should be seen as essential to
any mental health practitioner. It informs but is never didactic, it encourages
reflection, but is not without critique, and it does not make claims above its
station. It recognizes that psychiatry is, and always has been, intimately
wrapped in philosophical concepts; it does after all concern itself with some
of the most fundamental questions of the human experience. It will be of great
assistance as we begin to anticipate and comprehend the ramifications and
implications of DSM-V. The final sentence in the text is perhaps a fitting way
to close: the "genuine scientific advances (of psychiatry) have to go hand
in hand with an understanding of the rational pattern that governs minds, a
pattern that may well never be codified in a deductive scientific theory".
Perhaps it is the process rather than the outcome that matters. But that is
another philosophical question.

© 2006 Mark Welch

Mark
Welch, Ph.D., Assistant Professor in the Faculty of Nursing at the University
of Alberta, Edmonton, Alberta and Co-Director of the PAHO/WHO Collaborating
Centre for Nursing & Mental Health

Categories: Philosophical, Ethics