Nassir Ghaemi’s The Concepts of
Psychiatry is an important contribution to the literature of philosophy of
psychiatry and will be especially useful to psychiatrists and psychologists
looking for an introduction to the central issues.  It provides an excellent survey of the ways that questions of
scientific methodology are relevant to the status of psychiatry and it argues
for a pluralist view that other psychiatric methodologists, whether they agree
with it or not, will find helpful in sharpening the debate. 

The book is divided into three
parts, Theory, Practice, and After Eclecticism.
Ghaemi explains at the opening that he opposes the current biopsychosocial
model as it has influenced the development of psychiatry in recent
decades.  He regards pluralism and
integrationism as the most promising approaches to psychiatry currently available.  He believes that Karl Jaspers defended a
pluralistic approach in his classis General Psychopathology and so
Ghaemi devotes substantial space to explaining that work.  The heart of the discussion lies in the
nature of the scientific method of psychiatry, and he explains that for Jaspers,
psychiatry "is a science that relies on understanding meanings, in
addition to causal explanation" (p. 92). 
Furthermore, Ghaemi expresses a strong sympathy to a brand of
philosophical pragmatism that stresses the difficulty of knowing reality and
values plural perspectives while eschewing a simple-minded eclecticism. 

Ghaemi sets out a number of
important issues: the role that values play in psychiatric method, Eastern and
Hellenistic models of self and their relation to modern psychiatry, the role of
modern psychiatric classification and some of the debates that rage about how
best to categorize the maladies of the mind. 
He gives us some nice discussions of general features that occur in many
mental disorders such as depression, mania and psychosis.  He addresses the vexed questions of
psychopharmacological Calvinism, the scientific status of psychoanalysis, and
the relation between psychotherapy and psychopharmacology.  Throughout his discussions, he draws connections
between the theory and the practice and sheds light on the ways that
philosophical debate is relevant to clinical questions. 

It in the final part that Ghaemi
ties the many disparate threads of his book together.  Since he embraces pluralism and rejects what he sees as the
eclecticism and even intellectual laziness associated with the biopsychosocial
model, he has the burden of explaining what his view amounts to.  He explains that his project is still in
progress and so it is unfair to expect a finalized model at this stage.  Indeed, given the pragmatist background to
his method, there can be no finished system. 
Rather than insist that he has the final answers, he rather explains how
some approaches have stronger cases for them than others.  This will hopefully encourage further work
on pluralist and pragmatist approaches to psychiatry, and such work will be
able to bring in more technical philosophical approaches.  Ghaemi expects that a pluralist approach
will not only be conceptually superior to the biopsychosocial model but will
also lead to better treatment for patients. 
Thus it seems that one way to address this debate is to do an empirical
comparison of the different models. 

The Concepts of Psychiatry is
a welcome addition to the current work in the philosophy of psychiatry.  Philosophers will find is very helpful as a
survey to current work in theoretical psychiatry and psychiatric and
psychological researchers will find its proposals provocative. 

© 2005 Christian Perring. All rights reserved. 

Christian Perring, Ph.D., is Academic Chair of
the Arts & Humanities Division and Chair of the Philosophy Department at
Dowling College, Long Island. He is also editor of Metapsychology Online
Review.  His main research is on philosophical issues in medicine,
psychiatry and psychology.

Categories: Philosophical