To use words like “accessible” or “readable” of this small book, would be analogous to calling a typhoon a rainstorm: not wrong, just wildly insufficient. By interspersing short chapters, equally short endnotes and incisively-curated follow-up readings with a mix of illustrations, the three authors, a psychiatrist, a philosopher, and (for our purposes) a visual artist, have produced a veritable page-turner.

This has been achieved, moreover, without compromising by one wit most of the important philosophical ideas at stake in attempts to understand mental disorder: the separate, puzzling and freighted questions around why “mental” and why “disorder,” the place of social norms and social phenomena in these categories, and the ontology underlying psychiatric classification, as well as the new technologies that promise to revise how we think about, and likely treat, disorder. Relevant issues in more mainstream philosophy of mind, such as reductionism, the hard problem of consciousness, and mental causation, also receive a careful and illuminating analysis. So, notably, do the implications of Ian Hacking’s work, in a discussion about the different ways social factors, including both societal forces and ongoing self-creation, might effect, and affect, the symptoms and course of any given instance of disorder.

Also particularly valuable is the authors’ treatment of minimalist accounts of disorder, such as current framings in terms of the suffering and socially-defined disability, that are reliant on “downstream mental consequences”. In contrast to such accounts, it is proposed that we must think of mental disorders in more expanded terms, as those that “develop in a way that is explicable only if the ongoing contribution of mental events is considered…[including] the way in which the mental disorders come about… the way in which they manifest themselves, and… the way they pass off, or become entrenched” (page 26). Mental processes will need to “manifest, develop or persist” for such conditions to rank as mental disorders, sustained by processes of facilitation, inhibition, and catalysis, for example. Such stress on the complex interactivity involved in assigning the mental in mental disorder also carries a warning against over-simplification for definitions that would abjure a “medical model” anchoring mental disorder in biology. 

As its subtitle makes clear, Understanding Mental Disorder approaches these matters from the philosophy of science, particularly biological medicine.  This orientation allows for a range of intriguing analogies, illustrations and stories from the history of science, as well as persuasive reasoning about why psychiatric categories cannot be expected to resemble those of chemistry. It also means that the normative issues involved in understanding mental disorder, towards which so much of others’ philosophical analysis has been directed, are treated sparingly. But the attention towards the place of psychiatry within medicine is a welcome one.

Central mental health norms are dealt with here, although because the warrant for psychiatric interventions is granted on partly social grounds, it is explained, the values that are enforced will be relative to time and place: those that “enjoy currency in the society within which our flourishing is achieved” (page 86). Without biological or evolutionary criteria to distinguish them, condition of mental disorder apt for medical treatment, and perhaps even justifying forced intervention, will be those that obstruct personal flourishing (of oneself or another person). Flourishing is understood in terms of an absence of distress, or impairment in social and occupational roles, i.e., in the limited way accepted by mainstream psychiatry, where forms of flourishing that rest on divergent values find little support.

On the whole, this book offers a fair-minded, and measured defense of key tenets of present day medical psychiatry. Extreme positions, including mind-body reductionism, are rejected, and person-centered approaches to care find favor. Addressed only glancingly are some of the more fundamental challenges to which psychiatry is subject today.

In their preface the authors note the hoped-for readership of this volume: psychiatrists and other medical practitioners, and also those who encounter psychiatric diagnosis in other ways, such as patients. But we can add a further group. This would be an ideal text to introduce to the philosophy of mental health undergraduate students in philosophy or to graduate students in other disciplines.  

© 2019 Jennifer Radden

Jennifer Radden, previously of University of Massachusetts, Boston, has most recently published Melancholic Habits: Burton’s Anatomy & the Mind Sciences (Oxford University Press, 2016)