Psychiatry is unique in medicine in being on the border between science and the humanities. Science provides insight into the 'causes' of a problem, enabling us to formulate an 'explanation', while the humanities provide insight into its 'meanings' and helps with our 'understanding'. The new interdisciplinary field of 'philosophy of psychiatry' has developed to explore the range of issues relevant to this border country. The Oxford Textbook of Philosophy and Psychiatry is a unique textbook which provides a detailed introduction to (...) the field, a framework for study and skill development, and an overview of current research. It focuses on case studies in 5 key topic areas. Each case study is supported by selected readings from both philosophy and mental health, thinking skills exercises, self-test questions, key learning points and detailed guides to further reading. (shrink)
The state of the art of contemporary philosophy and psychiatry is reviewed. Section 1 describes the new field as an international open society of ideas. Section 2 introduces values-based practice. Although originally a philosophy-into-practice initiative, values-based practice is now developing more strongly in areas of bodily medicine such as surgery. An example from surgery illustrates how values-based practice has been implemented as a partner to evidence-based practice in supporting shared clinical decision-making as the basis of best practice in contemporary person-centered (...) clinical care. Section 3 explores the difficulties presented by implementing values-based practice in mental health as illustrated by a case example of anorexia. This shows that these difficulties derive from the particularly intense challenges of values pluralism presented by anorexia. The resources of phenomenology provide the basis for an effective response to these challenges. Section 4 generalizes the argument of Section 3 showing that an effective response to the wider range of challenges of values pluralism arising across the board in mental health is available from the resources of the international open society of ideas of contemporary philosophy and psychiatry. The article concludes with a promissory note on values and a cautionary note on science. (shrink)
Understood in their historical context, current debates about psychiatric classification, prompted by the publication of the DSM-5, open up new opportunities for improved translational research in psychiatry. In this paper, we draw lessons for translational research from three time slices of 20th century psychiatry. From the first time slice, 1913 and the publication of Jaspers’ General Psychopathology, the lesson is that translational research in psychiatry requires a pluralistic approach encompassing equally the sciences of mind (including the social sciences) and of (...) brain. From the second time slice, 1953 and a conference in New York from which our present symptom-based classifications are derived, the lesson is that, while reliability remains the basis of psychiatry as an observational science, validity too is essential to effective translation. From the third time slice, 1997 and a conference on psychiatric classification in Dallas that brought together patients and carers with researchers and clinicians, the lesson is that we need to build further on collaborative models of research combining expertise-by-training with expertise-by-experience. This is important if we are to meet the specific challenges to translation presented by the complexity of the concept of mental disorder, particularly as reflected in the diversity of desired treatment outcomes. Taken together, these three lessons – a pluralistic approach, reliability and validity, and closer collaboration – provide an emerging framework for more effective translation of research into practice in 21st century psychiatry. (shrink)
Schizophrenia has been investigated predominately from psychological, psychiatric and neurobiological perspectives. This book is unique in examining it from a philosophical point of view. It should appeal to every reader who wants to better understand this major mental illness, providing unique insights into the 'experience' of schizophrenia.
Nature and Narrative is the launch volume in a new series of books entitled International Perspectives in Philosophy and Psychiatry. The series will aim to build links between the sciences and humanities in psychiatry. Our ability to decipher mental disorders depends to a unique extent on both the sciences and the humanities. Science provides insight into the 'causes' of a problem, enabling us to formulate an 'explanation', and the humanities provide insight into its 'meanings' and helps with our 'understanding'. Psychiatry, (...) if it is to develop as a balanced discipline, must draw on input from both of these spheres. Nature (for causes) and Narrative (for meanings) will help define the series as a whole by touching on a range of issues relevant to this 'border country'. With contributions from an international star-studded cast, representing the field of psychiatry, psychology and philosophy, this volume will set the scene for this new interdisciplinary field. This will be of interest to all those with practical experience of mental health issues, whether as providers or as users/consumers of services, as well as to philosophers, social scientists, and bioethicists. (shrink)
In Two Minds is a practical casebook of problem solving in psychiatric ethics. Written in a lively and accessible style, it builds on a series of detailed case histories to illustrate the central place of ethical reasoning as a key competency for clinical work and research in psychiatry. Topics include risk, dangerousness and confidentiality; judgements of responsibility; involuntary treatment and mental health legislation; consent to genetic screening; dual role issues in child and adolescent psychiatry; needs assessment; cross-cultural and gender issues; (...) rational and irrational suicide; shared decision making in multi-agency teams, and the growing role of the user's voice in psychiatry. Key ethical concepts are carefully introduced and explained. The text is richly supported by detailed guides for further reading. There are separate chapters on teaching psychiatric ethics, including a sample seminar, and on writing a research ethics application. Each case history and discussion is followed by a critical commentary from a practitioner with relevant experience. Jim Birley adds a comparative international perspective on psychiatric ethics. Cartoons by Johnny Cowee provide punchy counterpoint! In Two Minds is the sister volume to the third edition of Sidney, Paul Chodoff and Steven Green's highly successful Psychiatric Ethics. In providing a bridge between theory and practice, it will be essential reading for everyone concerned with improving standards in mental health care. (shrink)
This chapter introduces values-based practice as a resource for working with individually diverse values in health and social care, and describes its origins in an on-going development through the resources of philosophy. The chapter is in two main sections. Section I, Values-Based Practice, builds on two brief interactive exercises to introduce and explain the key features of values-based practice. As a relatively recent addition to the range of resources for working with values in health and social care, values-based practice is (...) distinctive in focussing on the diversity of values comprising individual lived experience. Like evidence-based practice, values-based practice is a process-driven rather than an outcome-driven methodology. That is to say, rather than offering prescribed answers, both approaches offer processes that support decision-makers in coming to answers for themselves based on the particular circumstances presented by the situation in question. Although entirely complementary, the processes involved are of course different. Where evidence-based practice relies on meta-analyses of the results of high-quality clinical trials to inform a consensual model of decision-making, values-based practice builds on learnable clinical skills and other process elements to inform a dissensual model of decision-making rather than seeking to overcome value-conflicts in reaching consensus. Working within a premise of mutual respect for differences of values, and guided by three key principles linking values and evidence, values-based practice, as described in the chapter, supports dissensual decision-making, balanced according to the circumstances presented by the decision in question, within frameworks of locally-set frameworks of shared values. Section II, The Theory-Practice Dynamic, then outlines the theory-practice dynamic on which values-based practice is based. The origins of values-based practice in mid-twentieth century ordinary language philosophy of the Oxford School are outlined. As the chapter illustrates, although a limited area of analytic philosophy, many aspects of values-based practice are informed by ordinary language philosophy, ranging from its premise, through the training exercises and other process elements described in Section I, to its role in hybrid empirical studies supporting its model of service delivery. The development of values-based practice, furthermore, as section II goes on to describe, is ongoing, with key initiatives drawing not only on both analytic and Continental traditions of European philosophy, but also on non-European philosophies such as those of Africa and the Caribbean. (shrink)