1 Philosophy and psychiatry

1.1 Psychiatry
We can begin with a simple definition of psychiatry, that usually appears in
the manuals of this discipline:
Most textbooks make some simple opening statement about it
being a branch of medicine concerned with disorders of the
mind. (Fulford, Thorthon, and Graham 2006: 4).
Psychiatry, at least in the UK and the USA, is practiced by medically qualified
people that can eventually prescribe drugs to treat mental illnesses.
Psychologists, on the other hand, are not medically trained professionals
and their intervention to change behaviour, attitudes, and dispositions are
based on discursive techniques or other forms of non-biological
intervention. Some might use psychoanalysis, but other types of approaches
and therapies are available.

1.2 Philosophy
Offering even a simple definition of philosophy is a difficult task.1 There is a
quote by the renowned British philosopher Sir Alfred Jules Ayer 29 (October
191027 June 1989) that points out the difficulty of this task, even for him:
What do you do?; people sometimes ask me. I am a
philosopher. If I am lucky, the conversation ends there, but
often it continues: Well, I suppose we are all of us philosophers
in our different ways; I mean we all have our own ideas about
the purpose of life. Now what I think Or else: A philosopher:
I envy you in these difficult times. To be able to take things
calmly, to rise above the petty vexations that trouble us ordinary
men. Or again: That must be fascinating: really to understand

1
It might be worth mentioning that one branch of philosophy, known as meta-
philosophy or philosophy of philosophy, is dedicated to investigating what
philosophy is and should be. For an introduction, see Overgaard, Gilbert, and
Burwood 2013.

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 people, to be able to reach their souls. I am sure you could give
me some good advice. Or, worst of all: What is
philosophy?(Ayer 1969: 1)
Without trying to define what philosophy is and to prescribe what it should
be, we can, at least have some general sense of the methods used by
contemporary philosophers.
Usually it is said that in contemporary philosophy there is a division
between continental and analytic or Anglo-American tradition. The
continental tradition, that includes as major exponents and inspirations
figures such as Edmund Husserl, Martin Heidegger, Jean Paul Sartre, Maurice
Merlau-Ponty, generally investigates meaning and ethical values with an
intuitive understanding of with a focus on the individual human experience
and its complex interactions with the social world. On the other hand,
analytic philosophy, and here we can mention Ludwig Wittgenstein, John
Langshaw Austin, George Edward Moore, involves detailed analysis of the
use of our language and or our concepts.
This course, apart from a lecture on Foucault, will be mainly focussed on
an analytic approach to the philosophical problem. Let us, now see, how
philosophy might interact with psychiatry.

1.3 Philosophy and psychiatry

The divide between continental and analytic traditions in philosophy is
interestingly reflected in their different engagement with psychiatry. The
continental tradition has shown more interest in psychiatry and has
exercised a major impact upon it than analytic philosophy. Karl Theodor
Jaspers, with his book General psychopathology (1913), offers a good
example of the rich exchanges between continental tradition and
psychiatry.2 In this highly influential book Jaspers sets out a classification of
mental disorders. This descriptive project is based on insights about the
description, explanation and understanding of our mental life that are
inspired by the work of the phenomenologist Edmund Husserl. In addition,
we can mention Maurice Merlau-Ponty, Jean Paul Sartre, and Martin
Heidegger as continental philosophers that have had an impact on
psychiatry. Finally, Michel Foucaults book Madness and Civilisation (1965),
offers an in influential application to the history of psychiatry and to
psychiatry itself of his blend of post-structuralism.3 With a narration of the
history of psychiatry, Foucault aims at discovering the political and social
dynamics that underlie the establishment of the practices of

2
An elementary introduction to Jasperss influential work on the foundations of
psychiatry is offered in Fulford, Thorthon, and Graham 2006, Chapter 8.
3
Foucault 2001.

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institutionalisation of psychiatry in the modern age. This work aims then to
make these institutions and practices possible targets of criticism.
On the other hand, the relation between analytic philosophy and the
medical investigation of mental disorders has been less strong. At least in its
inception, analytic philosophy has been not very sensitive to psychiatry and,
similarly, psychiatry has not been influenced significantly by this
philosophical current. In the eighties of last century, Anthony Quinton could
lament:
Madness is a subject that ought to interest philosophers; but
they have had surprisingly little to say about it. They ought to
have concerned themselves with madness just to the extent they
have taken themselves to be the custodians of the cognitive, of
rational belief and valid reasoning. (Quinton 1984: 17)
However, in the last twenty years or so, analytic philosophy of psychiatry has
emerged as an innovative and fast growing area of study.
There are some significant milestones of the recent development of
analytic philosophy of psychiatry. In term of publications, it is surely
important to mention the journal Philosophy, Psychiatry and Psychology that
publishes philosophical articles from different theoretical perspective. In
recent years, this journal has seen an increase of contributions by analytic
philosophers. In addition, in 2003 Oxford University Press began publishing
the book series International Perspectives in Philosophy and Psychiatry.
Amongst the many books by analytic philosophers that are published in this
series, it is important to mention: W.M. (Bill) Fulford, Tim Thornton, and
George Graham, Oxford Textbook of Philosophy and Psychiatry. Oxford:
Oxford University Press, 2006. This manual, that is the first of this type, aims,
amongst other things, to prepare students in the UK to take Exam of
admission to the Royal College of Psychiatrists. In terms of university
courses, both at MA level that at PhD, new programmes of philosophy of
psychiatry are proposed in some important universities in UK and USA.

1.4 From philosophy to psychiatry

There is a philosophy to psychiatry connection between philosophy and
psychiatry. Increasingly philosophers test their doctrines with empirical
results concerning mental disorders. The discipline of philosophy of mind is
a natural candidate for this type of exchange between philosophy and
psychiatry. Philosophers of mind have used mental disorders to test or shed
some light in their accounts of normal mental life. Let us mention some
classic issues of concerns for philosophy of mind and the areas of psychiatric
investigations that have been considered to address these philosophical
problems:
personal identity: personality disorders, bisected brain;

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 belief ascriptions: delusional thinking;
Introspection and self-knowledge: thought insertion.
Philosophical research at the intersection between philosophy of mind
and ethics has been affected by this new interest in psychiatry. For instance,
neurological, functional, genetic data concerning mental disorders have
been used in moral psychology in the investigation of the faculties required
for moral understanding and moral motivation. For instance, there are
certain disorders that that appear to affect the capacity to be motivated by
moral considerations (addictions, antisocial personality disorders etc.). Thus,
philosophers who debate about the faculties for moral judgement and
reasoning have used the relative psychiatric literature to clarify defend or
criticise their philosophical theories.

1.5 From psychiatry to analytic philosophy

The interaction between analytic philosophy and psychiatry goes also in the
direction from psychiatry to philosophy. This means that philosophers
apply their theories and insights to solve or clarify problems that emerge
directly from psychiatric theory and practice.
Philosophy of science and philosophy of mind can be applied to two
interrelated central issues in the psychiatric practice. First, what are mental
disorders and how should they be classified? Second, what types of
explanations should we provide of mental disorders?
Of course, another area where philosophers are engaged involves the
moral significance and evaluation of the psychiatric practices. Amongst
them, surely those surrounding the power of psychiatrists to treat patients
by means of confinement and pharmacological intervention, in certain case
even without the consent of the patient, are the most relevant.

1.6 Trying to individuate the philosophical problems of psychiatry

In order begin thinking about the ways in which philosophy and psychiatry
might interact, let us begin with a practical activity taken from Fulford et al.
2006. Let us consider the following case.
Mr AB, Age 48, Bank Manager - Presented in casualty with low
mood, biological symptoms of depression (he had been waking
early and had lost weight), and a hypochondriacal delusion (that
he had brain cancer). He had a past history of a serious suicide
attempt. He had come to casualty complaining of pain in his face
and asked for something to help him sleep. He was diagnosed
as suffering major depression but refused to stay in hospital for
treatment. On an application from his wife, he was admitted as
involuntary patient under the Mental Health Act, 1983

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 (applicable at the time in England and Wales). He made a full
recovery on antidepressant medication. At follow-up a few
weeks later, he admitted he had been planning to kill himself
when he believed he had brain cancer and had been feeling so
depressed. (Fulford et al. 2006: 4-5)
For a start, we might think that, clearly gathering and interpreting the
information provided about mister AB, to reach a diagnosis might involves
practical problems of application of the classificatory systems. So, we might
ask whether we are sure that the doctor has considered all the data available
in the correct way to infer that the patient has a major depression. Now
psychiatrists might think, for example, that MR AB in the vignette presents
a case of depression and that Mr AB should be treated as an involuntary
patient. However, other might disagree. One of the sources of disagreement
can follow from the interpretation of the information gathered about AB.
There can be disagreement whether he is having a mental illness and other
disorder. Usually, this is what might happen in the practice of bodily
medicine.
However, in mental health there are also certain other types of issues
involved. Philosophers of psychiatry think that already by analysing what is
involved in the simple and limited case of MR AB we can uncover problems
that require the intervention of philosophical reflection. Before moving on,
you might like to try yourself to discover these problems:
Exercise Make a list of philosophical problems that you think
are related to the situation of Mr AB.
The situation of Mr AB involves some conceptual problems tackled by
specific philosophical disciplines.
a) Ethical problems: should the agents right for autonomous
choice be respected or should we consider more important the
doctors exercise of his responsibility to act in the best interest
of the patient.
b) Epistemological issue: are his beliefs really delusions?
c) Jurisprudential issue: is Mr AB responsible for his actions, no
matter how foolish?
d) Philosophy of mind: if he has a mental illness, how does this
fact relate to facts about his brain?
However, there is a deeper conceptual problem that emerges from this
case in relations between philosophy and psychiatry. The decision to impose
involuntary psychiatric treatment on MR AB is based on two main
assumptions:
(1) he represents a risk (for himself or to the others),

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 (2) is suffering from a mental illness.
These two conditions for involuntary psychiatric treatment are
contemplated in many legislations, for instance here the decision on MR AB
is reached based on the UK Mental Health Act, 1983.
So, the assumption that the person is suffering from a mental disorder is
central in the practical decision to treat her, even against her will. However,
the notion of mental disorder is not defined in legal terms. Instead it should
be derived from psychiatry. So, what is a mental disorder or mental illness?
To answer to this question, it is surely relevant to consider how
contemporary psychiatry deals with it. This is the topic of the next lecture.

References

Ayer, A. J. 1969. Metaphysics and Common Sense. London: Macmillan.

Foucault, Michel. 2001. Madness and Civilization: A History of Insanity in

the Age of Reason. London and New York: Routledge.

Fulford, K. W. M., Thorthon, K., and Graham, G. 2006. Oxford Textbook of

Philosophy and Psychiatry. Oxford: Oxford University Press.

Overgaard, Soren, Gilbert, Paul, and Burwood, Stephen. 2013. An

introduction to Metaphilosophy. Cambridge: Cambridge University
Press.

Quinton, Anthony. 1984. "Madness." Royal Institute of Philosophy Lecture

Series 18: 1741.