Oxford Textbook of Philosophy and Psychiatry - Bill Fulford, Tim Thornton & George Graham
Review by Gerald Levy
MENTAL illnesses are malign conditions, enormously varied both in their form and in their aetiology, pervasive, omni-cultural, affecting all ages and both sexes, sometimes amenable to treatment, sometimes not, and often cripplingly severe. But even the simplest of them raises questions as to diagnosis and treatment.
Example: Zeno has become miserable, slothful and, lately, suicidal, following the death of his life-long companion. Two sets of questions arise. First, practical ones for the psychiatrist. Is Zeno suffering from an illness? Is his desire to die reasonable? Would medical intervention, if needs be by force, be justifiable? And, if so, should society incarcerate him, and forcibly treat him until his mind has healed?
Second, according to the authors, three types of philosophical questions arise. How does all this fit into Zeno’s philosophy of life? Conceptually, what is meant by saying that Zeno is ill? And how do moral philosophy, epistemology (theories of knowledge), and phenomenology (the proper description of the mental state) bite on all this?
Dr Fulford is a philosopher and consultant psychiatrist. For more than a decade he and his collaborators have been working on a programme of bringing philosophy to the aid of psychiatry.
This stimulating and generous book is the latest and the most lavish product of their endeavours. Their technique is to intertwine strands of philosophical exegesis with narratives which expose everyday problems in diagnosis and treatment.
They do not give answers but provide philosophical tools which may be of assistance in answering them. We are given extensive discussions of the work of scores of philosophers – including Descartes, JL Austin and Gilbert Ryle, St. Augustine, Husserl and Sartre, Karl Jaspers and Donald Davidson (both extensively treated), Russell, Gödel, Wittgenstein and John McDowell, Freud (ticked off for lack of scientific method), Thomas Szasz (and anti-psychiatry), Daniel Dennett and Kant.
Three central problems discussed by philosophers are: whether there are minds as well as bodies; whether there is such a thing as freedom of the will; and whether the only applicable model of human behaviour is entirely bio-chemical.
These questions have three things in common. Their meaning is not always entirely clear; they are inter-related; and there is no answer to them. But most of us incline one way or the other. All these questions are addressed, along with formal logic, bio-ethics, value-based practice, new agendas for psychiatric classification, and evidence-based medicine.
The book is beautifully produced, has extensive bibliographies and a CD of readings. Its target audience would appear to be anyone interested in psychiatry, psychiatrists, and trainee-psychiatrists who have begun to think about some of the assumptions and issues inherent in psychiatric practice that are not generally either identified or discussed.
It contains dozens of helpful exercises. But despite the exceptional clarity of the exposition of the many diverse ideas and theories which are paraded, it would take years of careful work to fully digest it. As used to be said of the Bible, it is a library rather than a book. Put another way, it’s an intellectual treasure chest.
Philosophy has for too long been an academic subject considered remote from the problems of everyday life, and with a shrinking constituency.
But it contains the product of 25 centuries of thought, and it is this product that Dr Fulford and his collaborators make available to any serious discussion of the problems of mental illness. They deserve our thanks.
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