The Concepts of Psychiatry: A Pluralistic Approach to the Mind and Mental Illness

Afterword

Afterword It is in the nature of our subject that every thoughtful psychiatrist can choose only between having his philosophic standpoint explicit or leaving it implicit; a philosophic standpoint of some sort he must have. —AUBREY LEWIS, 1967 Psychiatry rests on philosophical questions and assumptions. The main purpose of this book has been to raise questions and discuss concepts , rather than to provide answers. No single theoretical framework has been suggested that will satisfy those who seek a single ideology. Philosophers may find this a weakness, but it is only so if one accepts that such is the purpose of philosophy: system-building. That is not a purpose I accept. I have tried to do something along the lines of Socrates’ tradition: I have sought to clarify the concepts of psychiatry by asking questions, by providing insights, by using ideas from different sources. In so doing, I have applied ideas from Karl Jaspers, Freud, existentialists, and others. I have sought to show that research and practice in psychiatry rely on certain concepts—hidden, confused, and vague as they may be. And the discussion of concepts is what philosophy is all about. Those who might deny having any conceptual assumptions suffer from a myopia of not recognizing that they too have philosophical ideas, which they impose on their psychiatric research or practice without realizing it. The purpose of this book has been to make the discussion of these philosophies overt, to bring them to the surface, follow their outlines, and delineate their implications. For psychiatrists, this should help us to choose and apply our philosophies in psychiatry more rationally . For patients and the lay public, this book hopefully provides an explication of what psychiatry is all about and helps demystify the field. Psychiatry, as a field of theory and practice, is committed to certain views regarding what there is (mind-brain theories), how we know about psychiatric realities (epistemology), and what we value (ethics). Which view one espouses on these matters has important practical consequences. The purpose of this type of investigation is to promote conceptual clarity about one’s assumptions and values. This in turn leads us to the general theoretical framework of pluralism, which entails open-mindedness toward diverse ideas, flexibility in using different methods in psychiatry, and a commitment to finding and applying the best method for a specific circumstance. Emil Kraepelin wrote in 1917, when surveying the previous one hundred years of psychiatric practice: “Our satisfaction over the progress already made is tinged with regret. . . . We must openly admit that the vast majority of the patients placed in our institutions are according to what we know forever lost, that even the best of care can never restore them to perfect health. . . . Even under the most favorable conditions, the fruits of scientific labor generally ripen very slowly, and in our field, quick, dazzling results are unthinkable” ([1917] 1962, 152, 154). As the end of a second hundred years of psychiatric research and practice approaches, I think it is not implausible to have expected more progress than we have achieved, given the tireless work of so many brilliant psychiatric clinicians and researchers. Yet, much progress was stymied by fruitless conflict and inflexible beliefs. If psychiatric theory and practice can achieve and sustain a pluralistic, pragmatic attitude, the profession might be able to better serve the purposes of scientific progress and its ultimate goal of healing those suffering from these all-too-human afflictions. 310 Afterword ...