Horizons on the World

In 1958, the Philosopher Elizabeth Anscombe famously wrote: “it is not profitable for us at present to do moral philosophy; that should be laid aside at any rate until we have an adequate philosophy of psychology, in which we are conspicuously lacking” (Anscombe 1981, p. 26). I suspect Anscombe would still hold this view, even if she would acknowledge some progress. It is interesting to reflect, therefore, on why this might be true despite the appearance of the Oxford Textbook of Philosophy and Psychiatry. Of course, Anscombe spoke of the philosophy of psychology, whereas here we are dealing with psychiatry. The difference suggests the importance in this context of abnormal psychology and its relevance to biomedical clinical practice. Nevertheless, the distinction between psychology and psychiatry need not detain us.

Perhaps we should be detained momentarily by the difference between of and and. The Textbook is definitely one of philosophy and psychiatry, which is interesting because the authors certainly refer by the end of the book to “the new philosophy of psychiatry” (where the emphasis is mine). Indeed, the Oxford University Press Web sites in both the United Kingdom and the United States (seemingly by mistake) call the book the “Oxford Textbook of Philosophy of Psychiatry.” It is certainly the intention of the authors that these are not two disciplines but one. Psychiatry inevitably raises philosophical issues; they are at its core. As Jennifer Radden (2004) said in the Introduction to her own volume in the same series: “Psychiatry, it seems fair to say, is a branch of medicine and a healing practice with a subject matter and presuppositions that are deeply and unavoidably philosophical. Recognition of this has spawned a new research field, the philosophy of psychiatry” (p. 3).

The series itself (called—for those interested in conjunctions—International Perspectives in Philosophy and Psychiatry) is testimony to the success and dynamism of the “new” discipline, which can boast an international network with regular conferences, numerous individual book and journal publications, and its own journal, Philosophy, Psychiatry, and Psychology, now in its 14th year. Much of the inspiration and enthusiasm behind this movement has come from Bill Fulford, the first named author of the Textbook. As a psychiatrist and philosopher he has combined with philosophers from the United States (George Graham) and the United Kingdom (Tim Thornton) to produce a work of considerable breadth and depth that is unlikely to be equaled for many years. So it is even more interesting to wonder about the extent to which it is true that we do not yet have an adequate philosophy of psychology (or psychiatry) to allow us to do moral philosophy.

The Textbook emanates from a Masters course taught by Fulford and Thornton at Warwick University in the United Kingdom. It proceeds by way of exercises and reflections linked to an astonishing array of extracts from philosophical, phenomenological, psychological, sociological, ethical, scientific, and psychiatric sources, which come on an accompanying CD. It could be used as an off-the-shelf resource; but equally it can be dipped into at almost any point and found to convey difficult concepts or arguments with commendable clarity. Moreover, the links between philosophy and practice are maintained throughout.

This is clearly so in Part 1, which introduces core concepts in both philosophy and psychiatry, often with recourse to case examples. Thus, having pondered philosophically on various types of definition, the authors quickly move to discuss the difficult issues around the nature of illness and disease. Not only do such debates have a historical interest, being centrally important to much of the anti-psychiatry movement, but they also continue to be relevant to debates ranging from attention-deficit disorder in children to mild cognitive impairment in older people.

A good example of where philosophy and psychiatry come together—and where the exposition is helpful (to my mind) in terms of clinical practice—is in connection with the notions of empathy and understanding. This crops up in Part 2, which deals with the philosophical history of psychopathology. Chapter 10 provides a good account of the tensions between the approach of Wilhelm Dilthey and those of Heinrich Rickert and...