Why Psychiatric Ethics and Social Science Should Be Friends

The on-the-ground case conference at the interface of philosophical ethics and clinical psychiatry is an innovative idea that advances pedagogy in presenting a creative approach to teaching and practicing psychiatric ethics. In the current exercise of the proposed partnership, there was a generally positive outcome. The philosopher and the psychiatrist learned from each other, were able to find norms that made their collaboration productive, and found that clinical care was enhanced. My commentary aims to help others replicate this model, and preserve its virtues without its vulnerabilities.

Define the Kind of Philosophical Knowledge Most Relevant to Collaboration with Psychiatrists

Would a mathematical logician or philosopher of aesthetics be as good of a collaborator as a moral philosopher? Probably not. Consider restricting philosopher collaborators to those with expertise in moral philosophy, and/or philosophy of mind/psychiatry/psychology/neuroscience.

Emphasize that "Knowledge by Acquaintance" Is Not Just More and Better Information, But Primarily Concerns Moral Imagination, Which Is the Actual Moral Basis for Future Deliberation Between Collaborating Professionals in Psychiatric Ethics

The authors insightfully apply the distinction Bertrand Russell made between knowledge by description and knowledge by acquaintance to the realm of collaborative ethical reasoning in psychiatric practice. The authors explain how their collaboration shows how real-time, face-to-face, and experiential knowledge provided a sense of intrinsic properties of who a patient under consideration really is, and how this is more foundational knowledge than third-person descriptions of patients, as is found in research papers and studies.

This claim seems to be almost certainly correct in the case of the described successful philosopher-psychiatrist collaboration. But it can be developed further to yield additional fruits for better collaboration.

It is difficult for explicit and abstract information and reflective beliefs to influence moral behavior. Knowledge of moral theory doesn't translate to more ethical behavior, as studies of the beliefs and behaviors of actual ethicists and moral philosophers suggest no effect of their knowledge on their behaviors (and in some cases negative ethical effects; Schwitzgebel, 2009; Schwitzgebel & Rust, 2009, 2010; Schwitzgebel, Rust, Huang, Moore, & Coates, 2012). Analogously, there is a danger of seeing the additional "knowledge by acquaintance" gained in the collaboration as merely more information to add to a theory of what is happening to the patient and how to respond in light of abstract ethical consideration. Rather, the main contribution of knowledge by acquaintance is not additional information, but of moral experience: of what it is like to be the patient in the midst of difficult to imagine crisis, the turmoil of loved ones of the patient, the sociality of suffering, and so on. Rather than being the final piece of an informational puzzle or theory of mental disorders, knowledge by acquaintance is the first step to any future moral deliberation between collaborating professionals and professors. The immersion in the phenomenology of clinical life should be the first step of any ethical discussion, not for better theorizing, but because knowledge by acquaintance is the ideal basis for cultivating cracks of moral imagination that allow for the application of compassion and attributions of human dignity to stigmatized patients with mental illness. Indeed, this understanding of knowledge by acquaintance as moral imagination can constrain—and in some cases even subvert (as in case 3)—the most logically scrupulous and theoretically compelling moral formulations that would be unhelpful, or even cruel, if straightforwardly implemented without moral imagination.

Broaden the Participation Beyond Philosophers to Include Phenomenologically Oriented Social Scientists

What does the philosopher add with their expertise, and why limit the psychiatric ethics team to adding only philosophers? The philosopher does add something unique and special. They add to the discussion knowledge of various theories of morality and their history, both as they relate to psychiatric practice, and beyond this domain. They also add a special concern for skeptical questioning...