Scientific Expertise, Service Users and Democratising Psychiatric Research

Friesen outlines six different reasons for democratizing scientific research. Three of them are epistemic and three are ethical. In this commentary I consider how service users might relate to values if significant levels of scientific knowledge are required to understand those values. I specifically consider the traditional theoretical virtues discussed by philosophers of science (Psillos, 1999; Solomon, 2001) whereby we might judge scientific concepts based upon their simplicity, consistency or coverage. This raises questions of how democratic approaches should function when expertise is important.

There is a general problem of how democratic institutes should function when members lack understanding. For example, most voters in current European democracies have limited understanding of economics. They may understand some broad principles but would not understand how to actually manage an economy on a daily basis. A simple solution to this is that political parties outline a broad framework and then are given consent to run the economy once elected. Our elected representatives or members of an unelected bureaucracy actually then make the "on the ground" decisions about how to run the economy given the broad framework which the political party was voted in on. This hopefully then means that, with varying degrees of success, people who have some understanding of economies are playing a key role. We can certainly ask important questions about this system, such as what level of economic understanding do citizens have and what level they need, who should constitute the unelected bureaucracy and whether the bureaucracy could actually be elected. My simple point is that this is one approach to limiting the decision-making of people who may lack economic expertise. In relation to democratizing psychiatric research, I consider whether Friesen's approach might mean service users require a level of expertise that they typically lack.

Friesen outlines how there is a very high level of value decision involved in psychiatry given the gap between data and theories. Friesen thinks service users should be included in decisions over what values to use. I now provide an example of where making good value decisions might require significant levels of scientific knowledge. I consider a specific type of value applied to a specific area. There has been recent discussion of service users being involved in decision-making over modifying psychiatric diagnoses, whereby they might play a role in deciding what psychiatric diagnoses there are and what their diagnostic criteria should be (Bueter, 2019; Fellowes, 2023; Tekin, 2022). I consider how we can assess psychiatric diagnoses using theoretical virtues. It should be emphasized that this problem may or may not have applicability to other areas of service user involvement, that theoretical virtues are not the only values which are important for assessing psychiatric diagnoses and that scientists might themselves make bad decisions in relation to theoretical virtues. I now outline five theoretical virtues.

First, simplicity. There are lots of different ways to understand simplicity but here I consider how simple a system of psychiatric diagnoses (i.e., the Diagnostic and Statistical Manual of Mental Disorders [DSM]) is. We can ask if the system of psychiatric diagnoses is too simple because it contains too few diagnoses or too complicated because it contains too many diagnoses. Simplicity and complexity might also depend on the degree different diagnoses have overlapping symptoms. We can judge a particular psychiatric diagnosis on the degree it adds to simplicity or complexity. Establishing the strength of this theoretical virtue requires knowledge of many different psychiatric diagnoses.

Second, coverage. This relates to the degree that all the phenomena that we desire covered are being covered. We can ask whether a system of psychiatric diagnoses is or is not covering all the symptoms that we think need covering by psychiatry. We can judge particular diagnoses on how they contribute to coverage. Assessing this requires knowledge of a vast range of symptoms.

Third, embedded within a theoretical network. Scientific concepts can be connected to other scientific concepts. A diagnosis can be judged on the degree it connects to other well-established areas of science, whereby the diagnosis might have been formulated based upon being compatible with or...