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date: 11 November 2019

Introduction: History

Abstract and Keywords

In the editorial introduction the stage is set for the chapters in the section by a brief discussion of the relationship between the disciplines of philosophy and psychiatry. Then each chapter briefly is summarized or highlighted.

Keywords: boundaries between disciplines/fields, fusion of disciplines/fields, Quine, history lessons, Plato, madness, unreason

Philosophy and psychiatry. “Philosophy,” “psychiatry,” with an “and” in the middle. But how can that be? Isn’t philosophy just philosophy? Psychiatry just psychiatry? How can the former be conjoined with the latter in a fused twosome? Aren’t disciplines distinct?

W. V. O. Quine (1908–2000), the distinguished Harvard philosopher and logician, once remarked that boundaries between disciplines are useful for university administrators and librarians, but should not be overestimated—as boundaries. When we carefully examine academic, scientific, and medical fields and abstract from their administrative organizations and book stack locations, we recognize that two or more disciplines often form an interactive interanimating family of intellectual and practical concerns, connected in its members, informed by mutual influence and degrees and modes of co-reliance. On which library stack or journal holdings a discipline’s products are placed fails to reflect the family as a family and the internal interactions of its members.

Psychiatry and philosophy form one such family. Although psychiatry and philosophy are distinct fields or disciplines, and pull in opposite directions vis-à-vis clinical application and observation, with philosophy typically nestled in the canopy of overarching theory, and psychiatry often rooted in the soil’s edge of clinical and therapeutic utility, each is bound up in the other. Each both needs and animates the other, whether all of their respective family members recognize this fact or not. Psychiatry cannot function without philosophical presupposition and reflection. Philosophy, meanwhile, is impoverished without recognizing the forms and limits of the human mind as exhibited in psychopathology and in the onset and recovery from mental illness and disorder.

The fact that each of philosophy and psychiatry is bound to and in need of the other is revealed in the pages of this handbook. In aim and effect, that is what this handbook is about, viz., the fusion of the two fields.

Intellectual history contains vivid expressions of the two fields’ fusion. One important lesson of the history of mental health medicine and psychiatry, and of the roles of philosophical reflection and presupposition in the development of mental health medicine, is that many of the concerns of philosophy—especially in philosophy of mind, of science, metaphysics, ethics, and epistemology—are issues within psychiatry and mental health medicine. At the same time, many topics within psychiatry—rationality, autonomy, self-control, well-being, explanation, understanding, and numerous others—are issues that have been addressed by (p. 16) philosophy. The topics are proper and essential parts of the connections between philosophy and psychiatry.

To briefly mention one historically fecund example, the nature of reason and rationality, in general, and of insanity and rationality’s failure, in particular, became an issue central to mental health practice 2,500 years ago with the classical Greeks. When Plato, for example, looked for a kind or type of human affliction or ill-being, madness or insanity struck him as the outstanding candidate, for madness was, alas, the most “perfect” or exemplary case of the mind’s potential for dramatic imperfection. It served as a contrasting foil for his theory of human happiness and well-being. Madness exposes the rational mind as capable of falling apart and becoming profoundly ill and disordered. Plato was convinced that it unearthed the fault lines of the psyche.

The intellectual heritage bequeathed to us by the ancient Greeks is rich and resourceful indeed. But the nutritious conceptual soil from which current psychiatry grew over the course of history from Plato and through numerous other figures and periods also has produced vexing conceptual and therapeutic puzzles that have challenged successive generations of mental health practitioners and psychiatrists. It is the purpose of this first section of the handbook to offer several illustrative examinations of historical expressions or cases of the relationship between the theory and practice of mental health medicine, on the one hand, and philosophical reflection, presupposition, and analysis, on the other.

Seven chapters follow this introductory chapter in Section I. Chapter 3 by Daniel Robinson is on the roles that concepts of insanity and personal responsibility have played historically in analyses of the persons or rational agents fit for the rule of law and civil society. At a minimum, persons fit for participation in a civil society must be able to give and comprehend reasons for action, the actions of themselves and others. Robinson pays special attention to significant interactions between law and psychiatry and to the manner in which those interactions historically have been fueled by central and controversial philosophical assumptions. Robinson’s chapter also examines the extent to which mental disorders in general have, over history, proven to be grounds for mitigation of personal and legal responsibility.

In Chapter 4, Terence Irwin sketches the three alternative theories of mental health and well-being of Plato, Aristotle, and the Stoics. He explores the roles that various concepts played in those theories, contrastive and comparison concepts such as reason and unreason, virtue and vice, unity and disunity of personhood. In each case he examines how such concepts and their explications produce similarities and dissimilarities in how mental illness or disorder was conceived in the Ancient World. One feature of these ancient pictures is the role that reference to a conception of a person as caring guardian or “friend” of themselves plays in each theory. This is a person, in particular, who tries to avoid conflict and internal discord. In mental health, concord and unity is sought.

Irwin’s chapter is the point of departure for Chapter 5 by Edward Harcourt. Harcourt offers a series of reflections on where or how the ancients may have placed their theories of mental health and illness in the context of contemporary debates. Quite clearly some of today’s attitudes would have been alien to them, but others not. Harcourt tries to sort out which is which and to explore connections with current controversies, such as debates generated by the so-called personality disorders and the anti-psychiatry movement.

Katherine Arens in Chapter 6 writes about a major figure in the history of psychiatry, a psychiatrist who exhibits just how influential philosophical assumptions may be to the theory and practice of mental health medicine. The focus of her essay is Wilhelm Griesinger (1817–1868). Griesinger was professor of psychiatry at the University of Berlin. He came (p. 17) to be known as the father of modern biological psychiatry. Arens describes how Griesinger worked at the juncture between medical or clinical psychology and university psychology, sought a scientific paradigm for psychiatry, and made contributions to the diagnostics and therapeutic treatment of mental illness. She focuses on Griesinger’s influential masterpiece entitled Mental Pathology and Therapeutics (first published in 1845) and his assumption that three interactive elements are explanatorily responsible for the emergence and progression of mental disorders or illness. These are mind, body, and social–cultural environment. Besides trying to spare psychiatry the pointless task of identifying disorders in environmentally indifferent terms, Griesinger was interested in molar scale organism/environment interactions and in whether the clinical professions could develop a proper philosophical/empirical framework for distinguishing between healthy and unhealthy minds in what may be called environmentally embedded terms.

In Chapter 7, Christoph Mundt explores the background influences, immediate setting, impact, and internal content of Karl Jaspers’ (1883–1969) monumental General Psychopathology. Jaspers’ aim was to create a psychiatry balanced between emphasis on the brain and the experiences, intentions, and subjective meanings of individual persons and patients. The first aim was strictly mechanistic and impersonal; the second interpretative and person-centered. Mundt discusses a range of considerations required to understand Jaspers’ work, several major figures in philosophy, psychology, and elsewhere who influenced him, and the dimensions of understanding for a mental disorder or illness that Jaspers tried to articulate and promote. Given Mundt’s analysis, it is easy to see that many of Jaspers’ concerns and predilections are very much alive in psychiatry today.

The French philosopher Michel Foucault (1926–1984) is the subject of Chapter 8 by Federico Leoni. Leoni examines the moral and political power concerns that inform Foucault’s work on mental illness and the hidden instruments of the institutional control of human behavior that often mask themselves as medical knowledge and as forms of psychiatric language and intervention. Several of Foucault’s key claims are offered for detailed inspection, including his charges that in certain respects mental institutions resemble prisons and that psychiatric labels and diagnostic practices are often fueled by financial interests and reinforced by economic incentives.

For most of western European history, depressive illness, of one form or other, has been central to the very idea of mental affliction and ill-being. The early church fathers, for example, wrote of a sin of acedia, a state of depressive despair or despondency that may take its sufferer into an emotional darkness that is beyond moral persuasion and religious ministration. In Chapter 9, Jennifer Radden and Somogy Varga argue that first-person narratives or memoirs of depression offer a kind of micro-history, a history within the life of an individual sufferer or patient, of this central form of mental disorder. Just as the history of mental illness or disorder, in general, or of the field of mental health medicine or psychiatry, requires its own historiography, its own proprietary form of interpretation, so the class or genre of illness and disability memoirs, like those written about the experience of depressive illness, requires its own interpretative framework or epistemology. So argue the authors of this chapter. They offer guidelines for the interpretation of disorder narratives or memoirs—insights into the cautionary lessons or importance of a narrative. At the core of every illness is the person with the illness. A mature conceptual synthesis of perspectives on an illness must somehow honor that core. The key is determining the proper forms and limits of that “somehow” in the case of patient narratives.