Philosophy of psychiatry: theoretical advances and clinical implications.

Summary

Philosophy and psychiatry have a long history together, and recent work emphasizes integrating facts and values in understanding mental disorder, moving beyond strict scientism to a soft naturalism that supports both evidence-based and values-based care. A pluralist approach to psychiatric science, encompassing ontological, explanatory, and value pluralism, acknowledges multi-level causal interactions and the importance of lived experience. Embodied cognition, viewing the brain-mind as embodied, embedded, and enactive, offers a conceptual framework that integrates cognitive-affective neuroscience with phenomenological psychopathology.

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Abstract

Work at the intersection of philosophy and psychiatry has an extensive and influential history, and has received increased attention recently, with the emergence of professional associations and a growing literature. In this paper, we review key advances in work on philosophy and psychiatry, and their related clinical implications. First, in understanding and categorizing mental disorder, both naturalist and normativist considerations are now viewed as important - psychiatric constructs necessitate a consideration of both facts and values. At a conceptual level, this integrative view encourages moving away from strict scientism to soft naturalism, while in clinical practice this facilitates both evidence-based and values-based mental health care. Second, in considering the nature of psychiatric science, there is now increasing emphasis on a pluralist approach, including ontological, explanatory and value pluralism. Conceptually, a pluralist approach acknowledges the multi-level causal interactions that give rise to psychopathology, while clinically it emphasizes the importance of a broad range of "difference-makers", as well as a consideration of "lived experience" in both research and practice. Third, in considering a range of questions about the brain-mind, and how both somatic and psychic factors contribute to the development and maintenance of mental disorders, conceptual and empirical work on embodied cognition provides an increasingly valuable approach. Viewing the brain-mind as embodied, embedded and enactive offers a conceptual approach to the mind-body problem that facilitates the clinical integration of advances in both cognitive-affective neuroscience and phenomenological psychopathology.

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