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Nature and narrative: an introduction to the new philosophy of psychiatry
  1. P Tyrer

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    Edited by Bill Fulford, Katherine Morris, John Sadler, and Giovanni Stanghellini. Published by Oxford University Press, Oxford, 2003, pp 274, £29.95. ISBN 0-19-852611-3

    Many of my colleagues are puzzled by the recent interest in philosophy by psychiatrists and other mental health care professionals. Paul Appelbaum, in a foreword to this book, suggests that philosophical phenomenology has brought “mental health professionals closer to the experience of their patients, and holds the key to strengthening the alliance between treaters and the people whom they treat”. My own view is that in an age of empiricism and a somewhat sterile world of evidence-based practice, the whole field of therapeutic endeavour that is not yet part of our evidence base has had little to guide it. Psychoanalysis has virtually failed, although still hanging on by its fingertips, and the necessary underpinning of practice by the basic sciences has not kept up with expectations.

    So philosophy has filled the gap, and in this book its messengers, many of whom are immensely eloquent, explain why. We are introduced to the work of Jaspers, Wittgenstein, and Sartre, to the concepts of hermeneutics and empirical linguistics, and an invitation to join the world of magic rather than the “narrow rationality of science”. As might be expected, this book is full of ideas, vibrant with rhetoric and debate, and always lively. Philosophy is like argument, most of all with each other, and argument is almost their evidence base.

    It all makes for an excellent read but the uninitiated might have to have a medical dictionary handy to identify some of the apparent neologisms that are common to the language of philosophy. What is clear from this book is that philosophy is clearly on its way back into psychiatry and cannot be ignored. This is but the first of a series on international perspectives in philosophy and psychiatry and my prediction is that philosophy will continue to be relevant to a large part of empirical psychiatry. As Fulford and his colleagues say in their first chapter “there are no theory-free observations” and the exactitude of philosophy will continue nagging at what Wittgenstein calls “concept clarification” until we have acceptable answers.

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