Book Announcement: Towards a Pre-Modern Psychiatry

Jenifer Booth writes: Psychiatry is a field where a lot of attention is focussed on scientific knowledge and scientific solutions. But how does this emphasis on science relate to the caring practice of medicine? In my book Towards a Pre-Modern Psychiatry, I address this question by applying a version of virtue ethics and pre-modern knowledge to psychiatry. In particular I use a version of the work of moral and political philosopher Alasdair MacIntyre, with a little help from that of the feminist philosopher Luce Irigaray.

I do this  by way of an analogy. I say you can think of Aristotelian knowledge as if it were displayed in a museum. Different traditions of enquiry, which can include even the history of science, are displayed in this museum. The museum goers are able to walk around and judge that knowledge. They are the decision makers on which virtue ethics depends. They can judge how traditions interact. This makes use of an argument made by MacIntyre that knowledge, even knowledge of science, can be seen as traditions of enquiry in which narrative is the basic genre. The tradition of enquiry of the psychiatrists can be seen as one tradition, and that of the patients (mental health service users) as another.

Further adaptation of this view of knowledge would see these two traditions of enquiry coming into dialogue with each other over a practice (another concept developed greatly by MacIntyre). In this case the practice is psychiatry. This coming together can again be thought of as taking place in the imagined space of a museum. This has the advantage that, where there is disagreement about an aspect of care, it must stay displayed in the museum space until it is resolved. Those communities deciding on what goes in their museum display do so in assemblies. The assembly is a second institution used to visualise Aristotelian, or more specifically Thomistic Aristotelian, knowledge.

Another concept I use in the book which fits with pre-modern philosophy is that of folly, defined as lacking legal responsibility but retaining good reasons for action. This means, in agreement with Foucault, that folly can retain a voice to which it is rational for us to attend. This can be the basis for a public health function in psychiatry which is attentive to those factors in society which people feel cause their apparently mad actions.

Using MacIntyre`s concept of tradition-constituted enquiry, I ask how psychiatry can reform itself, both by revising its own core concepts, and by coming into dialogue with other traditions of enquiry. Based on the aforementioned work on museums and assemblies as models of knowledge, I suggest that objectivity in psychiatry is a result of negotiation between two different sorts of friendship: the kind of friend who gives you drugs in order to do your duty, and the kind who empathises with all you have been through. I argue that the former approach is currently more dominant in psychiatry.

Using Masterman`s elucidation of Kuhn`s concept of paradigm and insights from the feminist philosophy of Luce Irigaray, I also suggest how psychotherapy can also be reformed in a pre-modern direction.

This book would be of interest to medical humanities scholars in part because of the emphasis on narrative. MacIntyre`s philosophy provides an interesting narrative sociology which undepins his Thomistic Aristotelian approach and I show that this is readily applicable to psychiatry. The book is also an example of how mental health is a field where the ethical problems of the nature of medicine are particularly acute and are hence able to be thought about more readily.

Towards a Pre-Modern Psychiatry is published by Palgrave Macmillan.

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