Tuesday, 21 January 2014

Philosophy & Psychiatry The Next 100 years

I was led to this colloquium by a tweet from Medical Humanities – a tremendously active and inspiring bunch of people at Durham University – and thought I would enquire within. It was the third part of a travelling symposium marking the centenary of Karl Jaspers’ General Psychopathology.

In the few weeks preceding it, there had been a week long summer school in Oxford: Philosophy of Psychiatry: Mind, Value and Mental Health.

 After which was the 15th INPP conference/travelling three centre UK Symposium – firstly in Durham. The one day workshop there was titled Current and Future Applications of Phenomenology in Psychiatry. This included presentations such as ‘Rethinking the First Person in Phenomenological Psychopathology’ and ‘Incomprehensibility: A New Ethics for Psychiatry’.

 The second part, at King’s College London, was entitled ‘Conceptual Issues and the DSM’. Among others, there were sessions on “The Definition of Disorder in the DSM: Evolving but Dysfunctional’ and ‘Lost in Translation: Dysfunction and Domains’.  I was to attend the third part.

The dominant theme was (and still is) Making Change Happen.  And how philosophy and psychiatry can work together to achieve this.
Back in January I was asked to provide a 100 word biography/declaration of interest and passed the first test (and only test!).  Then hefty reading material started to appear in my inbox – some surely only decipherable by the initiated.
Highly intrigued and appetite whetted, I set off at a punishing 4.30 am for Oxford one bleary July morning and was for the next two days buried in a fabulous mix of ideas, thoughts, secret languages, buzzy presentations and edgy controversy – all adding up to a really mind-changing experience.

Not being a philosopher or a psychiatrist I guess I, as A.N.Other, would have positioned myself with the service user/survivor cohort – if pressed. I began to boldly declare myself as an ex-psychotic (for that I am), as I found the environment a safe and trusting one.  Swiftly I realized that my lack of knowledge of academic philosophy was something of a hindrance (some of the presentations were so arcanely worded that only the inner cabal could decode). But nevertheless no-one made me feel at all deficient and the atmosphere was one of huge support and good will, and I summoned courage from somewhere to be able to feed back to the hall after the group sessions.

 Standout moments for me included the patience and kindness of academics within the groups, highlighting the ‘moral courage’ of the survivor in sharing their stories – and how possibly the psychiatric community could follow suit. Off-piste, the amazingly delicious conference dinner at which I talked to Anke Maatz, a young trainee psychiatrist from Zurich. Breakfast among European philosophy teachers from Lublin and Prague, lunch with a PhD student from Hearing the Voice and a researcher for SANE , and bonding with Alicia Monroe from Florida, Dean of Tampa medical school, whose words are very wise.  Conversations with Sanneke de Haan working with OCD patients who receive deep brain stimulation, and the ethics and outcomes of this intervention. Staying with me are Nev Jones (a US philosopher inter alia) and her fierce but principled calls for alternatives to heteronormative language and othering, as well as the dominance of men as main speakers at upcoming conferences. The power of the poster presentations included a graphic representation of a state of breakdown by Gay Cusack from Australia, calling out for the work of post psychiatrists Bracken and Thomas; I was haunted by an eerie film presented by a Social Sculpture DPhil student (and local psychiatrist) Dr Helena Fox which took us through an asylum like setting to an intricate study of folds of bedclothes and gradual revealing of hands within.

Topics flew around – value-based models, narrative and the nature and form of narratives, deacademicising the language, critiques of CBT, the case for psychodynamic psychotherapy, true freedom of thought, meaning in delusions and hallucinations, recovery and all its meanings, service user engaged philosophical research, co-production (experts-by-experience & by-training), and Thomas Fuchs’ lifeworld .

The colloquium opened with Victor Adebowale , cross bench peer and Chair of Turning Point,  and his hugely inspiring words about change and how to effect it.  The mindset has to change.  In his experience there is a tendency of  ‘letting the excellent get in the way of the good enough’. Renewal is crucial as well as a shift in power. Who holds the power is key – power needs to be shared.  

We all parted with great goodbyes and huge goodwill for change.  Future plans are being laid and hopefully the conversation that has been started will continue to gather momentum. Academia being naturally conservative and tending towards silos of expertise, the fact that the colloquium happened was a huge boost, and the power imbalances can start to be addressed. As a complete layperson and fairly philosophically naïve, I had come to the conference with the thought that it was about the philosophy OF psychiatry, rather than philosophy and psychiatry. This set me thinking…
 There is such a need to interrogate psychiatry for what it is. What is it? Does it need to be? Is it a cult or a construct? What could replace it?  Could psychiatrists all become neuroscientists in this brave and sinister new world of diagnosis by brain scan? Where will that lead us?

Is there a philosophy of psychiatry? What is it? How can the human rights abuses within the field be ethical? What is psychiatric ‘care’? How ethical is psychiatry’s dependence on the major pharmaceutical companies and the use of dangerous life-threatening drugs on young children and the elderly and others?  The fact that recovery is higher in developing countries than in industrialised ones needs to be examined.  People are still subjected to ECT and lobotomy; is this ethical?

There’s so much to explore, and I hope that this wonderful and awe inspiring conference is just the start.

St Catz Colloquium – Philosophy and Psychiatry - The Next 100 years. Making Change Happen – Oxford, St Catherine’s College.  Organizers: Bill Fulford, Matthew Parrott and Laetitia Derrington. Department for Continuing Education

Polly Mortimer

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