that's an interesting question... we could detail psychology as a middle ground between the two disciplines, but it's obvious that psychology isn't the dialogue between philosophy and psychiatry...and perhaps it's even more of an intersection between all three disciplines. I would say, at the least, that the dialogue between psychiatry and philosophy is concerned with: what is the self, what is mental illness, and what is healing? Psychology is the middle man, that operational zone between the two disciplines where philosophical problems are translated into methods, therapies, and experiments, as a medium of translation between psychiatry's "medicinal cause" and philosophical "meaning."

As a reflection of professional care, the difference between psychology and psychiatry concerns diagnosis and treatment. Psychiatry has developed as a medical approach and psychology has developed from views of individual behavior that come from many, often conflicting, models. The role of the "subjective" comes from different models of human development. The value and role of subjective reporting is also hotly contested. Both practices are keen upon useful approaches to real-time problems. In many clinics, both kinds are on teams evaluating people. The distinction between objective and subjective is too general in this case.

On the clinical psychology side, the development of the Boulder model has been prominent in the development of the practice. The goal was to introduce rigorous methods of research that could answer to the standards of "medical" research but remain as a separate discipline. I linked to it as a search page result to show that it is far from being a settled debate.

P.S. Both sides that I have encountered turn purple at the mention of Liang and Szaz.

I'm not sure how much difference philosophy makes to psychiatry. Doctors treat diseases, and the (apparently) the most effective treatment psychiatrists have is medications. They are diagnosers and prescribers. Most psychiatrists do little psychotherapy (it's too time consuming, given the number of patients, the number of psychiatrists, and insurance payment systems). I've always felt that my psychiatrists were on the same treadmill that my internist, orthopedists, or dermatologist were on.

I would guess that the experience of practicing psychiatry is different for doctors working in busy clinics, seeing one depressed, anxious patient after another, and doctors working in forensic psychiatry where their patients are in locked wards where some patients have barely contained murderous impulses. For that matter, the experience of being a depressed anxious patient isn't the same as being one with those with murderous rages.

It seems like we tend to talk about "mental health" as an absence. I haven't heard people say "she is really mentally healthy" -- just the reverse. Well, how crazy is she? Most people must be reasonably healthy mentally, else societies would be in far worse shape than they are. And even people who have episodic illness (like bipolar) may be described as "mentally healthy" a good share of the time. And then there are lots of highly functional, effective, people who have traits that are surely pathological.

Philosophy comes in handy here to explain some of the glaring contradictions humans exhibit, and for generalizing about how contradictory we are as a species, with our often uncoordinated and/or contradictory cognitive and emotional traits constantly screwing things up for ourselves.

To what extent is psychiatry able to look at subjective experiences of suffering and how does philosophy come into the picture of such understanding? — Jack Cummins

Great question Jack, I have been wondering this for some time. I studied psychology at uni and taught it in high school for years, but have only recently begun to explore philosophy.

I was reading Oliver Keenan's "Why Aquinas Matters Now" this afternoon and started to think that cultivating 'virtues' like prudence, fortitude and temperance in a therapeutic / clinical setting was sensible. There seem countless fruitful applications, to be honest. Any that spring to mind as most obvious to you?

I can't help but thinking that a 'philosophical' approach to counselling might feel more substantial or accessible to a certain subset of people who might need / want counselling but who are suspicious of the affirmative, empathetic approaches most associated with counselling?

I've always felt that my psychiatrists were on the same treadmill that my internist, orthopedists, or dermatologist were on. — BC

Well put. This certainly characterizes my experience with a psychiatrist over a year's worth of counselling at CAMH here in Toronto. Appointments with him were less frequent than those with my psychologist, but my psychologist was the one who benefitted me, likely due to the time constraints on him but less so upon her.

It seems like we tend to talk about "mental health" as an absence. I haven't heard people say "she is really mentally healthy" — BC

Good point. There is conflation with poor mental health and mental illness as well. For the concept of 'mental health' to be effective, it seems it would have to shine light on both ends of the spectrum. It's almost as if good mental health is considered the default, which is clearly not the case.

Philosophy comes in handy here to explain some of the glaring contradictions humans exhibit, and for generalizing about how contradictory we are as a species, with our often uncoordinated and/or contradictory cognitive and emotional traits constantly screwing things up for ourselves. — BC

It feels to me as if that 'handiness' isn't being deployed as much on the subjects of mental health and mental illness? Or am I missing something?

I see references to 'philosophical counselling' in therapeutic fields, but I am not sure if this is psychology with a philosophical gloss or a substantial philosophical project?

Does anyone know more about 'philosophical counselling'?

In the past, there was the opposition of antipsychiatry, in which thinking of RD Laing and Thomas Szaz saw psychiatry as a limiting way of trying to 'normalize' human experience. Those who were deviant were often labelled as 'mentally ill'. However, the arguments against this perspective involved ideas about the 'reality' of 'mental health' for those experiencing mental health problems, as well as those affected by risks entailed. — Jack Cummins

People are still against psychiatry: even though the whole mental health system has achieved more praise and acceptance. Now adays, the main opposition is based on the lack of effectiveness in taking the drugs. People in general are less concerned about normalization than they are about keeping their head on their shoulders. However, there will always be those who don't conform to socual norms and work performance expectations.

Psychiatry itself can't really do anything with subjective experience without patient input: "these pills are not helpful, give me different ones", and philosophy is largely unable to comment on the specific drugs, but we can talk in generalizations about them:

-is taking medication an effective way to survive? If yes, then when?

-can psychiatry exist without prescription drugs?

-Can psychiatrists eventually just make recommendations about fully legal drugs or herbal supplements?

-is psychiatry immoral, destructive, or flawed?

I'd have to say that psychiatry is very limited: it's basically just something people use in desperation, and i can't comment on how to properly administer it. You have to get a referral to see a psychiatrist, because MH proffesionals know that talk based therapy is more effective than medicating for a wide range of issues.

Psychology does draw upon the meaning aspects of understanding experience as well as neuroscience. Of course, there are different schools of thought within psychology. Some emphasise the physical basis of the brain.

Psychiatry is often focused on the way of correcting what is regarded as 'abnormal' through chemical treatments. However, the field of psychiatry often draws upon a bio psychosocial approach, understanding the way in which developmental and social circumstances affect or impinge on psychological wellbeing.

I hadn't come across the Boulder model, so thank you for pointing to that. It does seem that Szasz and Laing have lost their influence in the critique of psychiatric practice. There is a focus on critical psychiatry though. Psychiatry is bound up with values about norms or what is considered 'normal'. There are also political aspects of the practice of psychiatry too.

If the mind is a product of the body, why isn't its cure always found in the body, and often requires another mind? Is it because the mind acts as an independent property, gaining minimal autonomy? The same way we become separate beings from our parents?

What does that tell us about the universe and its properties, like humans? And what does it mean for humans' defiance of the universe?

Thank you for your detailed reply to the outpost. Often chemical treatments of what is regarded as 'abnormal' are the focus within psychiatry. I am also thinking that differences may occur geographically. I am most familiar with the profession of psychiatry in England. The psychiatrists are trained in medicine initially and often do training in therapy in later training. There was an emphasis on the psychodynamic model developed by Freud and others. More recently, that has shifted towards a cognitive behavioral approach.

The cognitive behaviourist approach does involve a philosophical look at underlying beliefs and the way that they affect emotional life. There is some emphasise on positive aspects of mental wellbeing as opposed to just looking at correcting what is perceived to be 'abnormal'.

The idea of philosophical counselling does sound worthwhile. There was a tradition of pastoral counselling but this was often in conjunction with a religious or spiritual approach to human life. However, idea of philosophical counselling could be much wider into the examination of human values, which would be compatible with the person-centred emphasis on values and human meaning.

Psychiatry may still be seen in a negative light insofar as it involves treatment to 'normalise' people. Often, the medications given have problematic side-effects. Nevertheless, many people do seek medication, especially antidepressants and sleeping tablets. It is often a combination of medication and talking therapies which may help. There is a move towards online therapies and my own feeling is that the online approaches may help some people. Nevertheless, the experience of being listened to by a human being may part of the essential experience of therapy.

It is often a combination of medication and talking therapies which may help. — Jack Cummins

that's usually what the professionals recommend, there are those who believe that the medications may have more of a placebo effect than a "correction of chemical imbalance". There doesn't seem to be any evidence that SSRIs correct neurotransmitter imbalance.

Your reply is important in pointing to the way in which the philosophy of mind is inherent to psychiatry. It may be asked to what extent can the 'cure' be found in the body? It is complex because the brain and nervous system are the centre of experience but influenced by so many factors, especially issues of beliefs and construction of meaning.

issues of beliefs and construction of meaning. — Jack Cummins

Are they beyond the reach of the body (by-products)?

Psychiatry is bound up with values about norms or what is considered 'normal'. There are also political aspects of the practice of psychiatry too. — Jack Cummins

Agreed. I propose that some measure of that is because of the focus upon diagnosis organized around saying what is wrong with a particular patient. There is also the politics of care or the lack of it.

Psychology is a part of that dynamic too but provides a better background to address your concerns. The different approaches to treatment grow out of models of human development. The range of differences between Freud and Vygotsky, for instance, are attempts to say where the "normal" comes from. The shift in treatment you observed in your comment to BC ultimately hinges upon models of development.

One work that vividly captures that dimension is Jung's On the Nature of the Psyche. When read by itself rather than as a component of a greater theory, it shows a caregiver suddenly coming face to face with individuals and asking: "What the hell is going on here?"

I'd have to say that psychiatry is very limited: it's basically just something people use in desperation, and i can't comment on how to properly administer it. You have to get a referral to see a psychiatrist, because MH proffesionals know that talk based therapy is more effective than medicating for a wide range of issues. — ProtagoranSocratist

Talk therapy in conjunction with medication is best practice for neurotic disorders, I believe?

But I'm not sure how quantifiable the benefits of, say, anti-depressants are. There is no causation established, but despite not knowing why, exactly, anti-depressants help, there are clearly documented positive effects. One of the best arguments for an anti-depressant is that it can provide a 'window' of improved functionality. Timed correctly, ideally supported with counselling, a depressed individual can take actions during this window to improve their mental health that would otherwise be unavailable.

But when it comes to psychotic disorders? Medication is hugely important. We have a controversy here in Canada regarded a schizophrenic man, high risk to self and others, paranoid delusions, who was not forced to take his meds (as he had been, previously) and who later killed a number of festival goers with his vehicle while in a psychotic state.

I know that as a population, mentally ill people are at a higher risk of being victims than perpetrators, but that generalization does miss high-risk populations.

Personally, mandated medication saved my schizophrenic brother's life. Obviously, this is a morally complex subject. And the side-effects that Jack references are pretty severe with anti-psychotics, which is another disincentive for high-risk individuals.

Is it morally justifiable to compel psychotics to take their medication? To what degree is a psychotic individual responsible for their actions?

Minds that exist without a body (AI), do they suffer from mental health issues? Or is it an exclusive experience of the minds produced by a body?

But I'm not sure how quantifiable the benefits of, say, anti-depressants are. There is no causation established, but despite not knowing why, exactly, anti-depressants help, there are clearly documented positive effects. — Jeremy Murray

There are obvious "documented positive effects" for alcohol, heroin, and tabacco as well.

Two famous books on this topic that are more on the critical side, Philip Rieff "The Triumph of the Therapeutic: Uses of Faith After Freud" and Christopher Lasch's "Culture of Narcissism" come to mind. I would say the 10,000 foot takeaway there is that there are major risks/issues if psychology and the language of health/wellness come to define ethics and the philosophy of "living a good life" and "being a good person." The fact that patients are very much "customers" in the US context adds a particularly interesting wrinkle to the idea that the "therapeutic" can guide ethics and politics (I touched on this in the thread currently up on self-help).

James Davidson Hunter's "The Death of Character: Moral Education in an Age Without Good or Evil" has been less influential, but deals with the wider effect of the "therapeutic" ethos, along with Dewey, Maslow, and Rogers profound effect on education.

Hunter does a pretty good job showing just how far psychology has penetrated into cultural institutions at least. For instance, he pairs texts prepared for Girl Scouts in the first half of the 20th century versus the 1980s, and a range of texts from the late 1700s to early 1900s versus those after 1970, showing how radically they have changed. The framing of ethical life is his focus, and this shifts radically towards the procedural ("values clarification"), while psychological terms like "self-esteem" and "self-actualization" take on a central role, while a explicit moral framing of "character" largely vanishes (although, pace Hunter, I would argue this older framing had already badly atrophied since 1500, and was essentially incoherent by 1900, and this is why it was banished—after all, what does "don't cheat because it isn't morally good" even mean?). An interesting finding he documents is that different worldviews (broken into: expressivist/emotivists, utilitarian, civic humanist, conventionalist, and theistic) are the strongest predictors of ethical decisionmaking (or at least, given how this research is done, simulated decisionmaking); moreso than race, class, sex, etc.

Certainly, psychology played a very large role in philosophy and culture more broadly. A criticism I'd like to point out here is that psychology, like economics, is not metaphysically neutral. Aside from empirical work, it provides an interpretive lens for how data is interpreted, which is based on ideals dominant in the field. This sort of philosophical backdrop, which one might describe better as a "world-view," "social imaginary," or even a "religion" (as in, the widest possible interpretive lens—God normally makes no appearance) obviously tracks with what is dominant in the culture, but even more so it tracks with what is dominant in the academy, which can drift quite far from the mainstream culture, or even between disciplines. But because the academy has had a huge influence on education (the key organ is socialization and indoctrination in Western society) there is a sort of feedback loop here, where the values of the academy make it into the wider culture. Our lexicon is chalk full of therapeutic terms today.

Hence, you can get prior philosophical (or almost aesthetic) commitments driving the ship in some ways. This is perhaps most obvious in the situationist critique against personality, character, etc. in social psychology and sociology, which centered on a philosophy that wanted dissolve the subject/individual (one might suspect, for largely philosophical reasons). Lo' and behold, programs when curricula loaded with texts that claimed that the illusory nature of the individual must be overcome also discovered that it the individual was illusory. And yet, this area later became ground zero for much of the replication crisis, and some of the claims it made for things like "priming" are, in retrospect, the sort of thing that should have rung alarm bells in the same way claims of psychokinesis do. But it was in line with fashionable and politically relevant dogmas, so it didn't.

What's also interesting here is how far different, related fields can diverge, social psychology and economics (which tends to absolutize the atomized rational actor) being prime examples. Social psychology might say the whole of economics is built on the fundamental attribution error.

I guess a difficulty here is that the tendency in philosophy to want to "defer to the sciences" can miss the ways in which the sciences are themselves often built on particular philosophies. And the more dominant and philosophy is in a science, the more transparent it becomes.

To speak of mental health, and mental illness is to subscribe to a medical model of mind and behaviour.

mental health involves subjective experiences and objective aspects of behaviour. — Jack Cummins

This is misleading. All experiences are subjective and all behaviour is objective.This applies to the experiences and behaviour of clinicians and patients alike.

The medical model belongs in the first instance to the clinician, internalised into her subjectivity as a way of seeing a patient. 'Patient' is thus an identity and social role projected onto the other, which he may accept or resist. This will inform his behaviour, and thus in turn the clinician's diagnosis. Hence resistance to the authority of the clinician is commonly regarded as a symptom of mental illness, sometimes called 'lack of insight'.

Nobody must question the medical model, because it is a scientific model. Scientists are objective and therefore mentally healthy.

To speak of mental health, and mental illness is to subscribe to a medical model of mind and behaviour. — unenlightened

Nobody must question the medical model, because it is a scientific model. Scientists are objective and therefore mentally healthy. — unenlightened

There are those that have benefitted under the medical model, which would mean that the medical model should not rejected entirely. But accepting your position that the medical model ought be subject to question and not accepted uncritically, what alternative do you propose for those suffering psychologically.

There are those that have benefitted under the medical model — Hanover

The question is, how exactly have they benefitted under the medical model.
The medical model probably helps those who already believe it.
It can also help in a "reverse psychology" kind of way, in that it helps people realize that the only thing worse than their suffering are the medical methods that are supposed to alleviate that suffering.

But accepting your position that the medical model ought be subject to question and not accepted uncritically, what alternative do you propose for those suffering psychologically. — Hanover

Well the immediate alternative is a social model. Rather than that you have got the imaginary pathogen of depression leading to the wrong chemicals in your brain, we would start from the idea that you are manifesting symptoms of a dysfunctional social matrix, such that you are being blamed for something that you have no control over, perhaps, or some other toxic relationship.

The late David Smail has developed this sort of model and written some nice books, and there are some other folks with related approaches that I might remember tomorrow.

Yes. I was waving toward that in my comments above concerning the world of the "patient."

I see some hope from the developmental conception side where there is a big world outside of the industry of the practitioner.

As far as assigning blame goes, there is a parallel dynamic in the practice of law in shifting sands of what it stands upon.

Edit to add: The two sides have some unsightly hook ups on a regular basis.

P.S. Both sides that I have encountered turn purple at the mention of Liang and Szaz. — Paine

Not if you include psychotherapeutic models like the person-centered approach founded by Carl Rogers , or cognitive therapies influenced by constructivism and social constructionism.

Szaz stood outside of the community of practitioners and called a pox upon all their houses. Liang was more of an 'ordinary language' protest to the accretion of diagnostic hierarchy. They annoyed practitioners for entirely different reasons.

Rogers was a well ensconced practitioner in the discipline of "organizational psychology", hardly a voice from the wilderness. Let me leave off from describing Liang other than to question his generalities.

Rogers was a well ensconced practitioner in the discipline of "organizational psychology", hardly a voice from the wilderness. Let me leave off from describing Liang other than to question his generalities. — Paine

Are you referring to R.D. Laing?

Yes. Dyslexic spelling.

Rogers agreed with Laing’s rejection of the traditional medical model that treated patients as “cases” rather than persons. He also appreciated Laing’s insistence that psychosis could be understood as a meaningful experience, rather than simply as a disease process.

In A Way of Being (1980), Rogers recalls how the antipsychiatry movement (Laing, Cooper, Szasz) echoed, in its own way, his own belief in the primacy of the subjective experience and the destructiveness of authoritarian institutions.

“Laing and others have challenged the idea that people we call ‘mad’ are meaninglessly disturbed… They insist that we look at their experience with compassion and understanding, and in that I feel a deep kinship.”
( Carl Rogers, A Way of Being)

There are many other practitioners who agree and the importance of theories of development is that such views held by many are meaningless theoretically.

The acknowledgement of a defect is not a theory in itself. It is new theory that leads to new treatments. Rogers wants his seat at the diagnosis table.