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Book Forum: Models of the Mind   |    
The Philosophy of Psychiatry: A Companion
Am J Psychiatry 2005;162:1397-a-1397. doi:10.1176/appi.ajp.162.7.1397-a
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Toronto, Ont., Canada

Edited by Jennifer Radden. New York, Oxford University Press, 2004, 447 pp., $74.00.

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The 30 chapters of this book are written by 25 philosophers and a handful of clinicians. Most are written by a single author, addressing the many philosophical aspects of psychiatric practice and targeting issues such as what it means to make a diagnosis, when is one not responsible for a criminal act, what does competence imply, and when is the self continuous or discontinuous. There are philosophical discussions of such varied topics as brain pain, desire, memory, values, evolution, research ethics, religion, race, and gender.

I wish I could say that the promise inherent in the nature of the topics translates into great reading, but it doesn’t. The idea for the book is excellent, and this may prove a very successful text if the intended readers are philosophy students. Clinicians, however, will find most of the chapters hard to read. The language of academic philosophy is not the language of bedside psychiatry. With some exceptions, the single-authored chapters by philosophers are so dense, so laden with jargon, and so embedded in a philosophical context inscrutable to the ordinary reader that their message is lost.

A notable exception is the chapter by Jennifer Church on the social construction of madness. This is a wonderful exploration of the pros and cons of viewing illness as socially constructed versus accepting it as biologically predetermined. This chapter is insightful, thought-provoking, and written in plain English. Another very readable, balanced, and useful chapter written by a philosopher, Daniel Robinson, is on the concept of dangerousness. On the whole, the chapters that work best are those written by a philosophy/psychiatry team. Sadly, there aren’t many of these. Michael Schwartz and Osborne Wiggins contribute a very good chapter dispelling the myth that clinical drug trials and neuroscience constitute the sole scientific methodologies of psychiatry. They talk about understanding and interpretation, the methodology of studying psychopathology and psychotherapy. This is important because it broadens the focus of what psychiatric practice encompasses and shields it from allegations of reductionism, charges to which biomedicine is vulnerable. Most of the co-authored chapters are worth reading—a comment on the fact that when two disciplines work together to produce a piece of writing, they abandon the jargon of their respective fields and write in a style that others can understand.

Because the idea for a book of this kind is so good, I would encourage the editor to try again. My prescription for excellence would be to restrict the number of topics and to select authors carefully. I would insist that philosophers and psychiatrists collaborate on each chapter. I would not allow bland reviews of a topic area and would insist that each chapter defend a point of view. I would ensure that all chapters be read by all authors and that wrestling with each other’s arguments be part of the task of writing. I would not permit the use of vocabulary that the general educated public does not understand. I look forward excitedly to such a book.




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