Narrate It Until You Become It

Research in phenomenology and philosophy of psychiatry has suggested that psychopathological disturbances of experience often involve an alteration of one's ‘sense of possibility’, dependent upon the presence of specific ‘existential feelings’ (Ratcliffe 2012). In this paper I provide an extended account of how the engagement with certain narratives can lead to a transformation of one's sense of possibility by eliciting affective experiences that are not consonant with the person's existential feelings. More precisely, I claim that, even when the experience of some types of emotion is generally precluded by a restricted sense of possibility, such emotions may be aroused by particular self-narratives, and I explore how this dynamic can give rise to enduring and wide-ranging affective changes.

On the Brink of Disaster

The notions of at-risk and subthreshold conditions are increasingly discussed in psychiatry to describe mild, brief, or otherwise atypical syndromes that fail to meet the criteria for clinical relevance. However, the concept of vulnerability is still underexplored in philosophy of psychiatry. This article discusses psychiatric vulnerability to clarify some conceptual issues about the various factors contributing to vulnerability, the notions of risk and protection, and the idea that there are multiple ways of crossing the threshold to clinical relevance. My goal is to lay the groundwork for a finer-grained discussion on psychiatric vulnerability that reflects the complex nature of mental conditions and illustrates the kind of thinking needed in clinical practice.

Conclusion

The ‘Conclusion’ summarises the main ideas of Philosophy of Psychedelics and makes some suggestions for future research. The first part of the chapter provides a chapter-by-chapter summary of the arguments of the book, and lists the various testable predictions that follow from these arguments. The second part suggests some other directions for future research, pointing to outstanding questions about psychedelics in various fields of inquiry, including philosophy of science, philosophy of psychiatry, ethics, epistemology, and the philosophy of transformative experience. The third part reflects on the significance of the book’s two central theses: that the Comforting Delusion Objection to psychedelic therapy fails, and that an ‘Entheogenic Conception’ of psychedelics as agents of epistemic benefit and spiritual experience is both consistent with naturalism and plausible in light of our best current evidence.

Reverse-mentorship of the core concepts in philosophy and mental health: a medical education case report

AimsThe aim of this medical education case report was to outline the development and outcomes of a reverse-mentorship project that enabled cross-generational collaborative learning. The project took the shape of a philosophy of psychiatry journal club facilitated by a psychiatry core trainee in west London, UK.BackgroundReverse-mentorship reverses traditional roles of mentor and mentee. It is an increasingly fashionable concept in medical education. The junior mentors the senior clinician. The implicit learning outcomes include provision of a two-way learning process, development of mentoring skills for the more junior clinician and collaboration that builds social capital within the workplace. Reverse-mentorship is effective when the junior mentor is recognised for their expertise in a particular area. In this instance, the junior mentor has a special interest in the philosophy of psychiatry.MethodJunior mentor and senior mentees formed a monthly journal club. The club tracked arguments from anti- and biological psychiatry on the meaning of mental illness. The debate offered insight into a semantic analysis of mental illness and a deeper conceptual understanding of medicine. The learning material derived from the core concepts of philosophy and mental health (Fulford et al.). The role of the mentor was to facilitate group discussion around arguments from relevant papers. A survey, adapted from a recent reverse-mentorship review article, measured the quality of educational experience for mentor and mentees.ResultOverall, mentees (senior clinicians) agreed that the mentor (junior clinician) displayed attributes and behaviours for effective mentoring across most domains, including enthusiasm, effective communication, respect for mentee expertise and active listening to the needs of the mentee. The mentor was particularly impressed with the mentees’ openness to learn new concepts and respect shown. General reflections on the experience of reverse-mentorship were positive overall. A thematic review highlighted particular aspects, including: a good way to learn a new skill and great opportunity to develop professional skills of mentoring.ConclusionThe importance of mentoring in medical education is well established. Reverse-mentorship is a new concept that looks to harness the unique qualities of millennials, including their aptitudes for empowerment, innovation and collaboration. This medical education case report shows that an enthusiastic junior clinician can successfully pilot an educational-mentoring scheme aimed at senior clinicians. To make more explicit the intuitive benefits of reverse-mentorship, longitudinal reviews are needed. However, this case report contributes important insights into this burgeoning field of medical education.

What is a mental disorder? An exemplar-focused approach

The question of ‘what is a mental disorder?’ is central to the philosophy of psychiatry, and has crucial practical implications for psychiatric nosology. Rather than approaching the problem in terms of abstractions, we review a series of exemplars – real-world examples of problematic cases that emerged during work on and immediately after DSM-5, with the aim of developing practical guidelines for addressing future proposals. We consider cases where (1) there is harm but no clear dysfunction, (2) there is dysfunction but no clear harm, and (3) there is possible dysfunction and/or harm, but this is controversial for various reasons. We found no specific criteria to determine whether future proposals for new entities should be accepted or rejected; any such proposal will need to be assessed on its particular merits, using practical judgment. Nevertheless, several suggestions for the field emerged. First, while harm is useful for defining mental disorder, some proposed entities may require careful consideration of individual v. societal harm, as well as of societal accommodation. Second, while dysfunction is useful for defining mental disorder, the field would benefit from more sharply defined indicators of dysfunction. Third, it would be useful to incorporate evidence of diagnostic validity and clinical utility into the definition of mental disorder, and to further clarify the type and extent of data needed to support such judgments.

Philosophy of psychiatry: quarter of a century in discussions

The papers presents the discussion field of a young branch of the philosophy of science the philosophy of psychiatry. As an interdisciplinary platform in the dialogue of sciences, schools and individual professionals, it unites psychiatrists and philosophers, psychologists and social workers in discussing on crucial issues. The paper analyses a multiple field of discussion of the philosophy of psychiatry, separating two stages of its brief development: the stage of institutionalization and fixing of problems (1995‒2005) and the stage of expansion (2005 present). Modern discussions are studied on the most important thematic blocks: (1)the methodology of human research; (2)the philosophical basis of psychiatric classification; (3)psychiatric ethics. The work presents the first complete and specialized review of discussions of the philosophy of psychiatry in Russian.

Evidence, Science, and Ethics in Talk-Based Healing Practices

This chapter considers the role of knowledge and evidence in comparing and contrasting the ethics of non-clinical counseling (NCC) and mainstream mental health care as practiced by psychiatry, clinical psychology, and social work. As helping traditions which mostly eschew diagnostic categorization and approach mental distress from different values, practices, and metaphysical standpoints, the three NCC traditions considered here are found to be prone to errors of omission, e.g., not knowing what one does not know. While mainstream mental health is also subject to these errors, the mainstream’s allegiance to evidence-based practices leaves it prone to neglecting the crucial role of the clinician in dialogue with the patient. The authors conclude by arguing for wider appreciation of the contributions of clinical interpretation from the philosophy of psychiatry.

Psychiatry Reborn: Biopsychosocial psychiatry in modern medicine

Psychiatry Reborn: Biopsychosocial Psychiatry in Modern Medicine is a comprehensive collection of essays by leading experts in the field, and provides a timely reassessment of the biopsychosocial approach in psychiatry. Spanning the sciences and philosophy of psychiatry, the essays offer complementary perspectives on the ever more urgent importance of the biopsychosocial approach to modern medicine. The collection brings together ideas from the series of Loebel Lectures by world leaders in the field of psychiatry and associated Workshops at the University of Oxford, including revised versions of the Lectures themselves, and a wide range of related commentaries and position pieces. With contributions from psychiatry, psychology, neuroscience, and philosophy, the book provides the most comprehensive account to date of the interplay between biological, psychological, and social factors in mental health and their ethical dimensions. The 23 chapters of this multi-authored book review the history and place of the biopsychosocial model in medicine, and explore its strengths and shortcomings. In particular, the book considers how understanding this interplay might lead to more effective treatments for mental health disorders as developments in genomic and other neurobiological medicine challenge traditional conceptions and approaches to the research and treatment of mental health disorders. The book explores the challenges and rewards of developing diagnostic tools and clinical interventions that take account of the inextricably intertwined biopsychosocial domains, and the ethical implications of the conceptualization. It concludes with chapters drawing together the book’s range of expertise to propose a best conception of the model, and how it might be adopted going forward in an age of exponentially increasing technological advances and of integrated/collaborative care. The volume is intended to present the biopsychosocial model as it stands today in the academy, the laboratory, and the clinic, and to start to address the challenges and potential that the model has for each.