The Identity Crisis in Psychiatry
There is a consensus that the field of psychiatry is facing a crisis (e.g., Tekin & Poland 2017) but the exact nature of the problem is less clear. Psychiatry is currently in search of its identity as a discipline within the biomedical sciences. The aim of this online workshop is to understand the different dimensions of the crisis and to develop a multidimensional response accordingly.
The crisis is partly epistemological in nature: there is widespread doubt concerning the validity of symptoms and disorders used to diagnose patients. Though its categories are grounded in objective epidemiological data, they also depend on social concepts of normality that change over time and culture. Since our societies are complex, volatile, uncertain and ambiguous, our concept of normality is undefined.
There is a socio-economic crisis: mental disorders have an unprecedented high level of prevalence globally. Despite record levels of funding, there remains substantial unmet need for psychiatric care, especially among children and adolescents. The desperate response of governments to regulate that state of disarray has led to excessive control and distrust in mental health services, resulting in an institutional crisis: clinicians have less and less time to work with patients to develop a robust therapeutic relationship. Administration and management has taken over sophisticated patient care.
There is a treatment crisis; the psychopharmacology and psychotherapy professionals currently rely on are limited in their efficacy, and new discoveries in genetics and clinical neuroscience have so far failed to translate into new treatment options for improving the lives of patients. There is a metaphysical crisis: the categories used to diagnose disorders fail to pick out “real” disorders and their causes as opposed to artificial clusters of symptoms. Mental disorders, unlike the diseases treated by other medical disciplines, are essentially subjective depending on the lived experience of suffering, and the uniqueness to each patient of their symptoms. Finally, there is the identity crisis itself, expressing the impotence and helplessness of the professional himself looking for a scientific and paradigmatic foothold.
his event is the first in the series of online workshops organised by the Lemon Tree Interdisciplinary Center for Psychiatry, Psychotherapy and Philosophy, Amsterdam University Medical Center. It will take place online, via Zoom.
The event takes place on:
Tuesday September 24th 2024 from 09:30 -14:30 (EST) / 15:30 – 20:30 (CET)
Wednesday September 25th 2024 from 09:30 -14:30 (EST) / 15:30 – 20:30 (CET)
To register for the conference and to receive the Zoom link, please send an email to: r.p.j.m.dings@amsterdamumc.nl
Places are limited so send your registration asap.
Date & Time
Location
Lemon Tree
Tuesday September 24th 2024
| EST | CEST | |
| 09:30 – 10:45 | 15:30 – 16:45 | Dan J. Stein |
| 10:45 – 11:00 | 16:45 – 17:00 | Break |
| 11:00 – 12:15 | 17:00 – 18:15 | Jennifer Radden |
| 12:15 – 13:15 | 18:15 – 19:15 | Lunch / Dinner |
| 13:15 – 14:30 | 19:15 – 20:30 | Awais Aftab |
Wednesday September 24th 2024
| EST | CEST | |
| 09:30 – 10:45 | 15:30 – 16:45 | Damiaan Denys |
| 10:45 – 11:00 | 16:45 – 17:00 | Break |
| 11:00 – 12:15 | 17:00 – 18:15 | Rachel Cooper |
| 12:15 – 13:15 | 18:15 – 19:15 | Lunch / Dinner |
| 13:15 – 14:30 | 19:15 – 20:30 | Serife Tekin |
A psychiatry of the future need not abandon all biomedical matters
“Much of the distinctiveness of the psychiatrist’s techne can be detached from the increasingly doubtful-looking biomedical presuppositions, and precarious analogies from the medical ‘imaginal,’ to which it has long paid fealty. Mental disorder and health understood not in terms of the clinic or treatment but as preventive public mental health might offer a new role for which their expertise uniquely prepares medical psychiatrists.”
Jennifer Radden
Emerita, Philosophy, University of Massachusetts Boston
Jennifer Radden is Emerita Professor of Philosophy at the University of Massachusetts Boston. She has published extensively on mental health concepts, the history of medicine, and ethical and epistemic aspects of psychiatry. She is currently guest editing a volume of the Review of Philosophy & Psychiatry about anorexia nervosa.
Damiaan Denys
Lemon Tree Center/Psychiatry, Amsterdam University Medical Center
Damiaan Denys is a faculty professor of psychiatry at Amsterdam University Medical Center, University of Amsterdam. He has published more than 500 scientific articles; contributed to anxiety and compulsivity, pioneered the application of deep brain stimulation in psychiatric disorders and received the 2020 IgNobel prize for his discovery of misophonia. Since 2024, he heads Lemon Tree, an interdisciplinary scientific center at the intersection of psychiatry, psychotherapy and philosophy at the Institute for Advanced Study of the University of Amsterdam.
The manifold face of psychiatry, its crises and psychotherapeutic salvation
There has been a crisis in psychiatry for some time. Even at the young discipline’s inception, there were sharp contradictions between the social and medical domains and between the philosophical, biologic and psychological preconditions. With the 1970’s anti-psychiatry, the legitimacy of psychiatry itself was questioned. These noises resonate again in the 2020s. We ask what gives rise to that pervasive sense of crisis in psychiatry. What does the crisis entail? We attempt to deconstruct the crisis. Is it academic or practical and scientific or clinical? Has society changed? We reflect on what psychiatry can look like in the next century. Where are its possibilities and where are its limits? Is the medical model appropriate for psychiatry? How should our psychiatrists of the future be trained? The most important question, however, is what we can learn from these crises about the essence of psychiatry?
A Beleaguered Discipline: Diagnosing Crises Within and Without
“Psychiatry as a medical discipline faces significant clinical and scientific challenges in the 21st century. It endures strong criticism from within the profession, related fields, and the general public. To better understand these challenges, this presentation will explore four key dimensions:
1) addressing the crisis in psychiatric theory in the post-Kraepelinian era,
2) navigating the epistemic power dynamics between psychiatry and other related disciplines,
3) correcting essentialist and reified views of mental disorders that contribute to public misunderstanding, and
4) tackling issues of iatrogenic harm and social control, which drive the psychiatric survivors movement.”
Awais Aftab
Psychiatry, Case Western University
Awais Aftab, MD is Clinical Assistant Professor of Psychiatry at Case Western Reserve University. His academic and public-facing work focuses on conceptual and critical issues in psychiatry. He led the interview series “Conversations in Critical Psychiatry” for Psychiatric Times, and a book adaptation is forthcoming from Oxford University Press later this year. He is a senior editor for the journal “Philosophy, Psychiatry, & Psychology.” He blogs online on his Substack newsletter Psychiatry at the Margins.
Dan J. Stein
Psychiatry, University of Cape Town
Dan J. Stein is Professor and Chair of the Dept of Psychiatry at the University of Cape Town, and Director of the South African Medical Research Council’s Unit on Risk & Resilience in Mental Disorders. His work has focused on anxiety and related disorders. His most recent volume is “Problems of Living: Perspectives from Philosophy, Psychiatry, and Cognitive-Affective Science”.
Beyond Scientism and Skepticism: An Integrative Approach to Psychiatry
In discussing controversies in psychiatry, I have found it useful to contrast classical, critical, and integrative positions.
A classical view of psychiatry has roots in Plato, the Vienna School, and Kraepelin, and holds that mental disorders are natural kinds; they are medical disorders, with discrete boundaries, explicable on the basis of neurobiological laws.
A critical view of psychiatry has roots in Pyrrhonism, the counter-Enlightenment, and the anti-psychiatry of the 1960s, and holds that mental disorders are human kinds; they are constructed variably over time and place, they have porous boundaries, and are best understood using hermeneutic approaches.
An integrative view of psychiatry has roots in Aristotle, pragmatic realism, and Jaspers, and holds that psychiatric disorders are soft natural kinds; they are psychiatric conditions, with fuzzy boundaries, and they are underpinned by biopsychosocial mechanisms.
My view is that an integrative approach can draw on the best of the classical and critical positions, so steering us between scientism and skepticism, avoiding hubristic proposals for new paradigms, and instead aiming for an iterative and pluralistic approach.
Responding to Psychiatry’s Identity Crisis: A Science in Practice View
One of the sources of crisis in psychiatry is the discipline’s struggle to advance scientific research on mental disorders while simultaneously trying to meet the clinical needs of patients. For example, the commitment to understand the biological mechanisms underlying mental disorders have led to an increased investment in neuroscience and genetics, with the hope that such research will eventually yield findings that will enable an etiological understanding of mental disorders and their successful treatment. However, this long-term investment in research does not necessarily help clinicians to meet the immediate needs of individuals diagnosed with mental disorders; as such this research is not yet translatable to clinical outcomes.
My goal in this talk is to develop strategies for better aligning psychiatry’s commitments to scientific research and positive clinical outcomes by taking cues from “philosophy of science in practice,” a contemporary approach in philosophy of science that highlights the need for philosophers to study scientific practices to advance their understanding of the relationship between scientific theories and the world. Heeding the call, I call for embracing pluralism about knowledge building practices in psychiatry in a way that is grounded as much on patient testimony and clinical encounters as it does on scientific research.
Serife Tekin
Philosophy, SUNY Upstate Medical University
Serife Tekin is an Associate Professor of Philosophy and Bioethics at the Center for Bioethics and Humanities at the Norton College of Medicine at SUNY Upstate Medical University in Syracuse, NY. Her work in philosophy of psychiatry takes place at the intersection of philosophy of science, mind and bioethics. Her recent book, Reclaiming the Self in Psychiatry: Centering Personal Narratives for a Humanist Science (Routledge) will be out in April 2025.
Rachel Cooper
Philosophy, Lancaster University
Rachel Cooper is a professor at the department of Philosophy, Politics and Religion at Lancaster University. Her major research interests lie within the philosophy of science and medicine, especially philosophy of psychiatry. Her research focuses on conceptual problems around psychiatric classification, and on understanding concepts of disorder and health.
A Beleaguered Discipline: Diagnosing Crises Within and Without
Three puzzles of psychiatric classification: why psychiatry isn’t like other sciences
This paper considers a series of puzzles regarding the basic logic of psychiatric classification:
Puzzle 1: What do psychiatric classification schemes classify? Does a psychiatric classification system aim to classify people or disorders considered as abstract processes, or something else?
Puzzle 2: How should we individuate disorders? If a patient satisfies diagnostic criteria for two psychiatric disorders, e.g. panic disorder and alcoholism, do they have two disorders, or just one complicated problem?
Puzzle 3: How can we draw the boundary between person and illness? Can we distinguish the person themselves from their illness? And, if we can, how should the line be drawn?
The puzzles turn out to be connected in interesting ways, and their consideration will reveal interesting differences between classification in psychopathology and other sciences.