Conference Review: “Philosophy and Psychiatry: The Next Hundred Years”

Anthony Fernandez, graduate student in Philosophy at the University of South Florida,  writes: This year the fifteenth annual meeting of the International Network for Philosophy and Psychiatry took the rather grand form of a tripartite traveling symposium entitled, Philosophy and Psychiatry: The Next Hundred Years. The occasion – the centenary of Karl Jaspers’ General Psychopathology. The meetings extended over a week, beginning Saturday, July 20th, and coming to a close on Friday the 26th. The first leg of the conference, Current and Future Applications of Phenomenology in Psychiatry, was hosted by Durham University, and organized by Hannah Bowden and Amanda Taylor Aiken. The second leg of the conference, Conceptual Issues and the DSM (The Diagnostic and Statistical Manual of Mental Disorders), was hosted by King’s College, London, and was organized by Derek Bolton and Roman Pawar. The third and final leg, Making Change Happen, was hosted by St. Catherine’s College, Oxford, and was organized by Bill Fulford, Matthew Parrott, and Lettitia Derrington.

First, some quick details: The first two conferences lasted a day each, and took the form of a workshop. The number of talks were kept to a minimum (five in Durham, six at King’s) and extended periods for discussion were left open. The final conference extended over two days and was remarkably unconventional in format (as I’ll get to below). The number of attendees at each conference varied, but was in the range of 25 to 50, with King’s College hosting the smallest conference and St. Catherine’s hosting the largest.

The symposium began on a Saturday morning in Durham. After a brief introduction and welcome by Bowdon, Aiken, and Fulford, we jumped right into a talk by Giovanni Stanghellini on the ethics of incomprehensibility. Stanghellini’s presentation took the form of an appropriation of Jaspers’ notion of incomprehensibility with the aim of developing a new ethic of understanding. The argument centered around the compelling story of a patient whose actions could not be made sense of. As Stanghellini argued, in order to genuinely understand that which at first seems incomprehensible, we must begin by finding a way to understand not the isolated actions of the patient, but the sense and structure of her world as a whole. Our own actions can only be made sense of within the context of our lives and the kind of world in which we inhabit. If the clinician hopes to genuinely understand her patient, she first needs to gain an understanding of the kind of world her patient inhabits, thereby opening a doorway for proper and successful treatment and care.

Nev Jones followed up with a talk about the importance of first-person narratives in phenomenologically informed psychology and psychiatry. Using a Foucauldian frame, she was able to create a context within which we might begin to question the proper role of patients and service users in psychiatric and philosophical research. She questioned whether the current norm, that is, understanding service users as sources of valuable qualitative data to be interpreted by others, is really as far as we can go. She asked us to consider the possibility of first-person theory, over and above first-person data.

Tim Thornton‘s presentation examined some of the recent work of Sass and Parnas, and focused on opening up avenues for dialogue between analytic and continental approaches in philosophy of psychiatry. Matthew Ratcliffe offered us a preview of his upcoming phenomenological investigations of auditory verbal hallucinations, sketching out the anticipated directions of research. And Angela Woods offered us some insights into the possibility of interdisciplinary approaches to phenomenological inquiries, investigating the phenomenologist’s relationship with historians, literary theorists, and service users, just to name a few.

All in all, the workshop certainly lived up to its name. A host of convincing proposals for future applications of phenomenology in areas of research not typically included within the philosophical bubble were put forward. While the project of applying phenomenology in the human sciences has been underway since phenomenology’s inception, it is notoriously difficult to do so successfully and faithfully. Nonetheless, I think this workshop will go a long way towards orienting our course and pushing us in the directions we need to go.

The second conference took a different approach from the first. Rather than organize all the talks around a common method of research or branch of philosophy, the organizers opted for a thematic narrative. This alternate form of cohesion allowed for presentations beginning from various perspectives, but converging on the same point, the DSM-5. It goes without saying that the DSM-5 received no rave reviews. But it was interesting to see the variety of ways in which the text can be picked apart.

The first few talks consisted of forays into the history of the DSM and some reporting on the less than transparent development of the DSM-5. With titles such as, “DSM-5 Process Ethics: Lessons Abandoned, Learned and Missed,” (John Sadler) and, “Buying the DSM Story? The Forbidden Psychodynamic Past of Sexual Problems – or, How Not to do the Historiography of Psychiatry,” (Katherine Angel) it’s easy to see the discontent, both in psychiatry and the humanities. With these talks, along with one given by Natalie Banner on the concept of dysfunction, we get a sense of the DSM project as ever changing, but rarely developing.

After we had all settled into our general dissatisfaction with the DSM-5, the conference shifted its focus. Elselijn Kingma, Werdie van Staden, and Grant Gillet took approaches that dwelled less on what the DSM is, and more on what the DSM could be. Van Staden’s talk, for example, revealed that in spite of the DSM’s claim to be descriptive and atheoretical, there are numerous references to causes throughout the text. These references, however, are usually exclusionary. For example, if a patient showed all the relevant symptoms for a diagnosis of schizophrenia, yet a physiological cause was discovered, the patient could not be classified as having schizophrenia. In light of the difficulties that stem from the implicit theoretical underpinnings of the DSM, van Staden walked us through some of his own solutions to the problem, proposing ways in which we might successfully tease apart descriptions from causes.

Overall the conference was an impressive interdisciplinary venture. Focusing the presentations around a theme that is of professional and practical concern to people in a variety of disciplines provided a strong bridge, allowing dialogue to travel across boundaries. The DSM, in light of its current notoriety, was the obvious choice for a workshop of this kind. However, I have no doubt this model can be applied in a number of areas, with successful interdisciplinary results.

The final conference, Making Change Happen, took a dramatically different form, not just from the workshops leading up to it, but from academic conferences in general. While a number of service users had been in attendance at the previous conferences, this conference was set up as a conscious (and conscientious) effort to integrate everyone involved. Presentations were given, as one would expect, by professional psychiatrists and academic philosophers, but also by a number of service users as well as those who work for government and non-profit organizations in the field of mental health.

To add to the already peculiarly diverse set of presentations, the conference was structured unlike any I have ever attended. The conference, which spread over two days, was broken up into four parts. Each part was devoted to bringing forth change in a particular area – philosophy, practice, science, and across the globe. Each session began with brief talks by a number of presenters on pre-circulated materials. These talks were followed by brief Q&A sessions. Once the Q&A was complete, the participants and audience were separated off into four different groups. The groups were given lists of questions they should address, all meant to spark discussion over how to bring about change in the area just discussed. After a fairly extended period of group discussion (approx. 30 minutes), the groups were all brought back together and one member from each group offered a brief summary of their group’s discussion and conclusions. The session was then brought to a close with a reflection by a predesignated participant upon the preceding presentations and discussions.

This seemingly disjointed hodgepodge of presentations, questions, group activities and open discussions somehow managed to gather everyone together into a collective focus on the issues at hand. Having only ever attended academic philosophy conferences, I had never thought to come to a conference with the expectation that something might actually be achieved. My general expectation was that we collectively agree to talk at each other until it’s time to grab a drink. And while we did do a bit of that, I couldn’t shake the feeling that in the end some real change might come about.

Acknowledgments: I would like to thank Sarah Wieten for reading over an earlier version of this review and offering a number of helpful suggestions.

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