Chapter

Anti-psychiatry, values and the philosophy of psychiatry

Tim Thornton

in Essential Philosophy of Psychiatry

Published on behalf of Oxford University Press

Published in print September 2007 | ISBN: 9780199228713
Published online February 2013 | e-ISBN: 9780191754531 | DOI: http://dx.doi.org/10.1093/med/9780199228713.003.001

Series: International Perspectives in Philosophy & Psychiatry

Anti-psychiatry, values and the philosophy of psychiatry

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At the heart of the debate about anti-psychiatry is a debate about the nature of mental illness itself. The anti-psychiatry view that mental illness does not exist has immediate repercussions for the justification of mental health care practice. Thus, the analysis of mental illness is not merely one question of interest to the philosophy of psychiatry, it is the key question. For that reason it is where I will begin. The first section of the chapter examines Szasz’ arguments based on the idea that mental and physical illness answer to distinct norms.Whilst physical illness is deviation from structural or functional integrity, mental illness, Szasz argues, depends on deviation from evaluative norms and thus mental illness cannot be treated by medical means. This view is contrasted with ologicallyminded defences of psychiatry offered by Kendell and Boorse. The second section describes two attempted overviews of the debate about mental illness. Fulford suggests that whilst value-theorists like Szasz, and descriptivists like Boorse and Kendell disagree about the status of mental illness they implicitly agree that physical illness is value-free. Fulford argues, however, that assumption is mistaken. He argues, instead, that illness as a whole is essentially value-laden, but mental illness appears more so because the values involved are more contested. Just because mental illness is valueladen, it does not follow that it is unreal. The third section examines Wakefield’s harmful dysfunction analysis of illness. This turns on reducing mental disorder to a biological dysfunction itself analysed into the purely descriptive terms of evolutionary theory. Biological functions look to be a promising way of ‘naturalising’ the idea of mental disorder because they are both normative (there is a prescriptive distinction between behaviour that accords with them and that which does not), but also rooted in scientific theory. I argue, however, that the very idea of biological function presupposes the kind of intelligibility exemplified in reason-giving. It does not explain it. Thus, it fails to explain disorder in more basic terms. The final section takes mild cognitive impairment as an example. The same general issues that concern mental illness as a whole apply to this difficult borderline condition helping to demonstrate the real difficulty of making a judgement as to its pathological status.

Chapter.  17448 words. 

Subjects: Psychiatry

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