Reviews Book

Nature and Narrative: An Introduction to the New Philosophy of Psychiatry

BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7431.113 (Published 09 January 2004) Cite this as: BMJ 2004;328:113
  1. D B Double, consultant psychiatrist (dbdouble{at}dbdouble.co.uk)
  1. Norfolk Mental Health Care NHS Trust, Norwich

    The current mainstream understanding of mental illness is that it is caused by biological dysfunction arising from pathology in the brain. This book promotes a wider perspective. However, its thesis does not follow the route of so called anti-psychiatry by rejecting the notion of mental illness altogether. Mental illness is not a “myth.” The term “illness” can be applied to psychological processes.


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    Eds Bill Fulford, Katherine Morris, John Sadler, Giovanni Stanghellini

    Oxford University Press, £29.95, pp 286 ISBN 0 19 852611 3

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    The book also tries to avoid a decline into relativism, by focusing on the role of values in medical practice. Mental illness is not merely a social “construct,” in the sense that it is not just contingent on our individual, idiosyncratic understandings. The book therefore acknowledges the political dimension of psychiatric practice. Governments try to provide psychiatric help to people in need of it. This aim can be perverted, as was the case for a while with Soviet psychiatry, for example.

    The editors say the message of the book is that meanings as well as causes are essential to good psychiatric care. They suggest that a new philosophy of psychiatry has developed over the last decade. They regard this renaissance in philosophy as likely to produce an enduring partnership with psychiatry.

    Psychiatry has been less able than other medical disciplines to emancipate itself from philosophy. This is at least because the nature of “mind” will always be problematic. Although internal mental processing may have been excluded from psychology in radical behaviourism, the “cognitive revolution” has repositioned mental states as central to information processing.

    The book may have succeeded in getting its message across. However, I do not think it sufficiently analyses the respective influence in practice of meanings and causes. While all mental health clinicians acknowledge the importance of meanings and causes, some will value meanings over causes and others the reverse, with consequences for how they treat patients.

    In other words, the book tends to stay within philosophy without teasing out the implications for clinical practice. The “new philosophy” may need to take a stance on various ethical issues. For example, let's ask a practical question: are drug companies exploiting people's emotional problems and does their influence need to be curbed? Although starkly phrased, this seems to be a fair question within the so called new framework. The meaningfulness of the way the question is answered is obvious.

    However, I suspect that the new philosophy does not see its function as partaking in the murkiness of the politics of everyday clinical work. I may be wrong. The book's first editor is research fellow in values in practice at the National Institute for Mental Health in England. In this role he may have the opportunity to make the values of psychiatry more transparent. I think that psychiatry, besides recognising the role of values and meanings, needs to be clear about their implications in practice.

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