Postmodernism is no philosophical basis for change
Editor -- I share many of the ideals of Bracken and Thomas1, especially the need to emphasise meaning and the patient's perspective in clinical practice. But postmodernism cannot be a philosophical basis for these aims. Postmodernism is the most recent and extreme form of relativism, and social theorists such as Habermas and Gellner have pointed out its nihilism, defeatism and self-refutation.2 3 Postmodernism has been likened to an "Millenium cult" which now will increasingly fade. Post-modernists are paradoxically authoritarian when refusing even to consider the possibility of an objective reality or causal explanations. Unlike scientists, they seem unable to tolerate ambiguity, despite claiming to celebrate it.
Postmodernism can be attractive in the lecture theatre, but not in clinical practice. If all interpretations are accepted as valid then ultimately this leaves no place for any universal morality, such as respect for another's opinion or consideration for the less fortunate. Postmodernism answers one question with another. How appropriate is this to clinical practice, when solutions are needed- and fast? Psychiatrists hold no absolute certainty in their work, but neither do physicists. Postmodernism contributes little to medicine beyond reminding us to recognise meanings, to be reflexive in our practice, and to be aware that the knowledge we gain is always tentative and influenced by its historical and social contexts.
Postmodernism encourages a crisis of authority and representation.
There is no assertion by Bracken and Thomas that for all our limitations, psychiatrists still know the most of all about mental illness. I recognise with them the need for debate on psychiatry's role in social control, especially the increasing pressure on us to be primarily risk assessors. Although we cannot claim to be "neutral, objective and disinterested" we can strive to recognise when we are not. There is little guarantee psychiatrists would be replaced in the process of compulsory care by others who are more "fair-minded", and every chance they could be replaced by groups who are less so. Other groups, with their own political agendas, may make claims to better represent our patients. For our patients, perhaps it could be "better the devil they know" in ourselves, rather than in those they don't.
Colin Hemmings Specialist Registrar in Psychiatry
START Homelessness Team,
Dugard Way, London SE11 4TH cph@talk21.com
1. Bracken, P. and Thomas, P. Postpsychiatry: a new direction for mental health. BMJ 2001;322:724-7.
2. Gellner, E. Postmodernism, reason and religion. London: Routledge,
1992.
3. Habermas, J. The Philosophical Discourse of Modernity. Cambridge,
Mass.: MIT Press, 1990.
Competing interests:
No competing interests
14 April 2001
Colin hemmings
specialist registrar in psychiatry
START Homelessness Team, Dugard Way, London SE11 4TH
Rapid Response:
Postmodernism is no philosophical basis for change
Editor -- I share many of the ideals of Bracken and Thomas1, especially the need to emphasise meaning and the patient's perspective in clinical practice. But postmodernism cannot be a philosophical basis for these aims. Postmodernism is the most recent and extreme form of relativism, and social theorists such as Habermas and Gellner have pointed out its nihilism, defeatism and self-refutation.2 3 Postmodernism has been likened to an "Millenium cult" which now will increasingly fade. Post-modernists are paradoxically authoritarian when refusing even to consider the possibility of an objective reality or causal explanations. Unlike scientists, they seem unable to tolerate ambiguity, despite claiming to celebrate it.
Postmodernism can be attractive in the lecture theatre, but not in clinical practice. If all interpretations are accepted as valid then ultimately this leaves no place for any universal morality, such as respect for another's opinion or consideration for the less fortunate. Postmodernism answers one question with another. How appropriate is this to clinical practice, when solutions are needed- and fast? Psychiatrists hold no absolute certainty in their work, but neither do physicists. Postmodernism contributes little to medicine beyond reminding us to recognise meanings, to be reflexive in our practice, and to be aware that the knowledge we gain is always tentative and influenced by its historical and social contexts.
Postmodernism encourages a crisis of authority and representation.
There is no assertion by Bracken and Thomas that for all our limitations, psychiatrists still know the most of all about mental illness. I recognise with them the need for debate on psychiatry's role in social control, especially the increasing pressure on us to be primarily risk assessors. Although we cannot claim to be "neutral, objective and disinterested" we can strive to recognise when we are not. There is little guarantee psychiatrists would be replaced in the process of compulsory care by others who are more "fair-minded", and every chance they could be replaced by groups who are less so. Other groups, with their own political agendas, may make claims to better represent our patients. For our patients, perhaps it could be "better the devil they know" in ourselves, rather than in those they don't.
Colin Hemmings Specialist Registrar in Psychiatry
START Homelessness Team,
Dugard Way, London SE11 4TH
cph@talk21.com
1. Bracken, P. and Thomas, P. Postpsychiatry: a new direction for mental health. BMJ 2001;322:724-7.
2. Gellner, E. Postmodernism, reason and religion. London: Routledge,
1992.
3. Habermas, J. The Philosophical Discourse of Modernity. Cambridge,
Mass.: MIT Press, 1990.
Competing interests: No competing interests