When I joined the staff of the Institute of Psychiatry some 35 years ago, there were no philosophers around. For some members of the institute, I was the nearest thing they had to a philosopher, to the extent of being someone from a non-medical background who thought about what they thought about what they were doing. About 15 years or so later, I started noticing an increasing number of academic philosophers taking an interest. There are various explanations for this. One came from a very, very eminent, nay be-knighted, psychiatry professor. I mentioned this growth of philosophical interest to him, and Sir Somebody succinctly explained that “this is because the Institute of Psychiatry has been very successful in getting large amounts of research grant funding, and they haven’t”. I would refer to this as the honey-pot theory.
A second explanation is that the emphasis of academic philosophy has changed. When I was an undergraduate, my university had two philosophy professors who were on such bad terms with each other that the university had to have two separate departments for them – the Philosophy Department and the Department of Moral & Political Philosophy. The Philosophy Department taught philosophy students pure logic and quoted Wittgenstein incessantly. Moral and Political Philosophy taught subsidiary courses to politics and economics students, etc., as well as its own undergraduates. On a more recent visit, I was intrigued to notice that philosophy has been subsumed into the School of Social & Political Sciences. Moral and Political Philosophy has won. I would call this the connecting philosophy with the real-world theory.
The third explanation, which seems to be the one endorsed here, is that in opposition to psychoanalysis, psychiatrists enthusiastically adopted the scientific and medical model in the 1980s and 1990s, eschewing social and cultural factors, and there is now a reaction to this, re-emphasising the differences between psychiatry and the rest of medicine, thus encouraging the redevelopment of the link with philosophy. This development has reached the stage where it can support a book series like the International Perspectives in Philosophy and Psychiatry. I was astonished to find that there are already 46 titles in this series, including the massive Oxford Handbook of Philosophy and Psychiatry (Fulford et al., 2013), which itself, of course, contains a lot on ethics.
Whichever explanation is accepted, and all three seem to me to have some validity, it is undoubtedly true that there is far more interest in the topic than there was a few years ago. Psychiatrists face far more ethical problems than other clinicians. Most doctors can assume that their patients have consented to treatment. Psychiatrists, more or less by definition, deal with people who may not be in a fit state to consent. Psychiatrists have to decide whether people accused of crimes are fit to plead. Psychiatrists have to take into account the needs of carers and of the wider society – administering tranquillizers to Alzheimer patients may have no clinical benefit for them at all but may make their behaviour sufficiently amenable for their carers to be able to cope, for example. All of these problems, and far more, are in need of ethical consideration. As I started writing this review, a case has come into court of a woman who is refusing kidney dialysis on the grounds that her life has “lost its sparkle”. The nephrologists are out of their depth and have automatically handed it over to the psychiatrists.
This book consists of 94 chapters (only one of them quoting Wittgenstein) by an international panel of 140 contributors, most of whom are academic philosophers or psychiatrists, with just a small scattering of service users, journalists, etc. The emphasis is, inevitably, on the Western model of mental healthcare, though there is a chapter on the Indaba in African practice, seven chapters on different religious approaches and one catch-all chapter on public health in developing societies to make this a rather more balanced book than many of the so-called “international” resources reviewed in Reference Reviews. It is still worth reminding ourselves that most people in the world live in non-westernized societies. We noted when reviewing the Encyclopedia of Immigrant Health (Loue and Sajatovic, 2012), for example, that there were an estimated 1m Afghan refugees living just in the Swat area of Pakistan alone (RR 2012/352). There are probably considerably more now, and I cannot see this book having much relevance to their mental healthcare, but then, they probably couldn’t afford to buy it anyway.
This book is broad-ranging, timely and relevant and covers an important subject in great depth. The great depth, however, presents a problem when considering which libraries should be recommended to purchase it. Individual chapters may be useful – the phenomenologists in the Maudsley Philosophy Group are sure to welcome Chapter 29 on The Patient as an Autonomous Person, for example, but even they are unlikely to use much more of the book. Most clinicians and most trainees simply do not have the time to go into the topic to this extent: They have so much else to learn. A quick look through parts of Psychiatric Ethics (Bloch and Green, 2009) is as much time as they can reasonably be expected to devote to the subject. Clinical libraries can, therefore, be recommended to note the reference value of this book (and of the rest of the series too) but may well find that their customers are looking for something shorter and simpler. The study of mental health and its treatment forms an important part of the real-world philosophy at the moment, so academic libraries catering for philosophy courses can be warmly recommended to consider it for acquisition. There is a strong public interest in (and sometimes justifiable distrust of) psychiatry, but this book is not really designed for public library use.
