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A Theory of Feelings Anger and Forgiveness"My Madness Saved Me"10 Good Questions about Life and Death12 Modern Philosophers50 Reasons People Give for Believing in a GodA Cabinet of Philosophical CuriositiesA Case for IronyA Companion to BioethicsA Companion to Buddhist PhilosophyA Companion to FoucaultA Companion to GenethicsA Companion to GenethicsA Companion to HumeA Companion to KantA Companion to Phenomenology and ExistentialismA Companion to PragmatismA Companion to the Philosophy of ActionA Companion to the Philosophy of BiologyA Companion to the Philosophy of LiteratureA Conceptual History of PsychologyA Critical Overview of Biological FunctionsA Critique of Naturalistic Philosophies of MindA Cursing Brain?A Delicate BalanceA Farewell to AlmsA Frightening LoveA Future for PresentismA Guide to the Good LifeA History of PsychiatryA History of the MindA Life Worth LivingA Manual of Experimental PhilosophyA Map of the MindA Metaphysics of PsychopathologyA Mind So RareA Natural History of Human MoralityA Natural History of Human ThinkingA Natural History of VisionA Parliament of MindsA Philosopher Looks at The Sense of HumorA Philosophical DiseaseA Philosophy of BoredomA Philosophy of Cinematic ArtA Philosophy of CultureA Philosophy of EmptinessA Philosophy of FearA Philosophy of PainA Physicalist ManifestoA Place for ConsciousnessA Question of TrustA Research Agenda for DSM-VA Revolution of the MindA Sentimentalist Theory of the MindA Stroll With William JamesA Tapestry of ValuesA Tear is an Intellectual ThingA Theory of FreedomA Thousand MachinesA Universe of ConsciousnessA Very Bad WizardA Very Bad Wizard: Morality Behind the CurtainA Virtue EpistemologyA World Full of GodsA World Without ValuesAbout FaceAbout the Beginning of the Hermeneutics of the SelfAction and ResponsibilityAction in ContextAction Theory, Rationality and CompulsionAction, Contemplation, and HappinessAction, Emotion and WillAdam SmithAdaptive DynamicsAddictionAddictionAddiction and ResponsibilityAddiction Is a ChoiceAdvances in Identity Theory and ResearchAftermathAfterwarAgainst AdaptationAgainst AutonomyAgainst BioethicsAgainst HappinessAgainst HealthAgency and ActionAgency and AnswerabilityAgency and EmbodimentAgency and ResponsibilityAgency, Freedom, and Moral ResponsibilityAl-JununAlain BadiouAlain BadiouAlasdair MacIntyreAlien Landscapes?Altered EgosAn Anthology of Psychiatric EthicsAn Ethics for TodayAn Intellectual History of CannibalismAn Interpretation of DesireAn Introduction to EthicsAn Introduction to Kant's Moral Philosophy An Introduction to Philosophy of EducationAn Introduction to the Philosophy of MindAn Introduction to the Philosophy of MindAn Introduction to the Philosophy of PsychologyAn Introductory Philosophy of MedicineAn Odd Kind of FameAnalytic FreudAnalytic Philosophy in AmericaAncient AngerAncient Models of MindAncient Philosophy of the SelfAngerAnimal LessonsAnimal MindsAnimals Like UsAnnihilationAnother PlanetAnswers for AristotleAnti-ExternalismAnti-Individualism and KnowledgeAntigone’s ClaimAntipsychiatryAre We Hardwired?Are Women Human?Arguing about DisabilityArguing About Human NatureAristotle and the Philosophy of FriendshipAristotle on Practical WisdomAristotle's ChildrenAristotle's Ethics and Moral ResponsibilityAristotle, Emotions, and EducationArt & MoralityArt After Conceptual ArtArt in Three DimensionsArt, Self and KnowledgeArtificial ConsciousnessArtificial HappinessAspects of PsychologismAsylum to ActionAtonement and ForgivenessAttention is Cognitive UnisonAutobiography as PhilosophyAutonomyAutonomy and Mental DisorderAutonomy and the Challenges to LiberalismBabies by DesignBackslidingBadiouBadiou's DeleuzeBadiou, Balibar, Ranciere: Rethinking EmancipationBare Facts And Naked TruthsBasic Desert, Reactive Attitudes and Free WillBattlestar Galactica and PhilosophyBe Like the FoxBeautyBecoming a SubjectBecoming HumanBehavingBehavioral Genetics in the Postgenomic EraBeing AmoralBeing HumanBeing Mentally Ill: A Sociological Theory Being No OneBeing Realistic about ReasonsBeing ReducedBeing YourselfBelief's Own EthicsBending Over BackwardsBerlin Childhood around 1900Bernard WilliamsBertrand RussellBetter than BothBetter Than WellBetween Two WorldsBeyond HealthBeyond Hegel and NietzscheBeyond KuhnBeyond LossBeyond Moral JudgmentBeyond PostmodernismBeyond ReductionBeyond SchizophreniaBeyond the DSM StoryBioethicsBioethics and the BrainBioethics in the ClinicBiological Complexity and Integrative PluralismBiology Is TechnologyBiosBipolar ExpeditionsBlackwell Companion to the Philosophy of EducationBlindsight & The Nature of ConsciousnessBlues - Philosophy for EveryoneBlushBob Dylan and PhilosophyBody ConsciousnessBody Image And Body SchemaBody ImagesBody LanguageBody MattersBody WorkBody-Subjects and Disordered MindsBoundBoundaries of the MindBoyleBrain Evolution and CognitionBrain FictionBrain, Mind, and Human Behavior in Contemporary Cognitive ScienceBrain-WiseBrainchildrenBrains, Buddhas, and BelievingBrainstormingBrave New WorldsBreakdown of WillBrief Child Therapy Homework PlannerBrief Inquiry into the Meaning of Sin and FaithBrief Therapy Homework PlannerBritain on the CouchBritish Idealism and the Concept of the SelfBrute RationalityBuffy the Vampire Slayer and PhilosophyBut Is It Art?Camus and SartreCartesian LinguisticsCartographies of the MindCarving Nature at Its JointsCase Studies in Biomedical Research EthicsCassandra's DaughterCato's TearsCausation and CounterfactualsCauses, Laws, and Free WillChanging Conceptions of the Child from the Renaissance to Post-ModernityChanging the SubjectChaosophyCharacter and Moral Psychology Character as Moral FictionCharles DarwinCherishmentChildhood and the Philosophy of EducationChildrenChildren, Families, and Health Care Decision MakingChoices and ConflictChoosing Not to ChooseChristmas - Philosophy for EveryoneCinema, Philosophy, BergmanCinematic MythmakingCity and Soul in Plato's RepublicClassifying MadnessClear and Queer ThinkingClinical EthicsClinical Psychiatry in Imperial GermanyCodependent ForevermoreCoffee - Philosophy for EveryoneCognition and the BrainCognition of Value in Aristotle's EthicsCognition Through Understanding: Self-Knowledge, Interlocution, Reasoning, ReflectionCognitive BiologyCognitive FictionsCognitive Neuroscience of EmotionCognitive Systems and the Extended MindCognitive Systems and the Extended Mind Cognitive Theories of Mental IllnessCoherence in Thought and ActionCollected Papers, Volume 1Collected Papers, Volume 2College SexComedy IncarnateCommitmentCommunicative Action and Rational ChoiceCompetence, Condemnation, and CommitmentConcealment And ExposureConceptual Analysis and Philosophical NaturalismConceptual Art and PaintingConceptual Issues in Evolutionary BiologyConfessionsConfucianismConnected, or What It Means to Live in the Network SocietyConquest of AbundanceConscience and ConvenienceConsciousnessConsciousnessConsciousnessConsciousness ConsciousnessConsciousness and Its Place in NatureConsciousness and LanguageConsciousness and Mental LifeConsciousness and MindConsciousness and the NovelConsciousness and the SelfConsciousness EmergingConsciousness EvolvingConsciousness ExplainedConsciousness in ActionConsciousness RecoveredConsciousness RevisitedConsciousness, Color, and ContentConsole and ClassifyConstructing the WorldConstructive AnalysisContemporary Debates In Applied EthicsContemporary Debates in Moral TheoryContemporary Debates in Philosophy of BiologyContemporary Debates in Philosophy of MindContemporary Debates in Political PhilosophyContemporary Debates in Social PhilosophyContemporary Perspectives on Natural LawContested Knowledge: Social Theory TodayContesting PsychiatryContext and the AttitudesContinental Philosophy of ScienceControlControlling Our DestiniesConversations About Psychology and Sexual OrientationCopernicus, Darwin and FreudCrazy for YouCreating a Life of Meaning and CompassionCreating ConsilienceCreating HysteriaCreating Mental IllnessCreating Scientific ConceptsCreating the American JunkieCreation, Rationality and AutonomyCreatures Like Us?Crime and CulpabilityCrime, Punishment, and Mental IllnessCrimes of ReasonCritical New Perspectives on Attention Deficit/Hyperactivity DisorderCritical PsychiatryCritical PsychologyCritical ResistanceCritical Thinking About PsychologyCritical VisionsCross and KhoraCruel CompassionCTRL [SPACE]Cultural Psychology of the SelfCultural Theory: An IntroductionCulture and Psychiatric DiagnosisCulture and Subjective Well-BeingCulture of DeathCultures of NeurastheniaCurious EmotionsCurrent Controversies in Experimental PhilosophyCustom and Reason in HumeCustomers and Patrons of the Mad-TradeCutting God in Half - And Putting the Pieces Together AgainCylons in AmericaDamaged IdentitiesDamasio's Error and Descartes' TruthDangerous EmotionsDaniel DennettDaniel DennettDark AgesDarwin and DesignDarwin's Dangerous IdeaDarwin's LegacyDarwin, God and the Meaning of LifeDarwinian PsychiatryDarwinian ReductionismDarwinizing CultureDating: Philosophy for EveryoneDeathDeathDeath and CharacterDeath and CompassionDeath and the AfterlifeDebating DesignDebating HumanismDecision Making, Personhood and DementiaDecomposing the WillDeconstructing PsychotherapyDeconstruction and DemocracyDeeper Than DarwinDeeper than ReasonDefending Science - within ReasonDefining Psychopathology in the 21st CenturyDegrees of BeliefDelusion and Self-DeceptionDelusions and Other Irrational BeliefsDelusions and the Madness of the MassesDementiaDemons, Dreamers, and MadmenDennett and Ricoeur on the Narrative SelfDennett’s PhilosophyDepression Is a ChoiceDepression, Emotion and the SelfDepthDerrida, Deleuze, PsychoanalysisDescartesDescartes and the Passionate MindDescartes' CogitoDescartes's Changing MindDescartes's Concept of MindDescribing Inner Experience?Descriptions and PrescriptionsDesembodied Spirits and Deanimated Bodies Desert Islands and Other Texts (1953-1974)Desire and AffectDesire, Love, and IdentityDesire, Practical Reason, and the GoodDeveloping the VirtuesDiagnosing the Diagnostic and Statistical Manual of Mental DisordersDialectics of the SelfDid My Neurons Make Me Do It?Difference and IdentityDigital SoulDimensional Models of Personality DisordersDisability, Difference, DiscriminationDisjunctivismDisorders of VolitionDisorientation and Moral LifeDispatches from the Freud WarsDisrupted LivesDistractionDisturbed ConsciousnessDivided Minds and Successive SelvesDo Apes Read Minds?Do Fish Feel Pain?Do We Still Need Doctors?Does Consciousness Cause Behavior?Does the Woman Exist?Doing without ConceptsDon't Believe Everything You ThinkDonald DavidsonDonald Davidson on Truth, Meaning, and the MentalDoubting Darwin?Dreaming and Other Involuntary MentationDSM-IV SourcebookDSM-IV SourcebookDSM-IV-TR CasebookDworkin and His CriticsDying to KnowDynamics in ActionDysthymia and the Spectrum of Chronic DepressionsEccentricsEducational MetamorphosesEffective IntentionsElbow Room: The Varieties of Free Will Worth WantingEmbodied Minds in ActionEmbodied RhetoricsEmbodied Selves and Divided MindsEmbryos under the MicroscopeEmergencies in Mental Health PracticeEmerging Conceptual, Ethical and Policy Issues in BionanotechnologyEmotionEmotion and ConsciousnessEmotion and PsycheEmotion ExperienceEmotion RegulationEmotion, Evolution, And RationalityEmotional IntelligenceEmotional ReasonEmotional ReasonEmotional TruthEmotions in Humans and ArtifactsEmotions in the Moral LifeEmotions in the Moral LifeEmotions, Value, and AgencyEmpathyEmpathy and AgencyEmpathy and Moral DevelopmentEmpathy and MoralityEmpathy in the Context of PhilosophyEmpirical Ethics in PsychiatryEnchanted LoomsEngaging BuddhismEngineering the Human GermlineEnjoymentEnvyEpicureanismEpistemic LuckEpistemologyEpistemology and EmotionsEpistemology and the Psychology of Human JudgmentEros and the GoodErotic MoralityEssays in Social NeuroscienceEssays in the Metaphysics of Mind Essays on Derek Parfit's On What MattersEssays on Free Will and Moral ResponsibilityEssays on Nonconceptual ContentEssays on Philosophical CounselingEssays on Reference, Language, and MindEssays on the Concept of Mind in Early-Modern PhilosophyEssential Sources in the Scientific Study of ConsciousnessEsssential Philosophy of PsychiatryEternal Sunshine of the Spotless MindEthical Conflicts in PsychologyEthical Issues in Forensic Mental Health ResearchEthical Issues in Human CloningEthical TheoryEthicsEthicsEthics and the A PrioriEthics and the Metaphysics of MedicineEthics and Values in PsychotherapyEthics Done RightEthics ExpertiseEthics in Plain EnglishEthics in PracticeEthics in Psychiatric ResearchEthics of PsychiatryEthics without OntologyEuropean Review of Philosophy. Vol. 5Everyday IrrationalityEvil in Modern ThoughtEvolutionEvolution and the Human MindEvolution's RainbowEvolutionary Origins of MoralityEvolutionary PsychologyExamined LifeExamined LivesExistential AmericaExistentialismExistentialism and Romantic LoveExperimental PhilosophyExperimental PhilosophyExperimental PhilosophyExperimental Philosophy, Rationalism, and NaturalismExperiments in EthicsExplaining ConsciousnessExplaining the BrainExplaining the Computational MindExplanatory PluralismExploding the Gene MythExploring HappinessExploring the SelfExpression and the InnerExpressions of JudgmentFaces of IntentionFact and ValueFact and Value in EmotionFacts, Values, and NormsFads and Fallacies in the Social SciencesFaith and Wisdom in ScienceFatherhoodFear of KnowledgeFearless SpeechFeeling Pain and Being in PainFeelings and EmotionsFeelings of BeingFellow-Feeling and the Moral LifeFeminism and Its DiscontentsFeminism and Philosophy of ScienceFeminist Ethics and Social and Political PhilosophyFeminist Interpretations of Rene DescartesFeminist TheoryField Notes from ElsewhereFinding Consciousness in the BrainFingerprints of GodFlesh in the Age of ReasonFolk Psychological NarrativesFolk Psychology Re-AssessedForces of HabitForgivenessForgiveness and LoveForgiveness and RetributionFoucault 2.0Foucault and PhilosophyFoucault NowFoucault, Psychology and the Analytics of PowerFoundational Issues in Human Brain MappingFoundations of Ethical Practice, Research, and Teaching in PsychologyFour Views on Free WillFrank Ramsey (1903-1930)Free WillFree WillFree WillFree WillFree Will and Action ExplanationFree Will and LuckFree Will And Moral ResponsibilityFree Will as an Open Scientific ProblemFree Will, Agency, and Meaning in LifeFree: Why Science Hasn't Disproved Free WillFreedomFreedom and DeterminismFreedom And NeurobiologyFreedom and ResponsibiltyFreedom and ValueFreedom EvolvesFreedom RegainedFreedom vs. InterventionFreedom, Fame, Lying, and BetrayalFreudFreud and the Question of PseudoscienceFreud As PhilosopherFreud's AnswerFreud, the Reluctant PhilosopherFriedrich NietzscheFrom Chance to ChoiceFrom Clinic to ClassroomFrom Complexity to LifeFrom Enlightenment to ReceptivityFrom Knowledge to Wisdom: A Revolution for Science and the HumanitiesFrom Morality to Mental HealthFrom Passions to EmotionsFrom Philosophy to PsychotherapyFrom Valuing to ValueFrontiers of ConsciousnessFrontiers of JusticeFurnishing the MindGalileo in PittsburghGenderGender and Mental HealthGender in the MirrorGender TroubleGenesGenes, Women, EqualityGenetic Nature/CultureGenetic ProspectsGenetic ProspectsGenetic SecretsGenocide's AftermathGenomes and What to Make of ThemGerman Idealism and the JewGerman PhilosophyGetting HookedGilles DeleuzeGlobal PhilosophyGluttonyGod and Phenomenal ConsciousnessGoffman's LegacyGoing Amiss in Experimental ResearchGoodness & AdviceGrassroots SpiritualityGrave MattersGrave MattersGreedGreek Models of Mind and SelfGut ReactionsHabilitation, Health, and AgencyHabits of MindHallucinationHandbook of BioethicsHandbook of EmotionsHappinessHappinessHappinessHappinessHappiness and EducationHappiness and the Good LifeHappiness Is OverratedHappiness, Death, and the Remainder of LifeHard LuckHarmful ThoughtsHaving the World in ViewHealing PsychiatryHealing the Soul in the Age of the BrainHealth, Illness and DiseaseHealth, Science, and Ordinary LanguageHegelHeidegger and a Metaphysics of FeelingHeidegger, Metaphysics and the Univocity of BeingHermann von Helmholtz's MechanismHermeneutics As PoliticsHeterophobiaHeterosyncraciesHeuristics and BiasesHeuristics and the LawHidden ResourcesHidden SelvesHiding from HumanityHigh Art LiteHistorical OntologyHistory of Psychiatry and Medical PsychologyHistory, Historicity And ScienceHobbesHomosexualitiesHope and Dread in PsychoanalysisHot ThoughtHow Can I Be Trusted?How Can the Human Mind Occur in the Physical Universe?How Children Learn the Meanings of WordsHow Could Conscious Experiences Affect Brains?How Do We Know Who We Are?How Emotions WorkHow Emotions WorkHow History Made the MindHow Images ThinkHow is Nature Possible?How Propaganda WorksHow Science WorksHow Scientific Practices MatterHow Scientists Explain DiseaseHow The Body Shapes The MindHow the Body Shapes the Way We ThinkHow the Mind Explains BehaviorHow the Mind Uses the BrainHow to Make Opportunity EqualHow to Solve the Mind-Body Problemhow to stop timeHow to Think More About SexHow We HopeHow We ReasonHuman CloningHuman Development, Language and the Future of MankindHuman EnhancementHuman Evolution, Reproduction, and MoralityHuman GoodnessHuman Identity and BioethicsHuman NatureHuman NatureHuman Nature and the Limits of ScienceHuman-Built WorldHumanismHumanism, What's That?HumanityHumans, Animals, MachinesHumeHumeHume on Motivation and VirtueHusserlHystoriesI of the VortexI Was WrongIdeas that MatterIdentifying the MindIdentity and Agency in Cultural WorldsIgnorance and ImaginationIllnessImagination and Its PathologiesImagination and the Meaningful BrainImagining NumbersImmortal RemainsImproving Nature?In Defense of an Evolutionary Concept of HealthIn Defense of SentimentalityIn Love With LifeIn Praise of Athletic BeautyIn Praise of Natural PhilosophyIn Praise of the WhipIn Pursuit of HappinessIn Search of HappinessIn the Name of GodIn the Name of IdentityIn the Space of ReasonsIn the SwarmIn Two MindsIncompatibilism's AllureIndividual Differences in Conscious ExperienceInfinity and PerspectiveInformation ArtsInformed Consent in Medical ResearchIngmar Bergman, Cinematic PhilosopherInhuman ThoughtsInner PresenceInsanityIntegrating Psychotherapy and PharmacotherapyIntegrity and the Fragile SelfIntelligent VirtueIntentionIntentionality, Deliberation and AutonomyIntentions and IntentionalityIntentions and IntentionalityInterpreting MindsInterpreting NietzscheIntroducing Greek PhilosophyIntrospection and ConsciousnessIntrospection VindicatedIntuition, Imagination, and Philosophical MethodologyIntuitionismInvestigating the Psychological WorldIrrationalityIrrationalityIs Academic Feminism Dead?Is It Me or My Meds?Is Long-Term Therapy Unethical?Is Oedipus Online?Is Science Neurotic?Is Science Value Free?Is the Visual World a Grand Illusion?Is There a Duty to Die?Issues in Philosophical CounselingJacques LacanJacques RancièreJacques RanciereJean-Paul SartreJohn McDowellJohn SearleJohn Searle's Ideas About Social RealityJohn Stuart MillJohn Stuart Mill and the Writing of CharacterJoint AttentionJokesJonathan EdwardsJudging and UnderstandingJustice for ChildrenJustice in RobesJustice, Luck, and KnowledgeKantKant and MiltonKant and the Fate of AutonomyKant and the Limits of AutonomyKant and the Role of Pleasure in Moral ActionKant on Freedom, Law, and HappinessKant on Moral AutonomyKant's Anatomy of EvilKant's Anatomy of the Intelligent MindKant's Theory of VirtueKarl JaspersKarl PopperKey Concepts in PhilosophyKierkegaardKierkegaard as PhenomenologistKierkegaard's Concept of DespairKierkegaard's MuseKinds of MindsKinds, Things, and StuffKnowing, Knowledge and BeliefsKnowledge MonopoliesKnowledge, Belief, and CharacterKnowledge, Possibility, and ConsciousnessLacanLack of CharacterLack of CharacterLanguageLanguage in ContextLanguage, Consciousness, CultureLanguage, Culture, and MindLanguage, Vision, and MusicLaw and the BrainLaw, Liberty, and PsychiatryLaws, Mind, and Free WillLeaving YouLectures on the History of Political PhilosophyLevelling the Playing FieldLiberal Education in a Knowledge SocietyLiberatory PsychiatryLife and ActionLife at the Texas State Lunatic Asylum, 1857-1997Life Is Not a Game of PerfectLife of the MindLife's FormLife, Death, & MeaningLife, Death, and Meaning: Key Philosophical Readings on the Big Questions Life, Liberty, and the Pursuit of UtilityLife, Sex, and IdeasLight in the Dark RoomLike a Splinter in Your MindLiving and Dying WellLiving NarrativeLiving Outside Mental IllnessLiving with DarwinLiving With One’s PastLockeLocke LockeLogic and the Art of Memory Loneliness in Philosophy, Psychology, and LiteratureLooking for SpinozaLooking for The StrangerLost SoulsLOT 2LoveLoveLove's ConfusionsLove's VisionLove, Friendship, and the SelfLove, Sex & TragedyLuckyLudwig WittgensteinLustLyingMachine ConsciousnessMad for FoucaultMad TravelersMade with WordsMadness And Death In PhilosophyMadness and DemocracyMadness at HomeMadness Is CivilizationMaking Natural KnowledgeMaking Sense of EvolutionMaking Sense of Freedom and ResponsibilityMaking the DSM-5Making the Social WorldMaking TruthMale Female EmailMan, Beast, and ZombieMandated Reporting of Suspected Child AbuseManiaManic Depression and CreativityMapping the Edges and the In-betweenMapping the Future of BiologyMarcus AureliusMaster PassionsMatters of the MindMe++Meaning and Moral OrderMeaning and Value in a Secular AgeMeaning in LifeMeaning in Life and Why It MattersMeaning, Basic Self-Knowledge, and MindMeasuring HappinessMeasuring PsychopathologyMedia MadnessMedical Enhancement and PosthumanityMedicine and Philosophy in Classical AntiquityMedicine of the PersonMedicine, Mental Health, Religion, Science and Well-BeingMelancholy And the Care of the SoulMelancholy and the Otherness of GodMementoMemory and NarrativeMental ActionsMental CausationMental Causation and OntologyMental HealthMental Health At The CrossroadsMental Health Policy in BritainMerit, Meaning, and Human BondageMerleau-PontyMerleau-Ponty and the Possibilities of PhilosophyMetacognition and Theory of MindMetacreationMetaethical SubjectivismMetaethicsMetal and FleshMetaphors of MemoryMetapoliticsMethods in MindMichel FoucaultMill's UtilitarianismMindMindMind and ConsciousnessMind and CosmosMind and MechanismMind GamesMind in a Physical WorldMind in Everyday Life and Cognitive ScienceMind in LifeMind TimeMind's LandscapeMind, Brain and the Elusive SoulMind, Brain, and Free WillMind, Reason and ImaginationMinding MindsMindreadersMindreading AnimalsMinds and PersonsMinds, Brains, and LawMinds, Ethics, and ConditionalsMindshapingMindsightMindworldsMirror, MirrorMixed FeelingsMockingbird YearsModels of the SelfModern Social ImaginariesModern Theories of JusticeModernity and SubjectivityModernity and TechnologyMoody Minds DistemperedMoral BrainsMoral DimensionsMoral FailureMoral ImaginationMoral LiteracyMoral MachinesMoral ParticularismMoral PsychologyMoral Psychology and Human AgencyMoral Psychology, Volume 1Moral Psychology, Volume 2Moral Psychology, Volume 3Moral Psychology: Volume IVMoral RepairMoral Responsibility and Alternative PossibilitiesMoral TribesMoral Value and Human DiversityMorality and Self-InterestMorality in a Natural WorldMorality, Moral Luck and ResponsibilityMotherhoodMotive and RightnessMoving Beyond Prozac, DSM, and the New PsychiatryMultiple Analogies in Science and PhilosophyMultiple Identities & False MemoriesMusic, Madness, and the Unworking of LanguageMy Brain Made Me Do ItMy Double UnveiledMy WayNarrativeNarrative and IdentityNarrative MedicineNarrative PsychiatryNarrative Theory and the Cognitive SciencesNatural Ethical FactsNatural Kinds and Conceptual ChangeNatural MindsNatural-Born CybogsNaturalism and the First-Person PerspectiveNaturalism and the Human ConditionNaturalism in the Philosophy of HealthNaturalism in the Philosophy of HealthNaturalized BioethicsNaturalizing the MindNatureNature and NarrativeNear Death ExperienceNeither Bad nor MadNeither Victim nor SurvivorNeuro-Philosophy and the Healthy MindNeuroethicsNeuroethicsNeurological Foundations of Cognitive Neuroscience Neurophilosophy at WorkNeurophilosophy of Free WillNeuropoliticsNeuropsychoanalysis in PracticeNeuroscience and PhilosophyNew Essays on the Explanation of ActionNew Philosophy for a New MediaNew Versions of VictimsNew Waves in Philosophy of ActionNietzscheNietzsche and Buddhist PhilosophyNietzsche on Ethics and PoliticsNietzsche's TherapyNietzsche, Culture and EducationNietzsche: The Man and His PhilosophyNihil UnboundNoir AnxietyNormative EthicsNormativityNorms of NatureNotebooks 1951-1959Notes Toward a Performative Theory of AssemblyNothing So AbsurdOblivionOn AnxietyOn ApologyOn Being AuthenticOn Being AuthenticOn BeliefOn BetrayalOn BullshitOn DelusionOn DesireOn EmotionsOn HashishOn Human RightsOn Loving Our EnemiesOn Nature and LanguageOn PersonalityOn ReflectionOn Romantic LoveOn the EmotionsOn the Freud WatchOn the Government of the LivingOn the Human ConditionOn the InternetOn the Meaning of LifeOn the Philosophy of LawOn the Pragmatics of CommunicationOn the Punitive SocietyOn TruthOn Virtue EthicsOn What MattersOn What We Owe to Each OtherOne Hundred DaysOnflowOnly a Promise of HappinessOntology of ConsciousnessOpen MindedOpen Your EyesOrgans without BodiesOther MindsOur Last Great IllusionOur Own MindsOur Posthuman FutureOur StoriesOut of Its MindOut of Our HeadsOxford Guide to the MindOxford Handbook of Psychiatric EthicsOxford Textbook of Philosophy of PsychiatryPanic DisorderPanpsychismPanpsychism in the WestPartialityPassionate EnginesPassionate EnginesPathologies of BeliefPathologies of ReasonPatient Autonomy and the Ethics of ResponsibilityPC, M.D.Perceiving the WorldPerception & CognitionPerception and Basic BeliefsPerception, Hallucination, and IllusionPerceptual ExperiencePerfecting VirtuePerplexities of ConsciousnessPersistencePersonal AutonomyPersonal Autonomy in SocietyPersonal IdentityPersonal Identity and EthicsPersonal Identity and Fractured SelvesPersonhood and Health CarePersonsPersons and BodiesPersons, Humanity, and the Definition of DeathPersons, Souls and DeathPerspectives on ImitationPerspectives on PragmatismPessimismPhenomenal Concepts and Phenomenal KnowledgePhenomenal ConsciousnessPhenomenal IntentionalityPhenomenology and ExistentialismPhenomenology and Philosophy of MindPhilosophersPhilosophers on MusicPhilosophers without GodsPhilosophical CounselingPhilosophical Counselling and the UnconsciousPhilosophical DevicesPhilosophical Foundations of NeurosciencePhilosophical History and the Problem of ConsciousnessPhilosophical Issues in PsychiatryPhilosophical Issues in PsychiatryPhilosophical Issues in Psychiatry IIPhilosophical MethodologyPhilosophical MidwiferyPhilosophical Myths of the FallPhilosophical Perspectives on DepictionPhilosophical Perspectives on Technology and PsychiatryPhilosophical PracticePhilosophical Reflections on DisabilityPhilosophizing About Sex Philosophizing the EverydayPhilosophy and HappinessPhilosophy and LivingPhilosophy and PsychiatryPhilosophy and PsychotherapyPhilosophy and Science FictionPhilosophy and the EmotionsPhilosophy and the EmotionsPhilosophy and the Interpretation of Pop CulturePhilosophy and the Moving ImagePhilosophy and the NeurosciencesPhilosophy and This Actual WorldPhilosophy As FictionPhilosophy BitesPhilosophy Bites BackPhilosophy for Counselling and PsychotherapyPhilosophy for LifePhilosophy in a New CenturyPhilosophy in an Age of SciencePhilosophy in Children's LiteraturePhilosophy of ActionPhilosophy of ActionPhilosophy of BiologyPhilosophy of BiologyPhilosophy of BiologyPhilosophy of BiologyPhilosophy of BodyPhilosophy of Film and Motion PicturesPhilosophy of LovePhilosophy of Love, Sex, and MarriagePhilosophy of MindPhilosophy of Mind and CognitionPhilosophy of Personal Identity and Multiple PersonalityPhilosophy of PsychologyPhilosophy of Public HealthPhilosophy of SciencePhilosophy of SciencePhilosophy of Technology: The Technological ConditionPhilosophy of the Social SciencesPhilosophy on TapPhilosophy PracticePhilosophy the Day after TomorrowPhilosophy's Role in Counseling and PsychotherapyPhilosophy, Neuroscience and ConsciousnessPhilosophy, Politics, DemocracyPhotography and PhilosophyPhysical RealizationPhysicalism and Its DiscontentsPhysicalism and Mental CausationPhysicalism, or Something Near EnoughPhysician-Assisted DyingPillar of SaltPin-up GrrrlsPlatoPlatoPlato, Not Prozac!Platonic Ethics, Old and NewPluralistic CasuistryPolarities of ExperiencesPolitical EmotionsPopper, Objectivity and the Growth of KnowledgePornPorn StudiesPornography, Sex, and FeminismPortrait of the Psychiatrist as a Young ManPostcolonial DisordersPostpsychiatryPosttraumatic Stress DisorderPower and the SelfPower SplitPractical Autonomy and BioethicsPractical ConflictsPractical Identity and Narrative AgencyPractical PhilosophyPractical RulesPractical Tortoise RaisingPractically ProfoundPracticing Feminist Ethics in PsychologyPragmatic BioethicsPragmatismPragmatism, Old And NewPraise and BlamePredicative MindsPreferences and Well-BeingPrescriptions for the MindPresocraticsPrimary and Secondary QualitiesPrimates and PhilosophersPrivacyPrivileged AccessProblems in MindProblems of RationalityProzac As a Way of LifeProzac BacklashProzac on the CouchPsyche and SomaPsychiatric Aspects of Justification, Excuse and Mitigation in Anglo-American Criminal Law Psychiatric Cultures ComparedPsychiatric Diagnosis and ClassificationPsychiatric EthicsPsychiatric HegemonyPsychiatric PowerPsychiatric SlaveryPsychiatry and Philosophy of SciencePsychiatry and ReligionPsychiatry as a Human SciencePsychiatry as Cognitive NeurosciencePsychiatry in SocietyPsychiatry in the New MilleniumPsychiatry in the Scientific ImagePsychiatry, Psychoanalysis, And The New Biology Of MindPsycho-Physical Dualism TodayPsychoanalysis and Narrative MedicinePsychoanalysis and the Philosophy of SciencePsychological Concepts and Biological PsychiatryPsychology and PhilosophyPsychology and the Question of AgencyPsychology's Interpretive TurnPsychology, Psychotherapy, Psychoanalysis, and the Politics of Human RelationshipsPsychotherapy and ConfidentialityPsychotherapy As PraxisPublic PhilosophyPunishmentPure ImmanencePurple HazePursuing MeaningQuality of Life and Human DifferenceQueer PhilosophyQuestions for FreudQuestions for FreudQuine and Davidson on Language, Thought and RealityRaceRace in Contemporary MedicineRadiant CoolRadical AlterityRadical ExternalismRadical HopeRational and Social AgencyRational CausationRational Choice in an Uncertain WorldRationality + Consciousness = Free WillRationality and FreedomRationality and the Reflective MindRationality in ActionRawls, Dewey, and ConstructivismRe-creating MedicineRe-EmergenceRe-Engineering Philosophy for Limited BeingsReading AutobiographyReading Bernard WilliamsReading SartreReadings in the Philosophy of TechnologyReal MaterialismReal Natures and Familiar ObjectsReal ScienceRealism in ActionReason & EmancipationReason in ActionReason in PhilosophyReason's GriefReasonably ViciousReasoning About Rational AgentsReasoning in Biological DiscoveriesReasons from WithinReasons without RationalismReclaiming CognitionReclaiming the SoulReconceiving SchizophreniaReconstructing Reason and RepresentationReconstructing the Cognitive WorldRecreative MindsRediscovering EmotionRediscovering EmpathyReference and ExistenceReference and the Rational MindReflections On How We LiveReframing Disease ContextuallyRefusing CareRegulating SexReinventing the SoulRelativism and Human RightsRelativism and the Foundations of PhilosophyRelativism and the Foundations of PhilosophyReliable ReasoningReligion without GodRelying on OthersRemembering HomeResponsibility and PunishmentResponsibility and PunishmentResponsibility from the MarginsRestraining RageRethinking ExpertiseRethinking IntrospectionRethinking Mental Health and DisorderRethinking RapeRethinking the DSMRethinking the Sociology of Mental HealthRethinking the Western Understanding of the SelfReturn to ReasonRevolt, She SaidRichard RortyRichard RortyRichard RortyRichard RortyRichard RortyRichard Rorty's New PragmatismRightsRights, Democracy, and Fulfillment in the Era of Identity PoliticsRise And Fall of Soul And SelfRitalin NationRobert NozickRousseauRousseau and the Dilemmas of Modernity Routledge Philosophy Guidebook to Derrida on DeconstructionRules, Reason, and Self-KnowledgeSaints, Scholars, and Schizophrenics: Mental Illness in Rural IrelandSartreSartreSartreSartre in Search of an EthicsSatisficing and MaximizingSaving GodScandalous KnowledgeSchizophreniaSchizophrenia and the Fate of the SelfSchizophrenia: A Scientific Delusion?SchopenhauerSchopenhauer's TelescopeScienceScience and EthicsScience and Pseudoscience in Clinical PsychologyScience and SpiritualityScience and the Pursuit of WisdomScience Fiction and PhilosophyScience Fiction and PhilosophyScience in Civil SocietyScience in DemocracyScience RulesScience WarsScience, Consciousness and Ultimate RealityScience, Policy, and the Value-Free IdealSciences from BelowScientific EvidenceScientific IrrationalismScientific PerspectivismScientific PluralismScientific Realism and the Rationality of ScienceScratching the Surface of BioethicsSecond NatureSecond OpinionsSecond PhilosophySecrets of the MindSecular Philosophy and the Religious TemperamentSecurity, Territory, PopulationSeeing and VisualizingSeeing DoubleSeeing Fictions in FilmSeeing RedSeeing Wittgenstein AnewSeeing, Doing, And KnowingSelfSelf and OtherSelf and SubjectivitySelf, No Self?Self-ConsciousnessSelf-ConstitutionSelf-ExpressionSelf-FulfillmentSelf-Knowledge and ResentmentSelf-Knowledge and Self-DeceptionSelf-Made MadnessSelf-Reference and Self-AwarenessSelf-Representational Approaches to ConsciousnessSelvesSentimental RulesSexing the BodySexualized BrainsShades of LonelinessShame and GuiltShame and NecessityShame and PhilosophyShop Class as SoulcraftShynessSigns, Mind, And RealitySimone de BeauvoirSimple MindednessSimulating MindsSimulation and SimilaritySinging in the FireSisyphus's BoulderSituating SemanticsSix Questions of SocratesSkeptical FeminismSkepticismSketch for a Theory of the EmotionsSleeping With Extra-TerrestrialsSlothSocial EpistemologySocial PhenomenologySocializing MetaphysicsSociological Perspectives on the New GeneticsSocratesSocrates CafeSocrates in LoveSocratic Moral PsychologySoft SubversionsSoren 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Critical PsychiatryReview - Critical Psychiatry
The Limits of Madness
by D.B. Double (Editor)
Palgrave Macmillan, 2006
Review by Tony O'Brien, RN, MPhil
May 29th 2007 (Volume 11, Issue 22)

"Critical psychiatry" is the name given to a body of ideas which, while critical of the conceptual foundations of psychiatry and its claim to authority in matters of madness, nevertheless sees a place for the continued existence of something like psychiatry, albeit very different in its approach. The Critical Psychiatry Network in the UK serves as a focus for debate, discussion, lobbying and publication. The editor of this volume, Duncan Double, is a psychiatrist whose name is synonymous with critical psychiatry. Members of the critical psychiatry network have published numerous conceptual analyses, as well as papers critical of the practices of psychiatry, and on public policy issues related to mental health. To my knowledge this is the first book specifically on critical psychiatry, although one of the contributors published a book by that name over two decades ago. There is also Bracken and Thomas's 2005 Postpsychiatry. Mental health in a postmodern world.

Since the height of the "anti-psychiatry" movement in the 1960s and 70s, psychiatry has retrenched into a new biological reductionism armed, if not with a new array of biological investigative tests, at least with a new language with which to claim its place in the pantheon of medical specialisms. It is not too much of a stretch to characterize the biological psychiatry of the early 21st century as a new discourse, a system of practices that, in Foucault's terms, "constructs the objects of which it speaks". But if critical psychiatry is still psychiatry, what are its values, its theoretical commitments, its philosophy and its practices? These are questions that Duncan Double attempts to answer in this collection of twelve readings, many from familiar figures in the critical psychiatry literature.

The book begins with an historical overview by Double. From the coining of the term "antipsychiatry" by David Cooper in 1967, this movement was defined more by its critics than by theorists working on a coherent project. Double reviews the work of Laing and Szasz, pointing out that both rejected the term "antipsychiatry", that the two were entrenched critics of each other's ideas, and that they shared a view, arrived at by different reasoning, of the invalidity of psychopathaology. Double points out that "antipsychiatry" remains a term of disparagement; a convenient label for inconvenient views. Cooper is described as a zealous fanatic, and the description is hard to resist given Double's characterization of Cooper's thought.

Much is made in literature critical of psychiatry, of the failure of psychiatry to produce a definitive "test" for disorders such schizophrenia. This is one of Thomas Szasz's foundational arguments. Such criticism misses the point in a number of respects. Firstly, such a test would not resolve the fundamental problem of meaning posed by madness any more than a biological marker of poetry writing would explain the meaning of poetry. Secondly, this argument suggests that the idea of a definitive test is itself coherent. In response to biologist ideologues, critics would be better to adopt the position of opponents of "string theory": "not even wrong". As Double states in relation to Szasz, criticisms that point to the absence of a definitive test are themselves immersed in the same positivist paradigm as those they argue against: for them it is at least plausible that the answer to the question of madness is ultimately biological.

With the historical foundations of critical psychiatry in place, John Heaton provides a philosophical analysis in chapter three. He identifies a methodological link between sceptical philosophers such as Socrates, Kant and Wittgenstein, and critical psychiatry, and introduces important arguments about positive and negative freedom. Heaton discusses the "two natures" of human beings; the natural and the meaning-making. Confusing one with the other has led to a positivist psychiatry, one which subjugates personhood to biochemical processes. Arguing against Freud, Heaton draws on Wittgenstein, especially the Tractatus, to advocate a psychology of persons, not the disembodied constructs of psychoanalysis. Cognitive therapy, currently the darling of mental health services, is also critiqued for its commitments to causal processes rather than meaning. These views place Heaton in conflict with others within the critical psychiatry tradition, who advocate the use of psychological and psychoanalytical interventions. Heaton also draws on Nietzsche's concept of genealogy to show how the culturally embedded nature of psychiatry is at odds with much of its objectivist thinking. He characterizes of psychiatrists and psychoanlaysts as speaking in a private language, of constructs incapable of verification, leaving little room for theory. Heaton advocates for philosophically based intervention, although it is not immediately clear that such intervention would necessarily avoid the hubris of practitioners, unequal power relationships, or exploitation of clients. It is not even clear that the approach Heaton advocates is, as he claims, atheoretical.

David Ingleby's chapter takes up the challenge of beginning to articulate what critical psychiatry is. This is an engaging chapter which follows Ingleby's career and its intersections with the waxing and waning of critical ideas in mental health. It takes some time for Ingleby to come to the point of the chapter: transcultural psychiatry, but his description of the rise in the 60s and 70s of social criticism, followed by its decline under the New Right, and its impact on his own work, is compelling. Ingleby was himself an immigrant, almost an exile, having moved from England to Holland in 1982 after being professionally ostracized by the psychiatric establishment for his unorthodox views. As he describes it, Ingleby was also a refugee from the neo conservativism of Thatcher's Britain. Exploring the nature of critical psychiatry, Ingleby provides a classical contrast between positivist and interpretive practices, aptly illustrated in his account of Littlemore Hospital. He describes two wards, imaginatively named 'A' and 'B', side by side, one practicing neo-Kraepelinian diagnostic psychiatry, the other Maxwell Jones' therapeutic community principles. These wards may have been poles apart, but for Ingleby, critical psychiatry is not a matter of choosing between positivist and interpretive paradigms:

Critical psychiatry, therefore, does not regard mental illness as a 'myth'; rather, it insists that an emphasis on biological determinants must never blind us to the possible human sense of people's behaviour and experience" (p. 67).

Ingleby discusses transcultural mental health care in the context of colonization and globalization, pointing out the proliferation of mental health services offered to individuals. This effectively individualizes societal and community problems.

I found Lucy Johnstone's chapter on the limits of biomedical models of distress a little disappointing. Johnstone draws on a number of different sources to show how the uncritical biological theorising that underpins much of the public discussion about mental illness. There are powerful arguments that can be mounted against a narrow biomedical model, although as noted above, Ingleby makes some allowance for "biological determinants". But some of Johnstone's arguments seem scientifically naïve. For example:

"Neurotransmitters are in a constant state of flux and change as the body seeks to regulate its functions (a process known as homeostasis); they do not get knocked out of balance at some arbitrary level….a perfect state of balance would be death" (p.87-8).

Just how that statement is intended to argue against biochemical causation is not at all clear. This is not to argue for biochemical causation, it is only to point out that not every argument against it is successful. Also, it is not correct to imply that homeostatic mechanisms cannot be "knocked out of balance". That is precisely what happens in dehydration, heat stroke, shock and neuroleptic malignant syndrome and the like. Johnstone is quite correct to state that complex processes resulting from trauma or detrimental early experiences can influence brain functioning. It would be surprising if they did not. But it is not clear how these influences are different in kind to neurotransmitters getting "knocked out of balance". Influences on brain functioning are not limited to those that support a particular worldview.

The comparison of mental illness with physical illness has been discussed previously in this review, but another comment is in order here. Johnstone makes the point that the concept of mental illnesses is fundamentally flawed, and so can never give rise to a valid set of categories, let alone a valid science. In making this argument, and it is one frequently made in critiques of psychiatry, Johnstone invokes a model of medicine which is at odds with how medicine is practised. Doctors are not scientists, they are health practitioners. They do not treat diseases, they treat people. Even in cases where diseases can clearly be demonstrated the doctor does not act as a scientist, but as a health practitioner responding to an expressed need, not simply to a disease state. There are plenty of cases, especially in primary care, where no pathology can be demonstrated, but doctors still feel an obligation to treat. Sometimes (but not always) they would be better not to, but that is another matter. The social construction of diseases is shown in the naming of new diseases (obesity, hyperlipidaemia) which are a response to social and political influences as much as scientific ones. If medicine is best understood as a practical human science rather than a pure science, much of this sort of critique of psychiatry is defused. Johnstone is on firmer ground in her discussion of how narrow biological explanations have supplanted alternatives in much mainstream psychiatric discourse. But conceding that there might be more conceptual similarity between psychiatry and the rest of medicine than Johnstone's analysis allows need not place us on the slippery slope to biological reductionism.

Terry Lynch writes about the increasing tendency of doctors, both specialist psychiatrists and general practitioners, to prescribe antidepressants. Most western countries now have "depression initiatives", and a core component of these initiatives is medical treatment with drugs. The World Health Organisation talks of a "global burden of disease" arising from the increasing prevalence of depression. It is no coincidence that this increasing prevalence occurs at the same time as an increasing prevalence of prevalence surveys. While I found myself in sympathy with Lynch's concern at this increasing medicalization of ordinary life, I found his analysis overwrought. Yes, there are those, perhaps many, doctors and other health professionals who describe low mood and depression using a fairly thoughtless analaogy with diseases like diabetes. But given the speciousness of such an argument it can be dealt with quickly; it doesn't need pages of discussion. It's rather like heaping more straw on the straw man to make sure it will burn. This chapter lacked a focus on its title of "Understanding Psychiatry's Resistance to Change". I was hoping to read, perhaps, of the marketing strategies of pharmaceutical companies, of the educational practices of medical schools, or the role of specialty colleges in maintaining biomedical hegemony. The best parts of this chapter were Lynch's descriptions of working with people carrying the diagnostic labels of psychiatry, helping them come off psychotropic medications, and helping them develop a more coherent and meaningful narrative about their experiences.

Joanna Moncrieff's contribution on the politics of psychiatric drug treatment is both sober and sobering. Despite the increasing number of national depression initiatives, the evidence for effectiveness of common pharmacological treatments is modest at best. Moncrieff, who has published numerous studies on this topic marshalls an impressive array of evidence in support of her contention that social influences have contributed to the increasing popularity of psychotropic medications, antidepressants in particular. Moncrieff locates this development within a general shift towards the redefinition of social problems as technical, especially medical problems. This, she argues, extends to proposed extensions of compulsory powers into the community.

Shulamit Ramon's contribution is an interesting case study of how the psychosocial orientation of social workers has been appropriated by organised psychiatry, and to some extent by social workers' own aspirations for professional status. The establishment of the "Approved Social Worker" role in the 1983 UK mental health legislation gave social workers a role in mediating psychiatric decision making in civil commitment, and in advocating a psychosocial perspective in this aspect of mental health care. Judging from Ramon's account, this legal status has proved to be something of poisoned chalice, meeting the professional aspirations of the discipline, but at the expense of the independence to fully engage in psychosocial initiatives. Changes to the English legislation will see social workers lose their exclusive advocacy role in civil commitment. Ramon has concerns about whether other disciplines, such as nursing, are adequately prepared to assume this role. More positively, freed from their legislative role, social workers may have an opportunity to refocus on psychosocial care.

The next two chapters return to the historical roots of modern psychiatry. Pat Bracken and Philip Thomas offer a model of "postpsychiatry", underpinned by postmodern concepts of democracy and citizenship. Postpsychiatry proposes a more overtly political agenda than critical psychiatry, although this is really a matter of emphasis rather than philosophical difference. Context is primary in postpsychiatry. Individualistic frameworks and medicalization are rejected. Bracken and Thomas argue for a separation of issues of care and treatment from the process of coercion. Many of their arguments are covered by Double and other contributors, but the issue of coercion deserves mention because, along with the conceptual challenges presented by Szasz's critique, legal coercion remains a fundamental problem for psychiatry.

Bracken and Thomas offer a limited analysis of this difficult issue. There is an acceptance that there are instances when "society" can justifiably "remove a person's liberty on account of mental disorder". The problem is that "society" cannot do that: it must authorize agents to act on its behalf. As an alternative to medical control of legal coercion Bracken and Thomas offer the alternative that doctors and others should be able to apply for detention, but not make the final decision. There are many examples where this model is institutionalized in law, but they have not resolved the problematic association of medical care with coercion. As Paul Appelbaum has showed in the United States, initial legal restraint on clinical decision making gave way to medical paternalism as courts were persuaded to accept medical testimony over legal arguments based on autonomy. The recent (2003) Scottish legislation on community treatment orders appears to be something of a model in terms of the protections provided. In addition to a set of guiding principles, the legislation contains a test of competence, judicial rather than clinical decision making, and the notion of reciprocity. Time will tell whether the Scottish ideals are achieved in practice.

Critical psychiatry's concern about legal coercion has been fuelled by the initial extremes of the proposed changes to legislation in England and Wales. The idea of preventative psychiatric detention of people with "severe personality disorder" has been dropped, but reservations arising from the overt political agenda of social control have remained. Duncan Double tells us in this book that the Critical Psychiatry network withdrew from the Mental Health Alliance in order to reserve its position on the new legislation. Much of the international debate about community treatment orders overlooks the current practice of "supervised discharge", a legal regime with most of the features of community treatment orders. It is rather a moot point whether a community treatment order is necessarily more coercive. Early indications from Scotland are that patients under the newly introduced community orders feel that the mandatory protections of the regime provide greater transparency and a greater sense of fairness than was the case in the previous leave of absence provisions. Critical psychiatry may not be reassured by such findings, but they seem to provide something of a way forward, given Bracken and Thomas's qualified support for some process of detention on grounds of mental disorder.

Critical psychiatry is clearly in need of an explanatory theory if it is to move beyond criticism to a positive model of madness. For this task Duncan Double turns not to the postmodernity advocated by Bracken and Thomas, but to the ideas of Adolph Meyer. Double's review of "the Meyerian legacy" is a timely reminder of a time when a psychiatrist could still respectably talk about psychological explanations of mental disorder, and not simply as an "alternative" to biology. Like many psychiatrists of his time, Meyer was a neurologist, and understood that neurological processes played a part in the manifestations of mental disorder. Yet Meyer was not a reductionist, like some of the modern day proponents of biological explanations. He was opposed to Kraepelin's bright line distinctions between mental disorders, and although he accepted psychoanalytical concepts, he was skeptical of Freud's overdetermined views of mental phenomena. Meyer was something of an eclectic theorist, ready to explore ideas he fundamentally disagreed with. His own "biopsychology" was less an attempt to provide a unifying theory, than an expression of his commitment to multiple explanations. Such an approach has obvious attraction to critical psychiatry. Double is well aware of Meyer's personal foibles, most notably his failure to respond to the blind biologism and unethical practice of his protégée Henry Cotton. This shameful affair has been incisively exposed by Andrew Scull, and Double acknowledges the palpable shortcomings of Meyer's handling of Cotton.

The growth of child psychiatry is discussed by Sami Timimi who, while following the critical pathway established by Double and others, introduces a more explicit analysis of the role of culture in constructing ideas of mental disorder, especially as they relate to children. Much of this chapter is given to a social history of childhood in Britain, with Timimi concluding that western children are at risk of exploitation while their parents are badgered by professionals to measure up to official standards of parenting. Children manifesting the stress from these twin pressures are diagnosed with mental disorder: the individual bearers of dual social tension. Timimi's is a wide ranging analysis which explores the expansion of pharmaceuticals in childhood problems, and questions the validity of the much diagnosed ADHD and more recently "childhood depression". In part this chapter critiques western child psychiatry and western views of childhood by comparing with non-western understandings of childhood; it is also and internal critique of western psychiatry on its own terms.

By this stage of the book I was still wondering, what is critical psychiatry? It is not that the book to this point did not address critical psychiatry; the themes of skepticism, contextualization and resistance to biological reductionism run through all of the chapters. But does this all come together in something approaching a theory? The answer seems to be "not yet." Double starts to answer this question by giving three meanings to the word "critical". They are: critical thinking, the careful application of reasoning to problems, which Double links to Dewey's ideas on reflective practice, "critical theory", which in a brief treatment includes theorists (such Foucault) whose ideas are critical of psychiatry as well as those such as Marcuse whose work is associated with the schools of critical theory; and finally the social practice of the Critical Psychiatry Network.

When it comes to outlining the key issues for critical psychiatry, I suspect that there is little here that a careful, reflective, socially conscious practitioner would take issues with, at least in principle. There are two key issues. One is that neurobiology is too narrow to account for mental disorder, the other is the importance accorded to ethical awareness in clinical practice.

Following this discussion Double returns to his most familiar territory, critique of biological psychiatry. He cites three examples of psychiatrists with differing degrees of commitment to the biological model. E Fuller Torrey will need little introduction to readers of this review. A number of his books have been reviewed on this site. Among advocates of the neurobiological model of mental illness, Torrey holds perhaps the most doctrinaire view of all. The other examples are Anthony Clare, and Julian Leff. Double's criticisms of Leff are interesting, given that (as Double acknowledges) Leff has undertaken considerable research on social issues in mental illness and has most recently published (with Richard Warner) a book on social inclusion for people with mental illness. Double criticises Leff's views on the neurobiology of mental illness, but allows that Leff "has more interest in the social perspective than most psychiatrists". That's really something of an understatement, and illustrates a problem for critical psychiatry. If critical psychiatry is going to change the way mental health services are provided, it will need to work with practitioners such as Leff, while agreeing to disagree about some fundamental views. No doubt Double and others of the critical psychiatry network are cautious of this approach, remembering Adolph Meyer's end of career doubts about whether he had been assertive enough about his psychobiological theory.

Currently, it seems that critical psychiatry is negatively defined; that is, by its critical stance towards the dominant biomedical psychiatric enterprise. Given the political dominance of biomedical psychiatry this is not surprising; it is probably necessary, meaning that critical psychiatry is a social movement, rather than a theoretical model.

A common response to such a critical work is to concede that some valid points have been made and, if nothing else, at least the book makes the reader think. Critical Psychiatry. The Limits of Madness does more than that. It begins the difficult process of deconstructing a social and political enterprise, and of rebuilding an alternative. There is a certain amount of repetition as a number of authors rehearse the arguments against biological understandings of mental distress. The book might have more appropriately been subtitled Limits to Medical Psychiatry, as chapter after chapter explores the shortcomings of the current medical model. Something I found a little puzzling was the use by more than one author of the descriptor "schizophrenic". This was at odds with the otherwise person centered tenor of the book. A future edition could also include a contribution from service users.

It seems churlish to criticize a book which overall does a fine job of critiquing the dominant model of psychiatry, both conceptually and empirically, but I would like to have seen more focus on alternatives. Terry Lynch's chapter perhaps suggested some of the possibilities of psychiatry devolving from a medical specialty to part of primary care practice. The UK has seen a number of mental health in primary care initiatives, although they have had mixed success. But if the medicalization of human distress is to be rolled back, primary care practitioners are going to play an important part in that.

Reviewing this book is made easier by the omission of any contribution from my own discipline, mental health nursing. Many of the criticisms of psychiatry can equally be directed at the discipline of nursing, with the exception, perhaps, of administrative dominance. This is not to say that nurses have been silent on the issues raised by critical psychiatry. Phil Barker, for example, has been a vocal critic of biological psychiatry, and of the institutional practices of mental health services. Barker's ideas are difficult to summarize theoretically, and in some respects he is conceptually, if not philosophically close to Szasz. He has developed an alternative, narrative based, model of the practice of nursing, which reflects many of the concerns articulated by critical psychiatry. In addition, a number of other nurses have provided critique of the medicalization of human problems. If critical psychiatry is to become a force in mental health care in the United Kingdom it will need to develop its alliance with nurses, and there seem to be plenty sympathetic to its ideals.

For critical psychiatry to avoid the excesses of antipsychiatry, it will need to occupy a position between antipsychiatry's total rejection of the notion of mental illness, and the currently dominant medical model. This book makes it clear that Double and others are well aware of the need to stake out this middle ground. Critical psychiatry cannot be disinterested; it is clearly founded on a positive commitments to humanistic, liberal ideals, as well opposition to conceptually flawed theories and oppressive practices. Association with coercion will not go away, but neither can it be accepted as inevitable. In any area of health care or social practice there is a balancing of interests, at the individual, social and political levels. If there is anything to be learned from the narrowly medical model that currently dominates societal response to madness it is that certainty in psychiatry is bought at the price of oversimplifying complex human problems.

 

© 2007 Tony O'Brien

 

Tony O'Brien RN, MPhil, Senior Lecturer, Mental Health Nursing, University of Auckland, a.obrien@auckland.ac.nz


Duncan Double sent the following response to Tony O'Brien's review, published May 31, 2007.

I am grateful for Tony O'Brien's attentive interest to my edited book and his appreciation that it is more than a critique of the biomedical model of psychiatry. I think it is important to be cautious about potentially undermining a critique by suggesting it does not provide enough of an alternative, in case this argument is used to buttress what is being critiqued. For example, it is commonly suggested that there is no alternative to justify prescribing psychotropic medication. Of course, part of the reason that the biomedical model has so much support is because it at least gives the semblance of "doing something". I agree, however, that more needs to be done politically to deconstruct the dominance of biomedical psychiatry. Perhaps Tony O'Brien and others can help us do this.

© 2007 Duncan Double


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