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In The Virtuous Psychiatrist, Jennifer Radden and John Sadler rightly state that the demands on the practitioner in psychiatry "go beyond those imposed by the medical and professional roles they inhabit" (p. 11). One of their central claims is that virtue ethics allows us to take into account a set of ethical obligations which lie beyond the common duties and responsibilities imposed by the standard account of professional biomedical ethics. The latter certainly fit psychiatry, but both, the distinctiveness of the psychiatric setting and the nature of mental disorders, seem to call for an alternative which is convincingly worked out in the Virtuous Psychiatrist.
Central to the virtue ethical approach is the emphasis on the character of the psychiatrists, who should be a special kind of person and moreover can be trained in the cultivation and habituation of specific virtues and character traits needed for psychiatric practice. The authors present a sampling of virtues needed within psychiatric practice, which are identified through particular features of the psychiatric setting as systematically introduced and discussed in beforehand. An example is the discussion of the controversial and central place of gender as an often neglected issue within psychiatric ethics, and their consequent call for an assignment of a new category of "gender-sensitive-virtues" in psychiatry, which then can be tied to specific virtues like respectfulness, tolerance and humility.
What takes the Virtuous Psychiatrist beyond other books developing the virtue-approach for psychiatric ethics is the author's effort to illuminate and circumscribe specific virtues in more detail, thereby illustrating the different ways in which the psychiatric setting calls for extra-virtues in practitioners. With respect to the "categorization" of virtues needed for psychiatric practice, the difference between generally valued moral virtues and specifically role-constitutive virtues is pointed out (e.g. unselfing and propriety are both new categories brought into the discussion). Phronēsis (usually translated with "practical wisdom" ) not surprisingly is introduced as a meta-virtue pointing together with so called "self-unifying virtues" (like self-knowledge and integrity) and authenticity towards the central idea that character and social role can be reunified in virtuous practice.
A skeptic might nevertheless object that even if we generally agree on virtues as a frame for psychiatric ethics and also agree that some of the virtues can be habituated, habituation might be questionable for at least some of the central virtues, like e.g. compassion and also for certain character traits like empathy and personal warmth. For having theoretical knowledge and even practical assistance from a role model may not necessarily lead to habituation in the full-blooded practical sense of actually feeling empathy for others or of emanating warmth. Here the practically informed reader might ask for a more precise outline on how exactly this habituation might be successfully mediated to trainees. With respect to the emphasis on character traits, however, even the skeptic might agree that specific virtues have a greater chance of being implemented if they meet certain character traits, which then may predispose someone more than others to strive for the virtues, or at least might increase the individual potential of actually meeting the standards tied to this ideally notion of the practitioner's character presented by the authors.
The discussion of virtues is remarkably well embedded into a general debate of the notions of self and character. Accordingly, the authors do not fail to account for certain difficulties associated with the adoption of a virtue-based framework for a professional ethics. In doing so, they discuss the possible tensions involved in re-unifying the concept of character and (sometimes incompatible) social roles that provoke tendencies of compartmentalization, as well as difficulties arising out of the habituation-model for cultivating virtues, not only as inherent problems for psychiatric but for professional ethics in general. The authors provide the reader with arguments to critically reassess accounts that have proclaimed a "lack of character" (John Doris 2002) or have argued for an understanding of virtues as mere professional skills (McIntyre 1980). Consequently, the authors aim to show that some professional skills actually can be construed as virtues, and counterbalance the idea of virtues as merely role- and context relative with the notion of character. It is character as comprised of stable, long-term dispositions to act and respond, which shapes a person's enduring moral identity, thereby strengthening the idea of a unity of self. In doing so, their account is not just challenging a postmodernist conception of the self as prone to steady risks of fragmentation due to several incompatible social roles, but rather can be read as offering an alternative to cope with these problems.
The complexity arising from these aspects of the practitioner's professional role is illustrated by a series of narratives extracted from clinical practice, which shall provide the reader with a deeper insight on typical conflicts and central aspects of the dynamics of the therapeutically enterprise and supervision processes. In doing so the Virtuous Psychiatrist has an impact especially for the practically informed reader in stressing on the conflict-solving potential of virtues in the light of healing as the regulative ideal of practice (p.200).
In examining the potential as well as limits of virtuous intervention and engagement, Jennifer Radden and John Sadler have written a great book that is especially recommended to all working in the healthcare system and in the psychiatric field in particular. Beside its inspiring potential for practitioners, the Virtuous Psychiatrist is an important contribution to the ongoing discussion of psychiatry as a field that needs its own ethical standards. It not only inspires the debate on norms and values in other areas of the profession, but once more reveals the need for putting the issue of psychiatric practice right into the centre of deep philosophical reflection.
© 2010 Kerrin Artemis Jacobs
Kerrin A. Jacobs is postdoctoral research fellow in the Animal Emotional II project at the Institute of Cognitive Science at the University of Osnabrueck (Germany). Her main research is on altered emotional experience in psychopathological conditions. Her work is practically informed as she is trained as a caretaker and worked in several asylums for psychiatric patients and battered women in Germany. Mail to: [email protected]