History, philosophy and practical psychiatry

Abstract

When working in the field of history and philosophy of psychiatry, one will sooner or later be confronted with the sceptical question of whether there is any practical use of such activities for psychiatry – both as a therapeutic discipline and as a continuously growing area of research. This year's history and philosophy section provides the readers with five reviews that address this issue from quite different perspectives, while they share (and, in a way, prove) the basic attitude that theoretical and practical levels of psychiatry are intertwined much more closely than one usually realizes.Focussing on the history of psychiatric institutions, Engstrom concludes that the shift from the carceral narrative of earlier decades to the present interest in the extramural dimensions of psychiatric work should not undermine the need for thorough research into the changing, but still important, roles of institutions. Haack and Kumbier review the literature on the concept of social psychiatry and its multifold, albeit often contradicting, practical consequences, for example, for professional role models or the interplay of different methodological approaches like neurobiological and psychopathological ones. They provide a broad range of perspectives from the 19th century to the reform and antipsychiatry movements in the second half of the last century and to the very recent developments in the interprofessional organization of psychiatric care.The latter aspect is emphasized by Jaeger and Hoff, who summarize and comment on recent articles on the recovery model. This concept, increasingly popular and widely used, but still partly fuzzy, enriches the classical symptom-oriented approach (the medical model, so to speak) by focusing on the patient's (and, not to forget, the relatives’) perspective and initiative. In this case, attention is not so much invited to the historical, but to the ethical and anthropological, dimension of psychiatric work.Two reviews show how intensely, but often implicitly, shifts in theoretical frameworks may alter clinical practice: Millard elucidates the evolving conceptualization of deliberate self-harm in postwar Britain. This is by no means only a matter of theoretical consideration, as it strongly reflects profound changes in the organization of mental healthcare. These changes made the ‘stories behind physical injuries’ accessible and interesting to psychiatrists and researchers. Woodbridge-Dodd's review of recent publications on values-based practice in mental health and psychiatry opens two perspectives: in the first place, she reports on new practical and research options made possible by implementing the dimension of values into basic psychiatric work. In the second place, this approach in itself is debated as connected with certain values, especially with a radical liberal approach – values that also have to be (and, indeed, are) acknowledged and discussed.The section editors hope that readers will arrive at a similar conclusion as they did: the complex interface between the historical and philosophical underpinnings of psychiatry on the one hand and its practical dimensions of diagnosis, therapy and research on the other hand has developed into a stimulating and rich scientific area that successfully operates within and beyond classical methodological or conceptual frameworks. In other words: the practical relevance of these topics for psychiatry is no longer in question.