PHILOSOPHY – CONTRIBUTION TO PSYCHIATRY

PRESENTER - Dr. Sriram.R, 2nd year MD Psychiatry PG

CHAIRPERSON – Dr. Sai, AP

ORGANIZATION

• WHAT IS PHILOSOPHY?• EPISTEMOLOGY• LOGIC• METAPHYSICS• ETHICS AND POLITICAL PHILOSOPHY• AESTHETICS• SPECIALIZED BRANCHES OF PHILOSOPHY• PHILOSOPHY OF MIND• PHENOMENOLOGY IN PHILOSOPHY• PHENOMENOLOGY IN PSYCHIATRY• EXISTENTIALISM• EXISTENTIAL THERAPY AND LOGOTHERAPY• PSYCHIATRY AS A MEDICAL MODEL• CONCLUSIONS

WHAT IS PHILOSOPHY?

• Philosophy is the study of general and fundamental problems, such as those connected with reality, existence, knowledge, values,reason, mind, and language. (Grayling, 1999)

• The word "philosophy" comes from the Ancient Greek φιλοσοφία (philosophia), which literally means "love of wisdom".

• The introduction of the terms "philosopher" and "philosophy" has been ascribed to the Greek thinker Pythagoras.

WHAT IS PHILOSOPHY?

• Philosophy is divided into many sub-fields. These include

– Epistemology

– Logic,

–Metaphysics,

– Ethics

–Aesthetics.

EPISTEMOLOGY

• Epistemology is concerned with the nature and scope of knowledge, such as the relationships between truth, belief, perception and theories of justification.

• The regress argument, a fundamental problem in epistemology, occurs when, in order to completely prove any statement, its justification itself needs to be supported by another justification.

• Rationalism is the emphasis on reasoning as a source of knowledge. Empiricism is the emphasis on observational evidence via sensory experience over other evidence as the source of knowledge.

EPISTEMOLOGY

• Parmenides (fl. 500 BC) argued that it is impossible to doubt that thinking actually occurs. But thinking must have an object, therefore something beyond thinking really exists.

• Plato (427–347 BC) combined rationalism with a form of realism. The philosopher's work is to consider being, and the essence (ousia) of things.

• Modern rationalism begins with Descartes, a French philosopher, mathematician and writer.

EPISTEMOLOGY

• Reflection on the nature of perceptual experience, as well as scientific discoveries in physiology and optics, led Descartes (and also Locke) to the view that we are directly aware of ideas, rather than objects :

– Is an idea a true copy of the real thing that it represents? Sensation is not a direct interaction between bodily objects and our sense, but is a physiological process involving representation.

– How can physical objects such as chairs and tables, or even physiological processes in the brain, give rise to mental items such as ideas? This is part of what became known as the mind-body problem.

– If all the contents of awareness are ideas, how can we know that anything exists apart from ideas?

Jean Piaget (1896-1980)

• Natural scientist

• Genetic epistemology

• Philosophy:

Jürgen Habermas

Piaget’s contribution to psychiatry

• Swiss developmental psychologist and philosopher known for his epistemological studies with children.

• His theory of cognitive development and epistemological view are together called "genetic epistemology".

• According to Jean Piaget, genetic epistemology "attempts to explain knowledge, and in particular scientific knowledge, on the basis of its history, its sociogenesis, and especially the psychological origins of the notions and operations upon which it is based"

Piaget’s contribution to psychiatry

• A Schema is a structured cluster of concepts, it can be used to represent objects, scenarios or sequences of events or relations. The original idea was proposed by philosopher Immanuel Kant as innate structures used to help us perceive the world.

• Piaget (1953) described three kinds of intellectual structures: behavioural (or sensorimotor) schemata, symbolic schemata, and operational schemata.

– Behavioural schemata: organized patterns of behaviour that are used to represent and respond to objects and experiences.

– Symbolic schemata: internal mental symbols (such as images or verbal codes) that one uses to represent aspects of experience.

– Operational schemata: internal mental activity that one performs on objects of thought

Piaget’s contribution to psychiatry

• The four development stages are described in Piaget's theory are

– 1. Sensorimotor stage: from birth to age two.

– 2. Preoperational stage: Piaget's second stage, the pre-operational stage, starts when the child begins to learn to speak at age two and lasts up until the age of seven.

– 3. Concrete operational stage: from ages seven to eleven.

– 4. Formal operational stage: from age eleven to sixteen and onwards (development of abstract reasoning).

LOGIC

• Logic is the study of the principles of correct reasoning.

• Arguments use either deductive reasoning or inductive reasoning.

• Deductive reasoning is when, given certain statements (called premises), other statements (called conclusions) are unavoidably implied.

• Rules of inference from premises include the most popular method, modus ponens, where given “A” and “If A then B”, then “B” must be concluded

LOGIC

• Propositional logic uses premises that are propositions, which are declarations that are either true or false.

• Predicate logic uses more complex premises called formulae that contain variables.

• Inductive reasoning makes conclusions or generalizations based on probabilistic reasoning. For example, if “90% of humans are right-handed” and “Joe is human” then “Joe is probably right-handed”.

METAPHYSICS

• Metaphysics is the study of the most general features of reality, such as existence, time, the relationship between mind and body, objects and their properties, wholes and their parts, events, processes, and causation.

• Traditional branches of metaphysics include cosmology, the study of the world in its entirety, and ontology, the study of being.

• Idealism, for example, is the belief that reality is mentally constructed or otherwise immaterial while realism holds that reality, or at least some part of it, exists independently of the mind.

ETHICS AND POLITICAL PHILOSOPHY

• Ethics, or "moral philosophy," is concerned primarily with the question of the best way to live, and secondarily, concerning the question of whether this question can be answered.

• The main branches of ethics are meta-ethics, normative ethics, and applied ethics.

• Meta-ethics concerns the nature of ethical thought, such as the origins of the words good and bad, and origins of other comparative words of various ethical systems, whether there are absolute ethical truths, and how such truths could be known.

• Normative ethics are more concerned with the questions of how one ought to act, and what the right course of action is.

ETHICS AND POLITICAL PHILOSOPHY

• Jeremy Bentham and John Stuart Mill are famous for propagating utilitarianism, which is the idea that the fundamental moral rule is to strive toward the "greatest happiness for the greatest number".

• Political philosophy is the study of government and the relationship of individuals (or families and clans) to communities including the state. It includes questions about justice, law, property, and the rights and obligations of the citizen.

• In The Republic, Plato presented the argument that the ideal society would be run by a council of philosopher-kings, since those best at philosophy are best able to realize the good.

AESTHETICS

• Aesthetics deals with beauty, art, enjoyment, sensory-emotional values, perception, and matters of taste and sentiment.

SPECIALIZED BRANCHES OF PHILOSOPHY

• Philosophy of language explores the nature, the origins, and the use of language.

• Philosophy of law (often called jurisprudence) explores the varying theories explaining the nature and the interpretations of law.

• Philosophy of mind explores the nature of the mind, and its relationship to the body, and is typified by disputes between dualism and materialism. In recent years there has been increasing similarity between this branch of philosophy and cognitive science.

• Philosophy of religion explores the questions regarding religion, including the nature and existence of God, the examination of religious experiences, analysis of religious vocabulary and texts, and the relationship of religion and science.

• Philosophy of science explores the foundations, methods, implications, and purpose of science.

• Metaphilosophy explores the aims of philosophy, its boundaries, and its methods.

PHILOSOPHY OF MIND

• Branch of philosophy that studies the nature of the mind, mental events, mental functions, mental properties,consciousness, and their relationship to the physical body, particularly the brain.

• The mind–body problem, i.e. the relationship of the mind to the body, is commonly seen as one key issue in philosophy of mind, although there are other issues concerning the nature of the mind that do not involve its relation to the physical body, such as how consciousness is possible and the nature of particular mental states.

PHILOSOPHY OF MIND

• Dualism and monism are the two major schools of thought that attempt to resolve the mind–body problem.

• Dualism can be traced back to Plato and the Sankhya and Yoga schools of Hindu philosophy, but it was most precisely formulated by René Descartes in the 17th century.

• Substance dualists argue that the mind is an independently existing substance, whereas Property dualists maintain that the mind is a group of independent properties that emerge from and cannot be reduced to the brain, but that it is not a distinct substance.

PHILOSOPHY OF MIND

• Monism is the position that mind and body are not ontologically distinct kinds of entities (independent substances).

• This view was first advocated in Western philosophy by Parmenides in the 5th century BC and was later by the 17th century rationalist Baruch Spinoza.

• Idealists maintain that the mind is all that exists and that the external world is either mental itself, or an illusion created by the mind.

PHENOMENOLOGY IN PHILOSOPHY

• Founded in the early years of the 20th century by Edmund Husserl.

• Edmund Husserl's phenomenology was an ambitious attempt to lay the foundations for an account of the structure of conscious experience in general.

• Phenomenology, in Husserl's conception, is primarily concerned with the systematic reflection on and study of the structures of consciousness and the phenomena that appear in acts of consciousness.

• This ontology (study of reality) can be clearly differentiated from the Cartesian method of analysis which sees the world as objects, sets of objects, and objects acting and reacting upon one another.

PHENOMENOLOGY IN PSYCHIATRY

• Phenomenology is the study of subjective experience, in PSYCHIATRIC terms, and is a component of “descriptive psychopathology”

• It is an approach to psychological subject matter that has its roots in the philosophical work of Edmund Husserl.

• For example, we might ask, "Is my experience of redness the same as yours?"

• While it is difficult to answer such a question in any concrete way, the concept of intersubjectivity is often used as a mechanism for understanding how it is that humans are able to empathise with one another's experiences.

PHENOMENOLOGY IN PSYCHIATRY

• Carl Rogers' person-centered psychotherapy theory is based directly on the "phenomenal field" personality theory of Combs and Snygg.

• That theory in turn was grounded in phenomenological thinking.

• Rogers attempts to put a therapist in closer contact with a person by listening to the person's report of their recent subjective experiences, especially emotions of which the person is not fully aware.

• For example, in relationships the problem at hand is often not based around what actually happened but, instead, based around the perceptions and feelings of each individual in the relationship. The phenomenal field focuses on "how one feels right now".

Karl Jaspers (1883-1959)

• Phenomenological/Existential

Psychiatrist

• Professor of

Philosophy

Karl Jaspers contribution to psychiatry

• He published a paper in 1910 in which he addressed the problem of whether paranoia was an aspect of personality or the result of biological changes.

• Jaspers set about writing his views on mental illness in a book which he published in 1913 as General Psychopathology. This work has become a classic in the psychiatric literature and many modern diagnostic criteria stem from ideas contained within them.

• Jaspers believed that psychiatrists should diagnose symptoms (particularly of psychosis) by their form rather than by their content.

Karl Jaspers contribution to psychiatry

• For example, in diagnosing a hallucination, the fact that a person experiences visual phenomena when no sensory stimuli account for it (form) assumes more importance than what the patient sees (content).

• He argued that clinicians should not consider a belief delusional based on the content of the belief, but only based on the way in which a patient holds such a belief.

• Jaspers also distinguished between primary and secondary delusions. He defined primary delusions as autochthonous meaning arising without apparent cause.

EXISTENTIALISM

• Existentialism is a term applied to the work of a number of late 19th- and 20th-century philosophers who shared the belief that philosophical thinking begins with the human subject—not merely the thinking subject, but the acting, feeling, living human individual.

• The individual's starting point is characterized by what has been called "the existential attitude", or a sense of disorientation and confusion in the face of an apparently meaningless or absurd world.

• The 19th-century philosophers SørenKierkegaard and Friedrich Nietzsche are widely regarded as the fathers of existentialism.

EXISTENTIAL THERAPY

• Existential psychotherapy is a philosophical method of therapy that operates on the belief that inner conflict within a person is due to that individual's confrontation with the givens of existence.

• These givens, as noted by Irvin D. Yalom, are: the inevitability of death, freedom and its attendant responsibility, existential isolation (referring to phenomenology), and finally meaninglessness.

LOGOTHERAPY

• Viktor Emil Frankl, M.D., Ph.D. (26 March 1905 – 2 September 1997)was an Austrian neurologist and psychiatrist as well as a Holocaust survivor.

• Frankl was the founder of logotherapy, which is a form of existential analysis, the "Third Viennese School of Psychotherapy“

• Frankl became one of the key figures in existential therapy and a prominent source of inspiration for humanistic psychologists.

• Logotherapy is based on an existential analysis focusing on Kierkegaard's will to meaning as opposed to Adler's Nietzschean doctrine of will to power or Freud's will to pleasure.

R.D. Laing (1927-1989)

• Scottish psychiatrist

and psychoanalyst

• Existential philosophy

and psychiatry

• Pioneer in family studies

• Critical psychiatry

• Laing's views on the causes and treatment of serious mental dysfunction, greatly influenced by existential philosophy, ran counter to the psychiatric orthodoxy of the day by taking the expressed feelings of the individual patient or client as valid descriptions of lived experience rather than simply as symptoms of some separate or underlying disorder.

• Laing was associated with the anti-psychiatry movement, although he rejected the label.

• He also challenged psychiatric diagnosis itself, arguing that diagnosis of a mental disorder contradicted accepted medical procedure.

PSYCHIATRY AS A MEDICAL MODEL

• Psychiatry now adheres to the “medical model”, which advocates “the consistent application, in psychiatry, of modern medical thinking and methods”

• The medical model merely commits us to a brain-based view of mental illness with few implications for science.

• It is true that clinical or scientific differences across practitioners seldom seem to have much to do with divergent interpretations of the medical model.

PSYCHIATRY AS A MEDICAL MODEL

• It may be helpful to distinguish minimal andstrong interpretations.

• A minimal interpretation makes no commitments about the underlying physical structure that causes mental illness.

• The strong interpretation of the medical model, in contrast, dissents on just this issue. It says that the proper medical understanding of disease is in terms of morbid anatomy.

PSYCHIATRY AS A MEDICAL MODEL

• Guze (1992), for example, is a minimalist. When he advocates seeing psychiatry as a part of medicine what he means is that we can classify disorders in terms of their characteristic symptoms and courses.

• Thomas Sydenham, was a 17th century English physician who distinguished varieties of pox based on their characteristic courses and outcomes.

• Andreasen (2001) embraces the strong interpretation. She argues that psychiatry now emerging as a form of cognitive neuroscience, is for the first time able to identify the specific pathophysiologies that underpin the symptoms of mental illness.

CONCLUSION

• A full account of mind cannot be provided by an understanding of brain.

• The history of psychiatry, psychology and psychoanalysis are intimately intertwined with philosophical questions.

• Understanding this history will help us avoid reductive modes of thought.

• Phenomenological psychiatry can teach us by elucidatinghuman experience and expanding our empathy.

REFERENCES

• A.C. Grayling (1999). "Editor's Introduction". In A.C. Grayling, ed. Philosophy 1: A Guide through the Subject. vol. 1. Oxford University Press. p. 1. ISBN 978-0-19-875243-1

• G & C. Merriam Co. (1913). Noah Porter, ed. Webster's Revised Unabridged Dictionary (1913 ed.). G & C. Merriam Co. p. 501. Retrieved 2012-05-13.

• Descartes, René (1998). Discourse on Method and Meditations on First Philosophy. Hacket Publishing Company. ISBN 0-87220-421-9.

• Hart, W.D. (1996) "Dualism", in Samuel Guttenplan (org) A Companion to the Philosophy of Mind, Blackwell, Oxford, 265-7.

• Hardy Leahy, Thomas (2001). A History of Modern Psychology. New Jersey: Prentice Hall. p. 381. ISBN 0-13-017573-0.

• Yalom, I (1980). Existential psychotherapy. New York: Basic Books. p. 9.

• http://plato.stanford.edu/entries/psychiatry/#MedModImp

• Guze, S. B., 1992. Why Psychiatry Is a Branch of Medicine, New York: Oxford University Press.

• Andreasen, N.C., 1997. “Linking Mind and Brain in the Study of Mental Illnesses: A Project for a Scientific Psychopathology,” Science, 275: 1586–93.–––, 2001. Brave New Brain, New York: Oxford University Press.

THANK YOU