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(1)VU Research Portal. Philosophy in Psychiatric Practice Ralston, A.S.G.. 2019. document version Publisher's PDF, also known as Version of record. Link to publication in VU Research Portal. citation for published version (APA) Ralston, A. S. G. (2019). Philosophy in Psychiatric Practice.. General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. • Users may download and print one copy of any publication from the public portal for the purpose of private study or research. • You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal ? Take down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. E-mail address: vuresearchportal.ub@vu.nl. Download date: 13. Oct. 2021.

(2) Chapter 1: Examining the philosophy of psychiatric practice. . 1.1 Introduction 1.2 Communication and method 1.3 The ‘common ground’ approach to philosophy and psychiatry: methods and challenges. Analysis of theory Linguistic philosophy and qualitative research Experimental research and clinical reasoning Historical and sociological research Integrating and translating the research 1.4 Description and prescription 1.5 Integrating the research 1.6 Implications for this study and overview 1.1 Introduction Š‡ ”‡ ‡– ”‡ƒ‹••ƒ ‡ ‘ˆ ”‘••Ǧ†‹• ‹’Ž‹ƒ”› ‹–‡”‡•– „‡–™‡‡ ’Š‹Ž‘•‘’Š› ƒ† ’•› Š‹ƒ–”›Šƒ•‰‹˜‡”‹•‡–‘ƒ‹’”‡••‹˜‡„‘†›‘ˆ‘™Ž‡†‰‡ƒ†–‘ ŠƒŽŽ‡‰‹‰ ‡™’‡”•’‡ –‹˜‡•‘’•› Š‹ƒ–”‹ –Š‡‘”›ƒ†’”ƒ –‹ ‡ǤŠ‡‰‡‡”ƒŽ˜‹‡™‹•–Šƒ–„‘–Š ’Š‹Ž‘•‘’Š› ƒ† ’•› Š‹ƒ–”› ƒ „‡‡ˆ‹– ˆ”‘ ™‘” ™‹–Š‹ –Š‹• ˆ‹‡Ž†Ǥ ‡†Ž‡” ƒ† ƒ”ƒ•ȋʹͲͲͺȌŽ‹•–ˆ‘—””‡ƒ•‘•™Š›’•› Š‹ƒ–”›‡‡†•’Š‹Ž‘•‘’Š›ǣ–Š‡’”‡•‡ ‡‘ˆ ƒ’”‹‘”‹ƒ••—’–‹‘•ƒ†„‡Ž‹‡ˆ•‘ƒ––‡”••— Šƒ• ƒ–‡‰‘”‹œƒ–‹‘ǡ ƒ—•ƒ–‹‘ƒ† ‡š’Žƒƒ–‹‘Ǣ–Š‡™‹†–Šƒ††‹˜‡”•‹–›‘ˆ–Š‡ˆ‹‡Ž†ƒ†–Š‡‡–Š‘†‘Ž‘‰‹‡•‹˜‘Ž˜‡†Ǣ –Š‡ˆƒ ––Šƒ–’•› Š‹ƒ–”›Šƒ••‡‡ƒŒ‘”•Š‹ˆ–•‹‹–• ‡–”ƒŽ’ƒ”ƒ†‹‰•‹‹–•”‡ ‡– Š‹•–‘”›Ǣƒ†ˆ‹ƒŽŽ›ǡ–Š‡ˆƒ ––Šƒ––Š‡•—„Œ‡ –ƒ––‡”‘ˆ’•› Š‹ƒ–”›†‡ƒŽ•™‹–ŠŠ—ƒ „‡Šƒ˜‹‘”ƒ†‡š’‡”‹‡ ‡ǡƒ†ƒ••— Š‹•‹–‹ƒ–‡Ž› ‘‡ –‡†–‘˜‹‡™•‘ˆ™Šƒ–‹– ‡ƒ•–‘„‡Š—ƒǤ–‹ŽŽǡ‡–ƒŽŠ‡ƒŽ–Š™‘”‡”• ƒ„‡ˆ‘”‰‹˜‡ˆ‘”˜‹‡™‹‰–Š‹• ƒ”‡ƒ ƒ• ƒ Š‹‡ˆŽ› ƒ„•–”ƒ – ‡–‡”’”‹•‡ ™‹–Š —‘™ ’”ƒ –‹ ƒŽ ”‡Ž‡˜ƒ ‡ –‘ –Š‡‹” ‡˜‡”›†ƒ› ’”‘ˆ‡••‹‘ƒŽ ƒ –‹˜‹–‹‡•Ǥ Š‹• ƒ› •‹’Ž› „‡ ƒ ‡š’”‡••‹‘ ‘ˆ ƒ ‘””‡•’‘†‹‰ Žƒ›ƒ ˜‹‡™ ‘ˆ ’Š‹Ž‘•‘’Š›ǡ „—– ‹– ƒŽ•‘ †‘‡• •‡‡ ”‡ƒ•‘ƒ„Ž‡ ˆ‘” ’”‘ˆ‡••‹‘• ‘•–Ž› ‘ ‡”‡† ™‹–Š ’”ƒ –‹ ƒŽǡ ’”ƒ‰ƒ–‹  ‰‘ƒŽ• –‘ ƒ• ‘ˆ –Š‘•‡ ™‘”‹‰‹’Š‹Žosophy: ‘‘How will your activities help my patients?’’, especially if –Š‡ ”‡Ž‡˜ƒ ‡ ‘ˆ ’Š‹Ž‘•‘’Š› ˆ‘” †ƒ‹Ž› ’”ƒ –‹ ‡ ‹• ‘– ‹‡†‹ƒ–‡Ž› ƒ’’ƒ”‡–Ǥ

(3)  —Žˆ‘”†‡–ƒŽǤȋʹͲͲ͸Ȍǡ–Š‡ƒ—–Š‘”•†‡ˆ‡†–Š‡’”ƒ –‹ ‡‘ˆ’Š‹Ž‘•‘’Š›‹’•› Š‹ƒ–”› as a ‘conscious‡••Ǧ”ƒ‹•ing exercise’: ‘‘Philosophy gives us a more complete view ‘ˆ –Š‡ ‡ƒ‹‰• ‘ˆ –Š‡ ‘ ‡’–• „› ™Š‹ Š ™‡ •–”— –—”‡ ƒ† ƒ‡ •‡•‡ ‘ˆ –Š‡ 9.

(4) Chapter 1. world.’’ But though philosophy and psychiatry share a common interest in the Š—ƒ‹†ǡ–Š‡‹”‰‘ƒŽ•ǡ‡–Š‘†•ǡƒ†’”‘ˆ‡••‹‘ƒŽ’ƒ”Žƒ ‡†‹ˆˆ‡”ǤŠ‹•ƒ›Ž‡ƒ† to a ‘communication gap’ between the disciplines (ibid.), obstructing fruitful ‘‘’‡”ƒ–‹‘Ǥ‡•’‹–‡’”‡˜‹‘—•‡ˆˆ‘”–•‹–Š‹•ƒ”‡ƒȋ‡Ǥ‰Ǥ —Žˆ‘”†ƒ†‘Ž‘„‘ʹͲͲͶȌǡ –Š‡”‡ ”‡ƒ‹ ™‘””‹‡• ƒ„‘—– –Š‡ ƒ ‡••‹„‹Ž‹–› ‘ˆ ™‘” ‹ –Š‡ ’Š‹Ž‘•‘’Š› ‘ˆ psychiatry to the average practitioner. Philips (2011) states: ‘‘Most publications in –Š‡ ’Š‹Ž‘•‘’Š› ‘ˆ ’•› Š‹ƒ–”› ƒ”‡ “—‹–‡ –‡ Š‹ ƒŽ—™Šƒ–‡˜‡” –Š‡ –”ƒ†‹–‹‘ ‘—– ‘ˆ ™Š‹ Š–Š‡›ƒ”‡™”‹––‡—ƒ†‡š’‡ –‹‰–Š‡–‘Šƒ˜‡ƒ‡ˆˆ‡ –‘‡–ƒŽŠ‡ƒŽ–Š practice is quite unrealistic ….If you really want to influence mental health care with Wittgenstein’s account of meaning as use and practice, you will have to get rid of the technical language and translate Wittgenstein’s analysis into the la‰—ƒ‰‡‘ˆ ’”ƒ –‹–‹‘‡”•ǡ •Š‘™ –Š‡ǡ ‹ –Š‡‹” Žƒ‰—ƒ‰‡ǡ ™Šƒ– ‹‰Š– „‡ –Š‡ ‹’Ž‹ ‹– philosophical assumptions they are working with, how those don’t serve them well, and how your suggestions might lead to better practice.’’. Š‹Ž‹’• Š‡”‡ ƒ’’‡ƒ”• –‘ „‡ ƒ”‰—‹‰ ˆ”‘ –Š‡ ’‘‹– ‘ˆ ˜‹‡™ ‘ˆ –Š‡ ˜ƒŽ—‡ ‘ˆ –Š‡ ‹–‡”†‹• ‹’Ž‹‡ ˆ‘” ‡†‹ ƒŽ ’”ƒ –‹ ‡ǣ –Š‡ ‰‘ƒŽ ‹• –‘ ”‡ƒŽŽ› ‹ˆŽ—‡ ‡ ƒ† ‹’”‘˜‡ ’”ƒ –‹ ‡Ǥ

(5) ‹ƒ‰‹‡ƒ›’ƒ”–‹ ‹’ƒ–•‹–Š‡ˆ‹‡Ž†™‘—Ž†ƒ‰”‡‡–Šƒ––Š‹••Š‘—Ž†„‡ •‘‡–Š‹‰‹–ƒ•’‹”‡•–‘ǤŠ‡„ƒ””‹‡”•Š‡•‡‡•ƒ”‡–Š‡Ǧ’Š‹Ž‘•‘’Š‹ ƒŽǦ‘technicality’ ‘ˆ’—„Ž‹ ƒ–‹‘•ƒ†–Š‡”‡Žƒ–‡†Žƒ‰—ƒ‰‡†‹ˆˆ‡”‡ ‡„‡–™‡‡–Š‡†‹• ‹’Ž‹‡•Ǥ—–Š‡ ƒŽ•‘ ’‘‹–• –‘ ‡–Š‘†‘Ž‘‰‹ ƒŽ †‹ˆˆ‡”‡ ‡•Ǥ Š‹Ž‹’• ‹• •—‰‰‡•–‹‰ –Šƒ– ‹ ‘”†‡” –‘ ƒ‡–Š‡‹”™‘”‘”‡ƒ ‡••‹„Ž‡–‘‡†‹ ƒŽ’”ƒ –‹ ‡ǡƒ—–Š‘”••Š‘—Ž†ƒ†ƒ’––Š‡‹” methods towards practice, implying use of empiricism (‘show them’) and pragmatism (‘better practice’)Ǥ. If we follow this advice, the empirical study of ‘implicit philosophical assumptions’ or Kendler and Parnas’ ‘a priori philo•‘’Š‹ ƒŽideas’ seems a suitable starting point.

(6) ˆ‹‡Ž†•ƒ•†‹˜‡”•‡ƒ• ‘‰‹–‹˜‡’•› Š‘Ž‘‰›ƒ†‡–Š‘‰”ƒ’Š›ǡ†‹ˆˆ‡”‡––‡”•Šƒ˜‡ been used to denote what they refer to as ‘a priori beliefs and assumptions’. Related terms in this regard are ‘philosophicaŽ ™‘”Ž† ˜iews’, ‘tacit knowledge’, ‘hidden beliefs’ and suchlike. Though no exact definition of these terms is given, they refer –‘ ‹†‡ƒ•ǡ ‘˜‹ –‹‘•ǡ ƒ† „‡Ž‹‡ˆ• ‘ –Š‡ ’ƒ”– ‘ˆ –Š‡ ’”ƒ –‹–‹‘‡” –Šƒ– ”‡Žƒ–‡ –‘ •‘‡–Š‹‰ †‡‡’‡”ǡ ‘” ”‡‘˜‡† ˆ”‘ǡ ‘•–‡•‹˜‡ Ž‹‹ ƒŽ ‘™Ž‡†‰‡ ƒ• ‹– ‹• ‡ ƒ’•—Žƒ–‡† ‹ –‡š–„‘‘•ǡ ‘‰‹–‹˜‡ ƒŽ‰‘”‹–Š• ‘” ”‡‰‹‡–‡† ’”ƒ –‹ ‡Ǥ ‘” convenience, the term ‘beliefs’ will be provisionally employed here. What characterizes these beliefs as ‘philosophical’ can be derived from the subject•‘ˆ ’Š‹Ž‘•‘’Š›ǣ–Š‡„‡Ž‹‡ˆ•’‡”–ƒ‹–‘ƒ––‡”••— Šƒ•–Š‡ƒ–—”‡‘ˆƒ‰‹˜‡‡–‹–›ǡ•— Š ƒ•‡–ƒŽ†‹•‘”†‡”ȋ‘–‘Ž‘‰›Ȍǡ–Š‡™ƒ›–Š‹•‡–‹–› ƒ„‡‡š’Žƒ‹‡†ȋ‡’‹•–‡‘Ž‘‰›Ȍǡ –Š‡ Ž‡‰‹–‹‹œƒ–‹‘ ‘ˆ ’”ƒ –‹ ‡ –Š”‘—‰Š • ‹‡ ‡ǡ Š—ƒǡ ƒ–—”ƒŽ ‘” ‘–Š‡”™‹•‡ ȋ’Š‹Ž‘•‘’Š› ‘ˆ • ‹‡ ‡Ȍǡ –Š‡ ƒ –—ƒŽ ƒ–—”‡ ‘ˆ –Š‡ ‡š’‡”‹‡ ‡• ‹˜‘Ž˜‡† 10.

(7) Examining the philosophy of psychiatric practice. (phenomenology) and what ‘good practice’ entails (ethics). A clearer and more ’”‡ ‹•‡‹˜‡•–‹‰ƒ–‹‘‘ˆ™Š‡”‡ǡ™Š‡ƒ†Š‘™’Š‹Ž‘•‘’Š‹ ƒŽƒ••—’–‹‘•‹ˆŽ—‡ ‡ –Š‡’”ƒ –‹ ‡‘ˆ’•› Š‹ƒ–”›‹‰Š–’”‘˜‹†‡’”ƒ –‹–‹‘‡”•ƒ’”ƒ‰ƒ–‹ ƒ†˜ƒ–ƒ‰‡ȋ‘ –Š‡ ƒ••—’–‹‘ –Šƒ– ƒ™ƒ”‡‡•• ‹–•‡Žˆ Ž‡ƒ†• –‘ „‡––‡” ’”ƒ –‹ ‡ȌǤ —– •Š‘—Ž† –Šƒ– ƒ••—’–‹‘–Š‡‘–„‡‡šƒ‹‡†‡’‹”‹ ƒŽŽ›–‘‘ǫŠ‹•’”‘’‘•ƒŽ‹‰Š–‡‡–™‹–Š ‘„Œ‡ –‹‘•ˆ”‘’Š‹Ž‘•‘’Š›•— Šƒ•–Š‘•‡Ž‡˜‡Ž‡†ƒ–‡š’‡”‹‡–ƒŽ’Š‹Ž‘•‘’Š›ǡ‘ˆ –Š”‡ƒ–‡‹‰ –‘ •—„•–‹–—–‡ ‡’‹”‹ ƒŽ ˆ‹†‹‰• ˆ‘” ’Š‹Ž‘•‘’Š› ƒŽ–‘‰‡–Š‡” ƒ† ƒ ‡†‹‰ –‘ ƒ –‡Ž‡‘Ž‘‰‹ ƒŽ ˆ‘—†ƒ–‹‘ƒŽ‹• ȋ‹ŽŽ‹ƒ•‘ ʹͲͳͷȌǡ ™Š‡”‡‹ philosophy’s value would be too dependent on human interests. How far down thi• ‡’‹”‹ ƒŽ’ƒ–Š•Š‘—Ž†Š‹Ž‘•‘’Š›ƒ†•› Š‹ƒ–”›‰‘ǫ. 1. ‡•Š‘—Ž†‘–‘˜‡”•–ƒ–‡–Š‹•’”‘„Ž‡ǡŠ‘™‡˜‡”ǣ„‘–Š’Š‹Ž‘•‘’Š›ƒ†‡†‹ ‹‡ƒ”‡ ‘–”‡†— ‹„Ž‡–‘ƒ•‹‰—Žƒ”‡–Š‘†‘Ž‘‰›ǡƒ†ƒ•‡ Š–‡ŽȋͳͻͺͺȌŠƒ•†‡• ”‹„‡†ǡ™‡ •Š‘—Ž† ‡‡’ ‘—” ‹†• ƒ† ”‡•‡ƒ” Š ’”ƒ –‹ ‡• ‘’‡ –‘ –Š‡ †‡˜‡Ž‘’‡– ‘ˆ ‹–‡”ˆ‹‡Ž† ‡–Š‘†• ƒ† Žƒ‰—ƒ‰‡Ǥ ‡•’‘•‡• –‘ ”‹–‹ ‹•• ‘ˆ ‡š’‡”‹‡–ƒŽ ’Š‹Ž‘•‘’Š›Šƒ˜‡‡’Šƒ•‹œ‡†–Š‡ ‘’Ž‡‡–ƒ”›ƒ–—”‡‘ˆ‡’‹”‹ ƒŽ™‘”˜‹•ǦǦ vis philosophy, and philosophy’s fundamental commitment to intellectual curi‘•‹–› ƒ† †‹˜‡”•‹–›Ǥ ‡ ™‹ŽŽ ”‡–—” –‘ –Š‹• “—‡•–‹‘ ‘ˆ –Š‡ ƒ‡” ‹ ™Š‹ Š –Š‡ ‹–‡”†‹• ‹’Ž‹‡ ƒ†‡˜‡Ž‘’ƒ†•‹—Ž–ƒ‡‘—•Ž›”‡ƒ‹ƒ ‡••‹„Ž‡–‘„‘–Š’ƒ”‡– disciplines. First though, I suggest Philips’ thoughts can be developed further.  . 1.2 Towards philosophy in practice Š‡’”‡•‡ ‡‘ˆƒ’”‹‘”‹’Š‹Ž‘•‘’Š‹ ƒŽ‹†‡ƒ•‹•–Š‡‘•–†‹”‡ –Ž›ƒ˜ƒ‹Žƒ„Ž‡ƒ†•‡ŽˆǦ ‡˜‹†‡–‡–”›’‘‹–ˆ‘”’Š‹Ž‘•‘’Š›‹–‘’•› Š‹ƒ–”‹ ’”ƒ –‹ ‡Ǥ

(8) †‡‡†ǡŽƒ”‰‡„‘†‹‡•‘ˆ literature have been devoted to the different ‘models’ of prac–‹ ‡ȋ‡Ǥ‰Ǥ„‹‘Ž‘‰‹ ƒŽ˜•Ǥ ’•› Š‘†›ƒ‹ ǡ ”‡†— –‹‘‹•– ˜•Ǥ ƒ–‹”‡†— –‹‘‹•– ’Š‹Ž‘•‘’Š› ‘ˆ ‹†ȌǤ ‘™‡˜‡”ǡ –Š‡’”‡•‡ ‡ƒ†ˆ— –‹‘‹‰‘ˆ•— Š‘†‡Ž•ƒ†‹†‡ƒ•™‹–Š‹ƒ –—ƒŽ’”ƒ –‹ ‡Šƒ˜‡ ”ƒ”‡Ž› „‡‡ •–—†‹‡† ȋ ˆǤ ƒ††‡ ʹͲͲ͹ǡ Ž‹ˆ‡ ƒ† ‹ŽŽ‹ƒ• ͳͻͻͷǡ  —‰Š ƒ† Žƒ˜ney 1998). An assumption implicit in Philips’ suggestion is that practitioners ’‘••‡••ƒ”‡’‘•‹–‘”›‘ˆ”‡ƒ•‘ƒ„Ž› ‘•‹•–‡–’Š‹Ž‘•‘’Š‹ ƒŽ„‡Ž‹‡ˆ•ǡ™Š‹ Š‹–—” ƒ”‡ ƒ’’Ž‹‡† ”‡ƒ•‘ƒ„Ž› ‘•‹•–‡–Ž› ‹ ’”ƒ –‹ ‡Ǥ —– ™Šƒ– †‘ ™‡ ‘™ ‘ˆ –Š‡ ƒ‡”‹™Š‹ Š’Š‹Ž‘•‘’Š‹ ƒŽ„‡Ž‹‡ˆ•ƒ†‘–‹‘•ǡƒ••‘ ‹ƒ–‡†™‹–Šƒ„•–”ƒ ––‡”• like ‘mental disorder’, ‘mind and body’ or ‘classification’ operate in practice? Are ’”ƒ –‹–‹‘‡”• ‘•‹•–‡– ‹ –Š‡‹” „‡Ž‹‡ˆ•ǫ ‘™ •—• ‡’–‹„Ž‡ ƒ”‡ –Š‡› –‘ •‘ ‹ƒŽ ƒ† ‹•–‹–—–‹‘ƒŽ‹ˆŽ—‡ ‡•ǫIf they subscribe to certain ‘models’ of mental disorder, or ’”‘ˆ‡••ƒŽŽ‡‰‹ƒ ‡–‘ƒ–Š‡”ƒ’‡—–‹ • Š‘‘Žǡ†‘‡•–Š‹•‹’Ž› ‘•‹•–‡ ›‘ˆ„‡Ž‹‡ˆƒ† ‡š’”‡••‹‘–Š‡”‡‘ˆ‹’”ƒ –‹ ‡ǫ —”–Š‡”‘”‡ǡ’”ƒ –‹ ‡†‘‡•‘–‘ —”‹ƒ˜ƒ ——ǣ ‹†‹˜‹†—ƒŽ’”ƒ –‹–‹‘‡”•ƒ”‡‡„‡††‡†‹˜ƒ”‹‘—•Ž‡˜‡Ž•‘ˆ‹•–‹–—–‹‘ƒŽ —Ž–—”‡•Ǥ Colombo and Fulford’s study (2004) of diverging models of mental disorder in 11.

(9) Chapter 1. interdisciplinary teams highlights the diversity of thought at ‘ground level’. Their •–—†› ‘—Ž†„‡•‡‡ƒ•ƒ•–ƒ”–‹‰’‘‹–ˆ‘”ˆ—”–Š‡”‡šƒ‹ƒ–‹‘‘ˆ–Š‡ƒ‡”‹ ™Š‹ Š ’Š‹Ž‘•‘’Š‹ ƒŽ ƒ••—’–‹‘• ƒ‹ˆ‡•– in practiceǡ ™‹–Š‘—– ƒ ’”‹‘”‹ ƒ••—’–‹‘•ƒ•–‘–Š‡‹” ‘•‹•–‡ ›ǡ†‡‰”‡‡‘ˆ ‘’Ž‡š‹–›ǡ‘”‡˜‡‘™‡”•Š‹’Ǥˆ ‘—”•‡ǡ–Š‡–Š‡”ƒ’‡—–‹ ‡ ‘—–‡”‹’Ž‹‡•–Š‡’”‡•‡ ‡‘ˆƒ–Ž‡ƒ•––™‘‹†‹˜‹†—ƒŽ•Ǥ Š‹•‹•ƒŽ‘ ƒ–‹‘‘ˆ ‘’Ž‡š ‘—‹ ƒ–‹‘ƒ† ‘ ‡’–—ƒŽ‹–‡”’Žƒ›Ǥ

(10) †›ƒ‹  ‘—‹ ƒ–‹˜‡’”‘ ‡••‡•‹˜‘Ž˜‹‰†‡˜‡Ž‘’‹‰‡š Šƒ‰‡•‘ˆ‹†‡ƒ•ǡ–Š‡“—‡•–‹‘‘ˆ ‘whose philosophy is it?’ may become difficult to answer. All –Š‹• ‘’Ž‹ ƒ–‡• Philips’ advice but does not obviate it, on the contrary: with this in mind philosophy ‹’”ƒ –‹ ‡•‡‡•ƒŠ‹‰ŠŽ›‹–‡”‡•–‹‰ƒ”‡ƒˆ‘”‡š’Ž‘”ƒ–‹‘Ǥ.

(11) ˆ™‡–ƒ‡ƒ™‹†‡”˜‹‡™‘ˆ–Š‡™‘”‹’Š‹Ž‘•‘’Š›ƒ†’•› Š‹ƒ–”›ǡ™‡ ƒ„”‘ƒ†Ž› †‹•–‹‰—‹•Š –Š”‡‡ ‡–Š‘†‘Ž‘‰‹ ƒŽ ƒ’’”‘ƒ Š‡• ™‹–Š ”‡•’‡ – –‘ –Š‡ ”‡Žƒ–‹‘•Š‹’ between philosophical beliefs and actual practice: first there is ‘pure’ conceptual ™‘”ǡˆ‘ŽŽ‘™‹‰–Š‡ƒƒŽ›–‹ ’Š‹Ž‘•‘’Š‹ ƒŽ–”ƒ†‹–‹‘ǡ‡šƒ‹‹‰ ‘ ‡’–•”‡Ž‡˜ƒ– –‘ ’•› Š‹ƒ–”› •— Š ƒ• ‡–ƒŽ †‹•‘”†‡”ǡ ‹†ǡ ˆ”‡‡ ™‹ŽŽǡ Žƒ••‹ˆ‹ ƒ–‹‘ǡ • ‹‡ ‡ǡ ”‡•’‘•‹„‹Ž‹–›ƒ†•— ŠŽ‹‡Ǥ— Š•—„Œ‡ –•ƒ”‡ƒŽ•‘•–—†‹‡†‹–Š‡”‡ ‡–”‡•—”‰‡ ‡ ‘ˆ –Š‡ ‘–‹‡–ƒŽǦ’Š‡‘‡‘Ž‘‰‹ ƒŽ –”ƒ†‹–‹‘ǡ ƒ††‹‰ ‡”‹ Š‹‰ ƒ† ‘˜‡Ž ’‡”•’‡ –‹˜‡• ‘ †‹ƒ‰‘•–‹  ‡–‹–‹‡• •— Š ƒ• • Š‹œ‘’Š”‡‹ƒ ȋ‹‰‰‹• Ƭ  Š™ƒ”–œ ʹͲͲ͹ǡ†‡’”‡••‹‘ȋƒ– Ž‹ˆˆ‡ʹͲͳͶȌǡ‘”†‡‡–‹ƒȋ‹ŽŽ‡––ʹͲͳͳȌǤ‡Žƒ–‡†–‘–Š‹•™‘” is the analysis of more general, encompassing ‘models’. The psychodynamic –”ƒ†‹–‹‘Šƒ•Ž‘‰„‡‡ƒ•—„Œ‡ –‘ˆ’Š‹Ž‘•‘’Š‹ ƒŽ•–—†›ȋ‡Ǥ‰Ǥ ‘’‹•Ƭ‘ŽŽŠ‡‹ ͳͻͺͶǡ ”ò„ƒ— ͳͻͺͷȌǡ „—– ‘–Š‡” ’•› Š‘–Š‡”ƒ’‡—–‹  ‘†‡Ž• Šƒ˜‡ ƒŽ•‘ „‡‡ •–—†‹‡† ȋŽ‹ˆ‡ ƒ† ‹ŽŽ‹ƒ• ͳͻͻͷȌǡ ƒ• Šƒ˜‡ ‡˜‘Ž—–‹‘ƒ”› –Š‡‘”› ȋ†”‹ƒ‡• Ƭ ‡ Ž‘  ʹͲͳͳȌ ƒ† „‹‘Ž‘‰‹ ƒŽ ’•› Š‹ƒ–”› ȋƒ Šƒ” ʹͲͲͲȌǤ Š‘—‰Š ‰‡‡”ƒŽŽ› •‡‡ ƒ• ’”‡Ǧ’ƒ”ƒ†‹‰ƒtic, the ‘models’ approach is present if there is a set of ontological ƒ†‡’‹•–‡‘Ž‘‰‹ ƒŽƒ••—’–‹‘•ƒ†Ȁ‘”˜ƒŽ—‡•‹’Žƒ ‡™‹–Šƒ•—ˆˆ‹ ‹‡–†‡‰”‡‡‘ˆ ‹–‡”ƒŽ ‘•‹•–‡ ›ƒ†•–ƒ„‹Ž‹–›Ǥ  •‡ ‘†ƒ’’”‘ƒ Š ƒ•–•–Š‡’Š‹Ž‘•‘’Š‹ ƒŽ‡–Ž‡••™‹†‡Ž›ǡƒ––‡†‹‰–‘ȋ‡’‹•–‡‹ Ȍ ’‡”•’‡ –‹˜‡•ǡ ”‡Žƒ–‹‰ –‘ –Š‡ ƒ—•‡• ‘ˆ ‡–ƒŽ †‹•‘”†‡”•ǡ ƒ† Ž‡ƒ˜‹‰ ˆ”‘ –Š‡ assumption of a more pluralist practice than the more monolithic ‘models’ ƒ’’”‘ƒ Š ȋ —‰Š ƒ† Žƒ˜‡› ͳͻͻͺȌǤ  —‰Š ƒ† Žƒ˜‡› †‡• ”‹„‡ •‡˜‡”ƒŽ ȋ‹–‡”ƒŽŽ› ‘•‹•–‡–Ȍƒ’’”‘ƒ Š‡•†‡ˆ‹‡†„‘–Šƒ• ‘ ‡’–•ƒ†’‡”•’‡ –‹˜‡•ǣ–Š‡ †‹•‡ƒ•‡ǡ†‹‡•‹‘ƒŽǡ„‡Šƒ˜‹‘”ƒ†Ž‹ˆ‡•–‘”›’‡”•’‡ –‹˜‡•Ǥ

(12) –Š‡‹”˜‹‡™ǡˆ‘”‡ƒ Š ’ƒ–‹‡–ǡ‡ƒ Š’‡”•’‡ –‹˜‡—•–„‡ ‘•‹†‡”‡†ˆ‘”‹–•„‡‡ˆ‹–Ǥ  Š‡ –Š‹”† ƒ’’”‘ƒ Šǡ „‡‹‰ ’”‘’‘•‡† Š‡”‡ǡ ‹• –‘ †”ƒ™ ˆ”‘ ‡š‹•–‹‰ ”‡•‡ƒ” Š –”ƒ†‹–‹‘•‡’‹”‹ ƒŽŽ›‡šƒ‹‹‰‡†‹ ƒŽ’”ƒ –‹ ‡ǡŽ‡ƒ˜‹‰ˆ”‘–Š‡’”‡‹•‡–Šƒ– ’Š‹Ž‘•‘’Š‹ ƒŽ‹†‡ƒ•ǡ„‡Ž‹‡ˆ•ƒ† ‘˜‹ –‹‘• ƒ„‡•–—†‹‡†‹ƒ –‹‘Œ—•–Ž‹‡‘–Š‡” ‹†‡ƒ•ǡ„‡Ž‹‡ˆ•ƒ† ‘˜‹ –‹‘•ǤŠ‹•’”ƒ –‹ ƒŽŽ›‡„‡††‡†ƒ’’”‘ƒ Š‹•ƒ’’ƒ”‡–‹ 12.

(13) Examining the philosophy of psychiatric practice. –Š‡–‹–Ž‡‘ˆ–Š‹•–Š‡•‹•Ǥ•–Š‡•–—†›’”‘ ‡‡†•ǡ–Š‡ˆ‹†‹‰•‘ˆ–Š‹••–—†›‘ˆ’Š‹Ž‘•‘’Š› ‹’”ƒ –‹ ‡™‹ŽŽ„‡”‡Žƒ–‡†–‘–Š‡‡•ƒ††‡„ƒ–‡•‹’Š‹Ž‘•‘’Š›ƒ†’•› Š‹ƒ–”›Ǥ. Š‡ˆ‘ —•‹–Š‹••–—†›‹•‘’•› Š‹ƒ–”‹•–•ǤŠ‡ Š‘‹ ‡–‘ˆ‘ —•ˆ‹”•–‘’”ƒ –‹–‹‘‡”• ™ƒ• ƒ†‡ ˆ‘” –Š‡ •‹’Ž‡ ”‡ƒ•‘ –Šƒ– –Š‹• •‡‡• –‘ „‡ ƒ ƒ”‡ƒ ™Š‹ Š •‘ ˆƒ” Šƒ• ”‡ ‡‹˜‡†ǡ”‡Žƒ–‹˜‡Ž›•’‡ƒ‹‰ǡŽ‡••ƒ––‡–‹‘ǤŽ•‘ǡƒ•–Š‡’”‹ƒ”›ƒ—–Š‘”‹•Š‹•‡Žˆ ƒ ’”ƒ –‹–‹‘‡”ǡ –Š‡ Š‘‹ ‡ ™ƒ• ƒŽ•‘ ‘‡ ‘ˆ ‘˜‡‹‡ ‡ǡ ”‡“—‹”‹‰ Ž‡•• –‹‡ ˆ‘” ‹‡”•‹‘‹–Š‡Žƒ‰—ƒ‰‡‘ˆ–Š‡’ƒ”–‹ ‹’ƒ–•Ǥ

(14) ˆ–Š‡ƒ’’”‘ƒ Š’”‘˜‡•‡Ž‹‰Š–‡‹‰ǡ the same approach could be taken to focus on patients’ views and actions and to –Š‡†›ƒ‹ ‹–‡”ƒ –‹‘•„‡–™‡‡’”ƒ –‹–‹‘‡”•ƒ†’ƒ–‹‡–•Ǥ  ‹–Š ”‡•’‡ – –‘ –Š‡ ƒˆ‘”‡‡–‹‘‡† ‡–Š‘†‘Ž‘‰‹ ƒŽ ‰ƒ’ ‹˜‡•–‹‰ƒ–‹˜‡ ‡–Š‘†• commensurate with both parent disciplines will be used: a ‘common ground’ approach. There is no ambition to ‘prove’ the value of philosophy empirically or to ƒ––‡’––‘‹–‡‰”ƒ–‡–Š‡’ƒ”‡–†‹• ‹’Ž‹‡•ǡ”ƒ–Š‡”–Š‡”‡•—Ž–•‘ˆ–Š‡’”‘Œ‡ –‹–•‡Žˆ ƒ›•—‰‰‡•–ˆ”—‹–ˆ—Ž™ƒ›•‘ˆ‰‘‹‰ˆ‘”™ƒ”†Ǥ

(15) ˆ–Š‡”‡ƒ”‡”‡ ‘‡†ƒ–‹‘•–‘„‡ ƒ†‡ƒ•–‘‹’”‘˜‡†’”ƒ –‹ ‡‘”ƒ•–‘’Š‹Ž‘•‘’Š‹ ƒŽ‘—–’—–ǡ–Š‡•‡ ƒ‘Ž›„‡ƒ†‡ ‘ ‡ –Š‡ ˆ‹†‹‰• Šƒ˜‡ „‡‡ ”‡Žƒ–‡† –‘ –Š‡ ”‡Ž‡˜ƒ– †‹• ‹’Ž‹ƒ”› †‘ƒ‹ǡ ‹ –Š‡ ‘–‡š–‘ˆ–Š‡”‡Ž‡˜ƒ–Œ—•–‹ˆ›‹‰ˆ”ƒ‡™‘”•ǤŠ‡’”‹ƒ”›ƒ‹‘ˆ–Š‹••–—†›‹•–‘ ‡š’Ž‘”‡Ǥ  Š‡ ‡–”ƒŽ’”‡‹•‡‘ˆ–Š‹••–—†›‹•–‘Ž‡ƒ˜‡ˆ”‘–Š‡’‘‹–‘ˆ’”ƒ –‹ ‡ǡ–‘‹†‡–‹ˆ› ™Š‡”‡ƒ†Š‘™’Š‹Ž‘•‘’Š›‹•‘’‡”ƒ–‹‰ǡƒ†–Š‡ ‡ˆ‘”–Š–‘ˆ‘ŽŽ‘™‹–™Š‡”‡‹––ƒ‡• —•ǤŠ‡”‡‹•ƒˆˆ‹‹–›‹–Š‹•’”ƒ –‹ ‡Ǧˆ‹”•–ƒ’’”‘ƒ Š™‹–Š‘‘›‡™‡‡”†Ʋ• ”‹–‹ ‹•‘ˆ Ž‹‰Š–‡‡– ’Š‹Ž‘•‘’Š› ”‡‰ƒ”†‹‰ –Š‡ ”‡Žƒ–‹‘•Š‹’ „‡–™‡‡ ’”ƒ –‹ ƒŽ ƒ† –Š‡‘”‡–‹ ƒŽ‘™Ž‡†‰‡Ǥ‘•‹–‹˜‹•–˜‹‡™•Šƒ˜‡‡’‹•–‡‹ ƒŽŽ›’”‹‘”‹–‹œ‡†–Š‡‘”‡–‹ ƒŽ ‘˜‡” ‡˜‡”›†ƒ› ‘™Ž‡†‰‡ǡ ƒ† ‹ –Š‡ ’”‘ ‡•• —•Š‡”‡† ‹ ƒ ’”‘„Ž‡ƒ–‹  •—„Œ‡ –Ȁ‘„Œ‡ –†‹ Š‘–‘›ƒ†ƒ†‡ˆ‹ ‹–˜‹‡™‘ˆ’”ƒ –‹ ƒŽ‘™Ž‡†‰‡ƒ•‹’‡”ˆ‡ – ƒ† ˆƒŽŽ‹„Ž‡ ȋ Žƒ• ʹͲͲͻȌǤ Žƒ• ƒ”‰—‡• –Šƒ– –Š‡ • ‹‡–‹•–‹  ˜‹‡™ ‘ˆ –Š‡‘”‡–‹ ƒŽ ‘™Ž‡†‰‡ƒ•ƒ„•‘Ž—–‡Šƒ•Ž‡†—•‡‹–Š‡”–‘„‡Ž‹‡˜‡–Šƒ–• ‹‡ ‡™‹ŽŽ’”‘˜‹†‡—•™‹–Š –Š‡ˆ—ŽŽƒ††‡ˆ‹‹–‹˜‡’‹ –—”‡‘ˆ”‡ƒŽ‹–›ǡ‘”ǡ‘–Š‡‘–Š‡”Šƒ†ǡ–Šƒ–‘—”•—„Œ‡ –‹˜‹–› ’”‡ Ž—†‡•—•ˆ”‘‡˜‡”˜‹‡™‹‰–Š‹•‹†‡ƒŽǤŠ‹•’‘•‹–‹˜‹•–˜‹‡™‘ˆ’”ƒ –‹ ‡ǡŠ‘™‡˜‡” ‡š–‡•‹˜‡Ž› ”‹–‹ ‹œ‡†‹’Š‹Ž‘•‘’Š›ǡ”‡ƒ‹•‹ˆŽ—‡–‹ƒŽƒ†ƒƒ•’‹”ƒ–‹‘ƒŽ„‡ƒ ‘ ˆ‘” ‡†‹ ‹‡ǡƒ† ’•› Š‹ƒ–”› ‹ ’ƒ”–‹ —Žƒ” ȋ ˆǤ ‹‡„‡”ƒ ʹͲͳ͸ȌǤŠ‡”‡ƒ”‡ Ž‡ƒ” parallels between Dooyeweerd’s criticism and arguments in the postpositivi•–ˆ‹‡Ž† ‘ˆ • ‹‡ ‡ •–—†‹‡• ȋ ˆǤ ƒ–‘—” ͳͻͺ͹ǡ ͳͻͻ͵ǡ ͳͻͻͻǡ ‡•• ͳͻͻ͹ȌǤ Š‡‹” ƒ’’”‘ƒ Š‡• •Šƒ”‡ƒ ‘‹–‡––‘–Š‡‘’‡‡••ǡ—–ƒ„‹Ž‹–›ƒ†”‡Žƒ–‡†‡••‘ˆ‡–‹–‹‡•ǡƒ†ƒ ‹–‡‰”ƒ–‹‘ ƒ– –Š‡ ‡š’‡”‹‡–‹ƒŽ Ž‡˜‡Ž ‘ˆ ‘™‹‰ ƒ† ƒ –‹‰Ǥ —”–Š‡”‘”‡ǡ „‘–Š ƒ ‘™Ž‡†‰‡–Š‡‹–”‹•‹ ‘”ƒ–‹˜‹–›‘ˆ’”ƒ –‹ ‡•ǡ„‡–Š‡›‡†‹ ƒŽ‘”• ‹‡–‹ˆ‹ Ǥ ”ƒ ‹‰•— Š‘”ƒ–‹˜‹–›‹‹–‡”ƒ –‹‘™‹–Š‡–‹–‹‡•ƒ›‹ˆ‘”–Š‡“—‡•–‹‘‘ˆ Š‘™ –‘ ‹’”‘˜‡ ’”ƒ –‹ ‡ǡ „—– ƒ‘– †‡–‡”‹‡ –Š‡ ƒ•™‡”Ǥ

(16)  –Š‹• •–—†› –Š‡ ‘science studies’ appr‘ƒ h, ‘following scientists through society’ is applied (with. 1. 13.

(17) Chapter 1. •’‡ ‹ˆ‹  –”‡ƒ–‡– ƒ† —•‡ ‘ˆ ƒ –‘” ‡–™‘” –Š‡‘”›Ȍ ƒ• ƒ ’‘•–’‘•‹–‹˜‹•– ‡–Š‘† •—‹–‡†–‘–Š‹•’Š‹Ž‘•‘’Š‹ ƒŽŽ›‡š’Ž‘”ƒ–‹˜‡‰‘ƒŽǤ‘’ƒ”ƒ’Š”ƒ•‡ƒ–‘—”ǡ™‡™‹ŽŽ„‡ attempting to ‘follow philosophy –Š”ough psychiatric practice, society, and history’.  . 1.3 The ‘common ground’ approach to philosophy and psychiatry: methods and challenges. —”ˆ‹”•–•–‡’‹ƒ‹‹‰–‘‡š’Ž‘”‡’Š‹Ž‘•‘’Š›ˆ”‘–Š‡‰”‘—†ǦŽ‡˜‡Ž’”ƒ –‹ ‡ ’‡”•’‡ –‹˜‡ǡ‹•–‘Ž‘‘–‘”‡•‡ƒ” Š–”ƒ†‹–‹‘•™‡††‹‰‡’‹”‹ ƒŽƒ’’”‘ƒ Š‡•–‘ ’”ƒ –‹ ‡™‹–Š’Š‹Ž‘•‘’Š‹ ƒŽƒ†Ȁ‘”‡–Š‹ ƒŽƒƒŽ›•‹•Ǥšƒ’Ž‡•‘ˆ’Š‹Ž‘•‘’Š‹ ƒŽ ˆ‹‡Ž†•‹ ‘”’‘”ƒ–‹‰‡’‹”‹ ƒŽ”‡•‡ƒ” Š‹ Ž—†‡Ž‹‰—‹•–‹ •ȋ—•–‹ͳͻ͸ͳȌǡ ’Š‹Ž‘•‘’Š›‘ˆ• ‹‡ ‡ȋ‹–”‘ˆˆͳͻ͹ͶȌǡƒ† ‘• ‹‘—•‡••ȋ†‡‘‡”ʹͲͲ͵ȌǤ

(18)  ‡–Š‹ •ǡ–Š‡”‡‹•ƒ„—”‰‡‘‹‰”‡•‡ƒ” Š’”‘‰”ƒ‹ ‘”’‘”ƒ–‹‰‡’‹”‹ ƒŽƒ† ’Š‹Ž‘•‘’Š‹ ƒŽ’‡”•’‡ –‹˜‡•–‡”‡†‡’‹”‹ ƒŽ‡–Š‹ •ȋ‹††‡”•Š‘˜‡ǡ„ƒƬ ‘Ž‡™‹ŒʹͲͲͻƒǡ„ǡƒ†‡™‡‡”ʹͲͳ͵ǡ—‹••‡ʹͲͳͷǡ‘•‡•ʹͲͳͷǡ„ƒ‡–ƒŽǤ ʹͲͳͲǡ˜ƒŽ–‡”‡ǡ„ƒƒ†‹††‡”•Š‘˜‡ʹͲͳʹȌǤŠ‡•—„†‹• ‹’Ž‹‡‘ˆ ‡š’‡”‹‡–ƒŽ’Š‹Ž‘•‘’Š›ȋ‘„‡ƒ†‹ Š‘Ž•ʹͲͲͺȌ‡š’Ž‹ ‹–Ž›˜‹‡™•–Š‡ ‘†— –‹‰‘ˆ‡’‹”‹ ƒŽ”‡•‡ƒ” Š•–—†‹‡•„›’Š‹Ž‘•‘’Š‡”•ƒ• ”— ‹ƒŽ–‘–Š‡’”‘Œ‡ – ‘ˆˆ‹‰—”‹‰‘—–Š‘™Š—ƒ•–Š‹Ǥ‡ƒ™Š‹Ž‡ǡ™‹–Š‹’•› Š‹ƒ–”›ǡ–Š‡”‡‹•‰”‘™‹‰ ƒ ‘™Ž‡†‰‡––Šƒ–’‡”ˆ‘”‹‰“—ƒŽ‹–ƒ–‹˜‡ƒ†ƒ–—”ƒŽ‹•–‹ •–—†‹‡•ƒ› ‡Šƒ ‡–Š‡˜ƒŽ‹†‹–›ƒ†ƒ’’Ž‹ ƒ„‹Ž‹–›‘ˆ— Š“—ƒ–‹–ƒ–‹˜‡”‡•‡ƒ” Šǡ‹’Ž›‹‰ƒ ‰”‘™‹‰‘’‡‡••–‘‡–Š‘†‘Ž‘‰‹‡•‘—–•‹†‡–Š‡ Žƒ••‹ ƒ–—”ƒŽ• ‹‡ ‡–”ƒ†‹–‹‘Ǥ ‡ ‡–™‘”‹˜‘Ž˜‹‰’Š‡‘‡‘Ž‘‰‹ ƒŽ‹“—‹”›‹•ƒ‘–Š‡”‡šƒ’Ž‡‘ˆƒ•Šƒ”‡† ‡’‹•–‡‹ ˆ”ƒ‡™‘”™‹–Š‹™Š‹ Š’Š‹Ž‘•‘’Š‡”•ƒ†‡–ƒŽŠ‡ƒŽ–Š’”ƒ –‹–‹‘‡”• ƒ ‘ŽŽƒ„‘”ƒ–‡ȋ‡Ǥ‰Ǥ™‡ƒ† ƒ”Žƒ†ʹͲͲ͹Ǣ — Š•ƒ† ŠŽ‹‡ʹͲͲͻȌǤ ˆ—”–Š‡”ˆ‡ƒ–—”‡‘ˆ’•› Š‹ƒ–”‹ ’”ƒ –‹ ‡‘ˆˆ‡”‹‰ƒ’‘••‹„Ž‡‡’‹”‹ ƒŽ‡–”›’‘‹–‹• –Š‡•–ƒ–—•ƒ†ƒ’’Ž‹ ƒ–‹‘‘ˆȋ‡š’‡”–Ȍ’”‘ˆ‡••‹‘ƒŽ‘™Ž‡†‰‡Ǥ . Analysis of theory Š‡ƒŒ‘”‹–›‘ˆ–Š‡Ž‹–‡”ƒ–—”‡‹’•› Š‹ƒ–”›ƒ†’Š‹Ž‘•‘’Š›ƒ‹•ƒ–‘†‡Ž•ǡ‹†‡ƒ•ǡ ƒ†ƒ••—’–‹‘•–Šƒ–ƒ”‡–ƒ‡–‘„‡’”‡˜ƒŽ‡–‹’•› Š‹ƒ–”‹ ’”ƒ –‹ ‡‘”–Šƒ–ƒ”‡ ‹Š‡”‡– ‹ ’•› Š‹ƒ–”‹  ƒ† ’•› Š‘Ž‘‰‹ ƒŽ –Š‡‘”‹‡•Ǥ Šƒ‡‹ ȋʹͲͲ͵Ȍǡ ˆ‘” ‡šƒ’Ž‡ǡ ’”‡•‡–•ˆ‘—”’‘••‹„Ž‡’Š‹Ž‘•‘’Š‹ ƒŽƒ’’”‘ƒ Š‡•Š‡„‡Ž‹‡˜‡•’”ƒ –‹–‹‘‡”•‡’Ž‘›ǣ †‘‰ƒ–‹•ǡ‡ Ž‡ –‹ ‹•ǡ‹–‡‰”ƒ–‹‘‹•ǡƒ†’Ž—”ƒŽ‹•Ǥ

(19) ˆƒ –ǡ–Š‡•‡†‡• ”‹’–‹‘• ƒ’’Ž› –‘ –Š‡ • ‹‡–‹ˆ‹  ƒ† ’”ƒ –‹ ƒŽ ’”‘„Ž‡ ‘ˆ Šƒ†Ž‹‰ †‹ˆˆ‡”‡– –Š‡‘”‹‡• ƒ† ‘†‡Ž• ˆ‘” –Š‡ ‡š’Žƒƒ–‹‘ ƒ† –”‡ƒ–‡– ‘ˆ ‡–ƒŽ †‹•‘”†‡”Ǥ ‡ ’”‘’‘•‡• Š‹• 14.

(20) Examining the philosophy of psychiatric practice. ‘†‡Ž„ƒ•‡†‘ƒ–Š‘”‘—‰Š‘™Ž‡†‰‡‘ˆ–Š‡•‡†‹ˆˆ‡”‡––Š‡‘”‹‡•Ȁ–Š‡”ƒ’‹‡•ƒ† on personal experience of his colleagues’ views. Other authors focus on ’•› Š‘Ž‘‰‹ ƒŽ –Š‡‘”‹‡•Ȁ–Š‡”ƒ’‹‡• •— Š ƒ• ’•› Š‘ƒƒŽ›•‹•ǡ „‹‘Ž‘‰‹ ƒŽ ’•› Š‹ƒ–”›ǡ ƒ† ‘‰‹–‹˜‡Ǧ„‡Šƒ˜‹‘”ƒŽ –Š‡”ƒ’›ǡ ‡šƒ‹‹‰ –Š‡ Ž‹–‡”ƒ–—”‡ ƒ† — ‘˜‡”‹‰ –Š‡ ‹’Ž‹ ‹–‘”‡š’Ž‹ ‹–’Š‹Ž‘•‘’Š‹ ƒŽƒ••—’–‹‘•™‹–Š‹ȋŽ‹ˆ‡ƒ†‹ŽŽ‹ƒ•ͳͻͻͷǡŽ‹ˆ‡ ‡–ƒŽǤʹͲͲͷȌǤ ‘™‡˜‡”ǡ‹–‹• ‘– Ž‡ƒ”ˆ”‘–Š‹•Ž‹–‡”ƒ–—”‡ how–Š‡•‡ƒ••—’–‹‘• ‘‡–‘–Š‡ˆ‘”‡‹’”ƒ –‹ ‡ǡƒ†™Šƒ––Š‡‹”ȋ†‹•Ȍƒ†˜ƒ–ƒ‰‡•‹‰Š–„‡ǤŠ‘—‰Š–Š‡•‡ ™‘”• ƒ› „‡ –ƒ‡ –‘ ƒ†‡“—ƒ–‡Ž› †‡• ”‹„‡ –Š‡ —””‡– ’Š‹Ž‘•‘’Š‹ ƒŽ •–ƒ–‡ ‘ˆ ’•› Š‹ƒ–”‹ ƒ†’•› Š‘Ž‘‰‹ ƒŽtheoryǡ–Š‡‡’‹”‹ ƒŽ”‡•‡ƒ” Š‡”™‹ŽŽ„‡‹–‡”‡•–‡†‹ –Š‡ “—‡•–‹‘ ‘ˆ Œ—•– Š‘™ ƒ† ™Š‡”‡ –Š‡ ’Š‹Ž‘•‘’Š‹ ƒŽ „‡Ž‹‡ˆ• ‹Š‡”‡– ‹ –Š‡‘”› ‹ˆŽ—‡ ‡practiceǡƒ†™‹ŽŽ™ƒ––‘†‡‘•–”ƒ–‡‹–Ǥ•‹‰‹ˆ‹ ƒ–ˆ‡ƒ–—”‡‘ˆ— Š‘ˆ –Š‹• Ž‹–‡”ƒ–—”‡ ‹• –Šƒ– ‹– ‹• ‡–‡”‡† ‘ ƒ••—‡†Ž› ‘Š‡”‡– ƒ† ‘•‹•–‡– –Š‡‘”‡–‹ ƒŽ ‘†‡Ž•ǣ Šƒ‡‹ †‹˜‹†‡• ’”ƒ –‹–‹‘‡”• ‹–‘ Ͷ ƒ’•ǡ ƒ† ’”‡˜‹‘—• ƒ—–Š‘”• Šƒ˜‡ ˜ƒ”‹‘—•Ž› ’”‘’‘•‡† ȋ™‹–Š ˜ƒ”‹ƒ–‹‘•Ȍ „‹‘Ž‘‰‹ ƒŽ ’•› Š‹ƒ–”› ˜‡”•—• ’•› Š‘ƒƒŽ›•‹•ǡ –Š‡ ‡†‹ ƒŽ ˜‡”•—• ’•› Š‘•‘ ‹ƒŽ ‘†‡Ž•ǡ ‘‰‹–‹˜‡Ǧ„‡Šƒ˜‹‘”ƒŽ versus humanistic theories, and so on. From a ‘models’ perspective, psychiatry has Š‹•–‘”‹ ƒŽŽ› ‘ˆ–‡ „‡‡ ’‘”–”ƒ›‡† ƒ• ƒ– „‡•– ƒ †‹ƒŽ‡ –‹ ǡ ƒ† ƒ– ™‘”•– ƒ „ƒ––Ž‡ǡ „‡–™‡‡ ‘’‡–‹‰ǡ‘‘Ž‹–Š‹ –Š‡‘”‡–‹ ƒŽ’ƒ”ƒ†‹‰•ȋ ˆǤŽŽƒ ‘„•‘‡–ƒŽǤʹͲͲʹǡ ƒ Š‡” ͳͻͻͷȌǤ Š‡ Š‡–‡”‘‰‡‡‹–› ‘ˆ ƒ˜ƒ‹Žƒ„Ž‡ –Š‡‘”› ‘•–‡•‹„Ž› ’”‘˜‹†‡• –Š‡ ’”ƒ –‹–‹‘‡”™‹–Šƒ‡ Ž‡ –‹  Š‘‹ ‡‘ˆ™Š‹ Š–Š‡‘”›‘”–Š‡‘”‹‡•–‘’‹ ƒ†ƒ’’Ž› ‹ ’”ƒ –‹ ‡Ǥ Š‹Ž‘•‘’Š‹ ƒŽ ƒƒŽ›•‹• ‘ˆ  ’•› Š‹ƒ–”‹  ƒ† ’•› Š‘Ž‘‰‹ ƒŽ –Š‡‘”‹‡• ‹• ’”ƒ –‹ ƒŽŽ› ”‡Ž‡˜ƒ– ‘ –Š‡ ƒ••—’–‹‘ –Šƒ– ‹ –Š‡ –”ƒ•Žƒ–‹‘ ˆ”‘ –Š‡‘”› –‘ ’”ƒ –‹ ‡ǡ–Š‡–Š‡‘”›Ǧ„‘—†’Š‹Ž‘•‘’Š‹ ƒŽƒ••—’–‹‘•ƒ†‡–ƒ‹Ž‡–•ƒ”‡ ƒ””‹‡† ƒŽ‘‰Ǥ. 1. ‘•– •— Š ƒƒŽ›•‡• ƒ••—‡ ƒ — ‘’Ž‹ ƒ–‡† ”‡Žƒ–‹‘•Š‹’ „‡–™‡‡ –Š‡‘”‡–‹ ƒŽ ƒ†’”ƒ –‹ ƒŽǡ‘” Ž‹‹ ƒŽǡ‘™Ž‡†‰‡ǤŠ‡”‡ƒ”‡”‡ƒ•‘•ǡŠ‘™‡˜‡”ǡˆ‘”†‘—„–‹‰ƒ ‘‡Ǧ–‘Ǧ‘‡ ”‡Žƒ–‹‘•Š‹’ „‡–™‡‡ –Š‡‘”›Ǧ„ƒ•‡† „‡Ž‹‡ˆ• ƒ† ’”ƒ –‹ ‡Ǥ Š‡ –”ƒ•Žƒ–‹‘ ˆ”‘ –Š‡‘”‡–‹ ƒŽȀ–Š‡”ƒ’‡—–‹  ‘†‡Ž –‘ ƒ –—ƒŽ ’”ƒ –‹ ‡ ‹˜‘Ž˜‡• ‘†—Žƒ–‹‘•ƒ–˜ƒ”‹‘—•Ž‡˜‡Ž•ǤŠ‡‘†‡Ž‹–•‡Žˆƒ›ƒˆˆ‘”†• ‘’‡ˆ‘”˜ƒ”‹ƒ ‡‹ ’”ƒ –‹ ‡ǡ‹ˆ•—ˆˆ‹ ‹‡–Ž›‡ ‘’ƒ••‹‰ƒ††‹ˆˆ‡”‡–‹ƒ–‡†ǤŠ‡’”‹‡‡šƒ’Ž‡Š‡”‡‘ˆ ™‘—Ž† „‡ ’•› Š‘ƒƒŽ›•‹•ǡ ™Š‹ Š –Š”‘—‰Š‘—– ‹–• Š‹•–‘”› Šƒ• —†‡”‰‘‡ ‘†‹ˆ‹ ƒ–‹‘• ƒ† „”‘—‰Š– ˆ‘”–Š „”ƒ Š‹‰ ƒ† †‡˜‡Ž‘’‹‰ –Š‡‘”‹‡•ǡ ’”‘†— ‹‰ ˜ƒ”‹‡† ’”ƒ –‹ ‡• ‹ –Š‡ ’”‘ ‡••Ǥ

(21) •–‹–—–‹‘ƒŽ ƒ† ˆ‹ƒ ‹ƒŽ ‘•–”ƒ‹–• ƒ› Ž‹‹– ƒ† ‹” —• ”‹„‡’”‘˜‹†‡†–”‡ƒ–‡–ǡ†‡˜‹ƒ–‹‰ˆ”‘™Šƒ–‹‰Š–„‡ Š‘•‡ˆ”‘ ƒ–Š‡‘”‡–‹ ƒŽ’‘‹–‘ˆ˜‹‡™Ǥ

(22) †‹˜‹†—ƒŽ’”ƒ –‹–‹‘‡”•’‘••‡••ƒƲ”‡’‘•‹–‘”›Ʋ‘ˆ’ƒ•– Ž‹‹ ƒŽ‘™Ž‡†‰‡ƒ’’Ž‹‡†–‘ —””‡– ƒ•‡•ǡ‹–‡”ƒ –‹‰‹’”ƒ –‹ ‡™‹–Š–Š‡‘”‡–‹ ƒŽ ‘™Ž‡†‰‡Ǥ ƒ•– „—– ‘– Ž‡ƒ•–ǡ ƒ› –Š‡”ƒ’› ‡‡†• –‘ „‡ –ƒ‹Ž‘”‡† –‘ –Š‡ —‹“—‡ Šƒ”ƒ –‡”‹•–‹ • ƒ† ‘–‡š–—ƒŽ ‹” —•–ƒ ‡• ‘ˆ –Š‡ ’ƒ–‹‡–Ǥ ‘™ ’”‘ˆ‡••‹‘ƒŽ ’”ƒ –‹ ‡‹••Šƒ’‡†ƒ†Š‘™–Š‡•‡‹ˆŽ—‡ ‡•™‘”ƒ”‡„‘–Š•–‹ŽŽ— Ž‡ƒ”ƒ––‡”•. 15.

(23) Chapter 1. (Norman 2000, 2005). Therapeutic ‘eclecticism’ may come in many forms. It may „‡’ƒ”–‘f an ‘‘all the way down’’ eclecticism from theory to practice, but one might ‹ƒ‰‹‡‘–Š‡”‘†ƒŽ‹–‹‡•‘ˆ–Š‡”‡Žƒ–‹‘•Š‹’„‡–™‡‡–Š‡‘”›ƒ†’”ƒ –‹ ‡ǡ™Š‡”‡ –Š‡ ’”ƒ –‹–‹‘‡” •—„• ”‹„‡• –‘ ‘” •‡ŽˆǦ‹†‡–‹ˆ‹‡• ™‹–Š ‘‡ ‡š’Žƒƒ–‘”› –Š‡‘”‡–‹ ƒŽ ˆ”ƒ‡™‘”ȋ‡Ǥ‰Ǥ’•› Š‘ƒƒŽ›–‹ ‘”„‹‘Ž‘‰‹ ƒŽ–Š‡‘”›Ȍ™Š‹Ž•–ƒ’’Ž›‹‰–Š‡”ƒ’‡—–‹  ‡–Š‘†•†‡”‹˜‡†ˆ”‘ƒŽ–‡”ƒ–‹˜‡–Š‡‘”‹‡•Ǥ

(24) –‹•ƒ––Š‡Ž‡ƒ•– ‘ ‡‹˜ƒ„Ž‡ǡƒ†‘’‡ –‘ •–—†›ǡ ˆ‘” ƒ –Š‡”ƒ’‹•– –‘ „‡ –Š‡‘”‡–‹ ƒŽŽ› ‘‹•–‹  ƒ† ‡–Š‘†‘Ž‘‰‹ ƒŽŽ› ’Ž—”ƒŽ‹•–‹ Ǥ Ž–‡”ƒ–‹˜‡Ž›ǡ ƒ Š‹‡”ƒ” Š› ‘ˆ †‹ˆˆ‡”‡– –Š‡‘”‹‡• ‹• ’‘••‹„Ž‡ǡ ‡–ƒ‹Ž‹‰ ‘ˆŽ‹ –• „‡–™‡‡ „ƒ ‰”‘—† ƒ••—’–‹‘•Ǥ

(25)  ‘–Š‡” ™‘”†•ǡ –Š‡ ”‡Žƒ–‹‘•Š‹’ „‡–™‡‡†‘‰ƒ–‹•ƒ†‡ Ž‡ –‹ ‹•‡‡†‘–„‡ƒ†‹ Š‘–‘›ȋ‘”ƒŠ‹‡”ƒ” Š›Ȍ„—– ƒ†‹•–‹ –‹‘ǡ™‹–Š˜ƒ”‹‘—•‘†ƒŽ‹–‹‡•‹„‡–™‡‡Ǥ‡•‡ƒ” Š‹–Š‡ƒ”‡ƒ‘ˆ’‡”•‘ƒŽ ‡’‹•–‡‘Ž‘‰› •—‰‰‡•–• –Š‡ ‘–‡š–Ǧ†‡’‡†‡ ‡ ƒ† †‘ƒ‹Ǧ•’‡ ‹ˆ‹ ‹–› ‘ˆ ‡’‹•–‡‘Ž‘‰‹ ƒŽ ’‘•‹–‹‘• ȋ‹‡••‡ʹͲͲ͹ǡ ‘ˆ‡” ʹͲͲͳȌǤŠ‡ •ƒ‡ ‹‰Š– ƒ’’Ž› –‘ ’Š‹Ž‘•‘’Š‹ ƒŽ ˜‹‡™• ’‡”–ƒ‹‹‰ –‘ ˜ƒ”‹‘—• †‹•‘”†‡”• ‘” ‹ †‹ˆˆ‡”‡– –”‡ƒ–‡– •‡––‹‰•Ǥ‘’—–‹–†‹ˆˆ‡”‡–Ž›ǣ”ƒ–Š‡”–Šƒ’”ƒ –‹ ‹‰ƒ•†‘‰ƒ–‹ •—’’‘”–‡”•‘ˆ‘‡ ‘‘Ž‹–Š‹  –Š‡‘”‡–‹ ƒŽ ƒ’’”‘ƒ Š ȋ™‹–Š –Š‡ ƒ••‘ ‹ƒ–‡† ’Š‹Ž‘•‘’Š‹ ƒŽ „‡Ž‹‡ˆ•Ȍ ‹””‡•’‡ –‹˜‡‘ˆ ‘–‡š–‘”’”‡•‡–‹‰’”‘„Ž‡ǡ‹–‹•’‘••‹„Ž‡–Šƒ–’”ƒ –‹ ‡‹•‘”‡ Š‡–‡”‘‰‡‡‘—•ǡ ƒ† ’”ƒ –‹–‹‘‡”• ‘”‡ ‡ Ž‡ –‹  ƒ† ’Ž—”ƒŽ‹•–ǡ –ƒ‹Ž‘”‹‰ –Š‡‹” ƒ’’”‘ƒ Š–‘–Š‡’”‘„Ž‡ƒ–Šƒ†Ǥ ‘”–Š‹••–—†›ǡ–Š‡”‡Ž‡˜ƒ–“—‡•–‹‘‹•ǣ–‘™Šƒ– †‡‰”‡‡ ‹• ’Š‹Ž‘•‘’Š› ‹ ’”ƒ –‹ ‡ †‡–‡”‹‡† „› „‘––‘Ǧ—’ ˜‡”•—• –‘’Ǧ†‘™ ’”‘ ‡••‡•ǫ. ‡•‹†‡• ƒ––‡†‹‰ –‘ ™‘”Ž† ˜‹‡™• ƒ† ‘†‡Ž•ǡ ‡’‹•–‡‘Ž‘‰‹ ƒŽ ™‘” ‘ –Š‡ ”‡Žƒ–‹‘•Š‹’‘ˆknowledge–‘’”ƒ –‹ ‡‹’•› Š‹ƒ–”›‹•”‡Ž‡˜ƒ–ǡ‘–Š‡ƒ••—’–‹‘ –Šƒ–’Š‹Ž‘•‘’Š‹ ƒŽ˜‹‡™•ƒ”‡’ƒ”–‘ˆ–Š‡‘™Ž‡†‰‡„ƒ•‡™‹–Š™Š‹ Š’”ƒ –‹–‹‘‡”• ƒ’’”‘ƒ Š –Š‡‹” ’”ƒ –‹ ‡Ǥ

(26) ••—‡• •—””‘—†‹‰ –Š‡ Ž‡‰‹–‹ƒ › ‘ˆ • ‹‡ ‡ ƒ† ‘™Ž‡†‰‡ Žƒ‹•‹’•› Š‹ƒ–”›ƒ”‡ƒ‘‰–Š‡‘•– ‘–‡–‹‘—•‹••—‡•‹–Š‡ˆ‹‡Ž† ȋ ”ò„ƒ—ͳͻͺͷǡ ‘”‰ƒͳͻͻͻȌǤƒ–‹‰„ƒ –‘ ƒ•’‡”•ƒ†„‡›‘†ǡ–Š‡“—‡•–‹‘ ‘ˆ –Š‡ „ƒŽƒ ‹‰‘ˆ ‘‘–Š‡–‹  ȋ‰‡‡”ƒŽǡ Žƒ™Ž‹‡Ȍ ˜‡”•—• ‹†‹‘‰”ƒ’Š‹  ȋ‹†‹˜‹†—ƒŽǡ ‡ƒ‹‰ˆ—ŽȌ ‘™Ž‡†‰‡ Šƒ• ”‡ƒ‹‡† ƒ ‘’Ž‡š ‹••—‡ ˆ‘” ’•› Š‹ƒ–”›Ǥ Š‡ ‹†‹˜‹†—ƒŽ’”ƒ –‹–‹‘‡”™‡Ž ‘‡•˜ƒŽ‹†‘‘–Š‡–‹ ‘™Ž‡†‰‡–‘‰—‹†‡–”‡ƒ–‡– †‡ ‹•‹‘•ǡ„—–ƒŽ•‘”‡“—‹”‡•‘™Ž‡†‰‡‘ˆ–Š‡‹†‹˜‹†—ƒŽ–Š‡›ƒ”‡ Šƒ”‰‡†–‘–”‡ƒ–ǡ ‘™Ž‡†‰‡ –Šƒ– ‹• •‹‰—Žƒ”ǡ ‡ƒ‹‰ˆ—Ž ƒ† ‘–‡š–—ƒŽǤ —‹‰ ƒŽ‘‰•‹†‡ –Š‡ –‡•‹‘ „‡–™‡‡ –Š‡ ‰‡‡”ƒŽ ƒ† –Š‡ ’ƒ”–‹ —Žƒ” ‹• –Š‡ “—‡•–‹‘ ‘ˆ –Š‡ †‡‰”‡‡ –‘ ™Š‹ Š ’•› Š‹ƒ–”‹  ’”ƒ –‹ ‡ǡ • ‹‡ ‡ ƒ† ‘ ‡’–• ƒ”‡ ˆƒ –—ƒŽ ‘” ˜ƒŽ—‡ǦŽƒ†‡ ȋ ˆǤ Š‘”–‘ ʹͲͲ͹ƒǡ Žƒ• ʹͲͳ͵ǡ —Žˆ‘”† ʹͲͲͺȌǤ ˜‹†‡ ‡Ǧ„ƒ•‡† ‡†‹ ‹‡ Šƒ• „‡‡ ’‘”–”ƒ›‡† ƒ• ƒ ‘• ‹‘—• ‘˜‡ ƒ™ƒ› ˆ”‘ ‹†‹˜‹†—ƒŽ Ž‹‹ ƒŽ ‘™Ž‡†‰‡ ƒ† ‡š’‡”–‹•‡ǡ–‘™ƒ”†•‘™Ž‡†‰‡–Šƒ–‹••‡‡ƒ•‘”‡• ‹‡–‹ˆ‹ ƒŽŽ›‹ˆ‘”‡†ǡ‘”‡ ”‡Ž‹ƒ„Ž‡ǡƒ†Ž‡••’”‘‡–‘„‹ƒ•Ǥ ‘™‡˜‡”ǡƒ• —’–ƒȋʹͲͳͶȌŠƒ•’‘‹–‡†‘—–ǡ ‘‡•™‹–Š‹–•‘™ ‘ ‡’–—ƒŽƒ••—’–‹‘•ƒ†ȋ‡’‹•–‡‹ Ȍ˜ƒŽ—‡•ǤŠ‡”‡‹–Šƒ• 16.

(27) Examining the philosophy of psychiatric practice. „‡‡’”‘’‘•‡†ƒ•–Š‡•‹‰—Žƒ”•‘—” ‡‘ˆ˜ƒŽ‹†‘™Ž‡†‰‡‹’•› Š‹ƒ–”›ǡ‹–Šƒ• ‘‡ —†‡” ”‹–‹ ‹•ˆ‘”‹–•Ž‹‹–ƒ–‹‘•ȋ ƒŽ—ʹͲͲͺȌǤŠ‹•†‹• —••‹‘‘–Š‡˜ƒŽ‹†‹–› ƒ†Ž‡‰‹–‹ƒ ›‘ˆ’”‘ˆ‡••‹‘ƒŽƒ†• ‹‡–‹ˆ‹ ‘™Ž‡†‰‡Šƒ•„‡‡‡”‹ Š‡†„›–Š‡ ‹ ”‡ƒ•‹‰ ’”‡•‡ ‡ ‘ˆ ‡š’‡”–• „› ‡š’‡”‹‡ ‡ ‘ˆ ‡–ƒŽ †‹•‘”†‡” ƒ• —•‡”Ǧ ”‡•‡ƒ” Š‡”•‘ˆ’Š‹Ž‘•‘’Š›ƒ†’•› Š‹ƒ–”›ȋ‘•‡ǡǤ‡–ƒŽǤʹͲͲ͸ǡƒƒ”–ƒ†„ƒ ʹͲͳͳ). The authority of professionals’ knowledge claims has met with competition from the growing ‘expert by experience’ professional movement, and the parallel ‰”‘™–Š ‹ —•‡”ǦŽ‡† ”‡•‡ƒ” Š ȋ‡‡”ƒ ʹͲͳ͸ǡ ƒ—Ž‡” ƒ† Š‘ƒ• ʹͲͲʹȌǤ Š‡ •—”‰‡‘ˆ‹–‡”‡•–‹–Š‡‹†‘ˆ‘™Ž‡†‰‡†‡”‹˜‹‰ˆ”‘’‡”•‘ƒŽ‡š’‡”‹‡ ‡ƒ› ”‡’”‡•‡– ƒ ”‡ƒ –‹‘ –‘ –Š‡ •–”‘‰ ˆ‘ —• ‘ ‘‘–Š‡–‹  ‘™Ž‡†‰‡ ‹ ”‡ ‡– †‡ ƒ†‡•‹–Š‡‡–ƒŽŠ‡ƒŽ–Šˆ‹‡Ž†Ǥ. 1. Ž‹‹–ƒ–‹‘‘ˆ–Š‡‘”‡–‹ ƒŽƒƒŽ›•‹•Ž‹‡•‹–Š‡™ƒ›‹™Š‹ Š’Š‹Ž‘•‘’Š›‘ˆ’”ƒ –‹ ‡ ‹•ˆ”ƒ‡†ǡƒ‡Ž› Š‹‡ˆŽ›‹ƒ‹†‹˜‹†—ƒŽ‹•–‹ ǡ ‘‰‹–‹˜‡ƒ‡”ǣ—†‡”Ž›‹‰–Š‡ ˜ƒŽ—‡‘ˆ’Š‹Ž‘•‘’Š‹ ƒŽƒƒŽ›•‹•‘ˆ’•› Š‹ƒ–”‹ –Š‡‘”›‹•–Š‡˜‹‡™–Šƒ–‹–‹•’‘••‹„Ž‡ to analyze the philosophy of practice by attending to individual practitioners’ ‘•–‡•‹˜‡ ‘” Š‹††‡ ƒ••—’–‹‘•ǡ ƒ• ‹ˆ –Š‡•‡ ƒ”‡ –Š‡ ‘Ž› ‘” ’”‹‡ ƒ –‘”• ‘ˆ ’Š‹Ž‘•‘’Š‹ ƒŽ ‹’‘”–Ǥ ‘™‡˜‡”ǡ ƒ• ‡–‹‘‡† ‹ –Š‡ ‹–”‘†— –‹‘ǡ ’Š‹Ž‘•‘’Š‹ ƒŽ ƒ••—’–‹‘•ƒ›„‡”‡’”‡•‡–‡†‹—Ž–‹’Ž‡‘–Š‡”Ž‡˜‡Ž•‡š‡”–‹‰‹ˆŽ—‡ ‡‘–Š‡ Ž‹‹ ƒŽ ‡ ‘—–‡”Ǥ –Š”‘’‘Ž‘‰‹ ƒŽ ƒ† ‡–Š‘‰”ƒ’Š‹  •–—†‹‡• ƒ”‡ ‡•’‡ ‹ƒŽŽ› ‡ˆˆ‡ –‹˜‡ ‹ †‡‘•–”ƒ–‹‰ –Š‡ ƒ‹ˆ‘Ž† ™ƒ›• ™‘”Ž† ˜‹‡™• ƒ† ȋ’Š‹Ž‘•‘’Š‹ ƒŽȌ ƒ••—’–‹‘•ƒ”‡‡„‡††‡†ƒ†‡ƒ –‡†™‹–Š‹•‘ ‹ƒŽ’”ƒ –‹ ‡•ƒ†‹•–‹–—–‹‘•ȋ ˆǤ ‹ ‘Ž‹‹ʹͲͳʹȌǤ•‡•‹–‹˜‹–›–‘–Š‡‹’‘”–ƒ ‡‘ˆ•‘ ‹ƒŽƒ†‹•–‹–—–‹‘ƒŽ ‘–‡š–‹• ƒ ”‡“—‹”‡‡– ‘ˆ ƒ› ‡’‹”‹ ƒŽ •–—†›ǡ ™Š‡–Š‡” ‹– Ž‡ƒ†• –‘ ƒ ‡–Š‘†‘Ž‘‰› ƒ– ”‡†— ‹‰ ‘–‡š–—ƒŽ˜ƒ”‹ƒ–‹‘ȋ“—ƒ–‹–ƒ–‹˜‡‡–Š‘†‘Ž‘‰›Ȍ‘”ƒ‹‹‰–‘ ƒ’–—”‡‹– ȋ“—ƒŽ‹–ƒ–‹˜‡‡–Š‘†•ȌǤ 

(28)  •’‹–‡ ‘ˆ –Š‡•‡ ƒ˜‡ƒ–•ǡ –Š‡ ™‘” ‘ ’•› Š‹ƒ–”‹  –Š‡‘”› ‹• ”— ‹ƒŽ –‘ ‡ˆˆ‘”–• –‘ ‡šƒ‹‡–Š‡’Š‹Ž‘•‘’Š›‘ˆ’•› Š‹ƒ–”‹ ’”ƒ –‹ ‡ǡ‹’”‘˜‹†‹‰ ‘ ‡’–—ƒŽ”‡•‘—” ‡• ˆ‘” –Š‡ ‡’‹”‹ ƒŽ ’”‘Œ‡ –Ǥ Š‡ ƒˆ‘”‡‡–‹‘‡† ‘•‹†‡”ƒ–‹‘• ‹’Ž› –Šƒ– ƒ› ‘†‡Ž•Ǧ„ƒ•‡†ƒ ‘—–™‹ŽŽ‡‡†–‘•’‡ ‹ˆ›‹–•Ž‡˜‡Ž‘ˆƒ’’Ž‹ ƒ–‹‘ǡƒ†‹–•’—”’‘”–‡† ‘•‹•–‡ ›ƒ ”‘•• ‘–‡š–•Ǥ

(29) ‘”†‡”–‘ƒ’–Š‡–‡””ƒ‹‘ˆ’•› Š‹ƒ–”‹ ’Š‹Ž‘•‘’Š› ‹’”ƒ –‹ ‡ǡƒ„”‘ƒ†‡”˜‹‡™‹•”‡“—‹”‡†–Šƒ–Šƒ–‘ˆ’•› Š‹ƒ–”‹ ƒ†’•› Š‘Ž‘‰‹ ƒŽ –Š‡‘”›Ǥ•™‡™‹ŽŽ•‡‡„‡Ž‘™ǡ–Š‹••–—†›’”‘ ‡‡†•ˆ”‘–Š‡„ƒ•‹•‘ˆ–Š‡‘‡Ǧ‘Ǧ‘‡ ‡ ‘—–‡”ǡ „—– ƒ‹• –‘ –”ƒ ‡ –Š‡ ’Š‹Ž‘•‘’Š‹‡• ‹ ’Žƒ ‡ –‘ –Š‡‹” ‡’‹•–‡‹ ǡ ‘–‘Ž‘‰‹ ƒŽǡ•‘ ‹ƒŽƒ†Š‹•–‘”‹ ƒŽ•‘—” ‡•„‡›‘†–Š‡ ‘ˆ‹‡•‘ˆ–Š‡‘ˆˆ‹ ‡Ǥ . 17.

(30) Chapter 1. Linguistic philosophy and qualitative research —Žˆ‘”† ȋʹͲͲͺȌ Šƒ• †‡˜‡Ž‘’‡† ’”ƒ –‹ ƒŽ ƒ’’Ž‹ ƒ–‹‘• ˆ‘” ’Š‹Ž‘•‘’Š‹ ƒŽ ‹†‡ƒ• ‹ ’•› Š‹ƒ–”›ǡ‘•–‘–ƒ„Ž›–Š”‘—‰ŠŠ‹•™‘”‹†‡˜‹•‹‰ƒ†‹’Ž‡‡–‹‰ƒŽ—‡•Ǧ ƒ•‡†”ƒ –‹ ‡ǤŠ‹•ƒ’’”‘ƒ ŠŠƒ•”‡ ‡‹˜‡†•—’’‘”–ˆ”‘–Š‡”‹–‹•Š ‘˜‡”‡– ƒ†Šƒ•„‡ ‘‡‹–‡‰”ƒŽ–‘–Š‡ƒ–‹‘ƒŽ ”ƒ‡™‘”‘ˆƒŽ—‡•ˆ‘”‡–ƒŽ ‡ƒŽ–Šǡ ƒ† ƒ• •— Š ‘—Ž† „‡ –ƒ‡ ƒ• ƒ Š‹‰ŠŽ› •— ‡••ˆ—Ž ‡šƒ’Ž‡ ‘ˆ ƒ’’Ž‹‡† ‡’‹”‹ ƒŽ philosophy. Much of Fulford’s philosophical work is rooted in the Ordiƒ”› ƒ‰—ƒ‰‡Š‹Ž‘•‘’Š›‘ˆ ǤǤǤ—•–‹ǡƒ†ƒ••— ŠǡŠƒ•ƒ•’‡ ‹ˆ‹ ‡’‹”‹ ƒŽ„‡–Ǥ ‰‘‘† ‡šƒ’Ž‡ ‹• –Š‡ •–—†› ‘ˆ ‘†‡Ž• ‘ˆ ‡–ƒŽ †‹•‘”†‡” ȋ —Žˆ‘”† ƒ† ‘Ž‘„‘ ʹͲͲͶȌǡ™Š‡”‡‹–Š‡ƒ—–Š‘”•ƒƒŽ›œ‡‹’Ž‹ ‹–‘†‡Ž•‘ˆ‡–ƒŽ†‹•‘”†‡”‘ˆ‡–ƒŽ Š‡ƒŽ–Š ™‘”‡”• ˆ”‘ ˜ƒ”‹‘—• †‹• ‹’Ž‹‡•ǡ —•‹‰ –‡š–—ƒŽ ƒƒŽ›•‹• ƒ† ƒ ƒ•‡Ǧ•–—†› method, based on the assumption, rooted in the Oxford tradition, that one’s ordinary use of language offers a window into one’s philosophical assumptions.   Š‹• ƒ••—’–‹‘ ‹• ƒŽ•‘ ‘‡ ‘ˆ –Š‡‡’‹•–‡‹  –‡‡–• ‘ˆ “—ƒŽ‹–ƒ–‹˜‡ ”‡•‡ƒ” Š ȋȌ ȋ‹Ž˜‡”ƒ2000), although what is termed ‘assumptions’ or ‘philosophy’ here may be referred to as ‘narrative’ or ‘discourse’ within some QR frameworks. It has been ”‡ ‘‰‹œ‡†„‡ˆ‘”‡–Šƒ–‹•‘ˆƒ•‹‹Žƒ”ƒ–—”‡–‘‡’‹”‹ ƒŽ’Š‹Ž‘•‘’Š‹ ƒŽ”‡•‡ƒ” Šǡ –Š‘—‰Š –Š‡ †‡‰”‡‡ –‘ ™Š‹ Š ’Š‹Ž‘•‘’Š‹ ƒŽ ‘ ‡’–•ǡ ˜‹‡™• ƒ† ƒ–‡‰‘”‹‡• ƒ”‡ †‡• ”‹„‡† ‹ •–—†‹‡• ˜ƒ”‹‡•Ǥ †‡” –Š‡ „”‘ƒ† Š‡ƒ†‹‰ ‘ˆ —Ž–—”ƒŽ •–—†‹‡•ǡ ƒ–Š”‘’‘Ž‘‰‹ ƒŽƒ†•‘ ‹‘Ž‘‰‹ ƒŽ”‡•‡ƒ” ŠŠƒ•ˆ‘ —•‡†‘–Š‡’”ƒ –‹ ‡ƒ† ‘ ‡’–• ‘ˆ ’•› Š‹ƒ–”›ǡ ‡’Ž‘›‹‰ ƒ ˜ƒ”‹‡–› ‘ˆ “—ƒ–‹–ƒ–‹˜‡ ƒ† “—ƒŽ‹–ƒ–‹˜‡ ‡–Š‘†•ǡ ‹ Ž—†‹‰‡–Š‘‰”ƒ’Š›ǡ’ƒ”–‹ ‹’ƒ–‘„•‡”˜ƒ–‹‘ǡ‰”‘—†‡†–Š‡‘”›’”ƒ –‹ ‡ǡ•—”˜‡›• ƒ†‹–‡”˜‹‡™•ȋ‡Ǥ‰Ǥ—Š”ƒʹͲͲͳǢŽ‡‹ƒͳͻͺͺȌǤ  —ƒŽ‹–ƒ–‹˜‡ ”‡•‡ƒ” Š ƒ †‡‘•–”ƒ–‡ –Š‡ ’”ƒ –‹ ƒŽ ”‡Ž‡˜ƒ ‡ ‘ˆ ’Š‹Ž‘•‘’Š›Ǥ ‘” ‡šƒ’Ž‡ǡ—‹••‡ȋʹͲͳͷȌƒ’’Ž‹‡†“—ƒŽ‹–ƒ–‹˜‡‡–Š‘†‘Ž‘‰‹‡•‹Š‡”‡š’Ž‘”ƒ–‹‘‘ˆ ‘’‡–‡ ‡ ‹ ‘„•‡••‹˜‡Ǧ ‘’—Ž•‹˜‡ †‹•‘”†‡”Ǥ Š‡ †‹ˆˆ‡”‡– ‡–Š‘†‘Ž‘‰‹‡• ›‹‡Ž†‡† ‹–‡”‡•–‹‰ ’‡”•’‡ –‹˜‡• ‘ –Š‡ ‘ ‡’–—ƒŽ‹œƒ–‹‘• ‘ˆ ‘’‡–‡ ‡ ƒ† ‹ ‘’‡–‡ ‡ ƒ– †‹ˆˆ‡”‡– Ž‡˜‡Ž• ‘ˆ ‹“—‹”›Ǥ •‹‰ •‡‹Ǧ•–”— –—”‡† ‹–‡”˜‹‡™• ‘ˆ ’”‘ˆ‡••‹‘ƒŽ•ǡ—‹••‡‡–ƒŽǤˆ‘—†–Š‡–‘ ‘ ‡’–—ƒŽ‹œ‡ ‘’‡–‡ ‡‹–‡”•‘ˆ ‘‰‹–‹˜‡”ƒ–‹‘ƒŽ‹–›ǡ‹ƒ‰”‡‡‡–™‹–Š–Š‡ƒ ȋ—‹••‡‡–ƒŽǤʹͲͳͷǡ ”‹••‘ ƒ† ’’‡Ž„ƒ— ͳͻͻͺȌǡ ƒ† ‹ ‘’‡–‡ ‡ ‹ –‡”• ‘ˆ ‡‘–‹‘•ǡ ˜ƒŽ—‡• ƒ† ‹†‡–‹–›Ǥ •‹‰ ƒ ƒ–—”ƒŽ‹•–‹  ƒ•‡ •–—†› ƒ’’”‘ƒ Šǡ –Š‡› •—„•‡“—‡–Ž› •–—†‹‡† practitioners’ and patients’ perspectives, which demonstrating that competence is ‘–just an assessment by the therapist, but also a ‘co-constructed reality shaped by the experiences and stories of patient and therapist’. This implies the relevance of ’”ƒ –‹ ƒŽ”‡ƒ•‘‹‰ƒ• ‘•–‹–—–‹˜‡‘ˆ ‘’‡–‡ ‡ǤŠ‡Žƒ–‡Ǥƒ””‡––ǡ’•› Š‹ƒ–”‹•– ƒ† ƒ–Š”‘’‘Ž‘‰‹•–ǡ ’‡”ˆ‘”‡† ƒ †‡–ƒ‹Ž‡† ‡–Š‘‰”ƒ’Š› ‘ˆ • Š‹œ‘’Š”‡‹ƒ ‹ ƒ ‘†‡” ’•› Š‹ƒ–”‹  Š‘•’‹–ƒŽ ‹ †‡Žƒ‹†‡ǡ —•–”ƒŽ‹ƒ ȋƒ””‡–– ͳͻͻ͸ȌǤ ‹• •–—†› 18.

(31) Examining the philosophy of psychiatric practice. Š‹‰ŠŽ‹‰Š–• –Š‡ ™ƒ› ‹ ™Š‹ Š ‹†‡ƒ• ƒ† ˜ƒŽ—‡• ‡„‡††‡† ‹ †‹ˆˆ‡”‡– Ž‡˜‡Ž• ‘ˆ Š‘•’‹–ƒŽ ™‘” ƒ† ‹–‡”ƒ – –‘ ”‡ƒ–‡ ƒ† ”‡ ”‡ƒ–‡ –Š‡ ‹ƒ‰‡• ƒ† ‹†‡–‹–‹‡• ‘ˆ ’ƒ–‹‡–• ™Š‘ Šƒ˜‡ „‡‡ †‹ƒ‰‘•‡† ™‹–Š • Š‹œ‘’Š”‡‹ƒǤ ‘” –Š‹• •–—†› ƒ””‡–– ‹˜‘‡†–Š‡•‘ ‹ƒŽ’Š‡‘‡‘Ž‘‰›‘ˆ Š—–œȋͳͻ͹ʹȌǤŠ‹•ƒ’’”‘ƒ Šˆ‘ —•‡•‘–Š‡ ‘philosophy of the mundane’, the takenǦˆ‘”Ǧ‰”ƒ–‡†Žƒ‰—ƒ‰‡‘ˆŠ‘•’‹–ƒŽ’”ƒ –‹ ‡ ƒ†–Š‡„ƒ ‰”‘—†ƒ••—’–‹‘•‘‡–ƒŽ‹ŽŽ‡••‹–‹’Ž‹‡•Ǥ‹–Š–Š‹•‹‹†–Š‡ •–—†› ƒ––‡†‡† –‘ –Š‡ ‘”†‹ƒ”› †ƒ‹Ž› ”‘—† ‘ˆ ƒ –‹˜‹–‹‡•ǡ –Š‡ ‘‘Ǧ•‡•‡ ”‡ƒ•‘‹‰ ‘ˆ –Š‡ Ž‹‹ ƒŽ •–ƒˆˆǡ ƒ† –Š‡ –ƒ ‹– ƒ••—’–‹‘• ’”‡•‡– ‹ ’‡”•‘ƒŽǡ –Š‡‘”‡–‹ ƒŽǡ–‡’‘”ƒŽƒ†‹•–‹–—–‹‘ƒŽˆ”ƒ‡™‘”•Ǥ’‡ ‹ƒŽƒ––‡–‹‘™ƒ•’ƒ‹†–‘ ƒ––‡”•–Šƒ–•‡‡‡†ǡ–‘–Š‡•–ƒˆˆǡ•‡ŽˆǦ‡˜‹†‡–ǡ•‘‘”†‹ƒ”›ƒ†ƒ–—”ƒŽ–Šƒ––Š‡›ƒ”‡ ‡˜‡” “—‡•–‹‘‡†Ǥ ƒ””‡–– ™ƒ• ƒ„Ž‡ –‘ †‡‘•–”ƒ–‡ –Šƒ– †‹ˆˆ‡”‡– –Š‡‘”‡–‹ ƒŽ ’‡”•’‡ –‹˜‡• ”‡ˆŽ‡ – –ƒ ‹– „‡Ž‹‡ˆ• ‡š’”‡••‡† ‹ †‹ˆˆ‡”‡– ‹†‹‘ms. ‘‘Clinicians, • ‹‡–‹•–•ǡ’ƒ–‹‡–•ǡƒ†–Š‡’—„Ž‹ ƒŽ‹‡ƒ”‡‹ˆŽ—‡ ‡†„›–Š‡•‡ —Ž–—”ƒŽ‹ƒ‰‡•ƒ† metaphors’’ (Fenton 1998). The (partially) tacit beliefs may, if they achieve a ‡”–ƒ‹ Ž‡˜‡Ž ‘ˆ ‘•‹•–‡ › ƒ† †—”ƒ„‹Ž‹–›ǡ ˆ‘” ƒ ‘ ‡’–—ƒŽ ‡–™‘” ‘” ‘framework theory’ and be embedded at one or more of the previously mentioned •–”— –—”ƒŽ Ž‡˜‡Ž•Ǥ › ƒ––‡†‹‰ –‘ –Š‡ ‘–‡– ‘ˆ •— Š –Š‡‘”‹‡•ǡ ™Š‹ Š ‘–ƒ‹ ’Š‹Ž‘•‘’Š‹ ƒŽƒ••—’–‹‘•ǡƒ†–Š‡‹” ‘•‡“—‡ ‡•ˆ‘”†ƒ‹Ž›’”ƒ –‹ ‡ǡ–Š‡‡’‹”‹ ƒŽ ‘‡ –‹‘ „‡–™‡‡ ’Š‹Ž‘•‘’Š‹ ƒŽ „‡Ž‹‡ˆ• ƒ† ’”ƒ –‹ ƒŽ ‹’‘”– ‹• †‡‘•–”ƒ–‡†Ǥ Š‡•–—†‹‡•‘ˆƒ””‡––ƒ† —Žˆ‘”†Ƭ‘Ž‘„‘•Šƒ”‡ƒˆ‘ —•‘–Š‡‡’‹”‹ ƒŽ•–—†› ‘ˆ ‘”†‹ƒ”› Žƒ‰—ƒ‰‡ ‘ˆ ’”‘ˆ‡••‹‘ƒŽ• ƒ• ƒ ˜ƒŽ‹† ‡–Š‘† ‘ˆ ‡š’Ž‘”‹‰  –Š‡ ȋ’Š‹Ž‘•‘’Š‹ ƒŽȌƒ••—’–‹‘•‘ˆ‡–ƒŽŠ‡ƒŽ–Š™‘”‡”•Ǥ

(32) –Š‹••–—†›ȋ•‡‡Šƒ’–‡” ʹȌǡ–Š‹•ƒ••—’–‹‘‘ˆ–Š‡Žƒ‰—ƒ‰‡‘ˆ’”ƒ –‹ ‡ƒ•ƒ™‹†‘™‹–‘ƒ –‹˜‡’Š‹Ž‘•‘’Š‹‡• ‹•‹–‡‰”ƒ–‡†‹–‘ƒ•–‡’™‹•‡ǡ‹š‡†Ǧ‡–Š‘†•“—ƒŽ‹–ƒ–‹˜‡”‡•‡ƒ” Šƒ’’”‘ƒ Š–‘–Š‡ •—„Œ‡ –ƒ––‡”Ǥ. 1. Experimental research and clinical reasoning. ”‘‹•‹‰•–—†‹‡•ˆ”‘–Š‡ˆ‹‡Ž†‘ˆ‡š’‡”‹‡–ƒŽ ‘‰‹–‹˜‡”‡•‡ƒ” ŠŠƒ˜‡ƒ’’‡ƒ”‡† ‹ ”‡ ‡– ›‡ƒ”•Ǥ ‡ ƒ”‡ƒ ‘ˆ ‹–‡”‡•– ’‡”–ƒ‹• –‘ ƒ–‡‰‘”‹œƒ–‹‘ ƒ† ƒ—•ƒŽ ”‡ƒ•‘‹‰ǡƒ†‹ƒ—„‡”‘ˆ’ƒ’‡”•‡š’‡”‹‡–ƒŽ‡–Š‘†•Šƒ˜‡„‡‡‡’Ž‘›‡† –‘†‡–‡”‹‡–Š‡’”‡•‡ ‡ƒ†ƒ–—”‡‘ˆ˜ƒ”‹‘—•”‡Žƒ–‡†„‡Ž‹‡ˆ•‹‡–ƒŽŠ‡ƒŽ–Š ™‘”‡”• ƒ† Žƒ›’‡”•‘•Ǥ Š‡”‡ ‹• ƒ •—„•–ƒ–‹ƒŽ Ž‹–‡”ƒ–—”‡ ‘ ‹ŽŽ‡•• ‡š’‡”‹‡ ‡• ƒ† ‘ ‡’–—ƒŽ‹œƒ–‹‘• ‘ˆ ’ƒ–‹‡–•ǡ ‹ Ž—†‹‰ ’Š‹Ž‘•‘’Š‹ ƒŽ ’‡”•’‡ –‹˜‡• –Š‡”‡‹ ȋ‡Ǥ‰Ǥ ƒ› ‘‘„• ͳͻͻ͵ǡ ƒ˜‹†•‘ ‡– ƒŽǤ ʹͲͲͺǡ ‡‡”ƒ ʹͲͳ͸ȌǤ ‹ ‡ –Š‹• •–—†› ˆ‘ —•‡•’”‹ƒ”‹Ž›‘–Š‡˜‹‡™•ƒ†ƒ –‹‘•‘ˆ’”ƒ –‹–‹‘‡”•ǡ–Š‹•Ž‹–‡”ƒ–—”‡™‹ŽŽ‘– „‡”‡˜‹‡™‡†Š‡”‡Ǥ‡•‡ƒ” Š‘’”ƒ –‹–‹‘‡”s’ perspectives has taken place more within the ‘clinical reasoning’ tradition (Norman 2000), which has focused more ‘–Š‡•–”— –—”ƒŽƒ•’‡ –•‘ˆ”‡ƒ•‘‹‰Ǥ‡ ‡–Ž›Š‘™‡˜‡”ǡ ‘ ‡’–—ƒŽƒƒŽ›•‹•Šƒ• 19.

(33) Chapter 1. ƒ––”ƒ –‡† ‘”‡ ƒ––‡–‹‘Ǥ ‘” ‡šƒ’Ž‡ǡ Š ‡– ƒŽǤ ȋʹͲͲͻȌ ˆ‘—† –Šƒ– Ž‹‹ ‹ƒ• ‘ ‡’–—ƒŽ‹œ‡ ‡–ƒŽ †‹•‘”†‡”• ‘ ƒ ‘–‹—— •’ƒ‹‰ˆ”‘ Š‹‰ŠŽ› „‹‘Ž‘‰‹ ƒŽ ȋ‡Ǥ‰Ǥƒ—–‹•–‹ †‹•‘”†‡”Ȍ–‘Š‹‰ŠŽ›’•› Š‘Ž‘‰‹ ƒŽȋ‡Ǥ‰Ǥƒ†Œ—•–‡–†‹•‘”†‡”•Ȍǡƒ†‘– ƒ•ƒ‘–‘Ž‘‰‹ ƒŽŽ›Š‘‘‰‡‘—•‹†ǤŠ‡•–—†› ‘ Ž—†‡•–Šƒ–‡˜‡‡š’‡”–‡–ƒŽ Š‡ƒŽ–Š Ž‹‹ ‹ƒ• ƒ‡ •–”‘‰ †‹•–‹ –‹‘• „‡–™‡‡ „‹‘Ž‘‰‹ ƒŽ ƒ† ’•› Š‘Ž‘‰‹ ƒŽ ’Š‡‘‡ƒǤ‹ƒ†ŠȋʹͲͲʹȌˆ‘—†–Šƒ– Ž‹‹ ‹ƒ•Š‘Ž† ƒ—•ƒŽ–Š‡‘”‹‡•™‹–Š respect to DSM diagnoses, imputing a causal structure to the ‘atheoretical’ feature Ž‹•–•‘ˆ–Š‡ǡƒˆˆ‡ –‹‰ Ž‹‹ ƒŽ†‹ƒ‰‘•‹•ǣ Ž‹‹ ‹ƒ•Šƒ†„‡––‡””‡ ƒŽŽ‘ˆ ƒ—•ƒŽŽ› ‡–”ƒŽˆ‡ƒ–—”‡• ‘’ƒ”‡†–‘ ƒ—•ƒŽŽ›’‡”‹’Š‡”ƒŽ‘‡•ȋ ˆǤŠƒ†‹ʹͲͲͺȌǤ. ‘–Š‡”•–—†›‡’Ž‘›‡†ƒ˜‹‰‡––‡‡–Š‘†–‘•–—†› ‘˜‡”–†—ƒŽ‹•–‹ ”‡ƒ•‘‹‰‹ Ž‹‹ ‹ƒ•ȋ‹”‡• ‘ƒ†‹”ƒ›‡”ʹͲͲ͸ȌǤŠ‡ƒ—–Š‘”• ‘ Ž—†‡†–Šƒ–‡–ƒŽŠ‡ƒŽ–Š ’”‘ˆ‡••‹‘ƒŽ• ‘–‹—‡–‘‡’Ž‘›ƒ‹†Ǧ„”ƒ‹†‹ Š‘–‘›™Š‡”‡ƒ•‘‹‰ƒ„‘—– clinical cases. ‘‘The more a behavioral problem is seen as originating in ‘‘psychological’’ processes, the mo”‡ƒ’ƒ–‹‡––‡†•–‘„‡˜‹‡™‡†ƒ•”‡•’‘•‹„Ž‡ ƒ† „Žƒ‡™‘”–Š› ˆ‘” Š‹• ‘” Š‡” •›’–‘•Ǣ ‘˜‡”•‡Ž›ǡ –Š‡ ‘”‡ „‡Šƒ˜‹‘”• ƒ”‡ ƒ––”‹„—–‡† –‘ ‡—”‘„‹‘Ž‘‰‹ ƒŽ ƒ—•‡•ǡ –Š‡ Ž‡•• Ž‹‡Ž› ’ƒ–‹‡–•ƒ”‡ –‘„‡ ˜‹‡™‡† ƒ• responsible and blameworthy.’’ One obvious advanta‰‡ ‘ˆ –Š‹• ‡š’‡”‹‡–ƒŽ ‡–Š‘† ™‹–Š ”‡‰ƒ”† –‘ ‘‡ ‰‘ƒŽ ‘ˆ –Š‹• •–—†› ȋƒ‹‰ ’Š‹Ž‘•‘’Š‹ ƒŽ ƒƒŽ›•‹• ƒ˜ƒ‹Žƒ„Ž‡–‘–Š‡’”ƒ –‹–‹‘‡”Ȍ‹•–Š‡ˆƒ ––Šƒ–‹–•‡–Š‘†‘Ž‘‰›ƒ ‘”†•‘”‡™‹–Š–Š‡ ‡’‹”‹ ƒŽ‡–Š‘†•ˆƒ‹Ž‹ƒ”–‘‡–ƒŽŠ‡ƒŽ–Š’”‘ˆ‡••‹‘ƒŽ•Ǥ

(34) –••–”‡‰–ŠŽ‹‡•‹‹–• ’”‡ ‹•‹‘ ƒ† ‹–• ’‘–‡–‹ƒŽ ˆ‘” †‡‘•–”ƒ–‹‰ •’‡ ‹ˆ‹ ‹–› ‘ˆ ’”ƒ –‹ ƒŽ ‹’‘”– ‘ˆ ’Š‹Ž‘•‘’Š‹ ƒŽƒ••—’–‹‘• ‘‡ –‡†–‘•’‡ ‹ˆ‹  ‹” —•–ƒ ‡•Ǥ. Š‡ Ž‹‹ ƒŽ ”‡ƒ•‘‹‰ ”‡•‡ƒ” Š ˆ‹‡Ž† ‹• ƒ —•‡ˆ—Ž ‘’Ž‡‡– –‘ –Š‡ ‹† ‘ˆ ‡š’‡”‹‡–ƒŽ ‘‰‹–‹˜‡ ”‡•‡ƒ” Š †‡• ”‹„‡† ƒ„‘˜‡Ǥ

(35) ˆ –Š‡”‡ ‹• ‡˜‹†‡ ‡ ‘ˆ ƒ—•ƒŽ †—ƒŽ‹• ‘” †‹‡•‹‘ƒŽ ‘ ‡’–—ƒŽ‹œƒ–‹‘• ‘ˆ †‹•‘”†‡” ƒ• †‡• ”‹„‡† ƒ„‘˜‡ǡ –Š”‘—‰Š™Šƒ–•‘”–‘ˆ ‘†—‹–†‘•— Š‹†‡ƒ•ƒ –—ƒŽŽ›‹ˆŽ—‡ ‡’”ƒ –‹ ‡ǫƒ™‡–ƒ‡ –Š‡ –‘ ˆ— –‹‘ ƒ• ‘‰‹–‹˜‡ ”‡’”‡•‡–ƒ–‹‘•ǡ ƒ† ‹ˆ •‘ǡ Š‘™ ƒ”‡ •— Š ”‡’”‡•‡–ƒ–‹‘• ƒ ‡••‡† ‹ ’”ƒ –‹ ‡ǫ Š ‡– ƒŽǤ ȋʹͲͲͻȌ ”‡ˆ‡” –‘ –Š‡ ‘ ‡’– ‘ˆ ‘framework theories’ (GodfreyǦ‹–Š ʹͲͲ͵Ȍ ‰—‹†‹‰ ‹ˆ‡”‡ ‡• ƒ† ”‡ƒ•‘‹‰ ƒ ”‘••ƒ‡–‹”‡†‘ƒ‹ǡƒ ‘ ‡’––Šƒ–†‘‡•‘–•‡‡ˆƒ””‡‘˜‡†ˆ”‘ ‘ ‡’–• developed within the field of ‘personal epistemology’ (see below). It is an empirical “—‡•–‹‘ ™Š‡–Š‡” Ž‹‹ ƒŽ ”‡ƒ•‘‹‰ ™‘”• –Š”‘—‰Š –Š‡ ƒ ‡••‹‰ ‘ˆ ‘‰‹–‹˜‡ ”‡’”‡•‡–ƒ–‹‘• ƒ† –Š‡‘”› ‘•–”— –• ‘–ƒ‹‹‰ •— Š ˆ”ƒ‡™‘”•Ǥ –—†‹‡• ‘ Ž‹‹ ƒŽ”‡ƒ•‘‹‰ƒ”‡‘‡™ƒ›‘ˆ‡š’Ž‘”‹‰–Š‡ƒ–—”‡‘ˆ–Š‡ ‘‡ –‹‘•„‡–™‡‡ –Š‡‘”›ƒ†’”ƒ –‹ ‡ƒ†ƒ”‡–Š‡”‡ˆ‘”‡”‡Ž‡˜ƒ––‘–Š‡‡š’Ž‘”ƒ–‹‘‘ˆ–Š‹••–—†›Ǥ

(36)  Šƒ’–‡”͵ǡƒ„”‹‡ˆ”‡˜‹‡™™‹ŽŽ„‡‰‹˜‡‘ˆ”‡•‡ƒ” Š‹–Š‹•ƒ”‡ƒǤ  . 20.

(37) Examining the philosophy of psychiatric practice. Historical and sociological research ‡‹‰Š‹•–‘”‹ ƒŽŽ›‹ˆ‘”‡†‘ˆ–‡ƒŽ‡”–•‘‡–‘–Š‡contingency of one’s views, and ‹– ƒ„‡‘•—”’”‹•‡–Šƒ––Š‡™‘”‹’Š‹Ž‘•‘’Š›ƒ†’•› Š‹ƒ–”›‘ˆ–‡‹ ‘”’‘”ƒ–‡• Š‹•–‘”‹ ƒŽƒƒŽ›•‡•ǡ‘•–”‡ƒ†‹Ž›•‡‡‹•–—†‹‡•‘ˆ•’‡ ‹ˆ‹ ‡–ƒŽ†‹•‘”†‡”•ȋ‡Ǥ‰Ǥ Ž‘ ʹͲͲ͵ȌǤ ‡””‹‘• Šƒ• ‡Žƒ„‘”ƒ–‡† ‘ –Š‡ ”‡Ž‡˜ƒ ‡ ‘ˆ Š‹•–‘”‹ ƒŽ ™‘” ‹ ’•› Š‹ƒ–”› ‹ †‹ˆˆ‡”‡– †‘ƒ‹• •— Š ƒ• ‘ ‡’–—ƒŽ‹œƒ–‹‘• ‘ˆ †‹•‘”†‡”ǡ •›’–‘ƒ–‘Ž‘‰›ǡ ƒ† –ƒš‘‘› ȋ‡””‹‘• Ƭ ‘”–‡” ͳͻͻͷǡ ‡””‹‘• ͳͻͻͻȌǤ

(38)  A History of Clinical Psychiatry ȋͳͻͻͷȌǡŠ‡™”‹–‡•ǣ. 1. “The history of clinical psychiatry may be defined as the study of the way in which clinical signals and their descriptions have interacted in successive historical periods, and of their psychosocial context. To estimate the extent to which earlier meanings (terms, concepts and behaviors) are preserved when clinical categories are transferred from one discourse to the next, historian and clinician need to know how descriptive and nosographic rules are formulated. For example, can it be assumed that ‘mania’, ‘melancholia’, or ‘hypochondria’ mean in 1995 the same as they did in 1800? How can differences be made explicit? One of the objectives of historical nosography is to decode the rules controlling psychiatric discourse, and make explicit the drafts upon which it is based.”.

(39) – ‹• –Š‡•‡ ”—Ž‡• ƒ† †”ƒˆ–• –Šƒ– ™‡ ƒ”‡ ‹–‡”‡•–‡† ‹ ˆ”‘ –Š‡ ’‡”•’‡ –‹˜‡ ‘ˆ ’Š‹Ž‘•‘’Š› ƒ† ’•› Š‹ƒ–”›Ǥ ‹•–‘”› ƒ› „‡ ˜‹‡™‡† ƒ• ƒ ”‡’‘•‹–‘”› ‘ˆ ’ƒ•– ’Š‹Ž‘•‘’Š‹‡• ȋ‡Ǥ‰Ǥ ‹††‡”•Š‘˜‡ǦHeerding 2000). Berrios’ argumen– ƒŽ•‘ †”ƒ™• ƒ––‡–‹‘–‘–Š‡ˆƒ ––Šƒ–™‡ ƒ‘–’”‡•—‡ ‘ ‡’–—ƒŽ‹œƒ–‹‘•‘ˆ‡–ƒŽ†‹•‘”†‡” ƒ”‡•–ƒ„Ž‡ ‘ ‡’–•‹–‡”•‘ˆ–Š‡‹”‡ƒ‹‰ǡƒ†‹–‡”•‘ˆ–Š‡‹” ‘‡ –‹‘•–‘ what he describes as the ‘biological signal’ (the easiest example of such in•–ƒ„‹Ž‹–› ‹•–Š‡ Šƒ‰‹‰‡ƒ‹‰ƒ––ƒ Š‡†–‘–Š‡ ‘ ‡’–‘ˆ‡—”‘•‹•‹†‹ˆˆ‡”‡–†‘ƒ‹• ƒ† Š‹•–‘”‹ ƒŽ ’‡”‹‘†•ȌǤ ‡•‹–‹˜‹–› –‘ •— Š —–ƒ„‹Ž‹–› ‹• ƒ ”‡“—‹”‡‡– ˆ‘” ’Š‹Ž‘•‘’Š‹ ƒŽƒƒŽ›•‹•Ǥ—––Š‹• ‹–ƒ–‹‘ƒŽ•‘†”ƒ™•ƒ––‡–‹‘–‘Š‹•–‘”‹ ƒŽ™‘”ƒ• ƒ empirical •‘—” ‡ ˆ‘” ’Š‹Ž‘•‘’Š›Ǥ ‹•–‘”‹ ƒŽ ƒƒŽ›•‹• ‹•ǡ ƒ– Ž‡ƒ•– ‹ ’ƒ”–ǡ ƒ ‡’‹”‹ ƒŽ —†‡”–ƒ‹‰Ǥ Š‹• ‹• ‡š’”‡••‡† ‹ –Š‡ ‡š–‡•‹˜‡ †‹• —••‹‘ ‘ˆ Š‹•–‘”‹‘‰”ƒ’Š›ͳ„›ƒŽŽƒ ‡ȋ‹ƒŽŽƒ ‡ƒ† ƒ ŠʹͲͲͺȌǤƒŽŽƒ ‡†”ƒ™•’ƒ”ƒŽŽ‡Ž• „‡–™‡‡ ‘–”‘˜‡”•‹‡• ‹ Š‹•–‘”› ƒ† ‹ ƒ–—”ƒŽ • ‹‡ ‡ ‘ –Š‡ •—„Œ‡ – ‘ˆ –Š‡ ”‡Žƒ–‹‘•Š‹’ „‡–™‡‡ –Š‡‘”› ƒ† †ƒ–ƒǣ ™Šƒ– ƒ”‡ ȋŠ‹•–‘”‹ ƒŽȌ ˆƒ –•ǫ ”‡ –Š‡› ‘„•‡”˜‡† ‘” ‘•–”— –‡†ǡ ‘”‰ƒ‹œ‡† ‘” ‘”‰ƒ‹œƒ„Ž‡ǫ ƒ –• ‘ˆ Š‹•–‘”› ƒ‘– „‡ ‘„•‡”˜‡††‹”‡ –Ž›ǡŠ‡‘–‡•ǡ„—––Š‡›•Šƒ”‡–Š‹•“—ƒŽ‹–›™‹–Š–Š‡—‘„•‡”˜ƒ„Ž‡•‘ˆ ƒ–—”ƒŽ• ‹‡ ‡•— Šƒ•„Žƒ ƒ––‡”‘”“—ƒ”•Ǥ ‘™‡˜‡”ǡŠ‹•–‘”‹ ƒŽ–”ƒ ‡•ƒ”‡‘’‡ Historiography: the study of the methodology of historians and the development of history as a discipline.. 1. 21.

(40) Chapter 1. –‘ ‡’‹”‹ ƒŽ ‹“—‹”›ǡ ”‡“—‹”‹‰ –Š‘—‰Š ƒ ‡–Š‘†‘Ž‘‰› •‡•‹–‹˜‡ –‘ –Š‡ ”‘Ž‡ ‘ˆ interpretations throughout the event’s history, in the originƒŽ ’‡” ‡’–‹‘ ƒ† †‡• ”‹’–‹‘ –Š‡”‡‘ˆǡ ‹–• •—„•‡“—‡– ‡Žƒ„‘”ƒ–‹‘ ƒ† ‹–‡”’”‡–ƒ–‹‘• –Š”‘—‰Š different social and scientific domains. A ‘oneǦsided and caricatured’ picture of the ƒ–—”ƒŽ • ‹‡ ‡• Šƒ• Ž‡† –‘ •‘‡ Š‹•–‘”‹ƒ• Ž‹‰‹‰ –‘ ƒ •‹’Ž‹ˆ‹‡† †‹ Š‘–‘› „‡–™‡‡ ‘„•‡”˜ƒ–‹‘ ƒ† –Š‡‘”› ™Š‹ Š Šƒ• Ž‘‰ „‡‡ ƒ„ƒ†‘‡† „› ƒ–—”ƒŽ • ‹‡–‹•–• ƒ† ’Š‹Ž‘•‘’Š‡”• ‘ˆ • ‹‡ ‡ ™Š‘ ”‡ ‘‰‹œ‡ –Š‡ ˆŽ—‹†‹–› ‘ˆ –Š‡ Ž‹‡ „‡–™‡‡†ƒ–ƒ ‘ŽŽ‡ –‹‰ƒ†–Š‡‘”‹œ‹‰Ǥ— Š†‹ Š‘–‘‘—•˜‹‡™•Šƒ˜‡ƒŽ•‘Ž‡†–‘ •‡’–‹ ƒŽ‘”’‘•–‘†‡”˜‹‡™•‘ˆ–Š‡‹’‘••‹„‹Ž‹–›‘ˆ‡•–ƒ„Ž‹•Š‹‰ƒ›ˆƒ –—ƒŽ„ƒ•‹• ˆ‘” Š‹•–‘”›ǡ ”‹–‹ ‹œ‡† „› ƒŽŽƒ ‡ ˆ‘” Ž‡ƒ†‹‰ –‘ ƒ ˆ‘” ‘ˆ ‹ˆ‹‹–‡ ”‡‰”‡•• ƒ† ‹Š‹Ž‹• –‘™ƒ”†• ‡ƒ‹‰ ȋƒ ˆƒ‹Ž‹ƒ” Šƒ”‰‡ ƒ‰ƒ‹•– ’‘•–‘†‡” •‡’–‹ ‹•ȌǤ ‡ ‘‰‹–‹‘‘ˆ–Š‡–Š‡‘”›Ǧ„‘—†ƒ–—”‡‘ˆƒ›ˆ‘”‘ˆ‘„•‡”˜ƒ–‹‘ƒ†‘ˆ–Š‡”‘Ž‡ ‘ˆ”—Ž‡•‘ˆ‡–Š‘†‘Ž‘‰›”‡ ‘‰‹œ‡†™‹–Š‹ƒ‰‹˜‡• ‹‡–‹ˆ‹  ‘—‹–›ƒ•ƒ‡ƒ• ‘ˆ ƒˆˆ‘”†‹‰ • ‹‡–‹ˆ‹  ˜ƒŽ‹†‹–› •‡”˜‡• –‘ †‡ˆ—•‡ •— Š ”‹–‹ ‹•ǡ –‘ —†‡”’‹ –Š‡ ‡’‹”‹ ƒŽ„ƒ•‹•‘ˆŠ‹•–‘”›ǡ„—––‘‡“—ƒŽŽ›‘’‡‹––‘ ”‹–‹ ƒŽƒƒŽ›•‹•„ƒ•‡†‘•— Š ”—Ž‡•‘ˆ‡–Š‘†‘Ž‘‰›Ǥ‹††‡”•Š‘˜‡Ǧ ‡‡”†‹‰‘–‡•–Šƒ–Š‹•–‘”‹ ƒŽƒƒŽ›•‹•ƒ› ”‹–‹ ‹œ‡ƒƒ Š”‘‹•–‹ ƒ†’‘•‹–‹˜‹•–”‡ƒ†‹‰•‘ˆ–Š‡†‡˜‡Ž‘’‡–‘ˆ‡†‹ ‹‡ƒ• purely progressive either in ‘converging on truth’ (cf. ‡†Ž‡” ʹͲͳʹȌ ‘” ‹ ‹’”‘˜‹‰’”‘ˆ‡••‹‘ƒŽ“—ƒŽ‹–›ǡ‘”‘–Š‡‘–Š‡”Šƒ†”‡’”‡•‡–‹‰–Š‡Š‹•–‘”›ƒ• ‘‡ ‘ˆ Šƒ‰‡ ™‹–Š‘—– ‹’”‘˜‡‡– ȋ•‹ ‡ –Š‡”‡ ƒ”‡ ‘ ‹†‡’‡†‡– ‡ƒ• ‘ˆ ‡•–ƒ„Ž‹•Š‹‰ƒ‡ƒ•—”‡‘ˆ–Š‡Žƒ––‡”ȌǤ Integrating and translating the research.  ‡šƒ’Ž‡ ™‹ŽŽ •‡”˜‡ –‘ ‹ŽŽ—•–”ƒ–‡ –Š‡ ’‘–‡–‹ƒŽ ‘ˆ ‘„‹‹‰ ƒ† ‹–‡‰”ƒ–‹‰ ‡’‹”‹ ƒŽ ™‘” ˆ”‘ –Š‡ †‹˜‡”•‡ •‘—” ‡• ‡–‹‘‡† ƒ„‘˜‡ ™‹–Š ’Š‹Ž‘•‘’Š‹ ƒŽ ƒƒŽ›•‹•Ǥ

(41) –Š‡’”‡˜‹‘—•Ž›‡–‹‘‡†•–—†›„›ƒ””‡––ǡ–Š‡”‡‹•‡š’Ž‹ ‹–”‡ˆ‡”‡ ‡ –‘’”ƒ –‹tioner’s ideas of patients being more or less (morally) responsible for–Š‡‹” „‡Šƒ˜‹‘”Ǥ

(42)  Š‹• ’”‘Œ‡ – Š‡ †‹• ‘˜‡”‡† –Šƒ– ƒ• ’ƒ–‹‡–• ”‡ƒ‹‡† ‹ –”‡ƒ–‡– Ž‘‰‡”ǡ–Š‡›™‡”‡–ƒ‡–‘„‡‹ ”‡ƒ•‹‰Ž›‘”ƒŽŽ›”‡•’‘•‹„Ž‡ˆ‘”–Š‡‹”ƒ –‹‘•Ǥ Š‘•‡ ’ƒ–‹‡–• ™Š‘ǡ ‹ –Š‡ ‘—”•‡ ‘ˆ –Š‡‹” Š‘•’‹–ƒŽ •–ƒ›ǡ ‘ˆ‘”‡† –‘ –Š‡ practitioners’™‹•Š‡•ƒ†–Š‡–”‡ƒ–‡–’”‘‰”ƒǡ™‡”‡•‡‡ƒ•‰‘‘†ǡ”‡•’‘•‹„Ž‡ ’ƒ–‹‡–•™Š‘•‡‘—– ‘‡™ƒ•ˆƒ˜‘”ƒ„Ž‡ǡ™Š‹Ž•––Š‘•‡–Šƒ–†‹†‘– ‘ˆ‘”–‡†‡† –‘ „‡ •‡‡ ƒ• ƒ‹’—Žƒ–‹˜‡ǡ ™‹–Š ƒ —ˆƒ˜‘”ƒ„Ž‡ ‘—–Ž‘‘Ǥ —– „‘–Š ‰”‘—’• ™‡”‡ •‡‡ƒ•‰ƒ‹‹‰‹’‡”•‘ƒŽ”‡•’‘•‹„‹Ž‹–›ȋƒ†ƒ ‘—–ƒ„‹Ž‹–›Ȍˆ‘”–Š‡‹”„‡Šƒ˜‹‘” ƒ• –‹‡ ’”‘‰”‡••‡†Ǥ Š‡ ‘ ‡’– ‘ˆ ‘”ƒŽ ”‡•’‘•‹„‹Ž‹–› Šƒ• Š‹‰Š ’”ƒ –‹ ƒŽ ”‡Ž‡˜ƒ ‡ ˆ‘” ’”ƒ –‹–‹‘‡”•ǡ •‘‡ ‘ˆ ™Š‘ ƒ”‡ ƒŽŽ‡† —’‘ †ƒ‹Ž› –‘ ƒ‡ ƒ••‡••‡–•–Š‡”‡‘ˆǤ–Š‡”•–—†‹‡••Š‡†ƒ†‹ˆˆ‡”‡–Ž‹‰Š–‘‘”ƒŽ”‡•’‘•‹„‹Ž‹–›ǡ –›‹‰ ‹– –‘ ƒ••—’–‹‘• ‘ˆ „‹‘Ž‘‰‹ ƒŽ ‘” ’•› Š‘Ž‘‰‹ ƒŽ ƒ—•ƒ–‹‘ ȋ‹”‡• ‘ ƒ† 22.

(43) Examining the philosophy of psychiatric practice. ‹”ƒ›‡”ʹͲͲ͸Ȍ‘”–‘‹ ”‡ƒ•‡†—†‡”•–ƒ†‹‰‘–Š‡’ƒ”–‘ˆ–Š‡’”ƒ –‹–‹‘‡”ȋŠ ‡–ƒŽǤʹͲͲ͵ȌǤŠ‡Žƒ––‡”•–—†›‘ˆˆ‡”•ƒƒ††‹–‹‘ƒŽ’‘••‹„Ž‡‡š’Žƒƒ–‹‘ˆ‘”‘‡‘ˆ Barrett’s interesting findings: over time, the rational understanding on the part of the staff of patients’ experiences and behavior increases, and given the association ‘ˆunderstanding of behavior with ‘normality’ and hence of moral responsib‹Ž‹–›ǡ staff’s views on patients’ responsibility for their behavior change accordingly. This Ž‡ƒ†•–‘–Š‡“—‡•–‹‘‘ˆ™Š‡–Š‡”•— Š”‡ƒ•‘‹‰‹•˜ƒŽ‹†ƒ†‡–Š‹ ƒŽŽ›•‘—†ǡ™Š‹ Š ‹• ƒ ‡try point for ethics suited to Philips’ goal of ‘improving practice’. I– ƒŽ•‘ ‘’‡• ƒ˜‡—‡• ˆ‘” ‘„•‡”˜ƒ–‹‘ƒŽ •–—†›ǡ ˆ‘” ‡šƒ’Ž‡ ˆ‘ —•‹‰ ‘ ƒ••‡••‡–• ‘ˆ ‘”ƒŽ”‡•’‘•‹„‹Ž‹–›–Š”‘—‰Š–‹‡‘ˆ’ƒ–‹‡–•™Š‘ƒ”‡‡š’‡”‹‡ ‡†ƒ•†‹ˆˆ‹ —Ž––‘ —†‡”•–ƒ† „› Š‘•’ital staff. Ahn’s demonstration of a continuum of causal ƒ––”‹„—–‹‘•ƒ ”‘••†‹ˆˆ‡”‡–‡–ƒŽ†‹•‘”†‡”•ƒŽ•‘•—‰‰‡•–•ˆ—”–Š‡”‘„•‡”˜ƒ–‹‘ƒŽ ”‡•‡ƒ” Š‘–Š‡”‡Žƒ–‹‘•Š‹’•„‡–™‡‡•— Š ƒ—•ƒŽ”‡ƒ•‘‹‰ǡ ‘ ‡’–—ƒŽ‹œƒ–‹‘• ‘ˆ †‹•‘”†‡”ǡ ƒ––”‹„—–‹‘• ‘ˆ ”‡•’‘•‹„‹Ž‹–› ƒ† „Žƒ‡™‘”–Š‹‡••ǡ –”‡ƒ–‡– ‘†ƒŽ‹–‹‡•ǡ ‡– Ǥ › Ž‘ ƒ–‹‰ ƒ† •’‡ ‹ˆ›‹‰ ’Š‹Ž‘•‘’Š› ‹ ’”ƒ –‹ ‡ǡ –Š‡ ”‡Žƒ–‡† “—‡•–‹‘• ˆ‘” ‡‹–Š‡” ’Š‹Ž‘•‘’Š›Ȁ‡–Š‹ • ‘” ‡’‹”‹ ƒŽ ‹˜‡•–‹‰ƒ–‹‘ ƒŽ•‘ „‡ ‘‡ ‘”‡•’‡ ‹ˆ‹ ǡƒ†–Š‡ƒ•™‡”•‘”‡‡ƒ•‹Ž›”‡ ‘‰‹œƒ„Ž‡–‘’”ƒ –‹–‹‘‡”•Ǥƒ””‡–– ”‡ˆ‡”•–‘–Š‡‹•–‹–—–‹‘ƒŽ‡„‡††‹‰‘ˆƒ––‹–—†‡•ƒ†ƒ••—’–‹‘•‹’”ƒ –‹ ‡•ǡ„—– ƒŽ•‘ ‹ ƒ–‡”‹ƒŽ ƒ””ƒ‰‡‡–• ȋ•— Š ƒ• –Š‡ ƒ–‡‰‘”‹œƒ–‹‘• ƒ’’Ž‹‡† –‘ ƒ‹‰ ™ƒ”†•Ȍǡ •—‰‰‡•–‹‰ ˆ—”–Š‡” •‘ ‹‘Š‹•–‘”‹ ƒŽ ƒƒŽ›•‹• ‘ˆ •— Š ƒ””ƒ‰‡‡–•Ǥ Š‡•‡ •–—†‹‡•‘–‘Ž› Šƒ”ƒ –‡”‹œ‡’Š‹Ž‘•‘’Š‹ ƒŽ‹†‡ƒ•ǡ„—–Ž‘ ƒ–‡–Š‡„‘–Š™‹–Š‹–Š‡ –Š‡‘”‡–‹ ƒŽ ˆ”ƒ‡™‘”• ƒ† ’”ƒ –‹ ‡• ‘ˆ ‹†‹˜‹†—ƒŽ Ž‹‹ ‹ƒ• ƒ• ™‡ŽŽ ƒ• ‹ –Š‡ ƒ–‡”‹ƒŽ ƒ† ‹ƒ–‡”‹ƒŽ ƒ””ƒ‰‡‡–• ‘ˆ ‡–ƒŽ Š‡ƒŽ–Š ‹•–‹–—–‹‘•ǡ ƒ† ™‹–Š‹ –Š‡„”‘ƒ†‡”•‘ ‹‘Š‹•–‘”‹ ƒŽ ‘–‡š–Ǥ

(44) –‡‰”ƒ–‹‰–Š‡ˆ‹†‹‰•‘’‡•—’‡™ƒ˜‡—‡• for collaborative ‘philosophy in psychiatry’ field work, with clear potential to ‹’”‘˜‡’”ƒ –‹ ‡ǤŠ‹••–—†›ƒ‹•–‘ˆ—”–Š‡”–Š‹•ƒ’’”‘ƒ Šǡ ‘„‹‹‰‡’‹”‹ ƒŽǡ ’”ƒ –‹ ‡Ǧ„ƒ•‡†ǡ “—ƒŽ‹–ƒ–‹˜‡ ”‡•‡ƒ” Š ™‹–Š Š‹•–‘”‹ ƒŽ •–—†› ƒ† ’Š‹Ž‘•‘’Š‹ ƒŽ ƒƒŽ›•‹•Ǥ. 1. . 1.4 Description and prescription ˆ‹ƒŽ™‘”†‘†‡• ”‹’–‹‘•ƒ†’”‡• ”‹’–‹‘•‹•”‡“—‹”‡†„‡ˆ‘”‡™‡‘˜‡‘Ǥ‹–Š ”‡•’‡ ––‘–Š‡ƒ’’Ž‹ ƒ–‹‘‘ˆ‡’‹”‹ ƒŽ‡–Š‘†•‹’Š‹Ž‘•‘’Š›‘ˆ’•› Š‹ƒ–”›ǡƒ†‹ –Š‹• ‹•–ƒ ‡ ‹ –Š‡ ƒ•‡ ‘ˆ –Š‡ ƒ’’Ž‹ ƒ–‹‘ –‘ ‡–Š‹ •ǡ  ‹ŽŽƒ ƒ† ‘’‡ ȋʹͲͲͺȌ address worries attached to the concept of ‘empirical ethics’, a research field ‹–‡‰”ƒ–‹‰•‡‡‹‰Ž› ‘ˆŽ‹ –‹‰‡’‹”‹ ƒŽƒ†‡–Š‹ ƒŽ‡–Š‘†•ǤŠ‡›ˆ‹”•–ƒ”‰—‡ǡ ‹ ƒ‰”‡‡‡– ™‹–Š –Š‡ Ž‹‡ ‘ˆ ”‡ƒ•‘‹‰ ‹ –Š‹• ‹–”‘†— –‹‘ǡ ˆ‘” –Š‡ ’”‹ƒ › ‘ˆ issues rather than methodologies for determining one’s (research) field of interest: methodologies are tools, and follow aims. They then refer to Hume’s is/ought 23.

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