John McDowell's contribution to philosophy has ranged across Greek philosophy, philosophy of language, philosophy of mind, metaphysics and ethics. His writings have drawn on the works of, amongst others, Aristotle, Kant, Hegel, Frege, Russell, Wittgenstein, Sellars, and Davidson. His contributions have made him one of the most widely read, discussed and challenging philosophers writing today. This book provides a careful account of the main claims that McDowell advances in a number of different areas of philosophy. The interconnections between the different (...) arguments are highlighted and Tim Thornton shows how these individual projects are unified in a post-Kantian framework that articulates the preconditions of thought and language. Thornton sets out the differing strands of McDowell's work prior to, and leading up to, their combination in the broader philosophical vision revealed in "Mind and World" and provides an interpretative and critical framework that will help shape ongoing debates surrounding McDowell's work. An underlying theme of the book is whether McDowell's therapeutic approach to philosophy, which owes much to the later Wittgenstein, is consistent with the substance of McDowell's discussion of nature that uses the vocabulary of other philosophers including, centrally, Kant. (shrink)

Essential Philosophy of Psychiatry is a concise introduction to the growing field of philosophy of psychiatry. Divided into three main aspects of psychiatric clinical judgement, values, meanings and facts, it examines the key debates about mental health care, and the philosophical ideas and tools needed to assess those debates, in six chapters. In addition to outlining the state of play, Essential Philosophy of Psychiatry presents a coherent and unified approach across the different debates, characterized by a rejection of reductionism and (...) an emphasis on the ineliminability of uncodified skilled judgement. The first part, Values, outlines the debate about whether diagnosis of mental illness is essentially value-laden and argues that the prospects for reducing illness or disease to plainly factual matters are poor. It also explains the important role of skilled contextual judgement, rather than a principles-based deduction, in ethical judgement. The second part, Meanings, examines the central role of understanding and a shared first person perspective, both against attempts to reduce meaning to basic information-processing mechanisms and to explain away the difficulties of understanding psychopathology in recent models of delusion. The third part, Facts, shows the importance of uncodified clinical judgements, both in assessing the validity of psychiatric taxonomy and in the application of Evidence Based Medicine. Despite advances in the codifaction of practice and operationalism of diagnosis, an element of judgement remains in the assessment both of what, at one level, is good evidence for diagnosis and treatment and what, at a higher level, is good evidence for the validity of classification overall. (shrink)

Values based practice is a radical view of the place of values in medicine which develops from a philosophical analysis of values, illness and the role of ethical principles. It denies two attractive and traditional views of medicine: that diagnosis is a merely factual matter and that the values that should guide treatment and management can be codified in principles. But it goes further in the adoption of a radical liberal view: that right or good outcome should be replaced by (...) right process. I describe each of these three claims but caution against the third. (shrink)

Tacit knowledge is the form of implicit knowledge that we rely on for learning. It is invoked in a wide range of intellectual inquiries, from traditional academic subjects to more pragmatically orientated investigations into the nature and transmission of skills and expertise. Notwithstanding its apparent pervasiveness, the notion of tacit knowledge is a complex and puzzling one. What is its status as knowledge? What is its relation to explicit knowledge? What does it mean to say that knowledge is tacit? Can (...) it be measured? Recent years have seen a growing interest from philosophers in understanding the nature of tacit knowledge. Philosophers of science have discussed its role in scientific problem-solving; philosophers of language have been concerned with the speaker's relation to grammatical theories; and phenomenologists have attempted to describe the relation of explicit theoretical knowledge to a background understanding of matters that are taken for granted. This book seeks to bring a unity to these diverse philosophical discussions by clarifying their conceptual underpinnings. In addition the book advances a specific account of tacit knowledge that elucidates the importance of the concept for understanding the character of human cognition, and demonstrates the relevance of the recommended account to those concerned with the communication of expertise. The book will be of interest to philosophers of language, epistemologists, cognitive psychologists and students of theoretical linguistics. (shrink)

Psychiatry is unique in medicine in being on the border between science and the humanities. Science provides insight into the 'causes' of a problem, enabling us to formulate an 'explanation', while the humanities provide insight into its 'meanings' and helps with our 'understanding'. The new interdisciplinary field of 'philosophy of psychiatry' has developed to explore the range of issues relevant to this border country. The Oxford Textbook of Philosophy and Psychiatry is a unique textbook which provides a detailed introduction to (...) the field, a framework for study and skill development, and an overview of current research. It focuses on case studies in 5 key topic areas. Each case study is supported by selected readings from both philosophy and mental health, thinking skills exercises, self-test questions, key learning points and detailed guides to further reading. (shrink)

Philosophy has much to offer psychiatry, not least regarding ethical issues, but also issues regarding the mind, identity, values, and volition. This has become only more important as we have witnessed the growth and power of the pharmaceutical industry, accompanied by developments in the neurosciences. However, too few practising psychiatrists are familiar with the literature in this area. -/- The Oxford Handbook of Philosophy and Psychiatry offers the most comprehensive reference resource for this area ever published. It assembles challenging and (...) insightful contributions from key philosophers and others to the interactive fields of philosophy and psychiatry. Each contributions is original, stimulating, thorough, and clearly and engagingly written - with no potentially significant philosophical stone left unturned. Broad in scope, the book includes coverage of several areas of philosophy, including philosophy of mind, science, and ethics. For philosophers and psychiatrists, The Oxford Handbook of Philosophy and Psychiatry is a landmark publication in the field - one that will be of value to both students and researchers in this rapidly growing area. (shrink)

One of the tasks that recent philosophy of psychiatry has taken upon itself is to extend the range of understanding to some of those aspects of psychopathology that Jaspers deemed beyond its limits. Given the fundamental difficulties of offering a literal interpretation of the contents of primary delusions, a number of alternative strategies have been put forward including regarding them as abnormal versions of framework propositions described by Wittgenstein in On Certainty. But although framework propositions share some of the apparent (...) epistemic features of primary delusions, their role in partially constituting the sense of inquiry rules out their role in helping to understand delusions. (shrink)

The paper outlines the role that tacit knowledge plays in what might seem to be an area of knowledge that can be made fully explicit or codified and which forms a central element of Evidence Based Medicine. Appeal to the role the role of tacit knowledge in science provides a way to unify the tripartite definition of Evidence Based Medicine given by Sackett et al: the integration of best research evidence with clinical expertise and patient values. Each of these three (...) elements, crucially including research evidence, rests on an ineliminable and irreducible notion of uncodified good judgement. (shrink)

Medicine involves specific practical expertise as well as more general context-independent medical knowledge. This raises the question, what is the nature of the expertise involved? Is there a model of clinical judgement or understanding that can accommodate both elements? This paper begins with a summary of a published account of the kinds of situation-specific skill found in anaesthesia. It authors claim that such skills are often neglected because of a prejudice in favour of the ‘technical rationality’ exemplified in evidence-based medicine (...) but they do not themselves offer a general account of the relation of practical expertise and general medical knowledge. The philosopher Hubert Dreyfus provides one model of the relation of general knowledge to situation-specific skilled coping. He claims that the former logically depends on the latter and provides two arguments, which I articulate in the second section, for this. But he mars those arguments by building in the further assumption that such situation-specific responses must be understood as concept-free and thus mindless. That assumption is held in place by three arguments all of which I criticize in the next section to give a unified account of clinical judgement as both practical and conceptually structured and thus justified in the face of a prejudice in favour of ‘technical rationality’. (shrink)

The recovery model has been put forward as a rival to the biomedical model in mental healthcare. It has also been invoked in debate about public policy for individual and community mental health and the broader goal of social inclusion. But this broader use threatens its status as a genuine model, distinct from others such as the biomedical model. This paper sets out to articulate, although not to defend, a distinct recovery model based on the idea that mental health is (...) an essentially normative or evaluative notion. It also aims to show that, supposing this suggestion were to be followed, the norms informing our notion of recovery would be more appropriately construed as eudaimonic than as hedonic in character. (shrink)

The idea that psychiatry contains, in principle, a series of levels of explanation has been criticised both as empirically false but also, by Campbell, as unintelligible because it presupposes a discredited pre-Humean view of causation. Campbell’s criticism is based on an interventionist-inspired denial that mechanisms and rational connections underpin physical and mental causation respectively and hence underpin levels of explanation. These claims echo some superficially similar remarks in Wittgenstein’s Zettel. But attention to the context of Wittgenstein’s remarks suggests a reason (...) to reject explanatory minimalism in psychiatry and reinstate a Wittgensteinian notion of level of explanation. Only in a context broader than the one provided by interventionism is the ascription of propositional attitudes, even in the puzzling case of delusions, justified. Such a view, informed by Wittgenstein, can reconcile the idea that the ascription mental phenomena presupposes a particular level of explanation with the rejection of an a priori claim about its connection to a neurological level of explanation. (shrink)

In Paradoxes of Delusion, Sass aims to use passages from Wittgenstein to characterize the feeling of “mute particularity” that forms a part of delusional atmosphere. I argue that Wittgenstein’s discussion provides no helpful positive account. But his remarks on more everyday cases of the uncanny and the feeling of unreality might seem to promise a better approach via the expressive use of words in secondary sense. I argue that this also is a false hope but that, interestingly, there can be (...) no interesting or substantial explanation of this failure. (shrink)

There has been a recent growth in philosophy of psychiatry that draws heavily (although not exclusively) on analytic philosophy with the aim of a better understanding of psychiatry through an analysis of some of its fundamental concepts. This 'new philosophy of psychiatry' is an addition to both analytic philosophy and to the broader interpretation of mental health care. Nevertheless, it is already a flourishing philosophical field. One indication of this is the new Oxford University Press series International Perspectives in Philosophy (...) and Psychiatry seven volumes of which (by Bolton and Hill; Bracken and Thomas; Fulford, Morris, Sadler, and Stanghellini; Hughes, Louw, and Sabat; Pickering; Sadler; and Stanghellini) are examined in this critical review. (shrink)

Introduction. Whatever its underlying causes, even the description of the phenomenon of thought insertion, of the content of the delusion, presents difficulty. It may seem that the best hope of a description comes from a broadly cognitivist approach to the mind which construes content-laden mental states as internal mental representations within what is literally an inner space: the space of the brain or nervous system. Such an approach objectifies thoughts in a way which might seem to hold out the prospect (...) of describing the ''alienated'' relation to one's own thoughts that seems to be present in thought insertion.1 Method. Firstly, I examine the general structure of cognitivist accounts of intentional or content-laden mental states. I raise the general difficulty of explaining how free-standing, and thus world-independent, inner states can still have bearing on the outer world. Secondly, I briefly examine Frith's model for explaining thought insertion and other passivity phenomena by postulating a failure of an internal monitoring mechanism of inner states. I question what account can be given of non-pathological cases and raise two specific objects. Results. Cognitivist accounts of the mind face a general, and possibly insuperable, challenge: explaining the intentionality of mental states in non-intentional, non- question-begging terms. There have so far been no satisfactory solutions. Cognitivist accounts of passivity phenomena in terms of a failure of internal monitoring face two objections. Firstly, accounting for non-pathological cases generates an infinite regress. Secondly, no account can be given of the paradoxical nature of utterances of the form of Moore's paradox: ''it is raining but I do not believe it''. Conclusions. A cognitivist approach presents an alienated account of thought in normal, non-pathological cases and is no help in accounting for thought insertion. (shrink)

Summary The aim of this paper is three-fold. Firstly, to briefly set out how strategic choices made about theorising about intentionality or content have actions at a distance for accounting for delusion. Secondly, to investigate how successfully a general difficulty facing a broadly interpretative approach to delusions might be eased by the application of any of three Wittgensteinian interpretative tools. Thirdly, to draw a general moral about how the later Wittgenstein gives more reason to be pessimistic than optimistic about the (...) prospects of a philosophical psychopathology aimed at empathic understanding of delusions. (shrink)

Jaspers’s binary distinction between understanding and explanation has given way first to a proliferation of explanatory levels and now, in John Campbell’s recent work, to a conception of explanation with no distinct levels of explanation and no inbuilt rationality requirement. I argue that there is still a role for understanding in psychiatry and that is to demystify the assumption that the states it concerns are mental. This role can be fulfilled by placing rationality at the heart of understanding without a (...) commitment to the attempt to use rationality to shed light on interpretation and mindedness as though from outside those notions. Delusions still present a significant challenge to philosophical attempts at understanding, but this merely reflects the genuine clinical difficulties such states present. (shrink)

Values based practice (VBP) is a radical view of the place of values in medicine which develops from a philosophical analysis of values, illness and the role of ethical principles. It denies two attractive and traditional but misguided views of medicine: that diagnosis is a merely factual matter and that the values that should guide treatment and management can be codified in principles. But, in the work of KWM (Bill) Fulford, it goes further in the form of a radical liberal (...) view: that the idea of an antecedently good outcome should be replaced by that of a right process. That however leads to a dilemma as to whether it can account for its own normative status. Given that difficulty, why might one adopt the radical version? I sketch a possible motive drawing on Rorty’s rejection of authoritarianism which replaces objectivity with solidarity as the aim of judgement. But I argue that, nevertheless, this does not justify the rejection of the more modest particularist version of VBP. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Compelling ReasonsTim Thornton, MA, MPhil, PhD, DLitt (bio)There are many compelling reasons to have an interest in the philosophy of/and psychiatry. In 1994, when persuaded by Bill Fulford to walk down the corridor at Warwick University to join in his teaching of what seemed a newly developing subject—against my protestations that I knew nothing about mental health care—my main interest was in the irreducibility of meaning to the 'realm (...) of [natural scientific] law,' in Sellars's phrase. This had the bonus of complementing Bill's championing of the irreducibility and centrality of values in psychiatry. (It was only later we realized we disagreed about the not inconsequential issue of whether norms and values were subjective preferences or objective features of the world.) It seemed plausible to me that the irreducibility of the space of reasons to the realm of law might have interesting consequences for psychiatry. But mine was a purely disinterested academic interest. This is perhaps the usual approach to what is in part a professionalized academic subject with its formal rules for publication and dissemination of research.It has only been in the last decade that I have experienced things in a more personal way, following what I would term, though psychiatry would not, a nervous breakdown. My image of a breakdown came from reading Saul Bellow's novel Herzog. The titular Herzog has been left by his wife, cruelly, and retires from academic life to write letters. For example, to Heidegger. "Dear Doktor Professor Heidegger, I should like to know what you mean by the expression 'the fall into the quotidian.' When did this fall occur? Where were we standing when it happened?" I thought I would be able to maintain some sort of inquiring mind and write experientially grounded philosophy of psychiatry as a catharsis. I could study my own illness. This immediately proved a ridiculous hope.As a philosopher with a cognitivist bent—language, thought, and intentionality being guiding interests—I had always assumed that madness was only really a matter of what Jaspers calls 'primary delusions,' belief-like states that strain their belief-status, are hard for others to make sense of, and occur only with particularly severe forms of mental illness. But madness is also a matter of doing, saying and feeling as well as pure reasoning. What I would, previously and disinterestedly, have described as a dysregulation of emotional reactions turned out to transform my entire experience of the world and my ability to think rationally about it. I lost the ability to put my experiences into words. In truth, I lost all interest in that project. Only when not distressed could I take a view on my loss of world. Distressed, I did not understand myself.This is a neat illustration of epistemic disjunctivism. But it also highlights a challenge for, and some of the brilliance in those who have contributed to, the philosophy of mental health care, through their expertise by experience. While experience may be a necessary condition for particular forms of expertise, my own case reveals that it is not sufficient. Further, even an everyday and familiar mental illness (like my own) can render the articulation of experience, in a way that makes sense to others, very much harder. Hence the fact [End Page 11] that there is a thriving mental health service and patient movement, making their own experiences available to others combining first-person narratives with conceptual and phenomenological insight is both admirable and helps to set a part of PPP's future agenda: bringing first-person experience within a philosophically and clinically informed discipline. [End Page 12]Tim Thornton Tim Thornton, MA, MPhil, PhD, DLitt, is Professor of Philosophy and Mental Health and Mental Health and Deputy Head for Research in the School of Nursing at the University of Central Lancashire. As well as contemporary philosophy of thought and language, his research concerns conceptual issues at the heart of mental health care. He has published research papers on clinical judgement, idiographic and narrative understanding, the interpretation of psychopathology and reductionism and social constructionism in psychiatry.Copyright © 2023 Johns Hopkins University Press... (shrink)

There has been considerable recent philo- sophical work on the nature of mental illness. Two..

The notion of capacity implicit in the Mental Capacity Act is subject to a tension between two claims. On the one hand, capacity is assessed relative to a particular decision. It is the capacity to make one kind of judgement, specifically, rather than another. So one can have capacity in one area and not have it in another. On the other hand, capacity is supposed to be independent of the ‘wisdom’ or otherwise of the decision made. (‘A person is not (...) to be treated as unable to make a decision merely because he makes an unwise decision.’ Department of Constitutional Affairs 2005, section 1). One may have capacity even if the decision one arrives at is seen as unwise by one’s doctor. In this short note, I explore this .. (shrink)

Psychopathy is often used to settle disputes about the nature of moral judgment. The “trolley problem” is a familiar scenario in which psychopathy is used as a test case. Where a convergence in response to the trolley problem is registered between psychopathic subjects and non-psychopathic subjects, it is assumed that this convergence indicates that the capacity for making moral judgments is unimpaired in psychopathy. This, in turn, is taken to have implications for the dispute between motivation internalists and motivation externalists, (...) for instance. In what follows, we want to do two things: firstly, we set out to question the assumption that convergence is informative of the capacity for moral judgment in psychopathy. Next, we consider a distinct feature of psychopathy which we think provides strong grounds for holding that the capacity for moral judgment is seriously impaired in psychopathic subjects. The feature in question is the psychopathic subject’s inability to make sincere apologies. Our central claim will be this: convergence in response to trolley problems does not tell us very much about the psychopathic subject’s capacity to make moral judgments, but his inability to make sincere apologies does provide us with strong grounds for holding that this capacity is seriously impaired in psychopathy. (shrink)

This chapter sets out an account of tacit knowledge as conceptually structured, situation specific practical knowledge. It sets this out against two claims from Michael Polanyi which conjoin the idea that we know more than we can tell with the suggestion that knowledge is practical. Any account of tacit knowledge which attempts to respond to Polanyi’s first claim faces a twofold test of adequacy. It must be tacit and it must be knowledge. To count as knowledge some content must be (...) known but that puts pressure on its tacit status. What stops such a content being put into words? I reject Polanyi’s attempt to answer this based on a distinction between focal and subsidiary awareness. And I reject Harry Collins’ process-based approach that looks more to ontology than epistemology or reference more than sense. By equating tacit knowledge with conceptually structured, situation specific practical knowledge or know-how, I show the respect in which it remains tacit. Although it can be expressed in demonstrations, and is related to concepts, it cannot be expressed in words alone. (shrink)

Idiographic understanding has been proposed as a response to concern that criteriological diagnosis cannot capture the nature of human individuality. It can seem that understanding individuals requires, instead, a distinct form of ‘individualised’ judgement and this claim receives endorsement by the inventor of the term ‘idiographic’, Wilhelm Windelband. I argue, however, that none of the options for specifying a model of individualised judgement, to explain what idiographic judgement might be, will work. I suggest, at the end, that narrative, rather than (...) idiographic, understanding is a more promising response to the limitations of criteriological diagnosis. (shrink)

Psychiatric diagnosis depends, centrally, on the transmission of patients’ knowledge of their experiences and symptoms to clinicians by testimony. In the case of non-native speakers, the need for linguistic interpretation raises significant practical problems. But determining the best practical approach depends on determining the best underlying model of both testimony and knowledge itself. Internalist models of knowledge have been influential since Descartes. But they cannot account for testimony. Since knowledge by testimony is possible, and forms the basis of psychiatric diagnosis, (...) its very existence is a factor in support of an externalist model of knowledge in general. Internalist and externalist models of knowledge also suggest different ways of responding to the practical challenges of basing psychiatric diagnosis on testimony. Thus the argument in favour of externalism also supports a potentially empirically testable hypothesis about interpretation of non-native speakers for accurate psychiatric diagnosis: interpretation of non-English speakers should be as transparent and unhindered by specialised medical knowledge as possible. (shrink)

The very idea of mental illness is contested. Given its differences from physical illnesses, is it right to count it, and particular mental illnesses, as genuinely medical as opposed to moral matters? One debate concerns its value-ladenness, which has been used by anti-psychiatrists to argue that it does not exist. Recent attempts to define mental illness divide both on the presence of values and on their consequences. Philosophers and psychiatrists have explored the nature of the general kinds that mental illnesses (...) might comprise, influenced by psychiatric taxonomies such as the Diagnostic and Statistical Manual and the International Classification of Diseases, and the rise of a rival biological ‘meta-taxonomy’: the Research Domain Criteria (RDoC). The assumption that the concept of mental illness has a culturally invariant core has also been questioned. This book serves as a guide to these contested debates. (shrink)

The World Psychiatric Association has emphasised the importance of idiographic understanding as a distinct component of comprehensive assessment but in introductions to the idea it is often assimilated to the notion of narrative judgement. This paper aims to distinguish between supposed idiographic and narrative judgement. Taking the former to mean a kind of individualised judgement, I argue that it has no place in psychiatry in part because it threatens psychiatric validity. Narrative judgement, by contrast, is a genuinely distinct complement to (...) criteriological diagnosis but it is, nevertheless, a special kind of general judgement and thus can possess validity. To argue this I first examine the origin of the distinction between idiographic and nomothetic in Windelband’s 1894 rectorial address. I argue that none of three ways of understanding that distinction is tenable. Windelband’s description of historical methods, as a practical example, does not articulate a genuine form of understanding. A metaphysical distinction between particulars and general kinds is guilty of subscribing to the Myth of the Given. A distinction based on an abstraction of essentially combined aspects of empirical judgement cannot underpin a distinct empirical method. Furthermore, idiographic elements understood as individualised judgements threaten the validity of psychiatric diagnosis. In the final part I briefly describe some aspects of the logic of narrative judgements and argue that in the call for comprehensive diagnosis, narrative rather than idiographic elements have an important role. Importantly, however, whilst directed towards individual subjects, narratives are framed in intrinsically general concepts and thus can aspire to validity. (shrink)

Both anti-reductionist and reductionist accounts of linguistic meaning and mental content face challenges accounting for acquiring concepts as part of learning a first language. Anti-reductionists cannot account for a transition from the pre-conceptual to conceptual without threatening to reduce the latter to the former. Reductionists of a representationalist variety face the challenge of Fodor’s argument that language learning is impossible. This paper examines whether Ginsborg’s account of ‘primitive normativity’ might provide some resources for addressing these issues. I argue that primitive (...) normativity can be understood in either of two ways: a ‘no conception’ version and a ‘local conception’ version. Rejecting the ‘no conception’ account of normativity in favour of a ‘local conception’ of a rule expressed in context-dependent demonstrations and examples provides one response to Fodor’s argument. It also provides anti-reductionism with at least one stepping stone to learning full-blown linguistically articulated concepts based on a more primitive local form of normativity. (shrink)

In “semantic vagueness in Psychiatric Nosology,” Nicholas Tilmes offers a conditional claim for further consideration. The conditional is that “if psychiatric vagueness exists, there is reason to think that some cases of it are at least partially semantic.” From this, some conclusions worth investigating follow. In this brief commentary I will set out a question Tilmes introduces by, like him, drawing on a paper by Miriam Schoenfield, which also examines vagueness as semantic, epistemic or ontic though she draws a contrasting (...) conclusion for her subject matter: moral judgment. Highlighting a supposed contrast between semantic and ontic vagueness will also highlight an issue for... (shrink)

KEYWORDS: Validity, reliability, values, taxonomy, clas- sification, McDowell.

Person Centred Medicine is a substantial and contentious view of healthcare that carries both ontological and epistemological presuppositions. This chapter examines two key aspects: that the person is a central, basic irreducible element in ontology and that person-level knowledge is both important and possible. Some reasons for holding both of these are sketched.

It seems obvious that one of the harms that dementia does is to undermine the person’s identity. One reason for thinking this is that personal identity has long been associated with continuity of a subjective perspective on the world held together by memory that that memory is severely curtailed in dementia. Hence dementia seems to threaten an individual’s identity as a particular person, gradually undermining it. But the necessity of the connection has been criticised by a number of philosophers and (...) healthcare professionals who subscribe to a narrative account of personal identity. If personal identity is constituted through a personal narrative rather than, for example, a memory connection, then while the capacity to author a self-narrative also seems to be threatened by dementia, that need not undermine personal identity providing that the narrative that constitutes identity can be co-constructed. In this paper I set out the danger of any such view, explore its motivations and provide a minimal account of the role of narrative in dementia making use of the Wittgensteinian notion of secondary sense. (shrink)

John McDowell is one of the most widely read philosophers in recent years. His engagement with a philosophy of language, mind and ethics and with philosophers ranging from Aristotle and Wittgenstein to Hegel and Gadamer make him one of the most original and outstanding philosophical thinkers of the post-war period. In this clear and engaging book Tim Thornton introduces and examines the full range of McDowell's thought. After a helpful introduction setting out McDowell's general view of philosophy Thornton introduces and (...) explains the following topics: • Wittgenstein on philosophy, normativity and understanding • value judgements • theories of meaning and sense • singular thought and Cartesianism • experience, knowledge and openness to the world • Mind and World and idealism • action and the debate with Hubert Dreyfus on conceptual content and skilled coping. This second edition has been significantly revised and expanded to include new sections on: McDowell's work on disjunctivism and criticisms of it; a new chapter on McDowell's modification of his account of perceptual experience and conceptual content and criticisms by Charles Travis; and a new chapter on action and McDowell's engagement with Hubert Dreyfus and the debate concerning skilled coping and mindedness. The addition of a glossary makes John McDowell, second edition essential reading for those studying McDowell, philosophy of language, philosophy of mind, ethics and epistemology, as well as for students of the recent history of analytical philosophy generally. Tim Thornton is Professor of Philosophy and Mental Health at University of Central Lancashire, UK. He is author of Essential Philosophy of Psychiatry (2007), Wittgenstein on Language and Thought (1998), co-author of the Oxford Textbook of Philosophy and Psychiatry (2006), and Tacit Knowledge (2013) and co-editor of the Oxford Handbook of Philosophy and Psychiatry (2013). (shrink)

According to the recovery model, mental healthcare should be aimed towards a conception of recovery articulated by a patient or service user in accord with his or her own specific values. The model thus presupposes and emphasises the agency of the patient and opposes paternalism. Recent philosophical work on the relations between respect, self-respect, self-esteem, shame, and agency suggests, however, two ways in which mental illness itself can undermine self-respect, promote shame and undermine agency, suggesting a tension within the recovery (...) model. I argue, however, that this is a tension rather than a fatal flaw by distinguishing between paternalist and non-paternalist clinical responses to this failure of agency. (shrink)

Psychiatry’s inchoate wish for a paradigm shift and the biopsychosocial model of mental illness’ critically examines the much discussed goal of a paradigm shift in psychiatric taxonomy. The chapter first highlights some illustrative calls for such a change and then sets these against the Kuhnian account of science from which the idea is taken, highlighting the connection to incommensurability. Relative to a distinction drawn from Winch, between putative sciences where the self-understanding of subjects plays no role and those where it (...) is fundamental, psychiatry falls into the latter kind. This suggests that the wish for a paradigm shift in psychiatry is either incoherent or a wish for a radical but unpredictable overhaul of a significant aspect of our self-understanding as subjects and agents. The biopsychosocial model of mental illness is thus a helpful reminder of the cost of a paradigm shift in psychiatry. (shrink)

Decision-making depends on bringing evidence together with values: decision theory for example employs probabilities and utilities; health economic decisions employ measures such as quality of life. The hypothesis guiding this chapter is that bringing evidence together with values in clinical decision-making requires an exercise of phronesis. Our aim however is not to justify our guiding hypothesis. It is rather to outline an account of phronesis that is in principle fit for the purposes of clinical decision-making if our guiding hypothesis is (...) correct. The chapter has three sections. Section 1 describes the growing gap between evidence and values in clinical decision-making: the missing link, we suggest, required to bridge this gap, is an appropriate account of phronesis. Section 2 provides an initial characterisation of the required account of phronesis via Michael Polanyi’s twin stipulation on the nature of tacit knowledge. Section 3 then fills out the required account using John McDowell’s characterisation of phronesis as a situation specific but at the same time conceptually structured form of practical discernment. A McDowellian account of phronesis, we argue, in satisfying Polanyi’s twin stipulation, provides an in-principle bridge between evidence and values. We conclude with a note on some of the further requirements if the gap is to be bridged not only in principle but in practice too. (shrink)

The harmful dysfunction account of disorder separates an explicitly normative or evaluative notion of harm from the idea of dysfunction which is subject to a reductionist naturalistic account. Dysfunction is analysed as a failure of function which is itself reduced via evolutionary biology. In this paper, I question this latter aspect of the account. Light can be shed on the prospect of reducing the apparently normative notion of dysfunction by comparing it with two distinct reductionist projects in the philosophy of (...) content which stand to each other as do the contrasting options in the euthyphro dilemma. A more modest project takes for granted the structure of normative relations between concepts and attempts to solve an engineering problem of how human thought can fit that structure. A more ambitious project aims to explain that structure itself in naturalistic terms. The ambitious project, however, is undermined by an argument from Wittgenstein. I argue that the harmful dysfunction analysis of disorder has to be interpreted as isomorphous with the latter project and is thus subject to the same objection. (shrink)

In response to the concern that criteriological psychiatric diagnosis, based on the DSM and ICD classifications, pigeon-holes patients, there have been calls for it to be augmented by an idiographic formulation [IDGA Workgroup, WPA 2003]. I have argued elsewhere that this is a mistake [Thornton 2008a, 2008b, 2010]. Looking back to its original proponent Wilhelm Windelband yields no clear account of the contrast between idiographic and nomothetic judgement. Abstracting from Jaspers’ account of understanding an idea of idiographic judgement based on (...) the contrast between singular and general causal relations also fails. I argue, however, that Windelband does provide a helpful clue in his remark that ‘every interest and judgement, every ascription of human value is based upon the singular and the unique... Our sense of values and all of our axiological sentiments are grounded in the uniqueness and incomparability of their object’ [Windelband 1980: 182]. This suggests a role for the idiographic not as the content of a particular kind of judgement but rather as characterising its aim. I argue that this connects to the issue of the generalisability of small scale qualitative social science research and to the critique of ‘looking away’ in moral philosophy. (shrink)

In this paper, I relate values-based practice (VBP) to clinical judgment more generally. I consider what claim, aside from the fundamental difference of facts and values, lies at the heart of VBP. Rather than, for example, construing values as subjective, I argue that it is more helpful to construe VBP as committed to the uncodifiability of value judgments. It is a form of particularism rather than principlism, but this need not deny the reality of values. Seen in this light, however, (...) VBP is part of a broader conception of clinical judgment that can be compared with Kant’s conception of reflective judgment. This is a useful way of marking similarities between a number of issues raised in philosophy, which can inform a better understanding of clinical judgment. (shrink)

This chapter gives an illustrated overview of recent philosophical work on the concept of delusion. Drawing on a number of case vignettes, examples are given of the wide range of theories that has been advanced to explain this most challenging of experiences. Some have agreed with the philosophical founder of modern descriptive psychopathology, Karl Jaspers, that delusions are “ununderstandable.” The large majority, though, has sought to understand delusion in terms of aberrations of one kind or another either of beliefs or (...) of the grounds or preconditions for beliefs. As a project in understanding, these theories offer helpful insights. A further group of theories focuses on the agential aspects of delusion as reflected, for example, in their role in the insanity defense. Agential theories converge with the person-centered approaches of contemporary empirical and clinical work on delusion. Such approaches bring an additional level of complexity in the form of delusions that are not pathological but adaptive in the life of the person concerned. As such they show the challenge of understanding delusion to be a project not just of understanding but of mutual understanding. (shrink)