Meaning and Matter in Psychiatry: A Historical View and New Approach

Abstract

In this article, I argue that a person-centered approach in psychiatry needs to pay attention to how mental illnesses are historically constituted and products of biological, social, psychological and cultural factors. Even if the ambition of the biopsychosocial model and the medical network model was to break with reductionist understandings of (mental) illness, I argue that these models risk stabilising, rather than deconstructing dichotomies between nature versus culture, brain versus mind, somatic versus mental or hard facts versus soft sciences. I rather propose to re-orient psychiatry as a form of “relational medicine” in which causes and reasons are treated as inseparable and where matter and meaning are entangled. A person-centered approach in psychiatry must start with the person including the embodied production of meaning in Society.

Philosophical health: Unveiling the patient's personal philosophy with a person‐centred method of dialogue

“…29 The problem here is not methodological reductionism in itself: authors in the field readily acknowledge that the received scientific approach is an appropriate methodology in many areas of scientific research, whose employment has unquestionably expanded our knowledge of biological processes. 9,16,18,21 The problem, instead, is that methodological reductionism all too easily slips into philosophical reductionism: from noting that the science of neurology has shown that specific brain processes are necessary if human emotions are even to be possible, some authors are inclined to conclude that a 'full' mapping of these chemical processes can tell us 'what emotions really are' 30,31 -as though the person's understanding of her own emotions could in principle be not only enhanced but actually replaced by the scientific account. Indeed, on this view, some are tempted to say it is the expert in neurology who knows what the emotional states of a given patient 'really are', not the patient actually experiencing those emotions and struggling to live with the problems they present.…”

“…17,33 Thus, our notions of freedom, purpose and value become false beliefs to be explained away by science. [17][18][19]21 As Stephen Tyreman notes, this reductionist mindset is highly pervasive. It generates the idea that society and culture should ultimately be reduced to psychology, which should, in turn, be reduced to biology, which should, in turn, be reduced to chemistry and physics.…”

“…The question then arises as to how we reintroduce the more holistic understandings of organisms, persons and communities that defenders of PCC have argued are urgently needed to inform healthcare practice and to make us ready for the health challenges confronting us in future. 3,[16][17][18][19][20][21] We believe the philosophical health approach can significantly contribute.…”

“…Both PCC and the philosophical health approach are, in part, a reaction against the dominance of ‘reductionist accounts of the person and the sort of narrow scientism that threatens to reduce both professional judgement and patient care to forms of technocracy’ 29 . The problem here is not methodological reductionism in itself: authors in the field readily acknowledge that the received scientific approach is an appropriate methodology in many areas of scientific research, whose employment has unquestionably expanded our knowledge of biological processes 9,16,18,21 . The problem, instead, is that methodological reductionism all too easily slips into philosophical reductionism: from noting that the science of neurology has shown that specific brain processes are necessary if human emotions are even to be possible, some authors are inclined to conclude that a ‘full’ mapping of these chemical processes can tell us ‘what emotions really are’ 30,31 —as though the person's understanding of her own emotions could in principle be not only enhanced but actually replaced by the scientific account.…”

“…Just as person‐centred care (PCC) represents a movement beyond previously dominant reductionist, mechanistic conceptions of physical and psychological health, 3,15–19 philosophical health is envisaged as a complement to physical and psychological health as they are currently understood in practice. Without abandoning the critical insights derived from reductionist, biomedical or quantitative accounts of persons and organisms, we need to revive ideas—regarding purpose, coherence, meaning and how people make sense of their lives—that are indispensable components of our understanding of a person's autonomy and well‐being, but have been side‐lined in the modern era 3,9,11–13,20,21 .…”