Tim Thornton

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

I believe that Wright’s constructivist account of intention is funda- mentally flawed [Wright 1984, 1986, 1987a, 1987b, 1988, 1989a, 1989b, 1991, 1992]. To understand why it fails it is necessary first to locate the account in its broader strategic context. That context is Wright’s response to Wittgenstein’s account of rule following. When so located the diagnosis of the account’s failure is clear. Wright’s account of intention is a species of the interpretative approach to mental content which is explicitly rejected by Wittgenstein.

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