Gerrit Glas

This book focuses on two important, interlinked themes in psychiatry, i.e., the relation between self (or: person), context and psychopathology; and the intrinsic value-ladenness of psychiatry as a practice. Written against the background of scientistic tendencies in today’s psychiatry, it is argued in Part I that psychiatry needs a clinical conception of psychopathology alongside more traditional scientific conceptions; that this clinical conception of psychopathology must be based on a fundamental rethinking of the interaction between illness manifestations, contextual influences and the patient as person, such that psychopathology is conceived as the product of this interaction rather than as the outward manifestation of a broken mechanism within the patient. In Part II, it is shown that self- and context-related factors have a large impact on who one is as a professional. I argue that an analysis is needed of the normative aspects of the relations that sustain and frame professional role-fulfilment. This analysis culminates into a so-called normative practice model (NPM) which distinguishes between qualifying, conditioning and foundational principles (or: rules, norms). The normative practice model helps to locate and resist scientistic defenses of the legitimacy of psychiatry and to replace them by a positive account that provides clinicians (and scientists) the conceptual tools they need to justify what they do in broader contexts. The main thrust of the argument is to show that psychiatry needs a value-sensitive account of its legitimacy, in which other normative dimensions are recognized than those that sustain the expert role. Psychiatrists should in other words not defend the legitimacy of their profession by referring to the expert role solely but provide a broader account in which justice is done to the broader social, legal, and economic contexts of professional activity. The analysis of this inherent normativity begins within clinical practice, it extends to the concept of disease as well as to wider domains of psychiatric care and the sociology of professions, and, finally, amounts into an analysis of the value-ladenness of interactions between healthcare institutions, the government, professional organizations and patient groups.

Philosophical issues with respect to anxiety and its pathological variants arise at the border between everyday and clinical understanding of anxiety, between clinical and scientific approaches and between scientific concepts and the philosophical frameworks they refer to. These four ways of understanding can be seen as epistemic levels that point at different aspects and qualities of anxiety. After a brief historical introduction the three interfaces will be discussed. Philosophical questions at the interface between the first two levels relate to the issue of where to draw the boundary between normal and pathological manifestations of anxiety and of how to balance the medical view with everyday understandings of anxiety. At the interface between clinical and scientific approaches, the question arises whether scientific theories and models are adequate, more particularly, which aspects of the clinical picture can be explained by scientific theories and concepts. The third interface, between scientific concepts and the philosophical frameworks they presuppose, is the origin of debates about what belongs to science and what should be regarded as meta-theoretical or paradigmatic. To what extent does a particular scientific concept stand on its own and to what extent does it borrow from pre-theoretical and/or philosophical views?

This is the second of three articles on the relationship between science, religion and professional practice in psychology and psychiatry. The first article pointed out that the weakness of the integration debate consists of lack of awareness of the epistemological distinction between everyday knowledge, professional knowledge, scientific knowledge and philosophical assumptions. This article shows how the integration debate gains new impetus by relating knowledge to practices and by investigating the intrinsic normative nature of professional practices. In the first part of the article I will analyze the structure of professional practices (psychiatry; psychotherapy), in order to gain insight into the role of norms and values in these practices. In the second part I show how the notion of integration can be elaborated upon along the dimensions of structure (levels; functions) and direction (opening-up; disclosure). It appears that the I-self relationship plays a crucial role in the conceptualization of the relation between these two dimensions