•  298
    Paper: On the very idea of a recovery model for mental health
    with Peter Lucas
    Journal of Medical Ethics 37 (1): 24-28. 2011.
    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 …Read more
  •  205
    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, …Read more
  •  192
    Radical liberal values‐based practice
    Journal of Evaluation in Clinical Practice 17 (5): 988-991. 2011.
    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 …Read more
  •  148
    Psychiatric explanation and understanding
    European Journal of Analytic Philosophy 6 (1): 95-111. 2010.
    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 understa…Read more
  •  103
  •  95
    Why the idea of framework propositions cannot contribute to an understanding of delusions
    Phenomenology and the Cognitive Sciences 7 (2): 159-175. 2008.
    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 framew…Read more
  •  95
    Against Explanatory Minimalism in Psychiatry
    Frontiers of Psychiatry 6. 2015.
    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 Witt…Read more
  •  85
    Reasons and causes in philosophy and psychopathology
    Philosophy, Psychiatry, and Psychology 4 (4): 307-317. 1997.
    This paper examines the account offered by Bolton and Hill (1996) of how reasons can be causes, and thus how symptoms of mental disorders can be both caused and carry meaning. The central problem is to reconcile the causal and rationalizing powers of content-laden mental states. I draw out these two aspects by putting them in the context of recent work in analytical philosophy, including Davidson's token identity theory and his account of mental disorder. The latter, however, can be used to emph…Read more
  •  82
    Essential Philosophy of Psychiatry
    Oxford University Press. 2007.
    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, cha…Read more
  •  78
    Thought insertion, cognitivism, and inner space
    Cognitive Neuropsychiatry. 2002.
    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 …Read more
  •  75
    Capacity, Mental Mechanisms, and Unwise Decisions
    Philosophy, Psychiatry, and Psychology 18 (2): 127-132. 2011.
    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 mere…Read more
  •  68
    Clinical judgement, expertise and skilled coping
    Journal of Evaluation in Clinical Practice 16 (2): 284-291. 2010.
    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 ra…Read more
  •  57
    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 …Read more
  •  48
    Mental Illness and Reductionism: Can Functions Be Naturalized?
    Philosophy Psychiatry and Psychology 9 (1): 229-253. 2000.
    There has been considerable recent philo- sophical work on the nature of mental illness. Two..
  •  43
    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…Read more
  •  40
    An intellect in view
    The Philosophers' Magazine 46 (46): 108-110. 2009.
  •  33
    Values-Based Practice and Reflective Judgment
    Philosophy, Psychiatry, and Psychology 15 (2): 125-133. 2008.
    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 par…Read more
  •  31
    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 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 Fulford, it goes further in the form of a radical liberal view: that the idea of an anteced…Read more
  •  27
    Tacit knowledge as the unifying factor in evidence based medicine and clinical judgement
    Philosophy, Ethics, and Humanities in Medicine 1 2. 2006.
    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 includin…Read more
  •  24
    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 serie…Read more
  •  24
    Reductionism / Anti-Reductionism
    In Jennifer Radden (ed.), The Philosophy of Psychiatry: A Companion, Oxford: Oxford University Press. pp. 191. 2004.
  •  19
    Should comprehensive diagnosis include idiographic understanding?
    Medicine, Health Care and Philosophy 11 (3): 293-302. 2008.
    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…Read more
  •  18
    Delusions: A Project in Understanding
    with Kwm Filford
    In , . 2016.
    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…Read more
  •  17
    Tacit Knowledge and Its Antonyms
    Philosophia Scientiæ 17 (3): 93-106. 2013.
    Harry Collins’s Tacit and Explicit Knowledge characterises tacit knowledge through a number of antonyms: explicit, explicable, and then explicable via elaboration, transformation, mechanization and explanation and, most fundamentally, what can be communicated via “strings”. But his account blurs the distinction between knowledge and what knowledge can be of and has a number of counter-intuitive consequences. This is the result of his adoption of strings themselves rather than the use of words or…Read more
  •  17
    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 in…Read more
  •  17
    An aesthetic grounding for the role of concepts in experience in Kant, Wittgenstein and McDowell
    Forum Philosophicum: International Journal for Philosophy 12 (2): 227-245. 2007.
  •  15
    Wittgensteinian Themes: Essays 1978-1989 (review)
    Review of Metaphysics 49 (4): 931-933. 1996.
    Wittgensteinian Themes gathers together 14 previously published essays written towards the end of Malcolm's life. The majority of essays provide exegeses of Wittgenstein's thought. It is arguable that both Wittgensteinian exegesis and Wittgensteinian philosophy run the risk of parochialism. This collection makes a commendable effort to escape that charge. Even in the exegetical essays, issue is taken with conflicting contemporary philosophers whilst four essays are direct attacks on opposing phi…Read more
  •  14
    Values and the singular aims of idiographic inquiry
    In Raffaele De Luca Picione, Jensine Nedergaard, Maria Francesca Freda & Sergio Salvatore (eds.), Idiographic Approach to Health, Information Age Publishing. 2018.
    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.ing from Jaspers’ account of understandi…Read more