Conceptual work to advance psychiatric and neuroscientific sophistication: a report by the WPA Section on Philosophy and Humanities in Psychiatry

During the last few decades, psychiatry has developed considerably, also owing to neuroscientific advances. These developments, however, have uncovered a multitude of complexities, reflected for example in current controversies over psychiatric classification1. The bar for conceptual sophistication by which psychiatry has to account for these complexities theoretically and clinically has consequently raised.

Physics has been in a similar situation. Its subsequent turn to conceptual tools resulted in opening up new explanations and horizons2. Equally so, psychiatry is now reconsidering its conceptual foundations, in partnership with neuroscience, with the aim of addressing its complexities. Oxford Philosophy, for example, has many faculty members working either in physics or in psychiatry and cognitive neuroscience.

This paper reports on progress in this regard, which has been the remit of the WPA Section on Philosophy and Humanities in Psychiatry. We highlight the international impetus behind the progress for both theoretical work and clinical practice.

The WPA Section on Philosophy and Humanities in Psychiatry is closely linked with the International Network for Philosophy and Psychiatry (INPP), comprising 43 national associations. Since 1994, the INPP has hosted 20 international conferences, of which most were endorsed by the WPA and the Section, held across five continents. The 20th International Conference was held in Hong Kong in 2018, and the 21st International Conference took place on October 22-24, 2019 in Warsaw, Poland.

For the past 25 years, a vast resource of scholarly articles has been generated in the peer-reviewed international journal Philosophy, Psychiatry & Psychology, published by Johns Hopkins University Press. Furthermore, since 2003, Oxford University Press has published more than 50 books in the series International Perspectives in Philosophy and Psychiatry. These include the Oxford Textbook of Philosophy and Psychiatry, a 73-chapter Oxford Handbook of Philosophy and Psychiatry, and the Oxford Handbook of Philosophy and Psychoanalysis. All these volumes are strongly international in scope, reflecting the rich traditions of thought and practice available to support the development of psychiatry from all over the world.

Members of the Section have contributed to these and other publishing initiatives both as editors and authors. Currently, the Section is supporting the production of the volume International Perspectives in Values-based Practice: Case Studies and Commentaries, forthcoming from Springer Nature.

From the vast number of international scholarly publications mentioned above, much may be gleaned regarding the specifics of both theoretical and practical progress afforded by partnership between empirical and conceptual work in psychiatry. Here we highlight two examples: one on diagnostic classification and another on a practical skills-based approach relevant not only to psychiatry but also to the rest of medicine.

A recent Forum in World Psychiatry 3, with an introductory paper and a set of commentaries, is a fine example of how empirical and conceptual work come together in diagnostic classification of psychopathology. From both clinical and philosophical backgrounds, the authors of the introductory paper represent a consortium working towards a Hierarchical Taxonomy of Psychopathology (HiTOP). Notwithstanding their emphasis on quantification, their paper accounts for much in terms of conceptual work. For example, they describe a hierarchy ranging from more general and broad to more specific and narrow concepts. They highlight furthermore the need to devise strategies “to parse similarities and differences” , and a need for “coherence in conceptualizing the entire breadth of the subject matter” since “a piecemeal classification would have limited utility in portraying the entire picture” .

The title of the paper explicitly declares its topic as conceptual. The commentaries, some of which are authored by members of our Section, clarify the premises, strengths and limitations of the paper. The pursuit of the commentaries is squarely that of conceptual work: clarification of the concepts and the reasoning applied, particularly where the complexity of the material makes clarity rather challenging, as is the case for classifying psychopathology.

The second example originates from rigorous conceptual work that drew on philosophical value theory to articulate values complexity in psychiatry4. This has led to the development of a new skills-based approach to working with complex and conflicting values in health care, called values-based practice (VBP). VBP is a partner to evidence-based practice: it links science with people5. Although developed originally in psychiatry, VBP is now being taken up in the rest of medicine: for example, the lead discipline in the Centre for Values-based Practice in Oxford is surgery. This means that psychiatry has been leading the way for the rest of medicine on how to deal practically with the emerging choices (and values driving those choices) opened up by scientific advances in medicine.

VBP is a partner not only to evidence-based practice but also to a whole range of other ways of working with values in medicine. Examples include such familiar disciplines as ethics, medical law, and health economics, but also emerging fields such as decision analysis. VBP adds to this growing toolkit of methods a particular and distinctive focus on the uniqueness of individual values. This is important particularly in psychiatry, being key to the recovery processes of generating connectedness, hope, identity, meaning and empowerment6, and has been endorsed more widely in medicine through developments in human rights legislation and medical law7.

VBP is an exemplar of how partnerships between conceptual and empirical research have brought conceptual resources to support psychiatry and other disciplines in responding appropriately to the complexities of clinical practice. VBP originates from conceptual analysis, but similar partnerships are seen in the work of Section members who have drawn on various other philosophical traditions, including phenomenology, ethics, African and Asian philosophies.

Inclusive partnerships are for example reflected in the recent Oxford Handbook of Phenomenological Psychopathology 8 and in the Oxford Handbook of Psychiatric Ethics 9, a double volume to which 149 authors across the world contributed, encompassing, in addition to a large part of the standard canon of psychiatric ethics, ground breaking domains essential to engaging with the diversity of values brought about by scientific advances in international psychiatry.