Psychiatry and Human Nature
- Professor Gareth Owen
- 12 minutes ago
- 5 min read
I am a psychiatrist with a long interest in researching topics like mental capacity, that lie in the borderlands between psychological medicine, ethics, and law. In this context, I do something unusual for a psychiatry professor: I teach psychiatry in a law school.
Teaching fundamentals
For several years, I’ve been teaching students with a range of academic backgrounds the ‘concepts of psychiatry’ and it’s been a very stimulating part of my life as a psychiatrist.
We start off with the mind/brain problem: how do mental phenomena and physical phenomena relate? This is a problem that powerful minds over millennia have not solved to the satisfaction of philosophy, but it is a problem that psychiatry quite literally sits upon. We explore in seminars how psychiatry struggles with this problem, not as an abstract puzzle but as a deeply contextual challenge related to real people in real clinical scenarios. Students realise that they can have a very strong position on the philosophical problem whilst not implementing their position consistently across varied clinical cases which we discuss together. For example, students who strongly believe the mind/body problem is unsolveable are willing to solve it in the direction of reductive materialism (i.e., the mental reduces to the physical) when discussing a case of delirium. The human situation, with its clinical particulars, emerges as more fundamental than the generic, abstract relation.
Then we move on to the basics of psychopathology. The psychiatrist Anne Farmer once stated: "descriptive psychopathology is the basis of measurement in psychiatry" and "descriptive psychopathology requires empathy". We consider in class the significance of that statement. It implies that psychiatry as a science (its most basic measurements) require, or depend upon, an empathic function that belongs to the humanities - i.e., imagining oneself in the shoes of another human being or grasping a lived experience. We think through what it means that psychiatry, at its very roots, is an explanatory, or natural, science AND an interpretative or humanistic inquiry.
Following this, we move to classification. For example, the Diagnostic and Statistical Manual of Mental Disorders or ‘DSM’ (sometime referred to as the ‘bible’ of clinical psychiatry) and the more recent classifications based on neuroscience. We trace the various ways in which people deeply involved in mental health rebel against classification. We understand what is means to say: “time to get rid mental disorder labels!” or “biology does not read the DSM!” or “complexities of mental life do not reduce to brain circuits!”. But we also imagine, in class, a psychiatry without classification and whether that could offer help to people presenting to clinicians with suffering. Suddenly attempts to classify feel more human again.
We also consider suicide, as it is traditionally seen in psychiatry, namely as a harm to prevent. But we also consider it, as it is increasingly seen in the context of end of life, as a human right - the right to death or to assistance in suicide. How can we manage the cognitive dissonance between policies that require psychiatrists to take a ‘zero tolerance’ approach to suicide and policies requiring psychiatrists to assist people to end their own life if they choose to? Resolving that dissonance would seem to require us to consider anew what suicide means as a human behaviour both to individuals and their communities.
Towards the end, we grapple with the complexities of involuntary treatment, including accounts from ‘anti-psychiatrists’ who seek to abolish it entirely.
Traditionally, involuntary treatment is seen as necessary for public protection. We unpack the motivations of writers who want to free people with mental disorders from any psychiatric power to treat them without consent. Is their motivation a desire to move society to a place where treatment would only need to be voluntary because everyone would be sufficiently supported? Or it is a desire to move society to a place where everyone has their just deserts and where we should not seek to protect people with mental disorders from the reach of the criminal justice system or from the choice of homelessness? We then consider what patients with severe mental illness say about periods when they have been gravely ill and had involuntary treatment; or what they want to happen if they were to get gravely ill in the future.
From these accounts students often conclude that it would be inhumane not to have a framework for involuntary treatment whilst feeling motivated to try to improve it. In discussing freedom and mental disorder, we appreciate how closely psychiatry lives to politics.
All of these topics – each one core to psychiatry - relate, in different ways, to human nature. I have noticed that it can be easier to see that relation when teaching psychiatry at a basic level, as I have done in the law school for years. In psychiatric practice and research, we tend to take it for granted.
Over the years it has become clear to me how unsettled the concept of ‘human nature’ has become in general intellectual life outside of psychiatry. Our era often self-identifies as a postmodern one, namely we reject any singular story or ‘grand narrative’ about who we are as human beings, leaving a multitude of perspectives. In other words, the postmodern view takes contested interpretations of ourselves to be our lot, negating the concept of any nature. However, our era equally self-identifies as a biological one, meaning we accept an account of ourselves as a byproduct of evolutionary forces in which there is no essence or purpose that defines us other than those of the mechanisms of the natural world. Both of these influential reflections on human nature may not be compatible, but they share the feature of being curiously anti-human nature.
This combination, of teaching that psychiatry relates deeply to human nature whilst realising that our general intellectual life has become antagonistic to the idea of human nature, propelled me to writing a book about it.
In writing the book I returned to some older philosophical ideas about human nature to help with current problems.
An idea that I make use of, and build on, in my book is Goethe’s distinction between the ‘classic’ and the ‘romantic’. Roughly speaking, the ‘classic’ perspective is the human being’s capacity to detach, whilst the ‘romantic’ perspective is the human being’s capacity to participate. Becoming more aware of the classic and the romantic perspectives allows us, I argue, to balance the goals of psychiatry better. And it gives us a distinction (a dualism even) that suits our nature better than any Cartesian dualism of mind and body can.
I hope curious readers pick up the book, engage with the themes and decide how persuaded they are of a need to renew interest in psychiatry and human nature!
You can buy Professor Gareth Owen's book here.
