Tacit judgement and clinical judgement: paradoxes for theory, necessities for practice
Values Based Practice
Here is a brief introductory video.
Here are the slides with audio
Writing for publication
Philosophy and illness
Developing (= having) original (inc. research) ideas: imagination and expertise
Conceptual analysis for nurses
Thinking about recovery in personality disorder
Pathology or Difference? On the ground rules for defining mental illness
What use is philosophy for nursing?
Mental health and wellbeing
Cross-cultural psychiatry
Philosophy of healthcare at UCLan
What is mental illness anyway?.
Structure
Szasz's attack on mental illness
Kendell's defence of illness as value-free
Fulford's defence of illness as value-laden
What are the consequences if mental illness is value-laden?
Against Michael Crotty's daft view of constructionism.
Structure
An outline of Crotty’s hierarchy
An assessment of his contrast of constructionism and objectivism through quotation and interpretation
A diagnosis of his assumptions:
His objectivism is pre-modern
His constructionism reads the social history of our representations back onto the world represented.
Two complications (pre-modern objectivism may be right & representations of the world are still representations)
A final rant
Is illness a value laden concept?
• The traditional picture
• Szasz’ arguments against mental illness and their connections to values.
• Kendell’s value-free account
• Fulford value-laden overview
• Consequences?
Recovery, paternalism and narrative in mental health care
• An abstract model of recovery from typical manifestos.
• The capabilities approach
• Two versions of the capabilities approach
• Cf: two versions of vbp and autonomy
• The ubiquity of narratives in Recovery
• The role of narrative on either approach to Recovery
On the challenges of trying to extract impact from a descriptive discipline: the case of philosophy of psychiatry.
Structure
Preliminary embarrassing confession.
The general challenge for humanities and the specific problem of Wittgensteinian philosophy.
The promise of the new philosophy of psychiatry.
An illustration of a route to impact: Values Based Practice
Two so far undeveloped areas
Rash conclusions.
Values ethics and professional knowledge: evidence and intuition
Structure
Clinical expertise
Patient, and other, values.
Truth (for social scientists) 101; Or how we should learn to stop worrying and love the truth
Structure
The temptation to avoid truth.
The challenges to theories of truth
The truistic link between assertion and truth
The failure of modesty
Two examples: Kendler on coherence for psychiatry and Crotty on constructionism
Is mental illness a value laden concept?
Structure
The traditional picture.
Szasz
Kendell.
Fulford
Consequences?
Values Based Practice in an hour
Structure
There is a traditional picture in which healthcare has a medical science-based value free core surrounded by a framework of medical ethical principles.
But the core of healthcare is value-laden: the very idea of illness
And no framework of principles is enough to deal with the necessary values.
Ten principles of Values Based Practice
If clinical judgement involves tacit knowledge, what should we mean by ‘tacit’?
Healthcare is increasingly governed by clinical guidelines and formal procedures which aim to codify standards of care. But clinical judgement may be thought to resist reduction without loss to such algorithms and to involve an essentially tacit dimension. But if so, what is the nature of such a tacit dimension to healthcare? Slides.
Structure
Why might tacit knowledge help?
Some putative examples of tacit knowledge.
What is tacit knowledge? A dilemma.
Tacit knowledge as context-dependent, conceptually structured practical knowledge.
Its application to clinical judgement.
Naturalism in the philosophy of content
This session introduces the philosophy of content (as the philosophy of the intentionality or aboutness of utterances and mental states) and its key challenge (of shedding light on how both true and false thought can be possible in the face of both a dilemma and the threat of regress using discussion by Ludwig Wittgenstein) before raising the question via a passage from the contemporary US philosopher of mind Jerry Fodor of how that challenge should be addressed.
The more general question raised - for which dealing with the puzzling nature of intentionality or aboutness is just an example - is whether philosophy should aim to ease puzzlement by reducing complex concepts to more basic, perhaps scientific, concepts, or whether there is an alternative.
Structure:
A thumbnail introduction to the philosophy of ‘content’
The central challenge for the philosophy of content
Fodor’s argument for reductionism (reductionist naturalism / ‘naturalism’) as the right kind of answer.
Is there an alternative?
Values in diagnosis
This session is an introduction to the evaluative native of mental illness diagnosis as part of the UCLan NU2225 Mental Health Law module.
There is an appealing idea that diagnosis in mental health care is a purely factual, value-free and scientific matter and that values only come into play in decisions about the treatment and management of conditions. Further, such values can be codified in both a background of mental health law (setting limits to what can be done) and medical ethical principles (guiding what should be done). Both of these ideas, however, are contested by the claims that
i) There is no value free core of diagnosis
ii) Principles - whether legal or ethical - are insufficient for good practice. (That is, there is more to good practice than not breaking the law and the extra element is not captured by ethical principles either.)
This session looks at i). ii) will be part of the module on Values Based Practice.
Structure
In the lecture: Szasz' two arguments that mental illness is a myth are quoted and articulated to suggest possible responses.
But they leave in place the premiss idea that mental illness is value-laden. Does that matter? And how might it too be questioned (via biological notions)
In group work: Three approaches to defining illness in such a way that there is mental illness.
Are the first two successfully value free? Are they plausible? Is the third - value-laden - view plausible? What follows from the values?
Typically, the criteria for particular diagnoses are value laden.
The slides are here.
Anti-psychiatry
Whilst the anti-psychiatry movement of the 1960s may seem to have run its course and to have been replaced by a plethora of more nuanced, less black or white, groups such as Critical Psychiatry, a first reading of the literature of many of the recent groups can seem confusing. Is what they say really any different from the view of psychiatry which a bio-medical psychiatrist might hold? Is it just a matter of where emphasis is placed?
To get a clearer view of the these subtle modern forms of opposition to mainstream psychiatry, it is still helpful to start by looking at what the anti-psychiatrists had to say and then seeing the echo of those claims and their modification and reworking in the present day.
Nevertheless, even this is difficult since the label 'anti-psychiatry' has been used more widely than to just those who accepted it. Thomas Szasz rejected it more strongly than he rejected psychiatry. And even RD Laing grew wary of it. Still, a tour of the radical views of Cooper, Szasz, Laing and Foucault helps suggest a quite different view of the nature of mental illness diagnosis than is accepted by most of psychiatry, the echo of which can still be heard in opposition groups today.
The slides are here.
Does (good) healthcare need nurses?
Although nurses increasingly take on more specialist roles, nursing itself appears to be generalist: involving a variety of different clinical and interpersonal skills. So is the role of nursing in modern healthcare a mere historical accident to be replaced, in time, by a range of distinct skilled medical technicians? This presentation will consider what healthcare is for and hence the key central role that nurses can play in patient care.
The slides are here.
Thinking about recovery
This lecture asks some initial questions about what sort of thing a view of recovery in mental healthcare is. What claims does it make? How does it disagree with other views? How does it connect to values in mental health? What open questions does it raise as to the limits of diversity or the effects of illness on autonomy?
Slides are here.