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By first analysing the arguments of psychiatry's critics and the philosophical ideas of such thinkers as Freud, Eysenck, Laing, Szasz, Sedgwick and Foucault and by then providing answers to the many contentious and diverse questions raised, Dr. Reznek aims to establish a philosophical defence of the theory and practice of psychiatry. As both a qualified philosopher and psychiatrist, the author is exceptionally p[laced to undertake the examination of a subject which has hitherto remained untackled. It will be easily accessible to a wide variety of non-specialists as well. It will be of specific interest to those involved in the practice of philosophy, psychiatry, clinical psychology, social work and psychiatric nursing.
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THE PHILOSOPHICAL DEFENCE OF PSYCHIATRY
PHILOSOPHICAL ISSUES IN SCIENCE General Editor W.H.Newton-Smith THE RATIONAL AND THE SOCIAL James Robert Brown THE NATURE OF DISEASE Lawrie Reznek INFERENCE TO THE BEST EXPLANATION Peter Lipton forthcoming TIME, SPACE AND PHILOSOPHY Christopher Ray MATHEMATICS AND THE IMAGE OF REASON Mary Tiles
THE PHILOSOPHICAL DEFENCE OF PSYCHIATRY Lawrie Reznek
London and New York
First Published 1991 by Routledge 11 New Fetter Lane, London EC4P 4EE This edition published in the Taylor & Francis e-Library, 2005. “To purchase your own copy of this or any of Taylor & Francis or Routledge’s collection of thousands of eBooks please go to www.eBookstore.tandf.co.uk.” Simultaneously published in the USA and Canada by Routledge a division of Routledge, Chapman and Hall, Inc. 29 West 35th Street, New York, NY 10001 © 1991 Lawrie Reznek All rights reserved. No part of this book may be reprinted or reproduced or utilized in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. British Library Cataloguing in Publication Data Reznek, Lawrie. The philosophical defence of psychiatry. — (Philosophical issues in science). 1. Medicine. Psychiatry I. Title II. Series 616.89 Library of Congress Cataloging in Publication Data Reznek, Lawrie. The philosophical defence of psychiatry / Lawrie Reznek. p. cm. — (Philosophical issues in science) Includes bibliographical references. Includes index. 1. Mental illness—Philosophy. 2. Psychiatry—Philosophy. I. Title. II. Series. [DNLM: 1. Philosophy, Medical. 2 Psychiatry. WM 100 R4667p] RC437.5.R49 1991 616.89′001-dc20 DNLM/DLC for Library of Congress 90–8823 CIP ISBN 0-203-98172-3 Master e-book ISBN
ISBN 0-415-03593-7 (Print Edition)
To my wife, Eleanor, For more than I can say
CONTENTS
1
2
3
4
Preface
ix
INTRODUCTION: PSYCHIATRY IN CRISIS
1
The clash of paradigms
1
The idea of a paradigm
7
Psychiatry is not a normal science
10
THE MEDICAL PARADIGM
13
The medical paradigm explained
13
The virtues of the medical paradigm
16
Challenges to the medical paradigm
24
SIGMUND FREUD AND THE PATHOLOGIZING OF NORMALITY
27
The essentialist fallacy
27
The continuum fallacy
32
The naturalistic fallacy
37
The psychodynamic paradigm
38
HANS EYSENCK AND THE NORMALIZING OF NEUROSIS
41
Learning to be neurotic
41
Re-educating an illness
49
The behavioural paradigm
52
RONALD LAING AND THE RATIONALIZING OF MADNESS
55
vii
5
6
7
8
9
Madness is method
55
The insane society
62