The Concepts of Psychiatry: A Pluralistic Approach to the Mind and Mental Illness

The author of The Concepts of Psychiatry: A Pluralistic Approach to the Mind and Mental Illness is S. Nassir Ghaemi, M.D., an assistant professor of psychiatry at Harvard Medical School. In his acknowledgments, Ghaemi covers a broad and comprehensive group of individuals under whose influence he has come in his journey of scholarship. This book is a manifestation of Ghaemi's absorptive and spacious mind as well as his significant capacity to assimilate information from a broad variety of sources. His stated goal is "to encourage psychiatrists and other mental health professionals to think about what we do."

The book is concerned with the epistemology of clinical thinking—our diagnostic categories as well as our understanding of the bases of mental illness. In this regard Ghaemi has examined the work of several philosophers as well as figures in the history of psychiatry. The first section of the book is titled "A Theory—What Clinicians Think and Why." The author quotes Sir Aubrey Lewis: "The psychiatrist then is confronted, whether he likes it or not, with many of the central issues of philosophy."

Ghaemi then assembles, in logical sequence, a series of chapters on the clinician's thought process and approach to patients. He is guided by a driving urge for pluralism and integration, with which he contrasts eclecticism. The reader gets a broad smattering of a variety of philosophical thought over the ages. Ghaemi himself, with a strong background in psychopharmacology, presents good summaries of major Western figures from the late 19th and early 20th centuries—Hegel, Karl Jaspers (who moved from psychiatry to philosophy), William James and Charles Sanders Peirce (the American pragmatists), Wilhelm Dilthey (the German philosopher of history), and Claude Bernard (the French philosopher of science who influenced Zola). He posits that these individuals all believed that good scientists perforce always do "philosophy," in the sense of "thinking hard" about what they are doing and why they are doing it—just as good philosophers always perforce keep up with science's latest finding.

Ghaemi continues with examinations of the methods of thinking of Karl Popper, Ernst Mayr, and the great German sociologist Norbert Elias. Elias believed that people in his discipline worried about being "insufficiently philosophical" only because the philosophers were the "oldest family" in the academic village—not because they were any better informed than all the newcomer disciplines. Elias gave himself permission to accuse mainstream post-Cartesian philosophers of being "insufficiently sociological."

I found Ghaemi's book challenging in its overinclusion. Why do we give philosophy the benefit of the doubt when all of modern sciences have spun off from philosophy because post-Cartesian idealism insists on barking up trees whose very existence they question in a forest of facts they choose to ignore? Why should Edward Hundert have to be accountable to Hegel? However, there are places where Ghaemi himself—and certainly the philosophers and psychiatrists he likes—must admit that whenever a fact puts us at odds with what we have been taught, evolution has given us the means of "thinking hard," resisting authority, and changing our minds, even without the benefit of the philosophical traditions Ghaemi so comprehensively reviews.

Dr. McCurdy is distinguished professor and dean emeritus in the department of psychiatry of the Medical University of South Carolina in Charleston.