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This introductory chapter discusses the field of the philosophy of psychiatry, detailing its relevance and emergence during the 1970s. It describes the philosophy of psychiatry as encompassing the philosophical assumptions and ideas that arise from, and the application of philosophical method to, not only psychopathology but also psychiatric theorizing, mental health categories, clinical practice, and psychiatric research. An overview of the five parts of the book as well as the chapters included in each part is presented.

Understanding and explanation are not innocent terms used interchangeably in psychiatric discourse. They are technical terms that represent two opposed approaches to a comprehension of human behavior. This chapter begins with a preliminary explication of the terms. It then offers a case history to exemplify their application in psychiatry—that involving Mrs. D. who suffers from clinical depression—and reviews the further development of the terms since their initial articulation.

The discourse of medicine is the final contributory stream in the flow of psychological ideas in the nineteenth century. It is also the one that has been most closely researched recently, and modern studies have enriched the complex profile of medical and, especially, psychiatric theory. Scholars have also investigated the overlapping world of Victorian sexuality, and described the frequently pathologized images of both female and male sexuality with which the period distressed itself. This chapter examines the way medical opinion considered psychological questions through an analysis of the work of two individual doctors, John Gideon Millingen and Sir Henry Holland, both of whom wrote in detail on psychological issues.

This chapter initially presents the case of Andrew, a man with pre-existing post-traumatic stress disorder (PTSD) that was exacerbated by the bullying he received while serving in the army. Modern biological psychiatrists assume that psychiatric disorders can be classified into a discrete number of diseases analogous to those encountered in physical medicine. Andrew's anxiety about his diagnosis is a reminder that this assumption may have important consequences for both clinicians and patients. For the clinician, classifying the patient's experiences under a diagnosis seems like an important first step in order to make sense of the patient's difficulties. For the patient, being diagnosed will often evoke some kind of emotional response. The chapter shows the importance of having a widely used system of psychiatric classification that provides a realistic and meaningful framework for understanding the problems of patients. This question of diagnostic validity lies at the center of modern psychiatric theory.

This chapter asks how the mental health profession can help the poor without pathologizing them. It observes that instead of examining the structural causes of poverty and inequality, experts too often focus on perceived individual character flaws or psychiatric deficits. It notes that deprivation theory remains very much alive in American culture, peering from behind seemingly race- and class-neutral adjectives. It concludes with a call for a closer evaluation of how psychiatric theories are used to shape public policy.