By Vincenzo Di Nicola
As contemporary psychiatry works through the current version of our identity crisis, some leaders in my field argue for a more scientific psychiatry, grounded in the so-called “evidence base” from genetics and neuroscience, while the great majority of clinical practitioners concern themselves with the humane care of the people whom come to us with their anguish and distress. This tension has been persistent in my field for the past century during which our colleagues in the humanities, often led by anti-psychiatric critics within the profession, have decried the “medicalization” of human suffering. With a group of psychiatrists at the University of Montreal, we are looking for a larger definition of our field, embracing the benefits of the medical model by enlarging the very definition of medicine to include the social determinants of health in the enriching context of the humanities.
Now, our pioneering course on “Psychiatry and the Humanities” for postgraduate students in the Faculty of Medicine at the University of Montreal offered in the fall of 2016 has been nominated for the Camille Laurin Prize for Achievement of the Year by the Quebec Psychiatric Association.
The course was conceived during my doctoral investigations in philosophy and supported by Emmanuel Stip, Chair of the Department of Psychiatry, who is a researcher in schizophrenia as well as a promoter of a larger vision of psychiatry, having done undergraduate work in philosophy in Paris with Gilles Deleuze. With a junior colleague, Ouanessa Younsi, an early-career psychiatrist and accomplished poet who is now completing a master’s in philosophy, we put together a proposal to address the complexity of contemporary medicine, illustrated by the biomedical problems of psychiatry contextualized by the humanities. The values that the course privileges are:
- Interdisciplinarity – collaborations and syntheses between medicine and the humanities,allowing these mutually enriching disciplines to address the complexity of human predicaments
- Dignity – each contribution to the course should reflect the whole and the dignity of human beings
- Beneficence – a key concept in bioethics translated into French through two related terms: bienveillance, reflecting a “positive regard,” meaning an affective disposition towards health and well-being, as well as bienfaisance, connoting “positive action.”
The course content is divided into three thematic blocks with contributions by invited faculty members in each block:
- Psychiatry and the humanities (arts and letters) – cinema and theater, poetry and literature, and music;
- Psychiatry and philosophy – bio-ethics, naturalistic philosophy, negation, philosophy of science, and antipsychiatry;
- Psychiatry and social science – anthropology, psychology, and theology/spirituality.
Many of the seminars addressed overlapping and mutually enriching perspectives on each topic and lively discussions and debates ensued, guided by the co-directors of the course. Coming from a variety of disciplines, from biochemistry to bioethics to various branches of medicine, the students enjoyed an open atmosphere of lively debate based on deeply-informed seminars by committed scholars of their respective fields. The students were evaluated on the basis of their seminar participation, journals of the course themes, and their long essays that they presented orally at the end of the course.
The students’ evaluations for this inaugural course were uniformly positive and encouraging: “I really appreciated this course. It is by far the most interesting and engaging course that I have taken during my university years.” “I appreciated the diversity of opinions and positions of the seminar leaders.” “The course was like a breath of fresh air that permitted us to see psychiatry from a more social point of view.”
The success of the course is such that it triggered the formation of a microprogram in psychiatry at the postgraduate level, eventually leading to a Master’s in Psychiatry, a first in francophone Québec.
To sum up, this course aims to move beyond the “two cultures” debate between science and the arts (invoked in C.P. Snow’s 1959 lecture at Cambridge University). Our goal is to offer an alternative to the reductive view of medicine now taking hold everywhere, notably in psychiatry under the guise of neuroscience.
My own contribution was a reading of antipsychiatry as a negation in both the philosophical and psychoanalytic senses, examining four traditionally trained academic psychiatrists-psychoanalysts who became leaders of the antipsychiatry movement as rebels, radicals, reformers and revolutionaries: radical psychoanalyst R.D. Laing in England, anti-institutional psychiatric reformer Franco Basaglia in Italy, rebel psychoanalyst Jacques Lacan in France, and anticolonial revolutionary Frantz Fanon in France and Algeria.
Ultimately, the question that we are interrogating in this course is framed by Peter Sloterdijk as one of philosophical temperaments. As Sloterdijk notes in his preface to Philosophical Temperaments, which is a series of brief but dense and profound readings of 18 influential thinkers, “the title is an unmistakable allusion to Fichte’s well-known dictum that the philosophy one chooses depends on the kind of person one is.” The notion of temperaments extends beyond philosophy and goes to the heart of human being. I have applied it to therapeutic temperaments in clinical practice (the phenomenological versus the technocratic temperament). My philosophy mentor Alain Badiou raises it with regards to the call to philosophy in the preface to After Finitude:
What wound was I seeking to heal, what thorn was I seeking to draw from the flesh of existence when I became what is called “a philosopher”?
Badiou answers the question by citing Henri Bergson’s notion that the question one feels compelled to find an answer to at all costs arises in the conditions of one’s youth. While the question of temperament frames the choices we face in any field – as it raises what sorts of questions and answers we find salient and edifying, to invoke Richard Rorty’s view of the matter in his distinction between systematic and edifying philosophies – I will conclude with physician-philosopher Karl Jaspers’ admonition. Jaspers reminds the physician that philosophy is unavoidable for the practice of medicine. In his ground-breaking textbook of phenomenological psychiatry, Jaspers concluded a century ago that:
If anyone thinks he can exclude philosophy and leave it aside as useless he will be eventually defeated by it in some obscure form or other.
Vincenzo Di Nicola, MPhil, MD, PhD, FRCPC, DFAPA, is a tenured Full Professor of Psychiatry at the University of Montreal, where he works as a Child & Adolescent Psychiatrist. Trained in psychology, psychiatry and philosophy, Professor Di Nicola completed his doctorate in philosophy at the European Graduate School, where he worked with Giorgio Agamben, Alain Badiou and Slavoj Žižek. His 2012 dissertation, “Trauma and Event: A Philosophical Archaeology,” was granted Summa cum laude and inspired his call for an Evental Psychiatry. He is now working with fellow psychiatrist and philosopher Drozdstoj Stoyanov on a volume called, Psychiatry in Crisis: At the Crossroads of Social Science, the Humanities, and Neuroscience, to be published by Springer International.