Tag Archives: Lived Experience

How should philosophy of psychiatry relate to the lived experience of service users?

Lancaster University Politics, Philosophy and Religion department runs a masters level module named What is Philosophy. On some weeks of the module a different philosopher within the department talk about their research and how it relates to more general questions about the nature of philosophy.

I did a session upon how philosophy of psychiatry relates to the lived experience of service users. Given my own background as an autistic individual who primarily researchers autism most my examples of services users related to individuals diagnosed as autistic. Within many different areas of philosophy there has been increased interest in broadening the evidence base of philosophy through incorporating the lived experience of a wider range of individuals, partly to move away from philosophy primarily being the domain of white, male, middle class individuals. There has been increasing interest in the lived experience of service users in philosophy of psychiatry, as is evident by multiple recent publications on epistemic injustice in psychiatry.

Questions relating to the correct application, limits and boundaries of philosophy are raised by this interest in lived experience. Lets assume, as I believe is uncontroversial, that there is value in broadening out the evidence basis of philosophy, such as by philosophers of psychiatry paying attention to what diagnosed people actually think about various issues with philosophical connotations. Philosophers might pay attention to whether diagnosed individuals thinks their diagnosis is pathological or not and pay attention to whether the diagnosed individual thinks their diagnosis accurately portrays how they actually are. However, once philosophers have considered what diagnosed individuals think then when can philosophers legitimately argue that the diagnosed individual is mistaken? When does philosophy of psychiatry have priority over service users on a philosophical issue or an issue with philosophical connotations?

One answer might be never. It could be argued that, for example, autistic people know what it is like to be autistic better than anyone else. Therefore, they are in an unique position to know whether autism is pathological and to know whether autism is a good diagnose compared to non-autistic people.

However, it is possible that lived experience has limits. Specifically, a demarcation can be made between the lived experience itself and forming concepts from the lived experience. It is possible that someone could have important lived experience and yet form unhelpful concepts from that lived experience. Perhaps someone has unhelpful implicit assumptions about the nature of health vs illness or what constitutes a good scientific concept when moving from their lived experience to forming concepts. Therefore, there could be room for philosophers of psychiatry to challenge the concepts which service users form without also challenging the lived experience itself.

It is possible that such a sharp demarcation between lived experience and concepts is untentable. Perhaps concepts might be required to understand experience (in a similar manner to how philosophers of science argue that observations are theory-laden). Therefore, lived experience might not always be so valuable if the person with the lived experience interprets it through flawed concepts. If so, this might give priority to philosophers. However, perhaps the sort of conceptual investigation which philosophers specialise in might itself be constrained by lived experience. Perhaps there are important concepts that philosophers are very unlikely to reach or understand, such as some concepts of what health is or what constitutes a good diagnosis, without the lived experience that is only present in diagnosed individuals. If so, this might give priority to service users.

Overall, I found the two hour session to be enjoyable and stimulating. I think these broader questions about the relationship between lived experience and philosophy is an undeveloped area. The development of epistemic injustice is important but I think more reflection is needed, at least within philosophy of psychiatry, upon what status lived experience should be given compared to philosophical reflection. Additionally, I suspect which should be given priority will probably be case specific rather than there being one rule which applies to all cases. Within my own research upon the status of psychiatric diagnoses I generally find drawing upon concepts from philosophy of science and highlighting them by drawing upon them examples from the history of psychiatry to be more valuable than drawing upon my lived experience of being autistic. That said, there are exceptions since I think the most interesting and important argument I have made was likely influenced by lived experience even if in the article I drew upon concepts in philosophy of science to make my argument (see The Value of Categorical, Polythetic Psychiatric Diagnoses” in British Journal for the Philosophy of Science, LINK , OPEN ACCESS LINK).