The Rise of Philosophy of Psychiatry: A Portrait of the 2022 AAPP Annual Meeting

The 2022 annual meeting of the Association for the Advancement of Philosophy and Psychiatry (AAPP) took place on May 21-22, 2022, New Orleans, LA in Hilton New Orleans Riverside (alongside the American Psychiatric Association (APA) annual meeting as one of their affiliates). For the past 3 decades, the AAPP annual meeting has been celebrated by psychiatrists, psychologists, and philosophers interested in the intersection of philosophy and psychiatry, and the enthusiasm was even more palpable this year.

This year’s meeting had an open theme, and it showcased a diverse range of topics. The influence of standpoint epistemology, epistemic justice, and related themes such as epistemic privilege, epistemic vigilance, and hermeneutic ignorance were noticeably prominent in the meeting, evident in the multiple sessions of the conference on both days, the keynote lecture, and the 2022 Jaspers Award winning paper. Other notable themes touched on by multiple talks included philosophical critiques of CBT, agency and moral responsibility in psychiatric disorders, psychiatric classification, and the nature of psychiatric disorders.

The 2020 AAPP annual meeting had been cancelled due to the pandemic, and 2021 meeting had been held online, so this was the first in person meeting since the pandemic. There was a renewed excitement not only at the prospect of attending live talks, but also at reconnecting with old friends and engaging in meandering philosophical conversations during breaks, meals, and while walking the streets of the French Quarter of New Orleans.

In what follows, I present very brief summaries of talks from the meeting. Readers are referred to the meeting program and the abstracts of the talks for details, which can be accessed here at the AAPP website.

Sarah Arnaud, PhD, and Anne-Marie Gagné-Julien, PhD, kicked off the meeting by talking about the new activism in psychiatry and the scientific turn evident in fields such as neurodiversity and mad studies. Utilizing Harding’s notion of “strong objectivity,” they argued that psychiatric activism can be understood as a legitimate form of scientific criticism, and that neurodiversity movement and Mad Pride are beginning to pursue scientific goals that may ultimately transform psychiatric science or establish scientific alternatives to psychiatry. (Arnaud and Gagné-Julien also host a popular philosophy of psychiatry webinar lecture series.)

Eleanor Harris discussed how individuals with delusions are particularly vulnerable to epistemic injustice and presented an account of epistemic over-vigilance as the mechanism behind epistemic injustice in the case of delusions. Riana Betzler, building on Olivia Bailey’s work on humane understanding (“the direct apprehension of the intelligibility of others’ emotions”), argued that medicalization and pathologization in psychiatry have the potential to violate humane understanding in the context of systemic and structural injustice.

Using the example of craniosacral therapy, G. Scott Waterman, MD, examined the links between a treatment’s purported mechanism of action, the status of the treatment as a placebo intervention, and the ethics of placebo administration, making a case for humility, and transparency in clinical practice.

In a creative and innovative presentation, Richard DeSantis showed how Hegel’s critique of stoicism can be interpreted as a critique of CBT, while also achieving the remarkable feat of making Hegelian thought accessible to a multidisciplinary audience. J.P. Grodniewicz, PhD, analyzed belief revision during the course of CBT in light of unificationist and fragmentationist models of belief-organization, arguing for the validity of the latter.

Serife Tekin, PhD

In the Edwin R. Wallace Memorial Lecture, one of the key highlights of the meeting, Serife Tekin, PhD, explored epistemic, scientific, and ethical problems with the use of psychotherapy chatbots in clinical settings, particularly how such practices are embedded within assumptions prevalent within WEIRD (Western, Educated, Industrialized, Rich, and Democratic) societies that do not carry over to other sociocultural settings. Tekin elaborated on this by pointing to the perils and pitfalls of using Arabic-speaking psychotherapy chatbots as way of addressing the mental health of Syrian refugees.

Brent Kious, MD, PhD, considered the ethical challenges posed by medical aid in dying (MAID) for psychiatric indications, focusing on instances where MAID is requested by patients who have declined reasonably safe and effective treatments, such as ECT for depression. Kious argued that MAID should not be offered if there are treatments available that remain unutilized by the individual that could substantially ameliorate the symptoms and if the illness-specific quality of life after treatment cannot reasonably be viewed as worse than death.

Jared Smith tackled the application of traditional accounts of reason-responsiveness and semi-compatibilism to individuals with OCD and the notion that individuals with OCD are insufficiently reactive and lack the control required for agency and responsibility. Smith argued that once a proper understanding of OCD is taken into account, it becomes obvious that individuals with OCD are overly receptive to reasons, not insufficiently receptive, and this presents a challenge to existing accounts of compulsions and responsibility.

Christina Weinbaum scrutinized brain disease and moral models of addiction, as well as Hanna Pickard’s notion of responsibility without blame, to argue for viewing addiction through Gideon Yaffe’s burden-based excuse approach, and advocated understanding moral responsibility as a spectrum rather than as a dichotomy.

Natalia Washington, PhD, undertook a philosophical investigation into the nature of diagnostic kinds and the goals of psychiatric nosology, arguing for diagnostic kinds as socially constructed extended kinds (building on the work of Ron Mallon), and advocated for the need to adopt a stance of prudential pluralism about diagnostic kinds in psychiatry as well as medicine.

Rosa Runhardt, PhD

Rosa Runhardt, PhD, analyzed the notion of reactivity in psychiatric classification and measurement (ie, diagnosis can influence attitudes and behavior of individuals such that subsequent measurement of symptoms is affected). Runhardt outlined instances where such reactivity can be considered legitimate and the implications for prediction and intervention in the case of mental disorders.

Katherine Rickus, MBChB, PhD, presented a paper examining epistemic privilege in psychiatry and inquired whether there could be a philosophical justification for a psychiatrist or a therapist to reasonably question a client’s first-person description of their own emotional states.

Kathryn Petrozzo’s talk was also focused on philosophical issues of responsibility and agency. She discussed how reduced responsibility in cases of psychiatric disorders is often discussed in terms of reduced agency, which has problematic consequences in the form of stigmatization and unfair treatment in the legal system, making a case for reconceptualizing agency in psychiatric disorders and punishment reform.

Bahar Orang, MD, (in a paper cowritten with Suze Berkhout, MD, PhD) discussed the intersection of policing, psychiatry, and the mental health crisis response in the context of activism around defunding the police. The notion of mental health crisis itself was interrogated and they used Sylvia Wynter’s “Man-as-Human” framework and Bruce La Marr Jurelle’s work on carceral and colonial modernism to critique coercive practices in psychiatry.

Bennett Knox

Bennett Knox presented their paper, recipient of the 2022 Karl Jaspers Award (forthcoming in the journal Philosophy, Psychiatry, & Psychology) on the standpoint of the psychopathologized and hermeneutical ignorance in psychiatry. Knox argued for “social objectivity” as a desideratum for psychiatry and the DSM, made a case for meaningful inclusion of the psychopathologized in the DSM revision process, and discussed how a failure to do so threatens DSM’s social objectivity and constitute epistemic injustice.

Alexander Pereira was also scheduled to present his paper “Specific Phobia is an Ideal Psychiatric Kind,” which had won the 2020 Karl Jaspers award but had to cancel due to a last-minute emergency.

Justin Garson, PhD’s fascinating talk tied historical and philosophical elements by examining how debates around defining madness in the Late Modern period were framed as a problem of distinguishing madness from idiocy. Drawing on Locke, Kant, Wigan, and Heinroth, Garson showed that madness was theorized not as an absence of reason but rather as carrying reason within it, although in a perverse form. He outlined the implications this has for contemporary philosophical discussions of mental illness. (Garson’s book Madness: A Philosophical Exploration has recently been published by Oxford University Press to widespread critical acclaim.)

Jonathan Fuller, MD, PhD

In one of my favorite talks of the meeting, Jonathan Fuller, MD, PhD, challenged the syndromic view of psychiatric disorders and made a case for understanding mental disorders as dispositions, similar to chronic medical disorders: “Chronic diseases are typically dispositions towards physiological manifestations; for instance, diabetes mellitus is a disposition towards hyperglycemia, while asthma is a disposition towards airflow limitation in the small airways. In contrast, mental disorders are dispositions towards the symptoms and behaviors that comprise their diagnostic criteria; for instance, major depressive disorder (MDD) is a disposition towards the symptoms/behaviors that comprise a major depressive episode, while substance use disorder is a disposition towards certain addiction behaviors.” Fuller argued that understanding mental disorders as dispositions allows us to account for the “stickiness” of mental disorders and their longitudinal course and management by pointing to a property underlying the syndrome.

Jack W. Kent Jr. followed up Fuller’s talk by offering a commentary on a 2018 paper by Fuller on chronic diseases. Kent Jr. argued that common characteristics of chronic disease also apply to mental illnesses, and that these may be better described as “chronic conditions” rather than as “chronic diseases” to better capture the interplay of voluntary and involuntary contributors to their progression.

The junior scholars were well-represented at this meeting, and it was widely commented that the quality of their talks was among the best things about the event. Another unique strength of the AAPP annual meeting (and of AAPP as an organization and of PPP as its official journal) is the balance of psychiatric clinicians and philosophers. The AAPP annual meeting is one of the few meetings worldwide with robust participation from both clinicians and philosophers where both can feel at home and take part in a transformative interdisciplinary dialogue.

Strong representation from University of Utah. From left to right: Brent Kious, MD, PhD; Kathryn Petrozzo; Bennett Knox; Natalia Washington, PhD. Photo courtesy of Kathryn Petrozzo.

Christina Weinbaum tweeted afterwards about her positive experience of the meeting: “@aapp_PhilPsych conference was completely and utterly fantastic. I met the most incredible people who are doing really important and meaningful work and having the opportunity to be a part of this family is something I'm so honored about. Thank you all for everything!”

Christian Perring, PhD, the president of AAPP, said in a statement to Psychiatric Times™: “Philosophy of psychiatry, like philosophy of medicine and medical ethics, continues to generate a good deal of interest among academics and clinicians. AAPP plays an important role in both stimulating interest and also enabling dialog between people in different fields. We were very pleased to see how much enthusiasm there was at our 2022 conference, especially among early-career scholars. It is a promising sign for the future of the field.”

The 2023 annual AAPP meeting will be held on May 20 and May 21, 2023 in San Francisco, CA, along with the 2023 annual meeting of APA. The call for abstracts for the 2023 meeting will be issued in the coming weeks on the AAPP website. Announcements are also made via the official AAPP twitter account @aapp_PhilPsych.

Dr Aftab is a psychiatrist in Cleveland, Ohio, and clinical assistant professor of psychiatry at Case Western Reserve University. He leads the interview series “Conversations in Critical Psychiatry” for Psychiatric Times. He has been actively involved in initiatives to educate psychiatrists and trainees on the intersection of philosophy and psychiatry. He is also a member of the Psychiatric Times^TM Editorial Board. He can be reached at awaisaftab@gmail.com or on Twitter (@awaisaftab).