Patients as Experienced-Based Experts in Psychiatry: Insights from the Natural Method

A primary goal of psychiatric epistemology is to identify the properties of mental disorders that are relevant for developing effective interventions. Sources of information individuating these properties include scientific research on mental disorders (e.g., clinical drug trials), data emerging from clinical settings (e.g., case studies), and first-person reports of those suffering from mental disorders or those who witness or observe such suffering. While dominant scientific frameworks in psychiatry recognize and rely on scientific and clinical data in their efforts to advance the science of mental disorders, they are not similarly committed to directly using the first-person perspectives of patients. More specifically, individuals who suffer from and are diagnosed with mental disorders have not systematically been made part of the scientific inquiry into mental disorders. This chapter calls for this problem to be rectified in scientific psychiatry. I argue that individuals diagnosed with mental disorders are “experience-based” experts on mental disorders and, as such, must be included in the scientific research aiming to expand knowledge in psychiatry. In developing this argument, I challenge the presupposition that individuals with mental disorders lack the expertise to make meaningful contributions to psychiatric epistemology. In the first section of the chapter I review the history of the creation and revision processes of the Diagnostic and Statistical Manual of Mental Disorders (DSM) to illustrate how patients have historically been left out of scientific inquiry in mental disorders, tracing it to a presupposition that they lack the expertise required for scientific investigation. In the second section critically examine the definition of expertise deployed by the American Psychiatric Association (APA), creator of the DSM, and develop an alternative definition by identifying patients as experience-based experts. My discussion is guided by Owen Flanagan’s natural method and the account of expertise developed by third-wave science studies scholars. My argument for including patients in psychiatric research is primarily conceptual: I challenge the assumption that individuals with mental disorders lack expertise in the scientific investigation of mental disorders. Unfortunately, while a discussion of how to develop better scientific policies (or scientific paradigms) involving patients would be interesting, it is beyond the scope of this chapter.