Psychiatry as normative practice

This article develops a conceptual framework of norm-responsive aspects of psychiatric practice. This framework is meant to support and conceptualize the idea that the practice of psychiatry is inherently value laden and responding to norms, principles, values, and ideals. I argue that these norms, principles, values, and ideals manifest a certain order, with qualifying, foundational, and conditioning norms and principles on the one hand and regulative ideals and core values on the other hand. These norms and principles are constitutive for psychiatric practice and define its inherently normative conditions. They are necessary elements, without which the practice of psychiatry cannot properly be understood. The core values and ideals on the other hand are the expression of ultimate concerns and an instantiation of the ethos of the profession. This ethos harbors an implicit worldview and orients and directs psychiatric practice to the kind of endeavor it is meant to be. The inherent normative nature of psychiatric practice is first approached by analyzing the web of relations that shape the interactions between professionals and patients. This exposition is followed by an analysis of the different norms and values that are operational within psychiatric practice itself. This analysis leads to the delineation of a normative practice approach of psychiatric practice. The distinction between different types of norms helps to elucidate weaknesses of scientistic and technicistic approaches in psychiatry. I show how the normative practice approach provides a richer, more nuanced, and more convincing account of psychiatry’s legitimacy.