Thoughts ii re. 2026 Lancaster Philosophy of Psychiatry Work in Progress Workshop

For me, applying Hodges' model I tend to place philosophy and psychiatry (mind, thought, belief, truth, intention ...) within the humanistic part of the model. So, Ewa Grzeszczak and - Philosophy of psychiatry and the methodology of social ontology - stood out. This is helpful as Homeostatic Property Clusters (HPC) are a useful structure, spanning bio-mathematics. As suggested previously with 'equality', we can place the philosophical non-trivial question of kinds at the centre of Hodges' model and proceed (if possible?) from there.

The requirement for a holistic, integrative and pluralistic framework is there in literature. A statement supported by Alessandra Civani's talk: 'What kind of concept is ‘incongruence’? I located a paper:

Enactive psychiatry - A pragmatic and pluralistic approach to mental health and disease

- (and now have a copy c/o and thanks to Alessandra) and am grateful to being pointed to de Haan:

An Enactive Approach to Psychiatry

 I will (must) return to these papers. Earlier on Hodges' model, I'd opined (as on 'X') how the -

• medical
• biomedical
• bio-psycho-social models - are insufficient in the 21st century.

There was a thematic feel to the presentations with Anna Golova - Self-illness ambiguity without a self-illness distinction - following nicely. The styling on the slides was an added bonus. I located an informative (co-authored) paper by Golova:

‘Is it me or my illness?’: self-illness ambiguity as a useful conceptual lens for psychiatry'

Part of the power of Hodges' model derives not so much from its duality; as its dual axes. The two axes can encompass and handle the relatedness between/within reductionism, holist perspectives, the self and otherness, illness and health (well-being).

An hours break brought us to an event which was very well attended, clearly open to the public:

6-7pm Prof Miriam Solomon – Royal Institute of Philosophy talk ‘Stigma as an actant in the history of psychiatry’

In setting out the talk's structure I liked Prof. Solomon's reference to the common, implicit "grime" theory of the dynamic of stigma, and "punching down" as a strategy for managing stigma. 'Grime' made me think of sense of smell, the grime in my father's work van, a diesel. Now so many memories are evoked with the merest whiff. More positively, the patina of physical and mental life also came to mind. You would - might think stigma has been dealt with by now, but of course we are socio-politically far from it.

There is a related podcast from 2025, which also covers Prof. Solomon's early studies. A previous paper was also noted in the slides:

Solomon, M. (2025). The Elusiveness of Hermeneutic Injustice in Psychiatric Categorizations. Social Epistemology, 39(2), 166–177. https://doi.org/10.1080/02691728.2024.2400068

 

Discussion of the DSM inevitably followed (and in the above podcast). In questions the 'reality' of severe mental illness, and suggestion of the acute challenge of managing the negative symptoms of psychoses.

 

Prof. Solomon's conclusion was well worth waiting for, including:

Stigma as an "actant" (cf. Bruno Latour's concept of an agent: causal role without intention)... DSM - ICD...

 

If stigma disappeared tomorrow, the DSM would not have the same categories. 

 

Stigma (more specifically, its management) is shaping the conceptual space, with both scientific and moral consequences.

[Added 4th March...] On Friday - Sam Fellowes, took on, or has taken on - the non-trivial issue of - Modelling psychiatric diagnoses when self-diagnosing - how does this work? Complexity was acknowledged on the first slide, with self-diagnosis, and modelling, set against the Duhem-Quine thesis. 

This technical aspect is welcome and no doubt essential given the socio-technical nature of diagnosis, touching as it does the public (society), primary care, psychiatry, service user groups, policymakers, informatics, and HM Treasury, amongst several 'stakeholders'. With the impact of the internet and social media, much (if not all?) of the vocabulary of mental health professionals has been co-opted and re-framed(?) by patient / service-user groups? It does not, for example, appear that the agency behind the DSM will be able to claim it back. Autism and ADHD were also discussed and debated. I located a previous chapter by Sam (pay-wall):

Fellowes S. Self-Diagnosis in Psychiatry and the Distribution of Social Resources. Royal Institute of Philosophy Supplement. 2023;94:55-76. doi:10.1017/S1358246123000218

 

This really is a thicket of thorns, it spreads as and wherever you go.

 

The welfare bill is such that there should have been government Ministers in attendance. I have responded on behalf of clients to PIP assessments. Agencies have invited me to interview for 'Disability Assessor' roles. Not only is this a complex web, but several logics obtain: a perverse temporal logic operates, binary logic and a fixed mindset can develop so that some (vulnerable!?) individuals can get stuck. Perhaps, a social imperative steps in and disrupts, life chances: their being a NEET ('a young person who is no longer in the education system and who is not working or being trained for work'. Ecosia) is better for someone else? 

 

To unpick, make sense of this, you need a foundational universal model.

 

There is a (co-authored) paper from Giulia Russo, who presented - Epistemic and political role of experience: https://philpapers.org/rec/RUSTPO-112 from which:

'As it is widely known, epistemic injustice was introduced by Fricker (2007) to unveil power relations that have negative consequences on people as epistemic agents. She distinguished in particular two different kinds of epistemic injustice: testimonial and hermeneutical. The first kind occurs when a person (usually in a disadvantaged and oppressed role within the epistemic relation) is damaged as a knower because, as the name suggests, their testimony is overlooked, dismissed or invalidated. The second kind of epistemic injustice occurs when a person is deprived of the epistemic resources to even explain or articulate their experience of distress, or of systemic oppression. In connection to this, the concepts of neurodivergence and neurodiversity come from the political and social arena, and are born explicitly to contrast dominant pathologizing narratives in psychiatry.'

In seeking some 'test' cases to try to model relationally, Hodges' model suggests at least four - without letting the care / knowledge domains wag-the-dog. Giulia's talk was very helpful, ranging across forms of epistemic injustice (addressed by others too), identity, neurodivergence, lived experience, self-, counter- and collective narratives with references. A great resource.

 

Frank Denning, reminded me of an important phenomena, in Using Stebbing’s Directional Analysis to Evaluate ‘Mentalizing’. Talking therapies, or more properly referral to talking therapies often presents several criteria that would-be subjects must 'pass'. An ability to mentalize, can represent one. This is understanable, for effectiveness, efficiency, efficacy ... it is to be found in the manual. But, in terms of power relations, gate keeping in various forms is a literal (virtual) key to service access. Hodges' model is no different (sigh!). At what age can people start to use Hodges' model? What mentalization is involved to cognitively engage in use of Hodges' model? 

 

I struggled to obtain a copy of Stebbing's original work from 1930, but see how closely tied the work is to physics. An Internet Archive copy is poor quality. The search will continue, as I suspect there are links to Bill Ross's text on Deleuzian cosmology. It is marvellous that work from 1930 resonates today. There is: 

Janssen-Lauret, F. (Accepted/In press). Directional Analysis in Susan Stebbing’s Philosophy of Physics. In S. Chapman (Ed.), Susan Stebbing on Logic and Analysis Springer Nature. 

https://pure.manchester.ac.uk/ws/portalfiles/portal/338653274/Directional_Analysis_in_Susan_Stebbing_s_Philosophy_of_Physics_Final_.pdf

Gloria Ayob - Flourishing as mental health - was encouraging. 'TASK 1:EQUATION' a slide was titled, including emotional disorder is meta-evaluative; there are negative and positive poles, plus isomorphism between unpleasantness-pleasantness and disorder-health. I think my stomach was protesting I should have paid more attention. There is a blog post by Gloria: https://blog.oup.com/2024/12/the-concept-of-emotional-disorder/

After lunch Richard Hassall - Hermeneutical Injustice and Damaged Intellectual Self-Trust in Psychiatric Service Users, a reminder of the time and effort that needs to be put into public and patient involvement and engagement in mental health service (when this is desired). References included J.L. Austin and J.S. Bruner. A paper:

Hassall R. Sense-making and hermeneutical injustice following a psychiatric diagnosis. J Eval Clin Pract. 2024 Aug;30(5):848-854. doi: 10.1111/jep.13971. Epub 2024 Feb 20. PMID: 38375925.

https://onlinelibrary.wiley.com/doi/10.1111/jep.13971 

Scoping reviews are more common it seems: Lara Calabrese - Exploring epistemic injustice in dementia care: a scoping review and a qualitative study, plus paper [with QR code on the slide]:

Calabrese L, Brigiano M, Quartarone M, Chirico I, Trolese S, Lambiase F, Forte L, Annini A, Bortolotti L, Chattat R. I'm still here and my opinion matters: a scoping review on the experience of epistemic injustice among people living with dementia. Curr Psychol. 2025 Dec 17;45(1):s12144-025-08519-y. doi: 10.1007/s12144-025-08519-y. PMID: 41445984; PMCID: PMC7618523.

 

The paper's title here brought to mind the radio programme "Does He Take Sugar?" Questions followed regards the studies methods. Since leaving I wondered if there has been an evaluation of Dementia Friendly Communities? Are there dots to usefully joined there?

 

The final talk was delivered (with gusto - pepped me up anyway) by Jacob Barlow - Epistemic borders: experts, communities, communication. Jacob's interest in pragmatism was apparent. I look forward to reading future work, and note Liverpool 2025: ‘Problems with Pragmatism in the Philosophy of Psychiatry’.

All in all, a stimulating and enjoyable event.

'Holistic pluralism'

Individual

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      INTERPERSONAL    :     SCIENCES               

HUMANISTIC  --------------------------------------  MECHANISTIC      

 SOCIOLOGY  :    POLITICAL 

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Group

Rational choice theory	Natural sciences theoretical & methodological pluralism functionalism
Social sciences - Humanities	policy

from Abstract:

"The theoretical and methodological pluralism that we suggest here, holistic pluralism, is one way to overcome incommensurability between the natural and the social sciences while avoiding functionalism, technological and environmental determinism, and over-reliance on rational choice theory." 

from Introduction:

"The fact that sustainability science is “dealing with interconnected problems” (Kauffman and Arico 2014:413) requires that researchers in the field take a comprehensive, integrated, and participatory approach to science and reality (Sala et al. 2013). This explicit ambition to integrate knowledge—across scales, sectors, and substance domains, and across the nature-society, science-society, and knowledge-action divides—implies that sustainability science must inherently live up to (at least) three things. It must build on several foundational disciplines and have the capacity for interdisciplinarity; it must embrace theoretical and methodological pluralism and have the capacity for reflexivity (Isgren et al. 2017); and it must integrate knowledge generated from engaging with different disciplines, theories, methods, and contexts, and thus aspire to transdisciplinarity. Rather than merging or unifying the actual disciplines or their theories and methods into integrated frameworks, we argue that pluralism is the best way forward for dealing with sustainability challenges, such as biodiversity loss, climate change, land use change, water scarcity, and ill health. In this article, we use ontological, epistemological, and theoretical reasoning to support our argument. The critical ambition is to provide the rationale for a new approach that has the potential to capture the best available knowledge on social and natural dimensions of sustainability; we call it social fields and natural systems. The problem-solving ambition is to describe the approach and illustrate it in two empirical examples. If successful, this will show how holistic pluralism is one possible way of integrating knowledge across the social and natural science divide."

Figure 2 Olsson, L., & Jerneck, A. (2018).

It may be useful to consider figure 2, using the domains of Hodges' model?

Note how in Hodges' model, as 'political ecology' seeks to interrogate the relationship between society and nature (the environment, the sciences): we see a diametric relation. Inevitably then, the political ecologist must also negotiate, interpret, seek the policy evidence from within; perhaps an output, a creation of citizens?

Olsson, L., & Jerneck, A. (2018). Social fields and natural systems: integrating knowledge about society and nature. Ecology and Society, 23(3). https://www.jstor.org/stable/26799148

Is Hodges' Model anathema to 'Extant Nursing Theories' ?

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 INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

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	Nursing Science Quarterly

"Are the extant nursing theories endangered species? Some nurse leaders think so. A cursory review of major nursing journals reveals the conspicuous absence of articles using nursing theories as guides to research and practice. These articles are often written by seasoned scholars and doctoral students in nursing, yet nursing science is absent. How can this be when PhD students are being prepared to be knowledge builders for the discipline and their teachers are the seasoned scholars?

This question took center stage in a recent international gathering of nurse researchers and theoreticians."

Parse RR. Are the Extant Nursing Theories Endangered Species? Nursing Science Quarterly. 2023;36(2):109-109. doi:10.1177/08943184221150254

 

 

Hodges' Model is a stranger in a strange land; and as usual I am writing from Wigan Pier - so vastly differing contexts and experiences acknowledged.

 

Whatever its status as a model of nursing, model of care, conceptual framework, nursing theory (level 'x'); as the editorial indicates, if the model were to have a 'home' it might be the USA with its nursing science PhD programmes. 

 

Clearly, this is not the case.

 

Unsuccessful in trying to learn of the international event mentioned, I can take encouragement from Hodges' model being 'stateless' and as such, being global, local and glocal in scope. There is succour in having an origin the model can call home here in the NW England (literal - person-centredness).

The medicalisation of nursing science may be an issue for PhD programmes in the USA, but the inter- multi- transdisciplinary potential of Hodges' model can encompass this - preserving and even assuring disciplinary identity as needed. An original purpose of the model was also curriculum design, and development.

"In all university systems it is the faculty and administrators of nursing programs who make curriculum decisions. These same faculty and administrators promulgate the use of theories from other disciplines to guide nursing research for PhD dissertations. What is wrong with this picture?"

I would suggest it is not 'big' - rich enough.

"What is the uniqueness of nursing as a discipline when medical science content has replaced the nursing theories and frameworks in PhD programs? The extant theories and frameworks concretized nursing as a unique discipline different from medicine in the 20^th century. Can nursing now be distinguished from medicine when the content of PhD programs is bereft of extant nursing theories and frameworks?"

Yes, nursing can and is being distinguished from medicine and all other disciplines: abstraction and scope of practice are key. 

So many 'literature searches' are incomplete (but I would say that).

It is actually a sad state of affairs should PhD programmes of study be the primary motivation for the development of nursing science. This is the 21st Century.

Nursing should be defined by the needs of national and global populations and associated national and global policy - especially ongoing gaps in those needs.

World Philosophy Day: "Why do we need evidence of mechanisms?"

December 17th 2019, 14h30-16h00

Bordeaux Pellegrin Hospital, Rheumatology Service, 12th floor

Phyllis Illari (University College London, UK)

"Why do we need evidence of mechanisms?" A PhilInBioMed seminar

Open to all

Phyllis Illari is a Senior Lecturer at University College London (Dept of Science & Technology Studies; Faculty of Maths & Physical Sciences) in the UK. She works in the philosophy of science, with particular expertise in causality, mechanisms and information.

Abstract

I will present a view of evidence of mechanisms as evidence of the activities, entities, their organization, and the phenomena they explain, using the idea of ‘minimal mechanism’ (Glennan and Illari, 2018). I will argue that this view allows us to theoretically organize an incredibly diverse array of forms of evidence and empirical practices. I will then home in on a specific way in which evidence of mechanism is crucial, arguing that it is important even for solid evidence of correlation. Any clinical study, even a well-conducted RCT, which is still one of our best methods of establishing a reliable correlation, needs decent answers to two questions: (i) what are the variables for disease, treatment and outcome? and (ii) how and when are they measured and why?

I will use the case of ‘vitamin D deficiency’ to show how important these questions are, even when they are not explicitly addressed in published results, because they are regarded as sufficiently standardised to be unimportant. Until recently, vitamin D deficiency was regarded as well-understood, reliably measurable in standardised ways, and linked to diseases such as rickets by well understood mechanisms. However, recent research has linked vitamin D deficiency to other diseases, in ways that expose the fact that different measuring techniques measure slightly different forms of Vitamin D. Those differences are now relevant.

Considering the case shows how deeply integrative our evidential pluralism needs to be, and therefore how complex our practices of reasoning about evidence are. Philosophical accounts need to be responsive to this.

For more information click here.

Best regards,

Wiebke Bretting
--
Dr. Wiebke Bretting
Project Manager ERC IDEM
ImmunoConcEpT, UMR5164
Université de Bordeaux
146 rue Léo Saignat
33076 Bordeaux
https://www.immuconcept.org/erc-idem/

My source:
Philos-L "The Liverpool List" is run by the Department of Philosophy, University of Liverpool https://www.liverpool.ac.uk/philosophy/philos-l/

Heterodoxy in Economics and Healthcare

I may as well face it: I am tarred with the same brush that paints psychiatry, hospital and community mental health services these days (and nights). Sometimes the media, with due cause I sadly add, dispenses with the brush: the paint comes by the bucket full and is hurled.

As a product of the Victorian asylum system I am bound to be tainted. This seems to be the case when seeking feedback on Hodges' model from activists for anti-psychiatry, patient activism, engagement, self-care, carers rights and recovery. There are those who feel even the latter is a political foil that stabs at the heart and mind of those in desperate need of mental health care. The situation is exacerbated even further, such is the politicisation of healthcare and mental health in-particular since austerity cast its shadow on funding.

In seeking comment on Hodges' model this is very much about pros and cons. Hodges' model being from the 1980's is an historical artifact, but I beg to differ as to its relevance. To that audience Hodges' model is probably the antithesis of "Love at First Sight". Like the psychiatric system and the legal powers it can exercise, the model says;

"Look I can help you. Let me show you how much I care.

Don't worry. We can make sense of this.

I'll just put you and everything not just in one box but several" 

NOW COME ON GET IN THERE!

If that is the reaction then the possibilities: creative, innovative, reflective, person centred... of then blurring and erasing these lines, divisions and gathering the whole person and their situation is lost.

So, if the new wave thinking in mental health provision eschews the paraphernalia of models and framework then what is the alternative?

The question is important, vital even when we look at the mental health nursing curriculum. Curricula are never fixed in the sense that the new emerges from the old. How radical is this change?

The above reflections are prompted by an excellent piece in the FT Weekend (1-2 October) by David Pilling on the teaching of economics. I recalled a few years ago the rumpus on campus reported across the media.

Individuals and families do seek explanations, both of what ails them, their treatment and the plan of care whether enacted as self-care - a care partnership - or emergency care in the first (and vital) instance. Pilling writes about the how economics is taught, the call for broader curricula (which is underway) and the role for heterodoxy.

So I've a few questions: Where is the heterodoxy in healthcare (beyond alternative medicine/homeopathy)? Is there really no need of a generic conceptual framework in healthcare?

If the new Econocracy needs a framework then students across disciplines may also find some value in Hodges' model...

Given the cross-disciplinary pressures on healthcare systems the world-over there really is a need rethink healthcare as well as economics. Arguing in response about the economic benefits of technology is indicated and well-justified, but it is not e-nough.

individual

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INTERPERSONAL : SCIENCES

HUMANISTIC-------------------------------  mechanistic

SOCIOLOGY : POLITICAL

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group-population

"The students gathered in response to an email ... Philosophy Ethics Individual Psychology (Robinson Crusoe)

(email...) It asked whether the economics they were learning, dominated by mathematical formula and abstract models, was relevant to the real world." "How far can economics be called a real science?" "Earle complains that the repeated use of such formulaic models presents a "closed system", immune to external interrogation. "You are taught a narrow way of thinking  about the economy as this  set of rules and laws  not to be questioned and  not to be engaged  with," he says. ..."

(Robinson Crusoe & Friday) Group Psychology Behavioural Economics

He would like, he says, to "put politics, and philosophy and, well, ethics back into economics by teaching it as a "contested", cross-disciplinary subject..." "Post-Crash Economics  has folded into Rethinking Economics" Post-Crash Economics Society

My source:
Pilling D. (2016). Crash and learn, Life & Arts, FT Weekend, 1-2 October, p.1-2.

'A' is for Pippa and thoughts from Bill in Australia

Pippa Crouch has been in touch to update me on her course assignment which was awarded an 'A'. This is great news Pippa - many congratulations!

Regular readers may recall that Pippa, an Occupational Health Nurse Advisor at East Grinstead Hospital, in South East England came across Hodges' model in the new year and found that the model suddenly fell into place for her. Pippa used Hodges' model in a paper studying for her Occupational Health degree.

I'd be pleased to provide some support for people who are interested in using Hodges' model in essays, case studies, posters....

In January I also exchanged a few e-mails with Bill Moloney a Clinical Nurse Consultant in Australia. Here are Bill's thoughts:

Hi Peter,

I am not an academic and respond as a clinician. I endorse your description of this work as a "resource" rather than a nursing model. It provides a wonderful inspirational matrix.

In the context of mental health care delivery it compliments any effort to provide for expansive, inclusive and least restrictive models of care. It certainly supports my opinion that the variables that impinge on the mental health of a community are various and multifaceted and cannot be provided for by any one "stand alone" mental health service. That mental health care is an all of community issue and required are strategies that include collaborative arrangements with services and agencies that influence the mental health of a community in an "All of Community" paradigm. Peter happy new year to you and yours, cheers, Bill

Bill Moloney
Clinical Nurse Consultant,
Consultation/Liaison Psychiatry
AAMHT, WSAHS (west )
Ph : (02) 9881 8888
PO Box 6010
Blacktown, N.S.W.

Thanks Bill and to Pippa for your interest.

One day I would love to travel to Australia, New Zealand or South Africa to see the night sky and of course visit these marvellous nations and the peoples. Amazing gardens too judging from Monty Don's recent travels.