Академический Документы
Профессиональный Документы
Культура Документы
Kutney
An Examination of PsychiatricMental
Health Outcomes From the Perspectives of
Logical Positivism and Phenomenology
Ann M. Kutney
The current philosophical paradigm in psychiatry is based in logical positivism, as outcomes are viewed as objective and scientifically verifiable. This approach, although making important contributions to the field, fails to acknowledge outcomes from the
perspective of the client. A growing movement within the mental health field is promoting the use of phenomenology and the
lived experience, which provides new opportunities for defining outcomes from the clients perspective. The purpose of this article
is to briefly review the main tenets of both philosophical perspectives and to demonstrate how these perspectives influence the
conceptualization of outcomes in psychiatricmental health nursing practice and research. Finally, a proposal is made for clinicians and researchers to adopt an integrative model, a blending of the two viewpoints, to capture the most complete experience of
the client and to define the most appropriate outcomes. J Am Psychiatr Nurses Assoc, 2006; 12(1), 22-27. DOI: 10.1177/
1078390306286443
Keywords: mental health outcomes; psychiatric nursing; mental illness; philosophy
The predominant philosophical view within a discipline shapes the nature of treatment outcomes that are
accepted and valued by that discipline. The current
philosophical paradigm in psychiatry is based in logical positivism, and hence, valued outcomes are those
that are objective and scientifically verifiable. This approach, although making important contributions to
the field, fails to acknowledge outcomes from the perspective of the client. A growing movement within the
mental health field is promoting the use of phenomenology and the lived experience, which provides new opportunities for defining outcomes from the clients
perspective.
This article will address psychiatricmental health
treatment outcomes at the client level. The philosophi-
22
cal perspectives of logical positivism and phenomenology will be used to frame different views of outcome
measurement. A discussion of logical positivism will
highlight the underpinnings of current outcome measurement, whereas phenomenology will be used to represent a more patient-centered philosophy of outcomes. The purpose of this article is to briefly review
the main tenets of both philosophical perspectives and
to demonstrate how these perspectives influence the
conceptualization of outcomes in psychiatricmental
health nursing practice and research. Finally, a proposal is made for clinicians and researchers to adopt an
integrative model, a blending of the two viewpoints, to
capture the most complete experience of the client and
to define the most appropriate outcomes.
LOGICAL POSITIVISM
The French philosopher Auguste Comte developed
positivism to establish a pure scientific philosophy in
which all knowledge results from experience (Miller,
1999). Logical positivism was a name subsequently
adopted by members of the Vienna Circle, a wellknown group of philosophers and scientists, including
Alfred Ayer, Moritz Schlick, Rudolf Carnap, and Karl
Menger, in the early 20th century to define their
unique position (Ayer, 1959).
The major tenet of logical positivism is that information is meaningful only if obtained through scientifically verifiable observations. Knowledge in the logical
positivism tradition is derived from sensory-based experiences, such as sight, sound, and touch. The logical
positivism perspective believes in a single reality that
is experienced by all people (Baker, 1992). The use of
the scientific method and formal logic, through the process of observation, hypotheses creation, and experimentation, allows verifiable conclusions about reality
to be made (Kitchener, 2004). Although logical positivism is not considered an active movement in the philosophical world today (Schumacher & Gortner, 1999;
Tolman, 1992), its influence can still be readily felt in
the realm of psychiatry and mental health.
LOGICAL POSITIVISM AND PSYCHIATRIC
MENTAL HEALTH OUTCOMES
In a reflective, historical account, Sabshin (1990)
documents the major turning points in 20th-century
American psychiatry, with an emphasis on the adoption of positivist ideals. In the years after World War II,
the field was driven by psychotherapy, with little interest in empirical methodologies. Because of the disciplines lack of connection with science, as well as a lack
of objective outcomes, stakeholders became skeptical of
the field and its contributions. On the verge of disappearance, psychiatry began to move toward an empirical, positivist philosophy in the late 1970s based on this
dire need to be seen as a recognized member of the scientific community. The positivist approach to outcome
measurement was fueled also by advancing discoveries
of the biological etiology of some mental illnesses, as
well as the development of psychotropic medications.
The creation of objective procedures and assessments,
as well as classification systems (i.e., the Diagnostic
and Statistic Manual of Mental Disorders manuals),
was evidence of a new paradigm.
As a consequence of these advances, clinicians consistently discounted the subjective experience of the
patient. Psychiatry rejected clients as a source of data
based on an institutionalized distrust of individuals
and their ability to report validly and reliably on their
own mental conditions and the scientists inability to
verify independently such reports (Baker, 1992, pp. 1011). Because the clients experience was viewed as scientifically unreliable and unverifiable, psychiatry
adopted a pure, objective approach to the assessment of
outcomes. However, it was a presumed fact that the scientists interpretation was true. This assumption was
possible because logical positivists believe in an objec-
23
Kutney
25
Kutney
27