Health and well-being 29
Philosophical rethink
inspires new clinical applications
In challenging conventional theories about the basis of interpersonal relations, Professors Dan Hutto and Shaun Gallagher have helped to inspire new and promising approaches for a range of clinical applications, including diagnosing and treating schizophrenia and autism spectrum disorders.
How we relate to and understand one another in daily life is a topic of intense academic debate and scrutiny. Many researchers take it for granted that even our most basic social interactions involve operating with a theory about mental states such as belief, desire, fear and hope.
In his acclaimed 2008 book, Folk Psychological Narratives, Professor Dan Hutto challenges this conventional thinking. He argues that engaging in socially supported narrative practices is what provides the crucial developmental training that leads to both an understanding and establishment of the human condition.
Dan Hutto, who is Professor of Philosophical Psychology, believes that people are not born with this core ability: ‘Our capacity to understand the reasons that motivate action in terms of articulated beliefs and desire has a narrative form. This understanding is developed from an early age through listening
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to conversations and stories about people and why they act. I call this the Narrative Practice Hypothesis.’
Professor Hutto’s research complements work by Professor Shaun Gallagher, Professor of Philosophy and Cognitive Science at the University and Moss Professor of Excellence at the University of Memphis, who focuses on embodied intersubjective practices, including gesture. Together they have developed a new approach for understanding the full range of our everyday or ‘folk’ psychological abilities. As an alternative to mainstream thinking, this Embodied and Narrative Practices (E&NP) framework opens up new avenues for diagnosis and treatment in a variety of clinical settings. Several research projects are proving its worth in psychopathology and physiotherapy.
For example, the Examination of Anomalous Self-Experience (EASE) interviews are used in the detection and early treatment of schizophrenia.
At a consortium of European centres involved in applying the training EASE technique, doctors used the E&NP framework to improve interviewing. They were able to recognise previously undiagnosed early schizophrenia in thirty patients, with a number subsequently receiving appropriate treatments.
The Early Intervention Team, NHS Coventry and Warwickshire uses narrative-based strategies with young people presenting their first episode of psychotic illness, typically schizophrenia. By fostering patients’ notions of self-worth and autonomy, and gaining better insight into their state of mind, clinicians minimise the chances of them suffering a chronic disorder. In fact, because of these measures very few patients required admission, many remained in education or employment and, at the end of the critical three-year period were discharged back to their GPs. Since adopting this approach the team has met both its Department of
Health caseload targets and national target for the duration of untreated psychosis.
The E&NP framework is also shaping the guidelines for assessing Autism Spectrum Disorders (ASD) and monitoring treatment. The guidelines encourage clinicians to focus on early social practices and problems with movement and gestures in children with ASD, rather than relying on standard ‘theory of mind’ measures. The new approaches are being evaluated at one of the largest children’s hospitals in Europe. Other new therapies are being explored by researchers associated with the Autism Research Centre in Cambridge. These aim to help children with severe autism improve their communication by training them to sequence actions and thus the narrative sequencing of concepts. Further research is needed, but early results are very positive.
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