Doing Justice: Psychiatry as a Vocation

Abstract Four clinical–academic psychiatrists, all with conceptual–psychological special interests, two with social/historical and two with philosophical/historical interests together with two clinician–philosophers with expertise in counselling and mental health nursing, respectively, explore conceptual and practical issues in relation to justice and psychiatric vocation. All white European, one female, the group identified the following as relevant areas for reflection: the legacy of the Enlightenment; Emil Kraepelin’s philosophical assumptions; the thought of his contemporaries Max Weber and Walter Benjamin, pioneers in social science and cultural history, respectively; empathy; political economy; the social determinants of mental health; personal autonomy; disenchantment and utopia in professional development and clinical practice; and clinical coproduction and Mad Studies. In psychiatry, experience mandates distrust towards macro-utopias, whether biological, social or psychological, indeed even of the biopsychosocial model if it remains rhetorical and does not lead to active opposition to social injustices. In contrast, within the firm boundaries of medical professionalism, we see opportunities for the impact of micro-utopian ambitions, whether in direct clinician–patient encounters or spirited engagement with communities, especially marginalised individuals and groups. We conclude that to do justice to psychiatry as a vocation requires embracing an outlook of Dialectical Pessimism . This combines radical or critical disenchantment with established social forces of domination and a vocational passion for (micro) utopias . To succeed in this, psychiatry needs to better face up to the limitations as well as successes in pursuing Emil Kraepelin’s powerful but narrow agenda, which has continued to bear disproportionately on research and practice, and to grasp the centenary of the anniversary of his death as opportunity to move beyond the profession’s long twentieth century. In that way, it may address more effectively the challenges of what some, since the Coronavirus Disease-2019 (COVID-19) pandemic and the daily impact of artificial intelligence (AI), have labelled the discipline’s early twenty-first century metacommunity era.