ABSTRACT
This chapter develops a heuristic framework for psychiatry as a normative practice. The first sections explore what terms like normative and normative practice mean and enumerate the requirements for the framework. The second part develops the normative practice approach, by outlining its background, explaining its constituents, and defining the roles it might play.
The normative practice approach sees the practice of psychiatry as inherently value laden and responding to norms, principles, values, and ideals. 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. The norms and principles are constitutive for psychiatric practice and define its inherently normative conditions. The core values and ideals, by way of contrast, 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 distinction between different types of norm helps to elucidate the weakness of (among others) managerialism in the organization of mental healthcare. The normative practice model interprets managerialism as being determined by a role reversal between the conditioning (economic) and the qualifying (moral) norms: The (economic) efficiency norm takes the place of (moral) norms such as benevolence and beneficence. It is also shown how the normative practice approach provides a richer, more nuanced, and more convincing account of psychiatry’s legitimacy.
