Appearing in our September issue, Susan McPherson’s paper, A NICE game of Minecraft,” addressed the “philosophical flaws underpinning UK depression guideline nosology.” Dr McPherson is a researcher in the field of mental health and social care at the University of Essex in the UK, on Twitter variously as @SMhuirich @HHS_Research @ResearchEssex.
This paper uses Minecraft as a metaphor to explain the philosophical problems with trying to divide up experiences of mental distress into discrete categories. Debates about this often take place between mental health professionals who have different ways of understanding peoples’ problems. These debates often focus on professional practices: psychologists usually ‘formulate’ problems in the context of a person’s life and background while psychiatrists usually provide a psychiatric diagnosis. A psychiatric diagnosis is a way of labelling and categorising distress. This article looks at how these philosophical problems apply to guideline development, focusing on the UK depression guideline. Developing a national guideline which determines population health care is removed from everyday clinical practice. It is a technical exercise led by researchers dealing with large amounts of research. This paper identifies important philosophical problems with the categories, definitions and sub-types of depression used in the UK guideline. It uses Minecraft as a metaphor to expose the problem, otherwise hidden among thousands of pages of technical documentation. It shows how the guideline, like Minecraft, has built its structures from virtual cuboids divorced from real experience. The resulting recommendations are like the implausible structures in Minecraft: divorced from real world physics.