Philosophy of Psychiatry at ISHPSSB 2015

Guest post by Natalia Washington:

Friends,

I just wanted to inform you about a very successful philosophy of psychiatry session, “New Dimensions in Philosophy of Psychiatry,” at the recent International Society for the History Philosophy and Social Science of Biology (ISHPSSB) conference in Montreal! (here is the conference webste: http://ishpssb2015.uqam.ca/)

Below, I share with you Kathryn Tabb, Phoebe Friesen, and I’s new work during our session. Before I do so, I want to highlight that there has been quite a few interesting philosophy of psychiatry presentations at the ISHPSSB, including Steeves Demazeux’s “The Ideal of Scientific Progress and the DSM”, and Serife Tekin’s “Self in Scientific Psychiatry.” I was delighted to see that we are a growing presence in the ISHPSSB community!

Here are the abstracts for our session:

New Dimensions in Philosophy of Psychiatry

In this session we examine some contemporary debates emerging in the philosophy of psychiatry, at the intersection of ethics, metaphysics, and philosophy of science, as philosophers, researchers, and practitioners begin to come to grips with psychiatry’s dual nature as a science and an evaluative system. In particular we ask, what is the appropriate ontological framework and methodology for psychiatric research? What kinds of things can psychiatry study and intervene upon? And, what kind of normative standards are the right ones to use in determining what counts as mental illness?

“Philosophy of Psychiatry after Diagnostic Kinds” Kathryn Tabb, HPS, University of Pittsburgh

A significant portion of the scholarship in analytic philosophy of psychiatry has been devoted to the problem of whether or not psychiatric disorders are natural kinds, and if they are not, what kind of thing they are. My contention is that this problem is fast growing less relevant to the concerns of practitioners and service-users of psychiatric medicine. Dissatisfaction with what I call the “diagnostic kind model” of psychiatric objects is currently appearing on a variety of fronts. Among clinicians of diverse orientations, it manifests as a dislike of, and in some cases open rebellion against, the hegemonic authority of the American Psychiatric Association (APA)’s Diagnostic and Statistical Manual of Mental Disorders (DSM). Among clinically-oriented researchers, it presents as a frustration with the demarcation of nosological boundaries that has so long occupied psychiatry as a science. Among scientifically oriented researchers, it is most obvious in the introduction by the National Institute of Mental Health (NIMH) of an alternative tool for classifying psychiatric research, the Research Domain Criteria project. I argue that by focusing on the problem of kindhood, philosophers have neglected the development of a conceptual account that could explain the sort of scientific progress that the NIMH is envisioning, which could also accommodate the sorts of challenges raised by practitioners about the insufficiency of the DSM to describe their patients or promote their best care. I take as my examples the employment of Richard Boyd’s homeostatic property cluster (HPC) kind account by various philosophers, and the “exemplar” account promoted by Dominic Murphy. I demonstrate that these accounts still rely on what I call the “received authority” of diagnostic kinds, the very assumption that the NIMH and others are criticizing.

“Let a Thousand Ontologies Bloom” Phoebe Friesen, Philosophy, CUNY

This project seeks to examine the way in which an overriding focus on the medical model in psychiatric investigations today stands in the way of the dual goals of psychiatric research, to heal and to explain. Like any model of the mind, the medical model contains assumptions regarding ontological priority, by attributing a certain kind of causal reality to a particular level (neurological), at the expense of others (cultural, psychological, genetic). During scientific investigation, attributions of ontological priority constrain what hypotheses will be tested, what is seen as relevant data, how that data is interpreted, and eventually what explanations and treatments will be developed. This suggests that today’s emphasis on the medical model may be leading us to miss out on potential explanations and treatments that could be developed in response to mental disorders. While an abundance of important work is being done focusing on the role of the brain in psychiatric illnesses and developing pharmacological treatments as a result, there are a number of levels or perspectives that are given far less attention, particularly those regarding an individual’s cultural and phenomenological experiences. For this reason, I argue that psychiatry would do well to adopt a stance of ontological pluralism, which encourages an exploratory and open-ended approach to ontology within research. Such an approach aims to lessen the impact of restrictive ontological frameworks on our potential for discovering relevant explanations and effective treatments that might not otherwise come into view.

“Individualism as a Solution to Paternalism in Psychiatric Practice” Natalia Washington, Philosophy, Purdue

While ideally a science consilient with the other sciences of the mind/brain, psychiatry also involves normative and evaluative concepts, as one goal of psychiatric practice is to alleviate the suffering caused by mental illness. But what kinds of evaluative standards are the right ones to use in determining what counts as mental illness? Because diagnosing an individual as having a mental disorder can be a way of saying that they have a condition that is bad and ought to be corrected, or that their pattern of behavior is somehow deviant or harmful, the evaluative nature of psychiatric diagnosis has historically been used as a tool of social control (Banaji, 2013; Satcher, 2001).

In this paper I argue that, in order to ensure that the concept of mental health will be a useful one for theorizing about human flourishing, it should pick out a real psychological phenomenon in human lives, which has significance to the individuals the theory is about. In short it must have normative authority, “the feature in virtue of which people have a reason to follow the imperatives of a normative theory” (Tiberius & Plakias, 2010). To this end, everyone to whom the theory is supposed to apply should have some motivation to care about what psychiatry recommends, and there should be standards of justification for these recommendations. I examine one contemporary attempt to articulate a normative theory for psychiatry—George Graham’s (2010) Rationality-in-Intentionality (RIT) thesis—and argue that it lacks normative authority. The specific norms RIT proposes come apart from what may actually be better for the individual in this case. Finally I argue that in order to solve the problem of paternalism, psychiatry must ground what it means to be mentally ill or mentally healthy in the concerns of individuals.

Looking forward to seeing you all again soon!

Natalia Washington

McDonnell Postdoctoral Scholar at Washington University, Saint Louis

www.nataliawashington.com

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