It is commonly thought that mental disorder is a valid concept only in so far as it is an extension of or continuous with the concept of physical disorder. A valid extension has to meet two criteria: determination and coherence. Essentialists meet these criteria through necessary and sufficient conditions for being a disorder. Two Wittgensteinian alternatives to essentialism are considered and assessed against the two criteria. These are the family resemblance approach and the secondary sense approach. Where the focus is (...) solely on the characteristics or attributes of things, both these approaches seem to fail to meet the criteria for valid extension. However, this focus on attributes is mistaken. The criteria for valid extension are met in the case of family resemblance by the pattern of characteristics associated with a concept, and by the limits of intelligibility of applying a concept. Secondary sense, though it may have some claims to be a good account of the relation between physical and mental disorder, cannot claim to meet the two criteria of valid extension. (shrink)

I argue that denial plays a central but insufficiently recognized role in addiction. The puzzle inherent in addiction is why drug use persists despite negative consequences. The orthodox conception of addiction resolves this puzzle by appeal to compulsion; but there is increasing evidence that addicts are not compelled to use but retain choice and control over their consumption in many circumstances. Denial offers an alternative explanation: there is no puzzle as to why drug use persists despite negative consequences if these (...) consequences are not straightforwardly known. I describe the nature of the causal knowledge that one's drug use is causing negative consequences; map the conceptual landscape of denial and explain how it can block such knowledge; and explore some of the processes and mechanisms that have been studied by philosophy and the cognitive sciences and which may underpin denial in addiction, including well-established information-processing biases, motivational influences on belief formation and self-deception, and cognitive deficits with respect to insight and self-awareness. I conclude by suggesting that addiction is as much a disorder of cognition as a disorder of conation. (shrink)

Despite several criticisms surrounding the DSM classification in psychiatry, a significant bulk of research on mental conditions still operates according to two core assumptions: a) homogeneity, that is the idea that mental conditions are sufficiently homogeneous to justify generalization; b) additive comorbidity, that is the idea that the coexistence of multiple conditions in the same individual can be interpreted as additive. In this paper we take autism research as a case study to show that, despite a plethora of criticism, psychiatric (...) research often continues to operate in accordance with this model. Then we argue that such a model runs into problems once facts about comorbidity are taken into account. Finally, we offer some suggestions on how to tackle the challenge raised by comorbidity and its impact on heterogeneity. To do so, we explore transdiagnostic stratification accounts and network models to show that combining these approaches can move us in the right direction. (shrink)

The causes and underlying natures of common mental disorders are, for the most part, quite mysterious. Our best taxonomies acknowledge this poverty of causal knowledge about minds, brains, society, and whatever else, to instead classify psychopathology based on clusters of detectable signs and symptoms: what it is to be, say, depressed, is simply to exhibit the minimum number of typical features for the right amount of time. Nothing in this approach references what causes and maintains a characteristic set of symptoms, (...) and so by conceptualizing disorders as syndromes psychiatry stands in stark contrast to somatic medicine, its close cousin, and other successful sciences that classify... (shrink)

Philosophy of psychiatry has boomed in the last few years. We are now seeing a growing literature on the nature of psychiatric explanation, including work that makes contact with longstanding disputes in the philosophy of science as well as more specific work on mental disorders. This paper looks at some recent work on both representing and explaining mental illness. An emerging picture sees explanation of mental disorder as first constructing causal-statistical networks that represent disease pathways as they unfold in time, (...) and then choosing strategies for causal explanation. The epistemic problems in psychiatry are huge, and they arise from the extreme variety in the causes and trajectories of mental disorders across patients. Existing concepts of levels of explanation and mechanism may seem like an obvious epistemic armoury, but they may not fit psychiatry very well, and philosophical theories of psychiatric explanation stress different ways of trying to understand robust patterns amid the individual variation. (shrink)

In this paper, I will argue that the NIMH’s new Research Domain of Criteria is a useful test of the philosophical hypothesis of eliminative materialism and demonstrates the superiority of a moderate eliminativism over integrationism, which is a rival philosophical framework for the cognitive sciences. I begin by going over the motivation for RDOC, which rests on the problems with the existing Diagnostic and Statistical Manual of Mental Disorders framework in psychiatry. Then, I introduce the main tenets of RDoC before (...) discussing eliminativism and trying to show what a moderate eliminativism looks like through the example of addiction. I then contrast that approach with intregrationism to the latter’s detriment. I end by wondering whether the broadly political consequences of eliminativism give us non-scientific reasons for resisting it, as it threatens to rob ordinary people of important means of self-description. (shrink)

I distinguish three evolutionary explanations of mental illness: first, breakdowns in evolved computational systems; second, evolved systems performing their evolutionary function in a novel environment; third, evolved personality structures. I concentrate on the second and third explanations, as these are distinctive of an evolutionary psychopathology, with progressively less credulity in the light of the empirical evidence. General morals are drawn for evolutionary psychiatry.

: In direct opposition to the dominant nativist perspective tracing back to Descartes, William James suggested that the sense of self is constructed through a never-ending process of reflexivity. In more recent years, empirical data from various psychological domains have further strengthened this constructivist perspective. Notably, Gergely and Watson’s social biofeedback model has been proposed as a central mechanism in the development of emotional introspection, which itself constitutes a crucial step in the process leading to a mature sense of self. (...) In accordance with the social biofeedback model, it has been suggested that reiterated failures in biofeedback mechanisms predispose an individual to mental suffering. While borderline personality disorder and antisocial behavior have received the most attention, here I make a preliminary attempt to examine the impact of dysfunctional biofeedback on the pathogenesis of narcissism, suggesting that some central features of pathological narcissism may result from serious and reiterated disruptions in social biofeedback. This preliminary exploration aims to deepen our understanding of the origins of psychological suffering. In this sense, my effort could contribute to the construction of a causal model going beyond the purely categorical, atheoretical analysis of mental diseases typical of the diagnostic and statistical manuals. Keywords: Self; Self-ing Process; Social Biofeedback Model; Narcissism Il farsi e il disfarsi del sé. Biofeedback sociale, meccanismi causali e narcisismo patologico Riassunto: La prospettiva costruttivista sullo sviluppo del sé, efficacemente difesa da William James in opposizione all’innatismo di stampo cartesiano, è oggi ulteriormente avvalorata da numerosi dati empirici provenienti da diversi ambiti della psicologia. Il modello del biofeedback sociale di Gergely e Watson è stato proposto quale meccanismo centrale nello sviluppo dell’introspezione emotiva. In accordo a tale modello, ripetuti gravi fallimenti del biofeedback predispongono al disturbo mentale, segnatamente al disturbo borderline di personalità e al comportamento antisociale. In questo saggio mi occuperò di disturbo narcisistico di personalità, suggerendo che anche alcuni dei sintomi principali di questa patologia potrebbero derivare da disfunzioni gravi e reiterate del biofeedback. Nonostante la sua natura preliminare, la mia indagine si inscrive nell’alveo di quelle ricerche che mirano costruzione di un modello causale che vada oltre l’analisi puramente categoriale e ateoretica tipica dei manuali statistico-diagnostici. Parole chiave: Self; Identità personale; Social Biofeedback Model; Disturbo narcisistico di personalità. (shrink)

Martin Luther King Jr. claimed that “the salvation of the world lies in the hands of the maladjusted”. I elaborate on King’s claim by focusing on the way in which we treat and understand ‘maladjustment’ that is responsive to severe trauma (e.g. PTSD that is a result of military combat or rape). Mental healthcare and our social attitudes about mental illness and disorder will prevent us from recognizing real injustice that symptoms of mental illness can be appropriately responding to, unless (...) we recognize that many emotional states (and not just beliefs!) that constitute those symptoms are warranted by the circumstances they are responsive to. I argue that there is a failure to distinguish between PTSD symptoms that are warranted emotional responses to trauma and those that are not. This results in us focusing our attention on “fixing” the agent internally, but not on fixing the world. It is only by centering questions of warrant that we will be able to understand and expose the relationship between agents’ internal mental states and their oppression. But we also need to ask when someone’s emotional response is unwarranted by their experience (as in the case of someone who develops PTSD after a non-traumatic event). If we fail to do this—as, I claim, both our mental healthcare and the broader social world fail to do—we treat warranted and unwarranted emotions as on a par. This undermines the epistemic judgment of the agent who has warranted PTSD symptoms, resulting in her failing to trust her evaluation of whether her emotional response to her own trauma is warranted by that trauma, and thus failing to recognize her own oppression. (shrink)

In clinical medicine, a diagnosis can offer an explanation of a patient's symptoms by specifying the pathology that is causing them. Diagnoses in psychiatry are also sometimes presented in clinical texts as if they pick out pathological processes that cause sets of symptoms. However, current evidence suggests the possibility that many diagnostic categories in psychiatry are highly causally heterogeneous. For example, major depressive disorder may not be associated with a single type of underlying pathological process, but with a range of (...) different causal pathways, each involving complex interactions of various biological, psychological, and social factors. This paper explores the implications of causal heterogeneity for whether psychiatric diagnoses can be said to serve causal explanatory roles in clinical practice. I argue that while they may fall short of picking out a specific cause of the patient's symptoms, they can nonetheless supply different sorts of clinically relevant causal information. In particular, I suggest that some psychiatric diagnoses provide negative information that rules out certain causes, some provide approximate or disjunctive information about the range of possible causal processes, and some provide causal information about the relations between the symptoms themselves. (shrink)

Philosophical Psychology, Volume 25, Issue 4, Page 617-621, August 2012.

In recent years, numerous articles and books in the humanities and the social sciences have been devoted to understanding the ascription of race, gender, ethnicity, sexual orientation, mental illness, and other ‘human kind’ concepts to persons. What may be more surprising given the enormous volume of this research and the diversity of its sources is that much of it shares a common commitment to understanding the categories picked out by these concepts in an non- essentialist way. For example, Iris Marion (...) Young suggests of social groups (including races, genders, classes, age groups, and ethnicities) that they. (shrink)

When we ask what natural kinds are, there are two different things we might have in mind. The first, which I’ll call the taxonomy question, is what distinguishes a category which is a natural kind from an arbitrary class. The second, which I’ll call the ontology question, is what manner of stuff there is that realizes the category. Many philosophers have systematically conflated the two questions. The confusion is exhibited both by essentialists and by philosophers who pose their accounts in (...) terms of similarity. It also leads to misreading philosophers who do make the distinction. Distinguishing the questions allows for a more subtle understanding of both natural kinds and their underlying metaphysics. (shrink)

The Homeostatic Property Cluster (HPC) account of natural kinds has become popular since it was proposed by Richard Boyd in the late 1980s. Although it is often taken as a defining natural kinds as such, it is easy enough to see that something's being a natural kind is neither necessary nor sufficient for its being an HPC. This paper argues that it is better not to understand HPCs as defining what it is to be a natural kind but instead as (...) providing the ontological realization of (some) natural kinds. (shrink)

This paper examines the adequacy of an evolutionary-oriented notion of rationality—ecological rationality—that has recently been proposed in economics. Ecological rationality is concerned with what it is rational to do, and in this sense is a version of what philosophers call ‘practical rationality’. Indeed, the question of the adequacy of ecological rationality as it is understood in the paper, is the question of whether ecological rationality is a genuine notion of practical rationality. The paper first explicates and motivates the notion of (...) ecological rationality by explicating the notion of practical rationality, grounding ecological rationality in an evolutionary approach to the emotions which is mainly illustrated by the example of fear, and outlining the reasons adduced in economics for generalizing ecological rationality beyond the emotions. The paper then argues that the raison d’être of practical rationality is first and foremost a specific role it plays in the explanation of behavior, or in telling why it has occurred. Finally, based on –, the paper argues that ecological rationality lacks a constitutive feature of practical rationality—namely, normativity—which is related to the latter’s basic explanatory role, and thus cannot be considered a genuine notion of practical rationality. While the paper focuses on the economic version of ecological rationality, its conclusions apply just as well to other, related, versions of the ecological notion that have been proposed in biology and evolutionary psychology. (shrink)

Because biologization of psychiatric constructs does not involve derivation of laws, or reduce the number of entities involved, the traditional term of ‘reduction’ should be replaced. This paper describes biologization in terms of redefinition, which involves changing the definition of terms sharing the same extension. Redefinition obtains through triangulation and calibration, that is, respectively, detection of an object from two different spots, and tweaking parameters of detection in order to optimize the picture. The unity of the different views of the (...) same object does not occur through derivation from one of them, as reduction suggests, nor does it obtain through mechanistic unity or the goal of explaining one mechanism, as the phrase ‘mosaic unity’ suggests. Instead, it depends on finding a specific angle of observation, from which linguistic consistency matches sound localization in the brain, so that all observations make sense together, just as an anamorphic picture makes clear sense only when observed from the right spot. (shrink)

The main thesis of this paper is that mental health practitioners can legitimately infer that a patient's given condition is a case of mental disorder without having diagnosed any specific mental disorder. The article shows how this is justifiable by relying either on psychopathological reasoning, on 'intentional' analysis or possibly on other modes of reasoning. In the end, it highlights the clinical and philosophical consequences of the plurality of modes of 'inferences to mental disorder'.

Conceptual analysis of health and disease is portrayed as consisting in the confrontation of a set of criteria—a “definition”—with a set of cases, called instances of either “health” or “ disease.” Apart from logical counter-arguments, there is no other way to refute an opponent’s definition than by providing counter-cases. As resorting to intensional stipulation is not forbidden, several contenders can therefore be deemed to have succeeded. This implies that conceptual analysis alone is not likely to decide between naturalism and normativism. (...) An alternative to this approach would be to examine whether the concept of disease can be naturalized. (shrink)

According to Ian Hacking, some human kinds are subject to a peculiar type of classificatory instability: individuals change in reaction to being classified, which in turn leads to a revision of our understanding of the kind. Hacking’s claim that these ‘human interactive kinds’ cannot be natural kinds has been vehemently criticized on the grounds that similar patterns of instability occur in paradigmatic examples of natural kinds. I argue that the dialectic of the extant debate misses the core conceptual problem of (...) human interactive kinds. The problem is not that these kinds are particularly unstable but ‘capricious’—their members behave in wayward, unexpected manners that defeats existing theoretical understanding. The reason for that, I argue, is that human interactive kinds are often ‘hybrid kinds’ consisting of a base kind and an associated status, which makes mechanisms that support patterns of change and stability systematically difficult to understand and predict. 1Introduction2The Extant Discussion 2.1Hacking’s account of interactive kinds2.2Classificatory feedback in non-human kinds3Natural kinds and Ontological Instability 3.1Understanding instability3.2The problem of stabilizing feedback3.3Summary4Capricious Kinds 4.1Biased conceptualization4.2Studying social status5Conclusion. (shrink)

Medical classification systems aim to provide a manageable taxonomy for sorting diagnoses into their proper classes. The question, this paper wants to critically examine, is how to correctly systematise diseases within classification systems that are applied in a variety of different settings. ICD and DSM , the two major classification systems in medicine and psychiatry, will be the main subjects of this paper; however, the arguments are not restricted to these classification systems but point out general methodological and epistemological challenges (...) of classifying diseases for differing purposes. Deciding what qualifies as a disease to be included into a classification system as well as choosing a specific validator for correctly systematising diseases is complicated because the broad applicability of medical classification systems simultaneously appears as aim and challenge. Drawing upon the case study of classifying Alzheimer’s disease, this paper will address three dilemmas in designing ‘good’ medical classification systems. They are due to general epistemological problems of medicine, such as the relationship between individual manifestations of diseases and the necessity of building groups in order to scientifically elucidate causes of diseases. Moreover, they involve pragmatic issues of designing usable classifications that allow for easily discriminating between classes of diseases, restricting, however, the completeness of disease representations. This paper wants to trace how the choice of certain validators is unavoidably value-laden and deeply intertwined with epistemological assumptions of how different uses relate to each other, resulting either in a prioritisation of (constrained) coherence or of (vague) pluralistic connectibility. (shrink)

In this paper, I defend a version of the medical model of disability, which defines disability as an enduring biological dysfunction that causes its bearer a significant degree of impairment. We should accept the medical model, I argue, because it succeeds in capturing our judgments about what conditions do and do not qualify as disabilities, because it offers a compelling explanation for what makes a condition count as a disability, and because it justifies why the federal government should spend hundreds (...) of billions of dollars, annually, on aid and accommodations for disabled people. After responding to a pair of objections Elizabeth Barnes has raised against the medical model, I contrast it with Guy Kahane and Julian Savulescu's welfarist account of disability, and with Barnes's own mere-difference view. Both of these accounts face serious challenges, although elements of Barnes's view can—and, in my opinion, should—be adopted by proponents of the medical model. (shrink)

The American Journal of Bioethics, Volume 11, Issue 8, Page 21-22, August 2011.

There has been much debate about whether the concept of disease articulated in Boorse’s biostatistical theory is value-neutral or value-laden. Here, I want to examine whether this debate matters. I suggest that there are two basic respects in which value-ladenness might be important: it could threaten either scientific legitimacy or moral permissibility. I argue that value-ladenness does not threaten the scientific legitimacy of our disease-concept because the concept makes little difference to the formulation and testing of scientific hypotheses. Likewise, even (...) if our disease-concept is value-laden, this does not show it is morally impermissible. To determine its permissibility, we must regard it as a tool to structure social institutions. Seen in that way, whether our disease-concept is morally permissible is a consequentialist matter and depends exquisitely on unanswered empirical questions. (shrink)

In their paper “Is psychopathy a mental disease?”, Thomas Nadelhoffer and Walter Sinnott-Armstrong argue that according to any plausible account of mental disorder, neural and psychological abnormalities correlated with psychopathy should be regarded as signs of a mental disorder. I oppose this conclusion by arguing that at least on a naturalistically grounded account, such as Wakefield’s ‘Harmful Dysfunction’ view, currently available empirical data and evolutionary considerations indicate that psychopathy is not a mental disorder.

Recently there has been a trend of moving towards biological and neurocognitive based classifications of mental disorders that is motivated by a dissatisfaction with the syndrome-based classifications of mental disorders. The Research Domain Criteria (indicated with the acronym RDoC) represents a bold and systematic attempt to foster this advancement. However, RDoC faces theoretical and conceptual issues that need to be addressed. Some of these difficulties emerge when we reflect on the plausible reading of the slogan “mental disorders are brain disorders”, (...) that according to proponents of RDoC constitutes one of its main presuppositions. Some authors think that endorsing this idea commits RDoC to a form of biological reductionism. We offer empirical and theoretical considerations for concluding that the slogan above should not be read as a reductionist thesis. We argue, instead, that the slogan has a pragmatic function whose aim is to direct research in psychopathology. We show how this function might be captured in the framework of a Carnapian explication as a methodological tool for conceptual engineering. Thus, we argue that a charitable interpretation of the aims of the proponents of RDoC should be understood as an attempt at providing an explication of the concept of mental disorder in terms of brain disorder whose main goal is to provide a more precise and fruitful notion that is expected to have a beneficial impact on classification, research, and treatment of psychiatric conditions. (shrink)

In this paper, I address the question whether mental disorders should be understood to be brain disorders and what conditions need to be met for a disorder to be rightly described as a brain disorder. I defend the view that mental disorders are autonomous and that a condition can be a mental disorder without at the same time being a brain disorder. I then show the consequences of this view. The most important of these is that brain differences underlying mental (...) disorders derive their status as disordered from the fact that they realize mental dysfunction and are therefore non-autonomous or dependent on the level of the mental. I defend this view of brain disorders against the objection that only conditions whose pathological character can be identified independently of the mental level of description count as brain disorders. The understanding of brain disorders I propose requires a certain amount of conceptual revision and is at odds with approaches which take the notion of brain disorder to be fundamental or look to neuroscience to provide us with a purely physiological understanding of mental illness. It also entails a pluralistic understanding of psychiatric illness, according to which a condition can be both a mental disorder and a brain disorder. (shrink)

In the context of psychiatric diagnosis, operationists claim that mental disorders are nothing more than the satisfying of objective diagnostic criteria, whereas realists claim that mental disorders are latent entities that are detected by applying those criteria. The implications of this distinction are substantial in actual clinical situations, such as in the co-occurrence of disorders that may interfere with one another's detection, or when patients falsify their symptoms. Realist and operationist conceptions of diagnosis may lead to different clinical decisions in (...) these situations, affecting treatment efficacy and ultimate patient outcomes. (shrink)

Philosophy of medicine has traditionally examined two issues: the scientific ontology for medicine and the epistemic significance of the types of evidence used in medical research. In answering each question, philosophers have typically brought to bear tools from traditional analytic philosophy. In contrast, this volume explores medical knowledge from the perspective offered by social epistemology.While many of the same issues are addressed, the approach to these issues generates both fresh questions and new insights into old debates. In addition, the broader (...) purview offered by social epistemology opens up opportunities to address new topics such as the role of consensus conferences, epistemic injustice, the value of medical knowledge, continuing medical education, and industry funding. This article situates and summarizes the contributions to this special issue. (shrink)

A common view in the philosophy of mind and philosophy of psychology is that there is an ideally correct way of categorizing the structures and operations of the mind, and that the goal of neuroscience and psychology is to find this correct categorizational scheme. Categories which cannot find a place within this correct framework ought to be eliminated from scientific practice. In this paper, I argue that this general idea runs counter to productive scientific practices. Such a view ignores the (...) plurality of aims and goals that neuroscientists and psychologists have in studying mental phenomena, and the necessity of employing distinct classificatory frameworks to achieve them. (shrink)

Jennifer Radden has drawn attention to two features of delusion, ambivalence and subjectivity, which are problematic for theories of delusion that treat delusions as empirical beliefs. She argues for an ‘attitude’ theory of delusion. I argue that once the cognitive architecture of delusion formation is properly described the debate between doxastic and attitude theorists loses its edge. That architecture suggests that delusions are produced by activity in the ‘default mode network’ unsupervised by networks required for decontextualized processing. The cognitive properties (...) of these networks explain the features of delusion which generate the debate between doxastic and attitude theorists. (shrink)

Much research in the philosophy of psychiatry has been devoted to the characterization of the normal and the pathological. In this article, we identify and deconstruct two postulates that have held sway in the philosophy of psychiatry. The first postulate concerns the belief that clinicians would benefit from conceiving of psychiatric disorders as stable entities with clear boundaries. By relying on a symptom-based approach, we support a conception of psychiatric disorders whose symptoms are the products of many activated mechanisms in (...) mutual interactions. The second postulate concerns the way in which the philosophy of psychiatry has approached the question of harm. We posit that clinicians perceive harms primarily through networks of clinical manifestations. The identification and deconstruction of these two postulates leads us to propose a practical definition of a psychiatric disorder that is useful for the clinician, while adopting a principle of prudential conservatism that does not exclude other theoretical definitions of psychiatric disorder that are useful as an epistemic hub. Thus, we propose the following definition of a psychiatric disorder that is relevant to clinical practice: “a set of clinical manifestations belonging to the prototypical central core of psychiatry, organized in a causal network, involving at least one harm, and whose set of harms exceeds the traditional threshold of significance for a given psychiatric disorder, directly related to an activated mechanism. Such a network composed of clinical manifestations is frozen in a state that is unable to allow the deactivation of these manifestations spontaneously without a therapeutic intervention”. (shrink)

In this paper, we want to take a critical stance towards Tsou’s recent proposal that a neuro-oriented version of the homeostatic property cluster kind model (MPCK) should be an ideal for the DSM. Our strategy will be to discuss the creation of the Social Pragmatic Communication Disorder (SPCD) in DSM-5 to show the limits of MPCK as an ideal for the next DSM deliberations over a set of diagnoses revisions. We argue that an ideal model for the DSM should address (...) the issues of deep uncertainties and pragmatic considerations to be useful in this context. (shrink)

Psychiatric researchers typically assume that the modelling of psychiatric symptoms is not influenced by psychiatric categories; symptoms are modelled and then grouped into a psychiatric category. I highlight this primarily through analysing research domain criteria. RDoC’s importance makes it worth scrutinizing, and this assessment also serves as a case study with relevance for other areas of psychiatry. RDoC takes inadequacies of existing psychiatric categories as holding back causal investigation. Consequently, RDoC aims to circumnavigate existing psychiatric categories by directly investigating the (...) causal basis of symptoms. The unique methodological approach of RDoC exploits the supposed lack of influence of psychiatric categories on symptom modelling, taking psychiatric symptoms as the same regardless of which psychiatric category is employed or if no psychiatric category is employed. But this supposition is not always true. I will show how psychiatric categories can influence symptom modelling, whereby identical behaviours can be considered as different symptoms based on an individual’s psychiatric diagnosis. If the modelling of symptoms is influenced by psychiatric categories, then psychiatric categories will still play a role, a situation which RDoC researchers explicitly aim to avoid. I discuss four ways RDoC could address this issue. This issue also has important implications for factor analysis, cluster analysis, modifying psychiatric categories, and symptom based approaches. (shrink)

Historians and sociologists of psychiatry often claim that psychiatric diagnoses are discontinuous. That is, a particular diagnoses will be described in one way in one era and described quite differently in a different era. Historians and sociologists often draw epistemic consequences from such discontinuities, claiming that truth is pluralistic, provisional and historicised. These arguments do not readily fit in with how analytical philosophers of science approach scientific realism. I show how the pessimistic meta induction does not capture the point which (...) historians and sociologists are making but scientific perspectivism seems to capture their point much better. I then highlight conceptual innovations which scientific perspectivists add. They demarcate between truth and objective reality, they specify which type of truth they endorse and they put down constraints on possible truths. This blocks an anything goes relativism which historians and sociologists can be in danger of falling into. I highlight my argument by discussing a discontinuous episode in the history of autism. I discuss three aspects of this discontinuity and show how scientific perspectivism can portray each aspect as non-trivially true. My argument shows that we can be scientific realists about autism even if we can formulate notions of autism in quite different ways. (shrink)

Critics who are concerned over the epistemological status of psychiatric diagnoses often describe them as being constructed. In contrast, those critics usually see symptoms as relatively epistemologically unproblematic. In this paper I show that symptoms are also constructed. To do this I draw upon the demarcation between data and phenomena. I relate this distinction to psychiatry by portraying behaviour of individuals as data and symptoms as phenomena. I then draw upon philosophers who consider phenomena to be constructed to argue that (...) symptoms are also constructed. Rather than being ready made in the world I show how symptoms are constructs we apply to the world. I highlight this with a historical example and describe methodological constraints on symptom construction. I show the epistemic problems with psychiatric diagnoses are also applicable to symptoms. Following this, I suggest that critics of psychiatric diagnoses should extend their criticism to symptoms or, if they still believe symptoms are relatively epistemologically unproblematic, should rethink their concerns over psychiatric diagnoses. (shrink)

Psychopathological delusions have a number of features that are curiously difficult to explain. Delusions are resistant to counterevidence and impervious to counterargument. Delusions are theoretically, affectively, and behaviorally circumscribed: delusional individuals often do not act on their delusions and often do not update beliefs on the basis of their delusions. Delusional individuals are occasionally able to distinguish their delusions from other beliefs, sometimes speaking of their “delusional reality.” To explain these features, I offer a model according to which, contrary to (...) appearances, delusions are not beliefs at all. Delusions are acceptances that are generated by pathologically powerful cognitive feelings. This model has implications for the way that we should think about non-pathological doxastic states and emotions. (shrink)

In this paper, I focus on life-threatening medical conditions and argue that from the point of view of natural properties, induction(s), and participation in laws, at least some of the ill organisms dealt with in somatic medicine form natural kinds in the same sense in which the kinds in the exact sciences are thought of as natural. By way of comparing two ‘divisions of nature’, viz., a ‘classical’ exact science kind (gold) and a kind of disease (Graves disease), I show (...) that there is no justifiable ‘ontological gap’ between disease kinds and exact sciences kinds. We have instead a difference of degree. (shrink)

This chapter examines the history of philosophy of psychology and philosophy of psychiatry as subfields of philosophy of science that emerged in the late twentieth and early twenty-first century. The chapter also surveys related literatures that developed in psychology and psychiatry. Philosophy of psychology (or philosophy of cognitive science) has been a well-established subfield of philosophy of mind since the 1990s and 2000s. This field of philosophy of psychology is narrowly focused on issues in cognitive psychology and cognitive science. Compared (...) to the thriving subfield of philosophy of cognitive science, there has been a lack of corresponding interest among philosophers of science in broader methodological questions about different paradigms and fields of study in psychology. These broader methodological questions about psychology have been addressed in the field of theoretical psychology, which is a subfield of psychology that materialized in the 1980s and 1990s. Philosophy of psychiatry emerged as a subfield of philosophy of science in the mid-2000s. Compared to philosophy of psychology, the philosophy of psychiatry literature in philosophy of science engaged with issues examined in an older and more interdisciplinary tradition of philosophy of psychiatry that developed after the 1960s. The participation of philosophers of science in the literature on theoretical psychology, by contrast, has been limited. (shrink)

This thesis is a philosophical examination of the explanatory roles of diagnoses in psychiatry. In medicine, diagnoses normally serve as causal explanations of patients’ symptoms. Given that psychiatry is a discipline whose practice is shaped by medical traditions, it is often implied that its diagnoses also serve such explanatory functions. This is evident in clinical texts that portray psychiatric diagnoses as referring to diseases that cause symptoms. However, there are problems which cast doubt on whether such portrayals are justified. I (...) address these problems and examine whether psychiatric diagnoses provide explanations of symptoms. The first problem is conceptual. In diagnostic manuals, psychiatric diagnoses are defined by their symptoms. This suggests that invoking them as explanations of the symptoms amounts to circularity. I argue that this can be resolved with an appropriate conceptual framework that captures the complex semantic values of diagnostic terms and their different uses in clinical discourse. I put forward such a framework based on two-dimensional semantics. The second problem is ontological. Empirical research suggests that diagnostic categories in psychiatry do not correspond to invariant causal types, but are associated with variable combinations of diverse causes that interact across biological, psychological, and social levels. Given this heterogeneity, I argue that psychiatric diagnoses fall short of paradigmatic cases of causal explanation, but that some can still provide other sorts of useful causal explanatory information. The original contribution of this thesis is the illumination of the conceptual relations between diagnoses and symptoms. This philosophical work is important, because it can be brought to valuable application in modifying psychiatric practice. (shrink)

Winner of the 2020 Essay Competition of the International Social Ontology Society. -/- Ian Hacking uses the looping effect to describe how classificatory practices in the human sciences interact with the classified people. While arguably this interaction renders the affected human kinds unstable and hence different from natural kinds, realists argue that also some prototypical natural kinds are interactive and human kinds in general are stable enough to support explanations and predictions. I defend a more fine-grained realist interpretation of interactive (...) human kinds by arguing for an explanatory domain account of the looping effect. First, I argue that knowledge of the feedback mechanisms that mediate the looping effect can supplement, and help to identify, the applicability domain over which a kind and its property variations are stably explainable. Second, by applying this account to cross-cultural case studies of psychiatric disorders, I distinguish between congruent feedback mechanisms that explain matches between classifications and kinds, and incongruent feedback mecha- nisms that explain mismatches. For example, congruent mechanisms maintain Western auditory experiences in schizophrenia, whereas exporting diagnostic labels inflicts incongruence by influencing local experiences. Knowledge of the mechanisms can strengthen explanatory domains, and thereby facilitate classificatory adjustments and possible interventions on psychiatric disorders. (shrink)

Cognitive science is the interdisciplinary investigation of mind and intelligence, embracing psychology, neuroscience, anthropology, artificial intelligence, and philosophy. There are many important philosophical questions related to this investigation, but this short chapter will focus on the following three. What is the nature of the explanations and theories developed in cognitive science? What are the relations among the five disciplines that comprise cognitive science? What are the implications of cognitive science research for general issues in the philosophy of science? I will (...) argue that cognitive theories and explanations depend on representations of mechanisms and that the relations among the five disciplines, especially psychology and neuroscience, depend on relations between kinds of mechanisms. These conclusions have implications for central problems in general philosophy of science such as the nature of theories, explanations, and reduction between theories at different levels. (shrink)

Many philosophers and cognitive scientists claim that our everyday or "folk" understanding of mental states constitutes a theory of mind. That theory is widely called "folk psychology" (sometimes "commonsense" psychology). The terms in which folk psychology is couched are the familiar ones of "belief" and "desire", "hunger", "pain" and so forth. According to many theorists, folk psychology plays a central role in our capacity to predict and explain the behavior of ourselves and others. However, the nature and status of folk (...) psychology remains controversial. (shrink)

Social “construction,” “constructionism” and “constructivism” are terms in wide use in the humanities and social sciences, and are applied to a diverse range of objects including the emotions, gender, race, sex, homo- and hetero-sexuality, mental illness, technology, quarks, facts, reality, and truth. This sort of terminology plays a number of different roles in different discourses, only some of which are philosophically interesting, and fewer of which admit of a “naturalistic” approach—an approach that treats science as a central and successful (if (...) sometimes fallible) source of knowledge about the world. If there is any core idea of social constructionism, it is that some object or objects are caused or controlled by social or cultural factors rather than natural factors, and if there is any core motivation of such research, it is the aim of showing that such objects are or were under our control: they could be, or might have been, otherwise. (shrink)

Moral psychology investigates human functioning in moral contexts, and asks how these results may impact debate in ethical theory. This work is necessarily interdisciplinary, drawing on both the empirical resources of the human sciences and the conceptual resources of philosophical ethics. The present article discusses several topics that illustrate this type of inquiry: thought experiments, responsibility, character, egoism v . altruism, and moral disagreement.

In recent years both philosophers and scientists have asked whether or not our current kinds of mental disorder—e.g., schizophrenia, depression, bipolar disorder—are natural kinds; and, moreover, whether or not the search for natural kinds of mental disorder is a realistic desideratum for psychiatry. In this dissertation I clarify the sense in which a kind can be said to be “natural” or “real” and argue that, despite a few notable exceptions, kinds of mental disorder cannot be considered natural kinds. Furthermore, I (...) contend that psychopathological phenomena do not cluster together into kinds in the way that paradigmatic natural kinds (e.g., chemical kinds and species) do; and, in light of this fact, I conclude that the normative ideal of natural classification—i.e. classifying real or natural kinds—is not appropriate as a general strategy for psychiatry. In the conclusion to this dissertation I propose an alternative way forward. Rather than assuming a priori that psychopathological phenomena cluster together into kinds, a more tractable and theoretically promising approach would be to first explain how particular kinds of experiences and behaviours—e.g, hallucinations, delusions, disorganized thinking, mania, low mood, etc.—are produced. (shrink)

Researchers attempting to explain and treat psychiatric disorders have long discussed the need for new disorder categories. A common proposal is to develop a causal classification system whereby psychiatric disorders are classified according to the causal processes that produce and sustain them. I evaluate the prospects for causal classification of psychiatric disorders. First, I motivate the need for a causal classification system of psychiatric disorders. Second, I introduce one framework for causal classification, the exemplar model. Third, I examine multiple forms (...) of causal complexity that the exemplar model must successfully navigate if it is to be a viable classification model for psychiatry. I argue that the exemplar model can handle some issues of causal complexity but not others. I conclude that psychiatry should utilize two models of classification, the exemplar model and the network model, because each fulfills some, but not all, of the purposes of classification systems. (shrink)