Thursday, 9 August 2018

Some speculation about Piaget on schemata and Wittgenstein

One of the better aspects of academia is getting interesting emails asking questions. An ex student, John, asked me this the other day.

“Hi Tim,

I understand that Wittgenstein maintains the correct use of a word will always presuppose our ability to use it. i.e. there is no separation between concept and ability to apply it. This made me think about Jean Piaget’s ‘schema theory’ involved in child development. As infants learn to interact with their environments, they develop mental schemata which assimilate objects from the environment. A schema might be learning to grasp and, by assimilating a toy into this schema, the child is able to pick it up. Piaget was confident that the child repeats and practices schemata before their successful use in assimilation. Schemata which fail to assimilate in the intended way are subsequently revised. He also maintains that this way of learning is maintained throughout development and into maturity.

On Piaget’s account, language would classify as symbolic schemata, where a given word will have its schema as anticipatory knowledge of the external environment. Initially, this makes me think that Piaget advocates a method of empirical judgement that easily falls foul of [Wittgenstein’s] regression [of interpretations].

Trying to find compatibility between Wittgenstein and Piaget, I’d be tempted to suggest that a word-schema lacks meaning for the child (even though he/she may know the sound of it etc.) until it is correctly applied and accurately assimilates the intended aspect of experience. At this point, the correct use of the word will be simultaneous with its application, pace Wittgenstein.

Would Wittgenstein buy into this theory of learning, do you think? What status would he give to undeveloped word-schemata - perhaps as having the same standing as objective definitions i.e. without meaning until applied?

John”

Sadly Piaget isn’t one of my authors so I spent an evening looking at ‘The Origins of Intelligence in Children’ to try the following quick, but possibly wholly misguided reply.

Schemata for Piaget start with examples such as grasping and develop into more concept-like instances. It is the latter that looks the better link to Wittgenstein but the former may shed light on our options. Let’s take the idea of grasping or ‘prehension’ (a word I seldom use, to be truth). Grasping seems to be something that floats free or successful and unsuccessful cases. That is, one might equally say of an action that it was an unsuccessful attempt at grasping or a successful grasping. Both have something in common. At some philosophical risk, we might use the same word (‘grasping’) for both. If so – and to put the point needlessly paradoxically! – grasping doesn’t reach as far as the world. I mean, there’s no necessary world-involvingness of any instance of ‘grasping’ (on this way of speaking). Grasping can be characterised in terms independent of the world as a free-standing action or event.

In fact, this seems wrong to me. Grasping is a teleological action and hence I think that the root concept is world-involving. If someone were grasping, then they were grasping something and we can ask what. They might try to grasp and fail, in which case we cannot ask what they were grasping with any guarantee of an answer (they may merely might succeed in grasping the wrong thing). What is world-independent and free-standing is the muscle and finger movements that coincide with successful and unsuccessful grasping alike. That inheres in the body and stops at the outer boundary of the skin. But for the moment, let’s loosely talk of ‘grasping’ to mean this and hence in accord with the earlier suggestion that the same word can be used for successful and unsuccessful cases.

Suppose, then, that we imagine a more concept-like schema on the basis of grasping. It too will be world-independent and will be applicable to orientations towards the world of a subject (necessarily an older child) where things go well and badly, where instances fit and where they fail to fit such a concept-schema. It now makes sense to ask how well the schema fits the experiences or the bits of the world experienced by a subject. Just as a grasping action that fits a mug may not work so well with stemmed wine glass, so perhaps a concept-schema for dog fits some instances of dogs better than others. Since it seems right to say that there will be some instances that cause even an experienced language user pause, this picture seems plausible at first.

But what is the analogue of the world-independent grasping action – or the muscle and finger movements that coincide with successful and unsuccessful grasping alike – for a concept-schema? Think of any free-standing mental (or neurological) state and call that the schema, if you like. Because it is free-standing it can exist however it stands to the world so it can cope with good fit, poor fit and lack of fit.

The problem now becomes: what gives such a free-standing state any kind of fit with the world? One possibility: an interpretation. But now, what encodes the interpretation: another free-standing concept-schema?

The diagnosis is that starting with a free-standing state is fatal for an account of thought’s directedness. Hence if Piaget’s account of schemata assume that they are world-independent and brought in better and worse contact with the world then they might fit some basic actions (especially when described in non-teleogical terms) but they won’t fit concepts. It will be a bad account of the conceptual. By contrast, a concept, on a Wittgensteinian view, is all in the reach to the world. It’s not in the mind. Or: it’s no more in the mind than the relation of being on the mat is in the cat.

Phenomenology and Mental Health Network (PMH)

Phenomenology and Mental Health Network (PMH)

Understanding the diverse character of lived experience

Network Leads
  • Lead: Marcin Moskalewicz, philosopher, Poznan University of Medical Sciences (Poland) & The Oxford Research Centre in the Humanities (TORCH)
  • Co-Lead: Richard Gipps, philosopher and psychotherapist, Faculty of Philosophy, University of Oxford
  • Co-Lead: Giovanni Stanghellini, psychiatrist and psychotherapist, Universit√† degli Studi G. d'Annunzio Chieti e Pescara (Italy)
Background and aims

Phenomenology is a rigorous philosophical method of studying the structures of consciousness and how these structures underlie and affect human experience. By undergoing a clinical turn, 20th century phenomenology became more pragmatic in seeking to understand the variety of lived experiences of patients suffering from mental disorders, often undermining a sense of a strict boundary between the normal and the pathological. Basic phenomenological themes, such as temporality, embodiment, intentionality, understanding, and intersubjectivity, thereby gained a new diagnostic and therapeutic significance. The tradition of phenomenological psychopathology became an important actor on the scene of 20th century psychiatry. The PMH network strives to promote the best of this tradition. It was launched at a workshop “Phenomenology and psychoanalysis: a dialogue” at St Catherine’s College in June 2018. The network connects philosophers, medical anthropologists, and social scientists with health care professionals – psychiatrists, psychotherapists, and caregivers, in order to bring together phenomenological expertise with actual life-world experience of the realities of mental health and illness.

Objectives The PMH network has the following objectives:

  • To provide a forum for the exchange of ideas between those working in mental health care and academic researchers in phenomenology
  • To explore the rich tradition of phenomenological psychopathology, its concepts, values, and critical potential
  • To investigate the ways in which phenomenology informs diagnosis and treatment, and to explore how its potential could be utilized and further expanded in order to improve the care for the mentally ill persons
  • To examine new (phenomenologically inspired) perspectives on mental illness in the context of diversity and plurality of human being
  • To undertake research programs in applied phenomenology and facilitate collaboration between members as well as to seek collaboration with ongoing initiatives elsewhere
  • To build a bridge between Central-European traditions of phenomenology and Anglo-Saxon scholarship
Members 
The network is open to all working at the intersection of phenomenological philosophy (as well as related fields of philosophy of mind and philosophical hermeneutics) and mental health. Membership is free of charge. To join please send a request to Marcin Moskalewicz at moskalewicz@gmail.com.

Meetings 
To advance our objectives, meetings and workshops will be organized regularly, some of them with an open call for papers in the conference format. The network will also support local initiatives.

Forthcoming events 
24th of October 2018, Diversity and Mental Illness (one-day workshop) at St. Catherine’s College. The workshop is a part of TORCH’s annual headline series Humanities & Identities and is co-sponsored by The Oxford Research Centre in the Humanities.

Friday, 29 June 2018

Mindfulness-inspired existential nihilism

I’ve been using the Headspace webpage to practice mindfulness meditation for the last 18 months or so. So far it has been with mixed success with respect to the reliability of any transformation of how I’m feeling but the ‘vocabulary’ of processes has become familiar: the sequence of forms of attention and its opposite.

I’ve pinched the picture from here. Which suggests that ‘Mindfulness to put it simply is being fully present in the moment. It means to be aware of our surroundings and to pay attention to what we are doing’.

Cycling up a lengthy hill in Cumbria a week ago, I realised that I wasn’t enjoying the experience very much. Or rather, I was finding it actively unpleasant. And so I tried some mindfulness techniques to identify the components of the experience. On reflection, it seemed that the bodily feeling of exertion, well short of pain, wasn’t in itself unpleasant: simply a feeling of bodily effort.

What made the general experience unpleasant was an overlying atmosphere of anxiety: not that that had a specific recognisable propositional content. It was not, for example, an anxiety of not being able to reach the top of the hill (what would it matter?). But there was a feeling ‘in the vicinity’ of anxiety that could nevertheless be neutralised just by focusing instead on what was in the bodily experience in the moment. What remained had no negative valence.

That seemed a quick victory for even my feeble skills in mindfulness meditation. But then it occurred to me that whilst that got rid of what is unpleasant about cycling consistently uphill, it also threatened to remove all the pleasure too. The pleasure, it seems to me, lies not in what is immediately bodily present but rather in the anticipation of the downhills to come, a memory of previous downhills but also uphills and the realisation that one is able to continue like this in ‘steady state’ over time. Further, it’s contributed to by a realisation that the activity on any one day will tend to sustain similar activity in the future. Hence also, the bodily tiredness and soreness to come is itself positive because of its history, what it means. The same bodily experiences imposed by drugs would not ‘in themselves’ be at all pleasant. But the knowledge that they result from a day in the saddle gives them a kind of satisfied pleasure.

But now what puzzles me about the virtues of this approach to bodily sensations – focusing on what is there ‘in the moment’ – is that subsequent retreat now seems impotent to re-establish previous pleasure. If the move that does the work of removing displeasure and pleasure is removal of a kind of temporal conceptual structure, a structure of habit, for example, simply adding back in past and future moments, also, presumably, stripped of positive (or negative) valence doesn’t seem able to re-establish the pre-meditative state.

It seems to me that mindfulness meditation, as I have no doubt misunderstood it, is a kind of equivalent of a form of philosophical scepticism, in this case promoting a kind of existential nihilism.

Tuesday, 1 May 2018

Psychiatry’s inchoate wish for a paradigm shift and the bio-psych-social model of mental illness

Overview

In recent years, there have been repeated calls for a ‘paradigm shift’ in psychiatry. In this chapter, I take this idea seriously and explore its consequences. Having illustrated calls for a paradigm shift, I sketch the Kuhnian account of science from which the idea is taken and highlight the connection to incommensurability. I then outline a distinction drawn from Winch between putative sciences where the self-understanding of subjects plays no role and those where it is fundamental and I argue that psychiatry falls into the latter kind. This suggests that the wish for a paradigm shift in psychiatry is either incoherent or a wish for a radical but unforeseeable overhaul of a significant aspect of our self-understanding as subjects and agents. The bio-psych-social model of mental illness is thus a helpful reminder of the cost of a paradigm shift in psychiatry.

Introduction: the inchoate desire for a psychiatric paradigm shift

During preliminary discussions of the development of DSM-5 (then referred to as ‘DSM-V’), there was a widespread assumption expressed that psychiatry needed a ‘paradigm shift’. For example, in the introduction to A Research Agenda for DSM-V the [Kupfer et al 2002], the editors, including the DSM-5 Task Force Chair Dr. David Kupfer claimed that:

limitations in the current diagnostic paradigm suggest that research exclusively focused on refining the DSM-defined syndromes may never be successful in uncovering their underlying etiologies. For that to happen, an as yet unknown paradigm shift may need to occur. Therefore, another important goal of this volume is to transcend the limitations of the current DSM paradigm. [Kupfer et al 2002: ix bold added]

In a paper published 8 years later (but before DSM-5) called ‘Paradigm Shifts and the Development of the Diagnostic and Statistical Manual of Mental Disorders: Past Experiences and Future Aspirations’, one of those editors, Michael First, expressed pessimism about such a possible radical change.

Work is currently under way on the preparation of DSM-5, which is due in May 2013. From the outset of the DSM-5 revision process in 1999, its developers were hopeful that the changes would be so significant so as to constitute a paradigm shift in psychiatric diagnosis. [First 2010: 691 bold added]

Despite hopes that DSM-5 may be able to move beyond its current descriptive categorical paradigm as a result of the fruits of the past 16 years of scientific research, based on A Research Agenda for DSM-V, the DSM-5 research planning conference presentations, and the initial drafts of the DSM-5 proposals, it seems evident that DSM-5 will continue to follow the DSM-IV paradigm, namely, a descriptive categorical system augmented by dimensions. Any future paradigm shift will have to await significant advances in our understanding of the etiology and pathophysiology of mental disorders. [ibid: 698 bold added]

Allan Frances, the Task Force Chair of the previous DSM-IV later described the initial optimism about the possibility of such a change as ‘absurdly premature’.

The DSM-V goal to effect a “paradigm shift” in psychiatric diagnosis is absurdly premature. Simply stated, descriptive psychiatric diagnosis does not now need and cannot support a paradigm shift. There can be no dramatic improvements in psychiatric diagnosis until we make a fundamental leap in our understanding of what causes mental disorders. The incredible recent advances in neuroscience, molecular biology, and brain imaging that have taught us so much about normal brain functioning are still not relevant to the clinical practicalities of everyday psychiatric diagnosis. The clearest evidence supporting this disappointing fact is that not even 1 biological test is ready for inclusion in the criteria sets for DSM-V. [Frances 2009a: 2 bold added]

Elsewhere, in ‘Whither DSM-V?’ he wrote:

Not surprisingly, the disappointing conclusion of all this effort was that there are no biological markers even remotely ready for inclusion in DSM–V. The good news is that the remarkable revolutions in neuroscience, molecular biology, and genetics of the past three decades have given us great insights into the functioning of the normal brain. The bad news is that our understanding of psychopathology is fairly primitive and may remain so for some time… Thus, it is obvious that our field lacks the fundamental understanding of pathogenesis that will be required before we can take the next meaningful step forward towards a paradigm-shifting aetiological model of diagnosis. [Frances 2009b: 391 bold added]

Such passages imply that the nature of the radical shift envisaged was a turn towards a biological disease model for psychiatry and that this was undermined by the lack of biological markers for psychiatric diagnostic categories. But even those who rejected a disease model still appealed for a ‘paradigm shift’. In a position paper written in the same year as DSM-5 was published, the British Psychological Society wrote:

The DCP [Division of Clinical Psychology] is of the view that it is timely and appropriate to affirm publicly that the current classification system as outlined in DSM and ICD, in respect of the functional psychiatric diagnoses, has significant conceptual and empirical limitations. Consequently, there is a need for a paradigm shift in relation to the experiences that these diagnoses refer to, towards a conceptual system which is no longer based on a ‘disease’ model. [British Psychological Society 2013: 1 bold added]

Since the publication of DSM-5, hope for a biological disease model for psychiatry has been placed, instead, on the NIMH’s Research Domain Criteria (RDoC). It is not a rival taxonomy but rather a research framework to underpin new approaches to investigating mental disorders.

RDoC itself does not propose an alternative nosology, but rather seeks to unfetter research from clinical definitions and provide an initial framework and set of constructs for reconceptualizing psychiatric research directions in line with basic neuroscience concepts… The RDoC framework seeks to reorient conceptions of psychopathology by encouraging infusion of neuroscientific thinking and data into such conceptions. [Hettema 2016: 349]

NIMH gave emphasis to RDoC as a paradigm with the hypothesis that research based on already defined behavioral constructs with known neural circuits will accelerate the development of fundamental knowledge applicable to psychopathology while reducing problems associated with heterogeneous clinical syndromes. [Carpenter 2016: 562 bold added]

In ‘Research domain criteria: a final paradigm for psychiatry?’, the philosopher of psychiatry Walter Glannon sums up an assessment with the claim that:

Despite its limitations, RDoC offers the most conceptually coherent and scientifically sound paradigm for explaining psychiatric disorders. [Glannon 2015: 3]

As I will explain (briefly) below, the fact that RDoC is not a rival taxonomy to DSM-5 but a framework and set of constructs for research provides some rationale for the use of the label ‘paradigm’. But aside from that specific feature of RDoC, the mere fact of the broader assumption that psychiatry is generally thought to need a paradigm-shift is worthy of note. It suggests the question: for what does one hope if one hopes for such a thing? ‘Paradigm’ is the great term of art of the historian of science Thomas Kuhn, author of The Structure of Scientific Revolutions [Kuhn [1962] 1996]. In the next section, I will draw out some of the consequences of this on a broadly Kuhnian picture of science. Central to this picture is the connection between paradigms and the meaning of theoretical terms and hence the connection between changing paradigms and the consequent incommensurability of the meanings of terms across time. It is this that helps to support Kuhn’s theoretical scepticism about whether sciences can be said to progress. And this in turn calls into question whether it can be rational to wish for a paradigm shift.

In the third section, I address a related but more substantial point. Whilst the wish for a paradigm shift typically reflects optimism about the developments of neuroscience, psychiatry aims to use its technical innovations to relieve human distress. An improved psychiatry should thus be better able to address those issues. But if so its understanding of mental illness and distress - which guides diagnosis, treatment, management and shared plans for recovery - had better remain closely wedded to the self-understanding of those it is supposed to help. And if so, any plans for a paradigm shift threatens either to disconnect medical psychiatry from the understanding of human agents which should guide it or to revise in unforeseeable ways much of every day human self-understanding. But in order to prepare the way to that conclusion, I will briefly outline the role of paradigms and paradigm shifts in Kuhn’s account of science.

Paradigms, paradigm shifts and incommensurability

The widespread and sometimes indiscriminate use of the word ‘paradigm’ in the description of scientific change is the result of the popularity of Thomas Kuhn’s Structure of Scientific Revolutions in which it is a key term [Kuhn 1996]. Margaret Masterman (a pupil of Wittgenstein and founder of the Cambridge Language Research Laboratory) identified 21 different ways in which Kuhn used the word but suggested that there were three main ideas [Masterman 1970: 61]. These are paradigm as metaphysical world-view, a sociologically describable body of activity and a particular concrete instance such as a textbook. To shed light on these it will be helpful to offer a thumbnail sketch of his account of scientific practice.

Kuhn argues that scientific activity falls into two sorts. In the main, scientists are engaged in ‘normal science’. This comprises the articulation and application of stable dominant theories and meta-theoretical assumptions to new areas. Kuhn refers to both background worldview and the agreed forms of activities with the word ‘paradigm’ (the first and second of Masterman’s uses). The paradigm offers a way of seeing the world and one such tool is a paradigmatic worked example, or classic solution (Masterman’s third sense). The business of normal science is puzzle solving: using familiar methods to arrive at solutions to problems against a background assumption that the paradigm provides the resources for such solutions.

As I advertised above, these characteristics suggest a rationale for calling RDoc a ‘paradigm’ as it is broader than just a taxonomy to rival DSM-5 but rather encourages a particular approach to explaining mental illness emphasising biological and neurological causes. It offers a way of seeing mental illness as a biological disease.

During periods of normal science, no serious attempt is made to refute or even defend the theoretical background and shared practices, which are instead simply presupposed. But these stable periods of normal science are punctuated by brief periods of revolutionary theory change. Sparked both by the accumulation of anomalous results – such as ‘puzzles’ that resist solution – and by the development of rival theories or even rival meta-theoretical assumptions, the dominant orthodoxy is cast aside and a new theory or set of theories put in its place. Only during these revolutionary periods is the truth of what will become the new scientific background called into question.

Thus, while during periods of normal science, some measure of progress can be based on an increasing ability to solve recognised puzzles against the background of a stable paradigm, that measure does not apply over periods of revolutionary change.

In the first place, the proponents of competing paradigms will often disagree about the list of problems that any candidate for paradigm must resolve. Their standards or their definitions of science are not the same. [Kuhn 1996: 148]

This reason for a lack of a common measure – the claim that standards of assessment are internal, and hence relative, to a paradigm is called ‘the incommensurability of standards’. But it is not the only reason to think that different paradigms are incommensurable.

More is involved, however, than the incommensurability of standards. Since new paradigms are born from old ones, they ordinarily incorporate much of the vocabulary and apparatus, both conceptual and manipulative, that the traditional paradigm had previously employed. But they seldom employ these borrowed elements in quite the traditional way. Within the new paradigm, old terms, concepts, and experiments fall into new relationships one with the other. The inevitable result is what we must call, though the term is not quite right, a misunderstanding between the two competing schools. [ibid: 149]

This source of incommensurability follows from his, at the time, influential view of the meaning of theoretical terms. Like other philosophers and historians of science, Kuhn reacted against an influential view of the meaning of theoretical terms taken from the Logical Empiricists of the 1930s [Feigl 1970]. On that older view, theories could be judged against the standard of theoretically neutral observations and that separation was supposedly maintained by the independence of observation from theoretical language. Although theoretical terms were grounded in the observational predictions they collectively inferentially warranted, observational terms were thought to be definable antecedently.

A group of arguments towards the end of the twentieth century undermined that distinction between theory and observation (establishing instead the ‘theory dependence of observation’) [eg. Churchland 1979, Hanson 1958, Kuhn 1996]. Kuhn concludes that the holism that had been thought to apply to theoretical terms – albeit a holism constrained from the outside by their implications for observation claims – must apply to theoretical and observational terms collectively. But without a stable set of neutral observation claims against which to judge them, the new holism seems to imply that a change of overall theory would change the context and hence the meaning of all now hybrid theory-observation terms. This seems to suggest that there is no standard by which to compare overall theories across a paradigm change since different paradigms defined different scientific languages leaving no resources for an objective translation manual. Translation depends instead on difficult judgements about the best way to render one description into another. And thus, paradigm change is incommensurable undermining the very idea that science progresses.

Kuhn himself notoriously suggests that, after such a shift, scientists inhabit a different world.

These examples point to the third and most fundamental aspect of the incommensurability of competing paradigms. In a sense that I am unable to explicate further, the proponents of competing paradigms practice their trades in different worlds. [Kuhn 1996: 150]

This is not the only way to view the meaning of theoretical terms and thus not the only view of the impact on the possibility of comparing theories of potential meaning change. One possible alternative, motivated by referential approaches to meaning influenced by Putnam, puts weight on the role of actual samples in fixing the extension of scientific terms [Putnam 1975]. But part of the force of the idea of a paradigm shift is that the change of worldview is radical and Kuhn’s view of meaning incommensurability is part of the reason for that. Any less radical account of the consequences of theory change would undermine the point of deploying the suggestive phrase ‘paradigm shift’.

This, however, suggests that, at the very least, there is something strange about psychiatry’s frequently expressed wish to usher in a new paradigm. Without a standard by which to judge progress across such a change, what rational motive is there to wish in advance for such a change? By what pre-shift standard can a replacement be said to be rationally preferable? Afterwards, there might equally be no grounds for rational regret and perhaps even a parochial preference for the newly familiar, but that does not provide a rational argument to favour the change.

That, however, is not my main purpose in recalling the close connection between paradigms, meaning and incommensurability. The main issue concerns the application of these ideas to psychiatry in particular. In the next section I will suggest that a paradigm shift would come at a high price for psychiatry and that the apparent willingness to pay that price suggests a radical scepticism about solving psychiatry’s current conceptual problems.

Scientific and lay understanding of mental illness

In order to develop my main concern, I will return to (and re-quote) the passage from Frances I quoted at the start. The most obvious reason for thinking that psychiatry is awaiting a paradigm shift are developments at the hard science end of psychiatry. Even Frances mentions ‘incredible recent advances in neuroscience, molecular biology, and brain imaging’ when discussing others’ confidence in the possibility of a new paradigm. Frances himself argues that ‘descriptive psychiatric diagnosis does not now need and cannot support a paradigm shift’ but he goes on to say that there ‘can be no dramatic improvements in psychiatric diagnosis until we make a fundamental leap in our understanding of what causes mental disorders’ and that the absence of biological tests in diagnostic criteria suggests that this has not been reached. But that comment does not distance himself from what might seem a plausible aspiration for a bio-medical psychiatry. What is needed, on this assumption, is greater biological understanding of ‘what causes mental disorders’ and a sufficiently ‘fundamental leap’ in that might give us the hoped-for paradigm shift.

I think there are two fundamental complexities that this view – a view from which Frances does not sufficiently distance himself – ignores. The first is that, within psychiatry, the focus of neuroscientific, biological and brain imaging technology is, nevertheless, mental pathology. Progress has been recently made in these areas and more progress is needed but, additionally, progress is also needed in determining not just what causes mental disorders but what they comprise. What is it, in other words, for something to be a mental disorder? There is no reason to think that an answer to this question can be provided by neuroscience, molecular biology, and brain imaging since, insofar as these can help shed light on psychopathology, one needs first to have decided the extension of that concept then to study its neurological and biological underpinnings. Given the conceptual complexity of the very idea of mental disorder, and that what is so classed is so contested, any leap forward in knowledge of brain mechanisms needs to go hand in hand with answers to that question.

The second complexity follows from the first. Suppose that innovations in neuroscience, molecular biology, and brain imaging were used to articulate a form of psychopathology on the basis of its neurological similarity to currently identified forms but which had no connection to any mental distress or suffering. That would not, I suggest, mark a triumph of neuroscientific psychiatry. Rather, it would amount to psychiatry losing its way by losing its connection to its particular distinct subject matter.

This point suggests a more general moral that derives from the Wittgensteinian philosopher Peter Winch’s arguments in The Idea of a Social Science and its Relation to Philosophy [Winch 1958]. Winch argues that there can be no such thing as a social science. The argument for this conclusion starts from the assumption that a central element of understanding meaningful behaviour is an understanding of the nature of rules. For this he draws on Wittgenstein’s lengthy discussion of rules, rule following and understanding in the Philosophical Investigations [Wittgenstein 1953]. Winch makes three claims:

1. Rules are central to so-called social science because actions are constituted as the actions that they are by the rules that govern them. Thus, to give one of his examples, putting a cross on a piece of paper is an act of voting given the right context of rules. Sound patterns, similarly, are constituted as meaningful assertions only given the rules of spoken language.

2. Explaining an action by citing a rule presupposes a grasp of the rule not just by the putative social scientist but also (to a first approximation) by the agent whose behaviour is being explained.

3. Rule following is grounded in implicit practical knowledge of what actions count as going on in the same way. Rule following cannot rest entirely on explicit linguistically codified knowledge because that explicit knowledge would require further implicit knowledge of how the written prescription is to be understood.

Rules also have a further implicit but important feature. They are normative: they prescribe correct and incorrect moves. In the example mentioned above, they prescribe the difference between a successful vote and a spoiled ballet paper. Only certain actions count as casting a vote. Thus, if understanding an event involves relating it to a rule, this form of understanding involves a notion of correctness. It involves understanding what makes it correct or appropriate as a piece of voting behaviour. This is not the same as saying that most votes are cast at a particular time of day or night or by a particular socio-economic proportion of the electorate. That may be discovered by empirical study. But the normative rules that characterize an event as an act of voting are not provided by any such statistical generalizations. With these claims in place, Winch goes on to argue that so-called social science is fundamentally dissimilar to natural science.

[W]hereas in the case of the natural scientist we have to deal with only one set of rules, namely those governing the scientist’s investigation itself, here what the sociologist is studying, as well as his study of it, is a human activity and is therefore carried on according to rules. And it is these rules, rather than those which govern the sociologist’s investigation, which specify what is to count as ‘doing the same kind of thing’ in relation to that kind of activity. [Winch 1990: 87]

In understanding social phenomena, the understanding possessed by the objects of study (human subjects, people) of their own behaviour plays a key role and this is not reflected in say the physics of billiard ball motion. The putative social scientist has to understand social behaviour by understanding it, at least in part, through the understanding that the agents he or she studies have. That is not to say that the analysis of social phenomena can go no further than agents’ self-understanding. But it is rooted in it.

I do not wish to maintain that we must stop at the unreflective kind of understanding of which I gave as an instance the engineer’s understanding of the activities of his colleagues. But I do want to say that any more reflective understanding must necessarily presuppose, if it is to count as genuine understanding at all, the participant’s unreflective understanding. [Winch 1990: 89]

Winch himself uses these points to argue, contentiously, that there can thus be no such thing as social science and, even more contentiously, that the proper study of social phenomena is continuous with philosophical analysis. Neither of these conclusions is necessary, however, for the more modest point that there is an important distinction between cases where the understanding of phenomena by those who are – or what is –being studied is important and those where it plays no role.

Psychiatry, unlike a more disinterested study of the brain, has an essential connection to human distress and suffering and to norms governing social dysfunction, emotional dysregulation etc. Thus, it has an essential connection to the concepts with which we, as subjects and agents, make sense of ourselves. The implication from Winch’s analysis is that norms, deviation from which constitute mental illnesses, have to be understood, at least initially, via agents’ self-understanding of them. This suggests a distinction between psychiatry and some at least of the natural sciences. While there seems to be no constraint imposed by the subject matter of much of natural science on the limits of conceptual innovation (as long as the concepts arrived at can still be understood by at least some scientists), the concepts of psychiatry need to retain some connection to those concepts in terms of which we ordinarily make sense of ourselves. Only so, can human experiences play at least some guiding role for psychiatric diagnosis, theorising and care.

Implications for psychiatric paradigm shifts and bio-psycho-social model

If the Winch-inspired argument above is correct, the psychiatry, unlike, for example, quantum physics, has to keep one foot on the ground via a lay understanding of the norms governing mental illness, disorder, dysfunction and distress. That in turn has implications for paradigm shifts in psychiatry, given their connection to incommensurability. If, on the one hand, a future psychiatry maintains its links to the ordinary understanding of mental illness that currently sets the agenda for mental healthcare, then that ordinary understanding provides a bridge head for scientific understanding, undermining the very idea of there being a paradigm shift. If the Winchean argument is right, whilst psychiatry can go beyond ordinary agents’ understanding of the norms deviations from which amount to illness, it must still be rooted in it. If, on the other hand, a radical change in psychiatry severs those links, that might amount to a genuine paradigm shift for medical psychiatry - because that would imply a lack of the commensurability – then it would lose its identify as a response to mental illness and distress. It would no longer be psychiatry.

Consistent with this basic framework, there is one other possibility. The call for a paradigm shift may be intended not just to cover scientific psychiatric theorising about the causes of mental illnesses and distress – for example, a turn to more biological models and biomarkers – but also everyday conceptualisations of them. That is, it might be a kind of counsel of despair. On the assumption that everyday thinking about mental illness is essentially confused and raises insoluble conceptual questions of the sort expressed in the dilemma, ‘mad or bad?’, it might be thought that the rational response is a kind of conceptual radical overhaul. But given the consequences of a Kuhnian paradigm shift, such a move risks putting into an ungraspable future not merely elements of medical science but also a significant element of our self-understanding as agents, the basic norms governing actions, emotions, responsibility and free will.

If this working through of the combination of Kuhn and Winch is correct, then the wish for a paradigm shift in psychiatry seems doubly misplaced. First, the connection to incommensurability undermines the rationality of the wish even when limited to an area of medical science. Second, a change which did not sever the connection to the concepts we use to make sense of ourselves would not be a paradigm shift since the innovation would be merely partial leaving in place standards for rational assessment of the technical innovations. But a paradigm shift localised to psychiatry which rendered the pre- and the post-shift worldviews incommensurable would have to sever the connection to those grounding concepts and that could only be because psychiatry had lost its way. Finally, a paradigm shift of not only medical psychiatry but also of the everyday norms against which folk conceptions of illness, distress and suffering are measured is such a radical view that there is no way now to conceptualise what it is for which one would be wishing.

Against this long-standing inchoate wish for a paradigm shift in psychiatry, the bio-psycho-social model of psychiatry is a helpful reminder of its potential costs [Engel 1977]. Our understanding of mental illness is not merely rooted in biological natural science. It is much more broadly rooted in psychological and sociological basic norms and rules governing activity, thought and feeling. Genuine fundamental change in that whole conceptual package is not something to be lightly entertained.

Bibliography

American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV), Washington, D.C.: American Psychiatric Association

American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5), Washington, D.C.: American Psychiatric Association

British Psychological Society (2013) Classification of behaviour and experience in relation to functional psychiatric diagnoses: Time for a paradigm shift DCP Position Statement Leicester: The British Psychological Society

Carpenter, W.T. (2016) ‘The RDoC Controversy: Alternate Paradigm or Dominant Paradigm?’ American Journal of Psychiatry, 173: 562–563

Churchland, P. (1979) Scientific Realism and the Plasticity of Mind, Cambridge: Cambridge University Press

Engel, G.L. (1977) ‘The need for a new medical model: a challenge for biomedicine’ Science: 196: 129-36

Feigl, H. (1970) ‘The “orthodox” view of theories: Remarks in defense as well as critique’ in Radner, M. & Winokur, S. (eds.) Analyses of theories and methods of physics and psychology. Minnesota studies in the philosophy of science Vol. IV. Minneapolis: University of Minnesota Press: 3-16

First, M. (2010) ‘Paradigm Shifts and the Development of the Diagnostic and Statistical Manual of Mental Disorders: Past Experiences and Future Aspirations’ Can J Psychiatry 55: 692–700.

Frances, A. (2009) ‘A Warning Sign on the Road to DSM-V: Beware of Its Unintended Consequences’ Psychiatric Times June 26

Frances, A. (2009) ‘Whither DSM-V?’ The British Journal of Psychiatry (2009) 195, 391–392.

Glannon W (2015) ‘Research domain criteria: a final paradigm for psychiatry?’ Front. Hum. Neurosci. 9:488. doi: 10.3389/fnhum.2015.00488

Hanson, N.R. (1958) Patterns of Discovery, Cambridge: Cambridge University Press

Hettema, J.M. (2016) ‘Psychophysiology of threat response, paradigm shifts in psychiatry, and RDoC: Implications for genetic investigation of psychopathology’ Psychophysiology. 2016 March ; 53(3): 348–350

Kuhn, T.S. ([1962] 1996) The Structure of Scientific Revolutions, Chicago: University of Chicago Press

Kupfer, D. J., First, M. B. and Regier, D. A. (eds) (2002) A Research Agenda for DSM–V, Washington, DC.: American Psychiatric Association

Masterman, M. (1970) ‘The Nature of a Paradigm’, in Lakatos, I. and Musgrave, A. (eds.) Criticism and the Growth of Knowledge, Cambridge: Cambridge University Press

Putnam, H. (1975) ‘The meaning of meaning’ in Mind language and reality, Cambridge: Cambridge University Press pp 215–71

Winch, P. ([1958] 1990). The Idea of a Social Science and its Relation to Philosophy, London: Routledge

Thursday, 1 March 2018

The UCLan view of mental health nursing

Well, if not quite that, this is the textbook of mental health nursing edited by my fine colleagues at UCLan (and two of my line managers so I have to say that!): Karen Wright and Mick McKeown. I have a chapter in it, an overview of concepts of disorder.

It's actually rather a good book with a strong ethos of service user involvement.

The details are here.

Thursday, 22 February 2018

Dialogues in Philosophy, Mental and Neuro Sciences

Dear Colleague,

I'm pleased to inform you that the new issue of the international online journal Dialogues in Philosophy, Mental and Neuro Sciences has been published, it is freely readable at :
www.crossingdialogues.com/current_issue.htm

The issue contains:
Volume 10, Issue 2, December 2017

ORIGINAL ARTICLES
The Effects of Reductive Physicalism within the Field of Mental Healthcare
A. K. Diaz and J. C. Honea

The body and the other: a crisis of the self-representation in the disorders of post-modernity
G. Castellini

NEW IDEAS
Associative and oppositional thinking: the difference between the brain hemispheres
L. Keating

HISTORY OF MENTAL CONCEPT
On psychic diseases
W. Griesinger

DIALOGUES
Psychiatry with Philosophy in Mind: A Comment on Moreira-Almeida and Araujo
H. H. Maung

Justifying theoretical pluralism in psychiatry: A rejoinder to Maung (2017)
S.de F. Araujo and A. Moreira-Almeida

Dialogues in Philosophy, Mental and Neuro Sciences proposes and includes Original Papers, Negative Experimental Results, New Ideas and Dialogues, as described in the guidelines for the authors.

Would you like to write a Dialogue? It is a short article (up to 600 words) freely published and without any deadline commenting another article already published on the previous issues of our Journal.

If you have any question about this Journal then please feel free to contact me at your convenience. I hope you find at least some of our publications of interest and value.
If you think someone of your friends or colleagues could be interested in our Journal please forward them this email. Anybody can register himself at our service of email-alert which will inform about new issues or other news about the Journal through an email. The service is completely free at www.crossingdialogues.com/alert.htm
Kind regards

Daniela Cardillo
Editorial Office
info@crossingdialogues.com


Wednesday, 14 February 2018

Two dimensions in the rule following considerations

Having a chat over coffee with Rupert Read last week, before giving a talk at UEA, I was struck by two distinct intuitions in critical responses to Wittgenstein’s rule following considerations. They seem unrelated or orthogonal. The first concerns how strongly determined are linguistic ‘moves’ which, nevertheless, accord with rules. The second concerns the nature of the determinacy whatever its degree: what underpins it. This makes me wonder whether they have any common motivation or, instead, whether running then together is confusing. I will try to distinguish them here though I will spend much more on one of them.

One expression of the former idea is that famous passage from Stanley Cavell:

We learn and teach words in certain contexts, and then we are expected, and expect others, to be able to project them into further contexts. Nothing insures that this projection will take place (in particular, not the grasping of universals nor the grasping of books of rules), just as nothing insures that we will make, and understand, the same projections. That on the whole we do is a matter of our sharing routes of interest and feeling, modes of response, senses of humor and of significance and of fulfillment, of what is outrageous, of what is similar to what else, what a rebuke, what forgiveness, of when an utterance is an assertion, when an appeal, when an explanation- all the whirl of organism Wittgenstein calls ‘forms of life’. Human speech and activity, sanity and community, rest upon nothing more, but nothing less, than this. It is a vision as simple as it is difficult, and as difficult as it is (and because it is) terrifying.

I think that this expresses this first aspect not because of the second half of the passage – which applies to the second, orthogonal view – but because of the claim that the projection is not ‘insured’ by the ‘grasping of universals nor the grasping of books of rules’. It is offered in part to undermine the assumption that language use is governed by formal rules. So it aims to correct the idea that linguistic usage just is rule following. Speaking a language isn’t to be modelled on grasp of universals or rule-books because they are not sufficient for the open-ended cut and thrust of language use. Language use is not so determined by formal rules but allows greater flexibility and improvisation. That’s, at least, how this seems to me.

Another expression of this sort of thought is Charles Travis’s mapping of the rule following considerations onto a Russellian distinction between knowledge by description and knowledge by acquaintance. This distinction underpins, according to his account, a 'prior' understanding of the meaning of an utterance and the 'novel' understanding one has when one becomes acquainted with the situation to which the prior understanding comes to apply. Thus one might have a prior understanding of the claim that ‘Pia’s shoes are under the bed’ and then, on seeing the situation in which they are directly alligned with and thus under a bed but three floors above, one comes to a potentially unexpected novel understanding (novel because situation-dependent). The potential slipperiness, the sense in which the prior understanding does not fully determine the novel understanding, is itself underpinned by Travis’ emphasis on occasion sensitivity. One is simply in no position to have the novel or situation-dependent thought in advance. That thought simply cannot come to mind, or be entertained, when one is framing a prior thought or understanding.

Elsewhere he gives this example:

A man in Ulan Bator is now standing before his yurt, sipping tea. (Make it ten o’clock his time.) I cannot think a thought, of him, that he is doing that—a thought which presents him as the one who must be some way for the thought to be true, and sipping tea before his yurt at ten as what he must be doing. I cannot do this, since I neither know, nor know of, anyone in Ulan Bator (though I am sure some people live there). I can, to be sure, think that everyone in Ulan Bator stands before his yurt at 10 and sips tea. What I thus think will be false if this man does not do that. The thought I thus think has a certain kind of generality which allows it to be true, or false, in this way. But as Frege points out (1914: 108-109, different example), that man falsifes my statement only given that he is in Ulan Bator—in present terms, only given that his being as he is participates in the instancing relation with that way for a thing to be. And it is just this last that I am not in a position to think—a corollary of not being able to think of him at all. Thinking a thought which is false, given his being as he is, is not the same thing as thinking a thought of him. [Travis 2011: 310-11]

This recalls another set of passages in Wittgenstein's Philosophical Investifations which also concern the apparent nor nativity of thought. Between paragraphs xx and yy Wittgenstein discusses connection between a prior the expectation of an explosion and the actual explosion which satisfies it. Clearly, one cannot have had a situation-dependent thought about that explosion (of the form: that! explosion) in advance of the explosion taking place. So what does connect a prior understanding (for example, of an expression of an expectation) and the novel understanding made available by having a situation dependent, demonstrative thought? There has to be some connection between prior and novel understandings. Tracks says:

[I]f an understanding of Sid’s words is one on which things being as they are...is things being... as Sid says, then that understanding should contain some understanding which requires the corresponding novel understanding(s) relative to it. It should be an understanding relative to which understanding Sid’s words as speaking of what is instanced by this... is a novel understanding, but, moreover, one which that prior understanding mandates... The issue it raises is how prior understanding can require novel ones. [Travis 2006: 130-1] [W]ords can be true (or false) only where they bear a prior understanding that requires the right novel one. If they are made true by things being as they are, that is by virtue of an understanding available anyway... [131]

Travis then presents two rival accounts of this putative connection.

We...have two contrasting models of meaning and understanding. They differ importantly as to what it is to be prepared to make given translations of the sort of which §459 speaks. ...[ibid: 129]

The first account assumes that to mean words in some particular way is to be related to an explicit abstract or disembodied representation.

On that expansion [of what are in themselves, pre-philosophically, innocent banalities about meaning], an explicit specification of an understanding someone means words to bear is always possible in principle. To give it would be, inter alia, to produce a representation of things being as meant... That representation would be explicit, which is to say that it would have a very special property: unlike our ordinary representations, it would not admit of understandings (of things being as thus represented). [ibid: 121]

Travis puts initial pressure on this account by stressing that, in general, our words ‘admit of understandings’. So giving the example of Sid saying that the shoes are under the bed, Travis argues that this might mean any of many options. They might have to be completely under the bed. Or having their ends protruding might be allowed. Or, rather less likely for us or for Sid, ‘in a plumb line with the bed, but three floors down’ [ibid: 120]. So a condition of adequacy of the first account is that it singles out just one such interpretation.

One the first model... for Pia to understand the sign as she does is for her to relate in a particular way to a very special sort of (disembodied) representation. That representation requires the particular transitions it does independent of anything Pia is prepared to recognise, and independent of any understanding we may happen to share as to what it requires...[ibid: 129]

Such a representation would thus be a synopsis of the solutions to indefinitely many problems; a synopsis from which all those solutions are recoverable. One would not need Pia’s form of worldliness, or any other particular form, to manage the recovery. It might be a task for an idiot-savant. [ibid: 124]

Although initial pressure is put on this model, Travis goes on to introduce a rival, second account before assembling his key Wittgensteinian objections to the first. Those objections are that nothing could do the work that the disembodied representation is supposed to do. I’m less interested in those (which apply more to my second orthogonal thread / intuition) than with the novel set-up. So to the second model:

On the second model... for Pia to understand the sign as she does is for her to be positioned to see the solutions to an indefinite range of novel problems as to which translations it requires – problems as to whether it requires doing this to the door now. For her to be so positioned is for her to share a competence we have to see how to take the sign, except where, for one or another special reason, she deviates in her understanding from that. [ibid: 129]

On this second account, to mean something by one’s words depends on the contingencies of the situation, or the ‘occasions’, in Travis’ key word: that is, on the practical competences of speaker and hearer (‘Pia’s worldliness places her to deal with an indefinite range of potentially relevant, and sometimes unexpected, considerations’ [ibid: 124]) and the relation between the speaker and facts about what it would be reasonable to be taken to mean in the situation. That third point is one of the ways in which Travis is a kind of communitarian Wittgensteinian.

Now the idea that one is presented with the possibility of a ‘novel’ understanding when one has a situation-dependent singular thought seems to go hand in hand with the idea that the prior understandings do not go as far as we might have assumed in determining correct moves. Travis’ examples of occasion sensitivity suggest that gaps in the determined nature of correctness are filled on the hoof by the reasonable judgements of speakers as they go on.

But it also seems to me that this fits much better, or only, the application of empirical concepts to the empirical world than, say, the mathematical rules that Wittgenstein also discusses. In their case, there seems to be much less room for occasion sensitivity and hence the first thread in response to rule following: the idea that linguistic moves may not be as determined as we thought and hence less rule-like in nature.

So what is the second thread?

I think it is the nature of the determinacy, to whatever degree, of rule following. Take an area of human practice where the notion of a rule book does apply and ask: what is the nature of the way in which rules extend to so far unthought-about cases, such as Kripke’s hypothetical so-far-unadded 68 and 57 (or whatever is the smallest so far un-added pair)? I will say much less about this but it clearly concerns the failure of both platonic notions of already existing sequenc of numbers, or ideal machines (or depictions of ideal machine) or actual causal machinery to explain the way in which rules that are determined get determined. Now I had always taken this to be the main target of the rile following considerations but a conversation with Rupert, reflection on Stanley Cavell and Charles Travis' stimulating account in Thought's Footing suggest that other people think that the former line of thinking is central. But for the second dimension, considerations which support the former seem irrelevant. So why are both presented as a response to what Wittgenstein says about rules? And is there any relation?