Thursday, 7 August 2014

Draft abstract for Amsterdam workshop this month

Draft abstract for Amsterdam workshop this month

Title: Anti-reductionist normativism: a price worth paying.

Key words: Causal explanation, intelligibility, normativity and reductionism

Abstract: There is momentum in the philosophy of psychiatry away from a picture of reductionism based on a well ordered hierarchy of levels of explanation and towards either cross level interaction or scepticism about the very idea of levels of explanation. This is a move towards explanatory pluralism and pragmatism and away from a metaphysical picture that can seem to be the unjustified imposition a priori claims about how the world must be. In this presentation, however, I will argue that the resultant austere picture carries two significant costs. First, it undermines our right to characterise states as mental states. That is, it shed no light on the intelligibility of states as mental. Second, it undermines our grasp of the pathological status of the conditions that form of the subject matter of psychiatry. Normativism offers a distinct, full blooded contrast to a reductionism of levels. Whilst it faces significant challenges, it promises to address these potential gaps in the intelligibility of the subjects of psychiatry and is thus a price worth paying.

Wednesday, 9 July 2014

On failing to read Lee Braver's Groundless Grounds

I hope that this will not seem like much of a criticism of Lee Braver's Groundless Grounds. I cannot offer a philosophical engagement with it because, although I have turned every page and, as much as ever, read every word (with the usual re-reading of particularly tricky, pithy passages) I don't think that I have actually read it.

So first a rough sketch of that thought and then, second, a brief suggestion as to why.

What do I think when I think that I have read a book in the, I guess, normatively charged sense of the word I am trying to deploy? Something like this: I have grasped sufficient of the surface meaning which amounts to grasping the way in which the author wants me to understand the ideas she is sketching. That isn't a very good way of putting the point and I do not mean to hint at acts of philosophy by pointing (contra Jonathan Lear on Wittgenstein). But much philosophy isn't entirely pellucid. Often I can give an account of the surface of a piece of philosophy without being yet in a position to assess it.

At the moment I am reading a 2009 paper by Alex Byrne criticising Travis's criticism of 'content' views of experience. I could describe the general argumentative structure and point to where the key terms of art are introduced and sketch their broad role. But right now I could not explain to someone else what Byrne means by 'non-comparative looks'. When, shortly (tomorrow?) I can then I will have read the paper. And only then will I be able to think (next week, after further intuition or judgement) about whether I am persuaded by the argument so constructed. There is a point at which, poor memory aside, I don't think I need to read the paper any more, I have reached a kind of data saturation, but I have not done with it. The further stage, however, calls for imagination on my part which may never come. But the paper itself has done its work.

I don't seem to be able to reach even that initial stage with Lee Braver's book, however. This seems odd because he writes well, with flair, and deploys a series of metaphors and similes to helpful effect. I bet some of his phrases make their way into my ways of explaining Wittgenstein (for which apologies to him in advance). But I think I know the problem.

Some years ago I had a frosty reception at a conference from a famous American philosopher of mind. After I had given my paper, he warmed and in conversation I realised that he'd assumed that I subscribed to a principle, which really irritated him:

W: Wittgenstein says that p, therefore p.

Although I do indeed assume a kind of hermeneutic principle of charity, and so use something like W as a regulative principle, working out what it is that Wittgenstein says, in the sense of means, takes some effort which turns on working out what it would be justified, perhaps for him but via for us, to say. So W ends up guiding an argument to establish the truth of p rather than being a naked appeal to authority. In the works on Wittgenstein that I am able to read (on this rather arch understanding), there is a similar method. By contrast, this book is closer to the locution: Wittgenstein insists... Thus even though the views ascribed do indeed hang together, they are not bound together in the surface presentation by an explicit structure of reasons. The surface form is more history of ideas than an attempt to inhabit an argumentative position and work out its rational connections. The net result is that I cannot get a hold on it, grasp a surveyable whole. The links which would help form the scaffolding of my understanding of it are hidden beneath the surface of the text.

It is a pity because although a book on Wittgenstein and Heidegger would not be the first of its kind nor one which deploys a contrast with the earlier Wittgenstein to illustrate the later (in truth best not to read this book at the same time as Marie McGinn's book on the Tractatus) still putting Heiddegger and Wittgenstein in my more explicit contrast to the Tractatus might help go further than Rorty's brisk comments on this thirty years ago.

PS: my thoughtful correspondent DY suggests, in a response by email, that he has/is never finished with a text: 'Subsequent reading illuminates things, and these things always need checking against previous materials. I reread and reread all the time!' I have to say that this rings rather truer than my own description above. But I guess, in a spirit vaguely influenced by the arguments between McDowell and Travis on perception, I want to confine these subsequent discoveries to acts of judgement after the fact of reading (akin to a Travisian move) whilst thinking that the reading mentioned here involves a lesser conceptual grasp (a McDowellian move). Indulge me!

Tuesday, 8 July 2014

Rough airport thoughts on craft versus science

In the last presentation of the conference I've been to, Tom Burns, Oxford Psychiatry, put forward a distinction to help to ward off anti-psychiatric criticism of psychiatric diagnosis. He suggested that anti-psychiatric commentators often helped themselves to an unfair characterisation of psychiatry in order to help support their own comments. But, he suggested, it was unfair to claim that psychiatric diagnosis failed tests of good science (one such accusation) because psychiatry was a craft not a science. Evidence for this was the very length of medical education, its connection to education by eminence, and it's practical focus. Merely learning the necessary DSM categories, for example, would take an ordinarily clever young person weeks rather than years.

As a fan of craft knowledge, I think that there is both something in the evidence for the craft status of medicine and that nothing negative follows for its status. But I am not sure of the dialectical purpose of the craft versus science distinction as applied here.

One might argue that psychiatry is not reducible to science alone but involves skills that can only be characterised as craft skills. One way to put that would be to say that it irreducibly involves know-how as well as knowledge that. But if so, how does offering both these elements protect diagnosis from criticism? Won't diagnosis naturally count as part of what Jennifer Aniston would perhaps describe as the 'science bit'?

One way to bring the craft to bear conceptually on the diagnosis element itself might be to stress the latter's status as Kantian reflective rather than determinate judgement. Again, I like this idea. But the conceptual package brought to bear on an individual - the combination of concepts and laws - is again surely a science, or at least a science in aspiration, in the case of psychiatry? To deny that would be to concede diagnosis to anti-psychiatry not to defend it.

So might one think that not only is the subsumption of an individual (person, case, event, experience) under a concept a skill (reflective judgement, again) but that the derivation of inferential consequences of that subsumption is also a skill, something, eg., that resists codification? Perhaps. If so, it might be akin to making a moral judgement on Dancy's view. Nothing generally follows. What follows depends only on the particular circumstances. But not merely in the way that the application of codified Newtonian physics to a particular object depends on its context but rather in a way that resists any general codification (akin to Newtonian laws). Now that would be radical. Psychiatry as moral advice, as it were, though not only concerned with what is Good. Can this really be Tom's view?

Monday, 7 July 2014

DSM-5 and the future of psychiatric diagnosis

I am in Geneva at a Brocher Symposium on DSM-5 organised by Matthew Smith. It is an interdisciplinary session with philosophers, historians, anthropologists and clinicians. My own contribution was to be a discussant for a paper by Vicky Long on the history of the the diagnosis of occupationally caused mental illnesses. Playing that role reminded me of the difficulty of commenting on one discipline from within another: the worry that one is simply missing the point. For example, if a paper charts the history of actual happenings, is it at all relevant to ask normative questions about whether something else would be or have been better? At its best, I guess that philosophy might be able to tease out some of the concepts both as deployed by historical 'actors' but also by historian analysts. (I lingered on the difference between work's tedium and the ennui and alienation it rationally prompts, on the one hand, and, on the other, it causing illness and then further how stable that distinction was.)

So far I am mainly chewing over a paper by Rachel Cooper, a precursor to which I heard last year. What was familiar was the idea that, just as the qwerty keyboard has become stuck because of the inertia of its beurocratic connections long after its initial rationale has ceased to apply, so the multiple uses of the DSM means that it is practically impossible to change (I can imagine Bruno Latour providing actual economic costings for changing it). That thought connected into a comment about the continuity, despite earlier talk of paradigm changes, of the actual content, the categories etc, of DSM-IV and DSM-5. What was new, however, was the fact that some framing comments about DSM have changed. The concept of disorder is no longer necessarily value-laden (it just usually is). DSM-5 is no longer supposed to be atheoretical but is grouped with the hope of spotting underlying theoretical uniformities. And... From this, Rachel drew two conclusions: there is no close connection between the theoretical frame of DSM and its content. And second, there is no reason to assume that the DSM has any single underlying broader conception of illness and healthcare. Afterall, it is written by several quasi autonomous subgroups and is read selectively and differently by its different readers. So the frame serves a less than obvious purpose. This prompted Gavin Miller to suggest, among other things, a kind of religious text analogy for the rhetorical purpose of the frame.

I am not sure about that. But there does seem to me to be an interesting question what the purpose of general definitions of disorder, or general comments on culture (discussed later by Stefan Ecks), is. Surely not, for example, to offer genuine guidance on whether a particular condition is a disorder (for the sorts of reasons Neil Pickering stresses). But to address that question would require some decision about the ground rules for answering it, for example, the role of the authors' intentions.

Wednesday, 18 June 2014

Eulogy for my mother, Mij Thornton

"My brother and I wanted to say something about my mother Mij’s friendships. She had a great capacity for making friends which, perhaps, she didn’t share with the male members of her family, sadly. She really enjoyed her friendships. But in thinking about what I would say about this, I realised how partial anything I might say would be. It is partial in two senses. Nothing a son says about his mother at her funeral would be anything other than biased. This is not the time for an objective view of a life. It is partial, however, for a second reason. I experienced, directly, only a very small proportion of Mij’s life and everything I did experience I experienced from my particular perspective. I am going to embrace that perspectivalness and describe three, and a half, aspects of Mij’s life as I experienced them. At the end, I will try to draw some consolation by thinking, again, about perspective and the metaphysical implications, or rather their lack, of indexicals. I like to think that Mij would forgive me this.

The first scene clearly reflects my perspective on Mij’s life. If anyone had asked the five year old me, when I first began to realise that she was a particular mother rather than motherhood in general, what made my mother special, I wouldn’t have said anything about her capacity for friendship. I would have said: she makes soft toys, creatures. On any long car journey, just before ‘the boys’ – my brother and I – became fractious, she would turn round and present us with a pair of kangaroos, turtles, rabbits or whatever. She made toys partly to please us but also because she enjoyed the exercise of creativity. Just as later she painted, made jewellery and sketched, she made soft toys very well.

If I wanted to connect this aspect of her with the broad theme of friendship I could say that in the collection of creatures she provided the very young Tim, she anticipated the support she would later provide of my own friends and the interest she took in them.

But there is an ironic coda to this aspect of my mother: the ‘halfth’ aspect (as in three and half) I mentioned earlier and mention of which the presence today of a long standing family friend today prompts. Although she was very skilled in the making of soft toys, the one creature she is likely to be remembered for might give the wrong impression. I badgered her to make me a frog and so she bought a pattern and did. But there was clearly something wrong with the pattern and despite a series of cosmetic surgery operations which would have made Harley Street proud he did not seem to be a success. And so my brother and I left him on a shelf and invested no great creativity in thinking up the name ‘Froggie’. Despite, or perhaps because of, this Froggie became a character, the Thornton Family mascot and was with me through my sixth form, university and stayed safely in Baildon when my partner and I went round the world for a year. He developed, in brother’s and my hands, a strident and assertive character. If Mij were to remove him from an armchair to sit down herself he would pipe up – and you have to imagine my brother’s and my voice here – ‘You wouldn’t do that to your other guests. You wouldn’t do it to Dr David Anderson!’. I can only imagine how irritating that must have been. The fact that Froggie survived to frog adulthood with both legs intact says much for my mother’s patience.

When she went back to it, Mij was committed to her work. But I saw only a little of it from my perspective. One scene, however, stands out. In a university holiday, she took me for lunch at a curry house on Lumb Lane. Part way through we were interrupted by one of Mij’s clients one of whose children had, I think, been taken into care. The woman, another mother, was, understandably, distressed, angry and  emotional. I felt an instinctive desire to protect my own mother from her. But I wasn’t sure how to do this. Mij, however, got straight up to talk to her. I didn’t hear exactly what she said. It involved connecting her client’s concern for her own child with Mij’s concern for me and the need to have a chance to talk properly. Afterwards, her client was not only calm and satisfied with what they had agreed but she hugged Mij. It would be wrong to say that this was an expression of mutual friendship. But it was a genuine and mutual fellow feeling. Although I had seen the alchemy by which this had emerged from initial hostility, I didn’t, and still don’t know, how it came about.

The third scene is happier. For a number of years, Mij went with her work colleagues to the Fighting Cock for lunch and a half pint of Thatchers Falling Down cider, every Friday. A school-friend and I overlapped with them for a few months during our year off jobs. Let me describe the scene: a spit and sawdust pub with bare floorboards, wooden benches and Formica tables. The hot menu comprised only a chilli con carne. Because most people arrived in twos, the standard order was for two chillies. Every few minutes the chef would emerge from the kitchen and shout out "Two chillies", with no further identification of whose they were. Relative to the shortness of one’s lunch hour that day, one learnt to wait for an appropriate length of time and then arbitrarily claim the next chillies in the spirit of ‘from each according to his abilities to each according to his needs’. A hint of a socialist utopia in the heart of Bradford.

When we were there at the same time, Mij would come over and talk to me. And if the pub were busy, her group might join us. But she wasn’t there to see me and so normally, having come over to say hello, she would return to her group. And so I witnessed her obvious pleasure at this chance to spend time with her colleagues, her friends, with whom she shared a vocation and set of values. She clearly really enjoyed being there with them. And the half of Thatchers’ Falling Down. In fact, I think she reconciled herself eventually to her retirement only when it became difficult for public servants to be seen in a social environments at lunchtime.

We have had a number of condolence cards which have said how good a friend Mij was. I am sure that that was true. But I also think that she was a good friend to other people because they - you - were good friends to her. Her capacity for friendship went hand in hand with her pleasure in the company of friends.

I will miss her more than I can say now. On such a day, in the grip of sadness, it is hard not to feel somehow trapped in the ‘now’. Today’s sadness seems so much more real than merely past happiness. But I take some comfort from the following thought about the nature of my perspective today. We use indexical words like ‘here’ to pick out the place where the word is spoken. We use ‘I’ to indicate the speaker or the thinker. ‘Here’ stands in contrast to other places over there. ‘I’ stands in contrast to other people such as him, her or them. Similarly to say or think ‘now’ picks out this moment in contrast the future and the past. But the use of the indexical words ‘I’ or ‘here’ does not undermine the reality of other people or other places. They are just as real. So, our use of ‘now’ does not make the past any the less real.

I wish Mij were alive here with us today. But she lived to be 81. She had a good job: both fulfilling and morally good. She had a loving family and enjoyed warm and close friendships. That life, her life, makes up a part of the world. So although today is a sad day it is also a chance to celebrate and be thankful for a good life, a life well lived."

Friday, 30 May 2014

Philosophers' Rally 2014 short video

There is short pop video of a few moments from this year's Rally here. Sorry it seems to have gone. I'll re-link if it returns.

Consultation on Proposals for New Mental Capacity Legislation for Northern Ireland

I learn from Colin Harper that the NI Mental Capacity Bill is now out for consultation. You’ll find the documents here.