Thursday, 7 January 2010

Kendler and Parnas (eds) Philosophical Issues in Psychiatry

I’ve been invited to contribute a paper on psychiatric explanation for an issue on ‘classification and explanation in psychiatry: philosophical issues’ of the European Journal of Analytic Philosophy. Since I’ve had the Kendler and Parnas collection Philosophical Issues in Psychiatry: explanation, phenomenology, and nosology on my shelves at home for a couple of months I’ve given it a quick skim over the last couple of evenings to help stimulate the digestive juices, as it were. (PS: The eventual paper is here.)

Two things strike me about the Kendler and Parnas collection. First, although the subtitle picks out explanation, phenomenology and nosology, the key issue seems to be the role of causation in psychiatric explanation (nearly half the titles of the chapters or commentaries have ‘cause’ of ‘causality’ in the title) and the question of how a compexity of causal pathways and distinct explanatory levels should be charted and then understood. Second, although there’s a chapter co-authoured by Parnas (one of the editors) and Sass on phenomenology and role of description in psychopathology, it sticks out like a sore thumb and neither the introduction nor commentary to it manages to fit it into the narrative structure of the rest of the book.

Well what is the significance of that? It suggests the centrality of one kind of explanation in thinking about psychiatry: one couched in terms of causal interventions on a complex biological organism. And of course, we are – obviously! – complex biological organisms concerning which/whom causal intervention is possible and a laudable aim for medicine. But it neglects the whole issue of fathoming what is going on in someone’s mental life that might go under the label of understanding.

Now one reason for that might be that the collection respects that post-Kantian and Jasperian distinction between explanation and understanding and thus takes the subtitle to rule out the latter. But I doubt it. The discussions of multi-level explanations (including John Campbell’s rejection of the view that higher level explanations must be short-hands for lower level mechanistic explanations) make no mention of the idea that some, at least, higher levels might be characterised in distinct understanding-orientated, normative terms.

Responding to this puts me in a slightly awkward position. On the one hand, I do not think that the issue of how to take a stereoscopic view of both the manifest image (of man in the world) and the scientific image should be the defining problem of philosophy. We should defuse that problem and look for local relations between aspects of each. But on the other, I think that we should take note of the important distinction between the kinds of concepts and not simply slide between levels.

Kendler, K.S. and Parnas, J. (eds) (2008) Philosophical Issues in Psychiatry: explanation, phenomenology, and nosology, Baltimore: Johns Hopkins University Press