I have been sent the questions I will be asked tomorrow in Amsterdam before my presentation. The one issue that simply confuses me increasingly these days is my attitude to biological reduction and the difference between what looks to be Fodor's attempt merely to solve an engineering problem (of how thought might track an antecedently understood logic) and Millikan's attempt to do more: to natuarlise logic itself. What if one used biological functions simply to solve the engineering problem?
Questions, morning session, April 9. Room 13A-11, main building VU.
Huib Looren de Jong
Assistant professor Philosophy / Psychology VU
Question on values, functions, and evolution. I immensely enjoyed reading your rich and complex book. You try to demonstrate that psychiatry is special in the sense that it is essentially evaluative, and that these values cannot be naturalized, in contrast with other domains of medicine where disease is (roughly) physiological dysfunction.
However, evolutionary explanations (Wakefield, Nesse) provide a way to naturalise functions as adaptations, and mental illness as a failure of proper function (in a harmful way). There seems no residual “value” left after such a reductive analysis, other than biological function. Your critique of an evolutionary approach to mental disease (p. 38-9) seems to rest on too narrow (physicalist, law-based) a conception of naturalism, ignoring biological function-based naturalism – of which Wakefield appears to be an interesting example. Thus, as such a biological function-based reduction shows, in the end psychiatry is in no way more special than the rest of medicine.
Student, Philosophy, Utrecht
Firstly, I would like to thank you for your extremely interesting book. I have a question concerning your introduction of relaxed naturalism. In Chapter 4, you ask how intentionality or meaning is related to the non-intentional aspects of the world. Cognitivism as well as constructionist discursive approaches of this problem appear to be reductionist. You argue, meanwhile, that meaning is normative and therefore cannot be reduced to non-normative aspects of the world. Rather, meanings should be conceived as a part of nature: ‘Psychiatry needs … to embrace an augmented sense of nature or the world, a relaxed form of naturalism.’
(p.164) In my view, however, the question remains open whether this broader conception of nature can actually offer an explanation of how intentionality is related to non-intentional aspects of the world. In other words: what is the positive argument for embracing relaxed naturalism?
Julia van Ooststroom
PhD student, University of Amsterdam, Law
As a (legal) philosopher working mainly in the German philosophical tradition, I found your book very inspiring and helpful as it gives a profound overview of the diverse arguments in the field (within the analytic tradition) and as it is written without ever losing pace. I would like to ask you the following question:
In Chapter 5, you write about the validity of psychiatric classification. In connection with this classification, I quote from an article from the New York Review of Books1 that deals with the control of the pharmaceutical industry over the practice of medicine, its research and even the definition of what constitutes a disease:
“In recent years, drug companies have perfected a new and highly effective method to expand their markets. Instead of promoting drugs to treat diseases, they have begun to promote diseases to fit their drugs. The strategy is to convince as many people as possible (along with their doctors, of course) that they have medical conditions that require long-term drug treatment. […]”
“To promote new or exaggerated conditions, companies give them serious-sounding names along with abbreviations. Thus, heartburn is now "gastro-esophageal reflux disease" or GERD; impotence is "erectile dysfunction" or ED; premenstrual tension is "premenstrual dysphoric disorder" or PMMD; and shyness is "social anxiety disorder" (no abbreviation yet). Note that these are ill-defined chronic conditions affect essentially normal people, so the market is huge and easily expanded.”
In your book you do not discuss this problem directly. Assuming that the “(psycho)pathology” can be measured objectively, do you think that these diseases fail validity, or is the psychiatric classification on the wrong lines for some other reason? In the latter case, where would you locate the problem? And what is the reason for not discussing this problem (that is real in the practice of daily medicine) in your book?
1 Marcia Angell, “Drug Companies & Doctors: A Story of Corruption”, The New York Review, January 15, 2009. http://www.nybooks.com/articles/22237
Professor of Philosophy of science, VU
The book advocates a Wittgensteinian approach to the philosophy of psychiatry and, in particular, a Wittgensteinian account of meaning (pp. 151-163). However, from such a perspective the claim that ‘the basic unit of meaning is the whole person’ (pp. 233-234) seems questionable. Wittgenstein’s central philosophical notions (form of life, language game, practice) essentially transcend the level of the individual. Put differently, individual people should always be conceived as embedded in broader contexts. It is these contexts (and not the individuals) that constitute the primary locus of meaning.
Acknowledging an ontological level beyond the individual is also important for normative reasons. The claim that ‘one can be justified by particular circumstances’ (p. 226) only makes sense if there is at least some ‘distance’ between the individual who endorses a particular claim and the form of life/language game/practice that incorporates the resources for judging this claim.
Student, Medicine and Philosophy
First of all, thanks for an excellent and extensive abstract of a very broad, complex en urgent discussion. It helped greatly in understanding the role of psychiatry in science and society.
My question regards the possibility of the use of a Wittgensteinian account in relation to the starting point of the discussion: Can we take a 'we make up the rules as we go along' standpoint, when the discussion was sparked off by the need for rules to justify, e.g., involuntary treatment in psychiatry? And what can be the role of 'common sense' if it is the lack of agreement that nourished the need for justification?
Your book makes clear that the psyche cannot be reduced to a single aspect of the whole person as a responsible agent. It also makes clear that clinical judgement cannot be naturalized. I agree that neither reduction nor naturalization is a proper means for justification of psychiatric knowledge or conduct, but I disagree in adopting a Wittgensteinian approach. Because the infinite regress that Wittgenstein points out, originates, in my opinion, not from the use of rules as such, but rather from a reification of rules. The lack of a 3rd person stance only becomes constrictive when the rules are put in the same ontological category as what they apply to: as having real existence (as opposed to ideal existence).
I agree that it would be logically absurd and a categorical mistake to demand from rules to apply seamlessly to particular cases, but wouldn't it be more useful to educate more in the ideality of rules than to go back to a 'common sense' account that wasn't there to begin with?
I hope I've been able to make my point clear in these few lines, and I am looking forward to your answer.
Psychiatrist, PhD Student Groningen
Could you please elaborate on the difference between the validity and utility of psychiatric classifications? (this question will be explained further by Berend during the session)