Monday, 9 April 2012

Mohammed Rashed on Religious Experience and Psychiatry

As the first part of a University of Glasgow AHRC funded project on transcultural psychiatry, I have been reading Mohammed Rashed's paper in PPP on Religious experience and psychiatry. What struck me most about the paper is how little he does to engage with and persuade those with an opposing – let me say simple minded realist – view. He begins with the DSM conjunction:

According to the DSM-IV (American Psychiatric Association [APA], 1994) the presence of psychotic symptoms (Criterion A) and social/occupational dysfunction (Criterion B) are sufficient to warrant one of the different ‘Schizophrenia group’ diagnoses. In the absence of social dysfunction an individual experiencing psychotic phenomena does not, by definition, ‘have’ a disorder. [Rashed 2010: 188]

He goes on to suggest a gloss on the second conjunct:

The inclusion of Criterion B in the DSM-IV serves the function of isolating ‘bad’ or ‘harmful’ psychotic experiences [ibid: 188]

So there is an obvious philosophically minded approach lurking here as a potential target: someone like Jerry Wakefield with his harmful dysfunction theory of mental illness. Criterion B picks up the harm. Criterion A is a specification or instance of the notion of dysfunction.

I know that the word ‘dysfunction’ appears in different conjuncts in the DSM definition and Wakefield’s account. It picks up harm in the former and stands in contrast to that in the latter. Still: the notion of social dysfunction in the DSM is not part of a naturalistic reduction (a reduction to more basic and ontologically more secure science) so I don’t think that that damages the analogy. Such social dysfunction is harm. By contrast Wakefield intends dysfunction to be unpacked in value-free terms via evolutionary theory. It is supposed to be plainly factual.

So – if I am allowed the comparison – someone like Wakefield can accept the broad form of the DSM definition and think that one conjunct is a plain fact (as to whether someone suffers a biological dysfunction) and the second picks out an evaluatively specified subset of such dysfunctions: the harmful ones. These are illnesses. On this view, even if religious experiences do not meet the harm criterion, providing they are caused by an underlying dysfunction then there is some biological failing in play: that would be a matter of accord, or not, with the biological facts and nothing to do with culture.

With that in play, the obvious place to introduce the issue of the nature of religious experience is with the harm criterion (as Rashed suggests it is for the DSM approach). That is where things might be complicated. We might to ask what harm amounts to relative to a culture. But I have the impression that the paper has a broader target. (I say impression because it might be the case that he is only concentrating on the element of harm or the normative character. I don't think that that is what he means, however.) When he describes the Lakota, who find it perfectly normal to see dead relatives, he responds to a commentator (Melford Spiro) who has something like the view I’ve sketched with this reminder:

Second, he is importing the assumptions of a certain epistemological tradition and applying them in a different culture as universal standards the violation of which is sufficient to constitute pathology. Of course, Spiro’s motivation is to oppose normative cultural relativism by arguing for universal, extra-cultural (here scientific) standards for judging experience. But in doing so he is missing the point: what makes an experience ‘pathological’ or ‘abnormal’ is in large measure a complex judgment that involves social and cultural norms, the response of others, the appraisal of the subject, the values of all those involved and finally the outcome of the experience. It is not a detached judgment that can simply be made by appeal to some universal standard according to which ‘the confusion of an event in the inner world with one in the outer world’ is sufficient for pathology. [ibid: 197]

The 'detached judgement' seems to concern more than just an imposition of what is culturally sensitive but rather an account of a functioning perceptual system (which seems to have gone wrong if one thinks one hears the dead in anything stronger than Rowan Williams' innocent sense). It is that aspect which Rashed here seems to reject.  But I am not at all sure that he has offered anything to undermine the realist position I’m thinking of. All I can see is far too strong: some fast and loose claims that if one rejects 1930s positivism (which should indeed be rejected) and reads Sellars and Wittgenstein then one ends up with the view that:

knowledge is inseparable from the social practice of justifying our beliefs to other fellow humans and is not a matter of ‘accuracy of representation.’...
Here we have the idea of knowledge as truths grounded in certain linguistic practices. When we report an experience we are giving a description of it—an interpretation—that stands or falls according to how well it resonates with the wider community we exist in and not on the basis of how well it represents some independent reality (whether internal or external) accurately.
[ibid: 198-9]

But while rejecting the foundationalism of the positivists is uncontroversial, rejecting scientific realism is not and needs some arguments. Note the last line of the quote. If I say that I am thirsty, this 'stands or falls' not on whether I really am thirsty, whether I have a thirst, but whether it resonates with the community. Now 'standing and falling' might simply mean such resonating, being popular, finding agreement. But it seems not. It seems that this is put forward to contrast with the idea of being true in virtue of my state of thirst or not. (One worry is that such sayings are expressions rather than descriptions. In saying I am thirsty, I express rather than describe my state. If one presses this point one might - though one need not - conclude that the utterance is not in the game of truth and falsity. But Rashed is happy with calling this a description. That is not his qualm.) If so then this claim is not just contentious but quite remarkable. False, too.

Still, he seems to need the idea that truth amounts merely to linguistic resonance to counter the realism of my Wakefieldian opponent and he/she will simply not accept such swift and radical philosophy. Without this the paper has Rorty’s philosophy as an undischarged assumption. That’s much less interesting. One can accept much of Rorty’s position without accepting his worries about truth.

I am left wondering what one should say with respect both to the case vignette of Femi (described at the start of the paper) and the Lakota. Suppose that we do not insulate or isolate the element for which culture plays a role to something like Wakefield’s harm criterion. Could it then really be the case that whether apparently hearing God speak or seeing dead people is pathological does not depend on whether God really speaks or dead people really can be seen? Surely the very notion of pathology here takes some risk in saying what we can see and hear? Surely we can only be so liberal, so ironic, about our world view?

PS: Mohammed Rashed replies to this post on his own blog here.