"I will teach you differences"

Seeing the current RSC production, I realised that I’d forgotten, if I ever knew, that the motto that Wittgenstein considered quoting at the start of the Philosophical Investigations comes from Lear. The Earl of Kent says to Oswald: “I will teach you differences” (meaning in this case differences of rank or status). For Wittgenstein, attention to the differences between word uses which we might otherwise too quickly assimilate, and thus be led into philosophical confusion (such as referring to pains and referring to objects), is key to philosophical clarity.

I was struck by this phrase in relation to the production itself which somehow didn’t at first seem quite to work (though things improved considerably after the interval). But how would one begin characterise what seem to be problems of pace or focus? They seem hard to put into informative words. In some remarks on aesthetics, Wittgenstein comments that such judgements are less like the expression ‘How nice!’ and more like the judgement about a jacket that its lapels (thus!) are too narrow. This suggests that one understands the aesthetics of lapels by understanding relations between different lapels (one sees the lapel in the context of other possibilities) and this in turn suggests an essentially practical dimension (in which actual lapels have a role to play). How much more theatrical direction must also be a matter of practical demonstration of differences.

Painting as photography

I’ve just been to the exhibition ‘The painting of modern life’ at the Hayward: paintings based on photography and it put me in mind of a recent discussion at the Kendal photography group asa64 of Roger Scruton’s 1981 article ‘Photography and representation’ (Critical Inquiry, 7: 577-603).

Scruton’s key idea is that painting, unlike photography, is ‘intentional’ and thus it is possible to have an aesthetic interest in the way it is representational.

Paintings are intentional in two senses:
1: Although painting can be about things, those things need not exist. (This is the philosophical use of the word ‘intentional’ which applies in the philosophy of thought and language meaning ‘aboutness’.)
2: What is depicted is the result of the painter’s intention, it is deliberate.

By contrast, though a photograph is of something, the relation is causal not intentional in either sense.
1: The object of the photograph must exist / have existed.
2: Its appearance does not realise an agent’s intention but how the object looked.

Thus, of any feature of a painting, we can ask what purpose the painter had in including it. This gives rise to an aesthetic interest in representation. By contrast, in photography, the details are there because they were there in the original scene. Thus, just as those with eyes to see can see human intentions expressed in human behaviour, so, with the right background, we can see a painter’s intentions in the painting. Understanding a painting is a matter of understanding thoughts (hence again the connection to intentionality) and seeing, in features of a painting, the vision of its subject that its painter intends to communicate.

In photography our interest, according to Scruton, is in the subject matter or object seen ‘through’ the photograph, not the representational qualities of the photograph itself. He asks, expecting the answers 'no':

Can I have an aesthetic interest in the photograph of a dying soldier which is not also an aesthetic interest in the soldier’s death? Or, rather, can I maintain that separation of interests and still be interested in the “representational” aspect of the photograph?

Hence if there is an aesthetic in photography it concerns the scene picked out in the way one might, equally, charge people to look at a particular view without being in the business of representation (of the view).

The asa64 group, perhaps predictably, were not sympathetic to the line of argument which seems to reduce the seriousness of photography. But I’ve found it a useful idea to have in mind when taking photographs. As a first step it seems worth asking: is the scene itself of aesthetic interest?

The exhibition ‘The painting of modern life’ nicely raises some of the issues in Scruton’s account. Some of the paintings are almost exact reproductions of photographs, produced by projecting the original image onto a canvas and then copying it in paint. So, because it is a painting, we can ask, with Scruton, of any detail why it is there. But, unlike the cases Scruton considers, we already know the answer: because that detail was there in the photo (including blurring, or the stray reflection in a window glass) and the artist has chosen to be so guided. In turn, the detail is there in the source photograph because it was there in the real scene. Still, there is choice and intention in the final painting, unlike the photography.

In fact, choices about the framing of the image (in the sense of selecting the boundaries) seemed the most interesting aspect of the choice / lack of choice involved. As Lois, my partner pointed out, insofar as the images looked like photographs they looked like not very good ones, and that rather undermined the final aesthetic outcome.

Someone must have traduced Jospeh K

Returning to Wittgenstein’s remark that ‘If a lion could talk, we could not understand him’ I’ve just been given the following delightful account of using public baths in Budapest last week.

It was initially one of the most disorientating and baffling experiences I’ve ever had with a series of cryptic rules of etiquette, bizarre pricing systems and an unguided labyrinth of rooms. The locals naturally knew exactly what they were doing and looked at us oddly when we were trying to figure out the complex locker use system that involved several keys of non-matching numbers, at least two attendants and a mystery swipe card that, as far as I could see, served no purpose whatsoever. In other words, I was thoroughly uninitiated into the practices and customs of the community (not just linguistically). What I found remarkable was that in some sense, light did indeed dawn over the few hours we were there. I still didn't get the intricacies of the system but grasped enough to get by, accompanied by hand gestures and liberal tipping. Thus the bathing experience turned from being daunting and unfathomable to, if not relaxing, then quirkily pleasant.

What I particularly like is the idea that one might somehow get the hang of this without knowing how one has the hang of it. Chicken sexing, perhaps. About the same time I was (rather less interestingly) in Borders in York, passing time whilst my folding bike was serviced and thus comparing translations of Kafka’s The Trial.

Someone must have been telling lies about Joseph K…/ Somebody must have been spreading lies about Joseph K… / Someone must have been traducing Joseph K… / Somebody must have been telling tales about Joseph K…/ Someone must have made a false accusation against Joseph K…

But aside from the quirky pleasure in re-reading familiar scenes in slightly different voices (like the very real pleasure in cover versions of familiar pop songs), I realised that in some translations K is just much more rational than in others. In one, for example, he is worried that his refusal to be interviewed might be taken seriously. In another he refuses to be interrogated. In a third he fears he has somehow refused to be tried. As a result he plans to return to the court / the court room / the council offices. Whilst the differences are subtle they slowly mount up such that K is either doing pretty much reliably what one would do oneself, or systematically always drawing slightly the wrong conclusions. This, I think, nicely illustrates the deep Davidsonian connection between interpretation and rationality.

Suddenly it dawned on me that part of what had seemed bizarre, off-kilter, and alienating about the writing (there's a word for this!) might be the result of the translation and not the original text. (This strangely depressing thought came in the same week as the revelations about Raymond Carver.)

Psychiatric virtue ethics

I’ve spent the day reviewing a manuscript for a book on psychiatric ethics written by Jennifer Radden (editor of The Philosophy of Psychiatry: A Companion) and John Sadler (co-editor of PPP and author of Values and Psychiatric Diagnosis).

The manuscript is for a book with OUP and is, as I would expect, very well written. The basic thesis is that ethical obligations on psychiatrists stem both from their status as professionals with client relations and also from their specifically medical role. Doctors have obligations to their patients. But, and this is what gives the book half of its purpose, psychiatry – over and above medicine in general – imposes yet further obligations on its practitioners. These, the book argues, are best articulated as a set of virtues that are called for by the roles psychiatrists adopt, and it is this that provides the second purpose of the book. Articulating ethics through virtues contrasts with the dominance within medical ethics of utilitarianism, Kantian deontology and the popular hotch potch: the Four Principles approach.

There is, however, a fairly standard objection to virtue ethics. Whilst utilitarianism (at least in those forms in which utility is not itself characterised in ethical terms; so when it is taken to be, eg, expected happiness) and Kantian deontology (with its uber categorical imperative and derived principles) promise specific guidance for ethical judgement, virtue ethics seem not to. The problem is that to determine what to do, one needs to determine what a virtuous agent would do. But there is no independent account of what the demands of virtue are from outside a perspective that has already earned the right to characterise itself in virtuous terms. (I should say that I don't think that this is a real worry. The idea that we can and should in general step outside our practices to justify them as from cosmic exile is a mistake, though a tempting one.)

Radden and Sadler footnote this worry but I think that they take their book to be engaged in a different project to that of defending the approach from first principles. Instead they spend 15,000 words of a central chapter setting out what they think the virtues are, in response to the challenges of psychiatry. That seems fine. What seems odder is, relatedly, that they do not attempt very firmly to demonstrate the advantages of virtue ethics over other approaches. They suggest, eg, that it complements rules-based approaches. (They do suggest that because good psychiatric practice requires affective responses from psychiatrists which cannot be governed by rules but can indirectly be inculcated, virtue ethics may be a better fit. But this point does not seem to carry much weight and I think it could not.)

The real weakness of an ecumenical approach, however, is that lacks an explanation of moral seriousness. It sounds instead as though one can add together a variety of different methods for framing ethical judgements just as one pleases and without a clear sense of what would make any such judgement right or wrong. What is it that disciplines a moral judgement?

That said, I'm very impressed with the book because its aims and purposes seem clear from the start and are carried out thoroughly.

New book on philosophy of psychiatry

I'm delighted to report that Rachel Cooper, a philosopher of psychiatry who, like me, graduated from the Cambridge HPS department, but in her case, unlike mine, the training seemed to 'take', has just published a new book on the philosophy of science of psychiatry.

I'll report back when I've read it but the manuscript version of it suggested a book well worth reading, genuinely combining philosophy and some history and making some contentious points.

Rationality and Compulsion #2

In the end, I was a little disappointed with Lennart Nordenfelt’s book Rationality and Compulsion (mentioned before). The second half ‘Irrationality, compulsion, and mental disorder’ applies the framework of ‘action theory’ from the first half to consider mental disorders. My qualm is two-fold.

Firstly, the real business of the book is postponed to the final two (of nine) chapters which does not seem to be enough of a return on the investment of coming to grips with the theoretical framework.

Secondly, I’m not sure that the framework really pulls its weight. Recall that the book is called Rationality and Compulsion. The final chapters discuss compulsion explicitly. Nordenfelt takes a condition of adequacy of any analysis of compulsion that it reflects the fact that if someone is compelled to do something then they could not avoid doing it [141]. Thus the analysis of obsession is a good opportunity to see what the action-theory framework can do. He considers the example of a subject who obsessively checks that she has turned off a tap.

The subject believes… that a risk exists that the water is still running from the tap. At other moments… she believes that this cannot possibly be so. Subjectively, overwhelming evidence also exists that the taps have been turned off. The situation can perhaps be described as follows: the subject cannot help having a completely unjustified, indeed foolish, belief...
[I]t is primarily the belief that the tap is running that is compelling. [177]

But there is no explanation of the tension in this case, the point that the subject believes both that the tap may be running and that it cannot be. Elsewhere, in the case involving wants as well as beliefs, Nordenfelt suggests that there are ‘conceptual’ limits to irrationality or a lack of fit between mental states and actions.

If a person genuinely wants to do F, has no conflicting want to do non-F, believes that he or she can do F, is capable of and not impeded from doing F, then he or she must for conceptual reasons at least try to do F. If A does not attempt to F, then something must be wrong with the premises. [117]

And earlier he expresses doubts about the psychological possibility of entertaining incoherent or conflicting beliefs.

A person who believes that both p and non-p at the same time has an incoherent belief. A logician would say that such a belief is irrational and logically forbidden. An interesting problem is whether such a belief is even psychologically possible. [100-1]

He goes on to argue that it is psychologically impossible to entertain a belief in the incoherent conjunction but that it is possible to hold a conjunction of beliefs which turn out, on investigation, to be incoherent. But this will not apply to the obsessional case (it is not a matter of investigation that the tap cannot be both on and off). Thus the account of the obsessional case does not seem to advance our understanding of it at all. Subjects of obsessional thoughts are compelled to have conflicting beliefs but we are not told anything about the nature of that compulsion.

Perhaps the best possibility for developing an account of obsession from the materials found in the book comes from its separation of rational and causal factors.

If no contact (or no relation whatsoever) exists between a particular want or set of beliefs, on the one hand, and an action on the other hand, it is not sensible to talk about the former being defective reasons for the latter. In order for a defective reason for F to occur, some relation must exist between the reason and the performance of F. And consider again the two plausible relations in this context, namely a causal relation and a rational relation. [114]

He goes on to suggest that a causal relation can exist even when the wants and beliefs ‘defectively rationalise’ the action. Further there is much talk of reasons being 'strong' or 'idle' which seems to mean causally strong or weak. But since he argues that ‘[r]ationalisation is a relation totally different from causation’ [97] this raises the question, which is simply not touched on, of what connection there is between rationalising force and causal force. Nordenfelt simply assumes a harmony between these two factors in most cases without saying why the ‘conceptual reasons’ that obligate action in the case quoted above also cause it. But this is surely the key question for a book that examines the relation of rationality and compulsion.

Contents and vehicles

One informal project that those of us from the more philosophical side of the Institute are engaged in is trying to get a better understanding of the embodied, embedded, enactive (and some add extended) approach to philosophy of mind that has sprung up recently from a number of distinct sources. My own sense that we should do this sprang from frequent references to this family of views in both philosophical and clinical papers at the Leiden IPPP conference in 2006. (My colleagues have their own reasons, of course, including interests in similar Continental philosophical approaches.)

Falling, as one is wont, to talking shop over a very fine pint in the Sun Hotel in Lancaster last night, I realised (very much guided by Gloria) that although I navigate much of philosophy through appeal to familiar distinctions (and when philosophers such as Quine propose giving up a distinction my general assumption is that something will be lost rather than gained) a fresh application of one can have me stumped and wondering whether I understood it in the first place.

In this case, the distinction is from the philosophy of thought between the content of mental states (often what comes after the word ‘that’ in saying, eg., Smith believes that Flaming Nora is a fine beer) and the vehicle for, or of, that content. In the case of the sentence I’ve just written, one might explain the vehicle as the squiggles you’ve read and the content as what they mean. In philosophy of thought or mind, the vehicles are usually neurological states in the head. One advantage of this approach is that the vehicles of content are what can causally explain a subject’s actions. As neurological states, they can operate the causal pushes and pulls that end up making a chap raise a glass to his lips. (It is less clear how the content itself – that FN is a fine beer – can do this.)

Now the neat picture that might be suggested was put under threat thirty years ago by arguments by Putnam and Burge that content – or meaning – was sometimes at least determined by external features: ie. features of the broader natural or social context. Thus Putnam argued that thoughts that I might express using the word ‘water’ are constituted as the thoughts they are by the chemical make up of the world (such that my twin on another world where the surrounding liquid is undetectably but chemically different expresses different thoughts using the same sounding sentences). Content, they argued, was broad or external, not narrow or internal and a fiddle was needed to preserve a simple causal role for internal vehicles (of something less than the full content or meaning of a thought, some internal element of thought common between me and my twin).

But in the context of the 3 (or 4) Es, the new notion is one of vehicle externalism. The thoughts themselves are carried by vehicles that are outside the skull. Such vehicles might be an extended feature of the body or, perhaps, a shopping list. Now I think I can begin to understand this. I think I can see how a shopping list might not only constitute my shopping intentions but ‘carry’ those intentions. But I begin to lose my grip now on the distinction between content and vehicle at just this point. What is its purpose? Without the neat picture of internal vehicles causing my actions neurologically, what is the need for the distinction between content and vehicle?

I’m suffering, in other words, from the confusion that is characteristic in philosophy as the ship, as it were, is put into the bottle. I look forward in about a week, I hope!, to when I understand what this amounts to. But typically, I will simply forget how I didn’t understand it before.

Everyday illness phenomenology

I’ve spent the last couple of days suffering a standard autumnal cold. The striking thing about such a normal experience is how bizarre aspects of it are. There is, for example, something quite unique about how it feels to begin to fall asleep during the daytime when one is escaping from the experience of illness which is so different from normal lazy post-prandial dozing. There is also something quite reassuring about making up a fire and settling down in front of a film (I tried Blue Velvet last night: not the best film for a cold, in fact) knowing that one isn’t up to doing any work or anything else practical. That is a kind of first person experience of illness as excuse.

But the oddest experiences for me are those that characterise sleeping badly at night and realising, for example, that one has been thinking nonsense for the last hour (literally things that make no sense though one hadn’t noticed it), or becoming convinced that getting to sleep involves some sort of quite other project or achievement (does this only happen to me?). These slightly shivery experiences are so different from the everyday experiences of thoughts going well and suggest a kind of fragility of the every day case (so in fact akin to the fragility of the everyday suggested in Blue Velvet after all).

It would be good to find a published account of the phenomenology of the common cold, to see what it is like for others. It would be a version of Jaspers’ account of static understanding: grasp of the very nature of what it is like (perhaps nothing else!) to be subject to fragmented and uncanny thoughts. But given that the phenomena only come along when one is not in the most objective of states, it’s hard to know how they could ever be accurately recorded. And that problem seems to me to generalise to other cases of fragmented and unusual thought processes or experiences.

My thoughts about my own coldiness are, however, rather put into perspective by the news that Peter Lipton, Chair of Cambridge HPS and who saved my PhD, died suddenly in his early fifties from a heart attack a couple of days ago. It’s very sad and quite shocking news.

In Berlin

I’ve just got back from my final conference of 2007: kindly invited by Thomas Fuchs and Martin Heinze to give a paper at the German Psychiatric Association (Deutsche Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde) in Berlin. It was a huge conference with many of the people one would expect (eg Alfred Kraus, Henning Sass) but also my colleague Kwame McKenzie turned out to be in from Toronto and staying in my hotel and the ubiquitous and very hard working Juan Mezzich had been and gone.

Coming from a philosophy background, the strange thing about psychiatry conferences is the different attitude to asking questions. At a philosophy conference, the cut and thrust of the questions after a paper or presentation is the main reason for attending (aside from networking to land one’s next job!). Without that, one might as well wait for the papers to be published and stay at home with decent beer. But at psychiatry conferences, questions are generally merely a polite extra. (I guess this is partly because of differing assumptions about what disciplines the disciplines.)

Thus I was very surprised to be asked a really good question on this occasion. I’d given a presentation arguing that it is a mistake for the WPA to call for an idiographic addition to criteriological diagnosis because no sense can be given to idiographic understanding that marks it off from a contrasting form and the very idea of individualised judgement threatens the validity of diagnosis, broadly construed. (Instead we should follow the more helpful idea that narrative elements be added: these are distinct, normative and not-precluded from possessing validity.) Delightfully I was asked whether my argument turned on neglecting Kant’s idea of reflective, rather than determinate, judgement, which cropped up here the other day. I don’t think it would help because I don’t believe in reflective judgement in Kant’s sense either (and for a related reason to my distrust of idiographic judgement). But I wonder whether a background in philosophy is still a much more common aspect of German psychiatry than it is in the UK. If so, that adds to the recent debate at PEHM about the relationship between the two disciplines.

Very odd to wonder round a city which functions so much like any other affluent European city but where I lacked any grasp of the language. There’s a phrase from Wittgenstein’s Philosophical Investigations which is often, I think, misapplied: If a lion could talk, we could not understand him. This is often used to support the idea that we wouldn’t be able to translate its utterances because its world would be so different from ours. But actually Wittgenstein mentions it in the context of considering being abroad somewhere where one does understand the language but not the people: one doesn’t share the right expectations. What stood out for me in this case was that even not understanding German (yes I’m embarrassed!) how much was understandable, how much is agreed in practice. The systems (in airports and restaurants) are their own translations.

Everyday philosophy of vision?

In an article in today's Guardian which reviews an exhibition of Sidney Nolan, and successfully persuades me to look at his work afresh, Germaine Greer says some irritating things about perception:

By now everyone should be aware that what we see is not really there. What is really there is a boiling stream of disconnected bits of information that is turned into a moving picture by the brain.

So far, so typically scientistic albeit with the racy addition of ‘boiling’. But even though there may be much work necessary behind the scenes to make the world visually available to a subject, it does not follow that all that is really seen is not what we think it is (but is instead the boiling stream). We need an argument but we don't get one. Oddly, she continues:

When it comes to recognising a picture, we have to post it up next to one of our brain-made images of the same thing. If the two don't tally we say that the photograph, drawing, painting, bust or whatever is a poor likeness. We even dare to say that it is unrealistic, as if our brain images were more real than somebody else's.

How is the comparison supposed to work? A real picture on the left and a brain-made image on the right? Or a brain-made image of the picture and a brain-made image of the scene? But if this latter idea, what is wrong with the idea of a comparison? Then:

There would be no point in painters simply doling out versions of pictures we can summon up at will; they impose their own convention on what they see.

Far from being motivated by her account of what is ‘really’ seen (the ‘boiling stream’ of neural events), the second part of this sentence could better fit the naïve model of vision Greer takes to be obviously false. If vision merely copied the world then that would explain the interest of an art which did not. Later she says:

When Nolan's paintings of the outback were exhibited at David Jones's department store in Sydney in 1949, according to Cynthia Nolan, "old ladies from central Queensland carrying string bags" came up with tears in their eyes and said: "It's so true, so real". The old lady writing this travelled from south-east Queensland to Sydney to see the current Nolan retrospective at the Art Gallery of New South Wales and found herself saying the same sort of thing. Cynthia Nolan's old ladies had not had the advantage of seeing Nolan paintings all their lives, as I have. For them the shock of recognition was exactly that.

So Greer now seems to think that somehow Nolan got things right. But how can that be, given her starting point?

I’ve no qualms with putting forward a revisionary philosophical view of vision but it is annoying to be told that this is obvious and we should all be aware of it. I suspect no one is or can be aware of any such thing because it isn’t true.

Judgement, understanding and contemporary music

My colleague Pat Bracken objected at a seminar last week to me suggesting that a clinical encounter between psychiatrist and patient / service user was a matter of judgement. My justification was that taking the idea of understanding patients seriously required aiming at getting their stories right (although rightness might be, say, narrative fit according to the patient) and the best word for aiming at rightness is ‘judgement’. (Additionally: judgement needn’t imply being judgemental and saying that psychiatric diagnosis / formulation is a matter of judgement doesn’t preclude other features of it such as interpersonal warmth.)

But I was asked later by Richard Gipps whether I really think that all understanding is a matter of judgement, with, further, the thought that judgement is matter of subsuming things (eg utterances) under concepts. I think that I do. But a weekend at the Huddersfield Contemporary Music Festival (coupled with a quick visit to the Yorkshire Sculpture Park) threatens that thought.

The question it raised was whether what I lack when I listen to a piece of music that seems simply unconnected poops and whistles is understanding in that sense, especially when contrasted with a piece in which there is a kind of repeated structure even though of a minimal form (James Wood’s ‘De telarum mechanicae’ was brilliant in this way). Still, in the latter case, it seems hard to think that it is a matter of bringing the experience under concepts. I have no vocabulary for it (the programme notes don’t encourage adoption of theirs; contrast the brilliance of architectural vocabulary).

Still, I think it is. One grasps at musical phrases, demonstratively labelled (a la McDowell’s description in Mind and World) as “like that!”, keeping that phrase in mind for a little while and thus navigates through the piece, even if falteringly and partially. Anything less than that isn’t any kind of understanding.

A few years ago, there was an excellent paper by David Bell (‘The art of judgement’ Mind 1987) which suggested that a response to a Jackson Pollock was a good way of exemplfying the kind of judgement in Kant’s Third Critique. Reflective judgement, by contrast with determinate judgement is a mid way between subjective whimsy and fully conceptual judgement.

If the universal (the rule, principle, law) is given, then judgment, which subsumes the particular under it, is determinate... But if only the particular is given and judgment has to find the universal for it, then this power is merely reflective. [Kant 1987: 18]

Bell suggests that the kind of understanding one has of Jackson Pollock is just such a preconceptual judgement. What's more he suggests Wittgensteinian support for this given Wittgenstein's suggestion that understanding music is a good comparison for understanding linguistic meaning. But I just don’t believe that there's any (conceptual) space for a third way here. It’s concepts or nothing!

Draft reply to Damiaan Denys

I am grateful to Damiaan Denys for the friendly tone of his critical response to Natalie’s and my paper and for his mention of my own contribution to the International Perspectives in Philosophy and Psychiatry book series: Essential Philosophy of Psychiatry.

In fact, the friendly tone appropriately reflects a large measure of underlying agreement alongside surface disagreement. We all agree that philosophy and psychiatry can stand in a useful mutual relationship. We all agree that there has been a history of interrelation especially within the phenomenological tradition. (Natalie and I mentioned this in a preliminary way though it was not our topic.)

But while Natalie and I saw grounds for optimism in the new developments in broadly Anglo-American philosophy of psychiatry, Professor Denys emphasises the grounds for pessimism in the diminution of philosophy within psychiatry itself. Aside from the suggestion that the rise of the new philosophy of psychiatry is the direct result of its loss within psychiatry – ‘Philosophy has left the psychiatric building. It is exiled from psychiatry, externalized and sequestered in the “new” philosophy of psychiatry’ - which seems unlikely, there is little substantial to disagree about. We see the glass half full (and the focus of our review was that full half), Damiaan Denys sees it half empty. All of us would like it to be fuller.

So what practical steps can we take to improve matters? A recent discussion of the World Psychiatric Association’s Institutional Program on Psychiatry for the Person that took place in London suggested some possibilities. The main focus of the meeting, organised by Juan Mezzich (and the Department of Health), was to find ways to augment a narrow criteriological model of diagnosis with a broader, more explicitly person-centred, approach to psychiatric formulation. But in the meeting different views were also expressed (mainly by psychiatrists) questioning the general need for diagnosis and also pointing out the view of some service users that their conditions should not be seen in negative, pathological terms at all. Such debate, although leading to no quick answers, suggests a positive and practical way to improve our understanding of mental health and mental health care but also the positive practical steps that this might underpin.

Professor Denys comments that most of the work of the new International Perspectives in Philosophy and Psychiatry book series is critical, for example ‘critically analyzing the conceptual foundations of academic psychiatry’. This is true and surely a good thing. What would be the point of a philosophical or conceptual engagement which was not critical, reflective, thoughtful? But he also suggests that such criticism, ‘coming from the outside’, is often perceived to be negative.

It is worth noting that most of the authors or editors we reviewed are qualified psychiatrists (with a couple of clinical psychologists, also) so the criticism is not in the sense implied external to psychiatry. But if it is perceived by some to be negative that suggests that there is work to be done in examining the assumptions about change and development of psychiatric services and about the shared and divergent values of those involved. In this process there is an important role for the new philosophy of psychiatry.

Control

I had lunch with Professor John Cox yesterday who will, hopefully, act as External Examiner for the Philosophy and Mental Health MA at Uclan. He outlined his growing interest in the role that spirituality might play in mental health. In the main, in discussions I’ve had about this both in the UK and at the Sun City philosophy of psychiatry conference, the idea has usually been coupled with formal religious faith traditions. But amongst most of my friends such traditions hold no interest. And yet as the WHO makes plain, the idea of experiencing life as having meaning seems very important both as an aim in itself and as a way of promoting mental health.

[T]hat mental health and mental well-being are fundamental to the quality of life and productivity of individuals, families, communities and nations, enabling people to experience life as meaningful and to be creative and active citizens. We believe that the primary aim of mental health activity is to enhance people’s well-being and functioning by focusing on their strengths and resources, reinforcing resilience and enhancing protective external factors. [WHO Europe Declaration]

And thus I wondered all the more, watching the very powerful and well directed film Control last night whether a sufficiently rich aesthetic life with both direct emotional engagement and discursive judgement might be enough to amount to spirituality in the WHO sense. I rather hope so. Of course it helped, watching Control, that the music has been a long standing part of the sound track of my own life since late adolescence.

Overly rational? Overly simple?

One of the projects undertaken by recent philosophy of psychiatry has been to try to resist Jaspers’ claim that primary delusions are un-understandable. It is the subject of chapter 3 of my Essential Philosophy of Psychiatry. The idea is to take seriously the strangeness of expressions of delusions but at the same time to try to understand them as from within. So it is not just a matter of predicting that such and such a lesion might lead to a particular kind of utterance. Understanding rather than explanation. But at the same time, an interpretation which was too straight forward would fail to capture what makes delusions difficult. So the aim is to ‘solve simultaneously for understanding and utter strangeness’ in Naomi Eilan’s phrase.

There are a number of strategies then available. Sass, eg., compares delusions with the philosophical ‘theory’ of solipsism. Maher suggests that delusions are rational responses to unusual experiences. Campbell and Eilan suggest that they are deviant framework propositions. And so on.

But as Richard Gipps suggested to Gloria and me at a seminar we gave in Uclan yesterday, perhaps philosophers (I should say ‘we philosophers’ to flag my shared guilt in this) are too obsessed with rational, successful utterance and belief. Perhaps, although most people hold mostly true beliefs, they misfire in some areas, not just in the sense of being false (well formed but false) but being bizarre.

I am quite sympathetic to this thought but it would need to be augmented by a kind of philosophical therapy, with, perhaps, comparisons with more familiar cases of beliefs and utterances which are not just like successful everyday cases. Today, three spring to mind.

1) Dennett’s case of the lemonade salesman.
The boy's sign says "LEMONADE—12 cents a glass." I hand him a quarter, he gives me a glass of lemonade and then a dime and a penny change. He's made a mistake. …but exactly which mistake? This all depends, of course, on how we tell the tale—there are many different possibilities. But no matter which story we tell, we will uncover a problem. For instance, we might plausibly suppose that so far as all our evidence to date goes, the boy believes:

(1) that he has given me the right change (2) that I gave him a quarter (3) that his lemonade costs 12 cents (4) that a quarter is 25 cents (5) that a dime is 10 cents (6) that a penny is 1 cent (7) that he gave me a dime and a penny change (8) that 25 - 12 = 13 (9) that 10 + 1 = 11 (10) that 11 not= 13
Only (1) is a false belief, but how can he be said to believe that if he believes all the others?

Dennett suggests that belief ascription turns on an ideal of rationality that can simply fail to apply and if so then there just isn't a fact of the matter as to what is believed.

2) The theological disagreement between Anglicans and Catholics concerning transubstantiation. Or rather: my Divinity O level understanding of this according to which the latter believe the bread becomes the body of Christ whilst the former take there to be a merely symbolic relation between them. But it is worth asking what it would be to believe that the bread becomes body? In what sense are these words used? Is there really a clear distinction between the theological approaches?

3) Cora Diamond’s example of the Lives of the Saints.
In her Realism and the Realistic Spirit she mentions the strangeness of the narrative structure of lives of the saints in which, for example, a saint might suffer the stigmata, might modestly keep them hidden and yet, straightaway, his followers detect them. In this narrative context, the rational stress between these elements is simply disregarded. A saint must be modest and yet the blessing of the stigmata must be detected.

Cases like these suggest that there are cases with which are more familiar in which the quest for a simple, literal, empirical perhaps, interpretation is vain. Perhaps they can relax the impulse to interpret the content of delusions in an overly rational and overly simple manner.

A response for PEHM?

I mentioned (on this blog) a reply to Natalie's and my overview of the OUP book series a little while ago. If anyone cares to support (financially) the free access journal Philosophy, Ethics and Humanities in Medicine (and surely free access journals are a Good Thing) merely by writing a comment, you might be interested in this email from its editor.

"Dear Natalie and Tim,

I am writing as Editor-in-Chief of the open-access, peer-reviewed, journal, Philosophy, Ethics, and Humanities in Medicine (PEHM) www.peh-med.com , regarding a recent publication.

How new is the new philosophy of psychiatry?Damiaan DenysPhilosophy, Ethics, and Humanities in Medicine 2007, 2:22 (20 October 2007)

PEHM has been challenged by a supporter – can there be a broad and lively response to a provocative and timely article such as Damiaan Denys – or not? Is the field of psychiatry interested in having such a serious discussion – and on an international level – in a medium such as ours? Our potential donor challenges us. He/she will donate $10,000 to PEHM to support future papers if there are a dozen good responses (comments) to Damiaan Denys article.

This current email is a request for a comment from you on Damiaan’s article. Comments are easily added to articles in PEHM by going to the web page of the article (http://www.peh-med.com/content/2/1/22/abstract) and – on the right of that page, in the side bar, notice, under “Tools” :
Tools:
· Email to a friend
· Order reprints
· Post a comment
· Sign up for article alerts

The section “Post a comment” - click on that and follow directions. Comments can be scholarly or informal, they can have references or not. They are posted subject to editorial review. They can be responded to by other comments. This discussion that I am looking for is about the future of philosophical psychiatry. How can psychiatry – as Damiann Denys asks, best “incorporate basic philosophical attitudes” ?

I believe that we can achieve the conditions set by our potential donor, and I am asking for your participation. Can you upload a comment? Can you help begin this discussion?
...
Best wishes and thanks,

Michael Alan Schwartz, M.D.
Editor-in-Chief
Philosophy, Ethics, and Humanities in Medicine (PEHM)
www.peh-med.com
mas1@mas1.cnc.net"

Why colours look the way they do

I went to a fascinating paper by Nick Unwin on ‘Why colours look the way they do’ yesterday evening but - or should that be ‘and’? - have been left baffled.

Colours have been taken by philosophers to be the best examples of qualia and hence often described as ‘nomological danglers’ because, so the thought goes, they dangle free of the physical laws. But in fact there’s been much work to explain colour vision and thus, as Nick put it, to take some small steps towards bridging the explanatory gap between our account of the physical world and the phenomena of consciousness. (He recommended Hardin’s Colour for Philosophers as a good start on this.)

One expression of the idea that colours are nomological danglers is that they might be inverted. For all we know, other people might see red where we see green and so on. If the inversion were systematic, it would not be detectable in the judgements they made about the colours of objects. But as Hardin and others have argued, there are in fact constraints on this because the relations between colours (including non-spectral colours like brown) are complex. Not just any inversion would work. In his paper, Nick argued that the ‘warmth’ of some colours would make inversions of red and blue detectable but that it might still be possible to mirror colours across the ‘warm-cold’ axis. He then discussed, in a fairly open ended way, whether this was conceivable, by looking, eg, at way shaded green grass would have to be translated into some forms of purpley pink (I think) and creating pictures of this.

What confused me was this. In the project of eliminating such sceptical possibilities as inverted colours what is needed are internal relations within the colour system which make no other systematic mapping possible. Indeed Nick called for the development of just such a pure phenomenal language. (Connections which are merely associative - between the colours and, say, thermally warm things - do not have anti-sceptical effects because a colour inverted subject might simply have different associations. Warm fires might look green to her.) But such internal features of colours do not seem to help much in explaining how colours are part of the natural world: closing the explanatory gap. Articulating such relations seems to be more describing how colours, as a whole, look than why they look as they do.

To put it another way, the project of eliminating scepticism here seems to require that there are sufficient internal, non-associative features of colours. But it seems odd that the project of explaining colour appearance (a project which includes discussion of the rods and cones of the eyes and of opponent processing of those outputs) should be held hostage to the fortunes of a particular anti-sceptical argument. In other projects of naturalising phenomena, scepticism doesn’t get a look in, let alone pride of place.

But as Nick pointed out, an explanation should be contrastive. It should explain why things are one way and not another. So, unusually perhaps, he argued that explaining colours does require this detour. That seems to me to be such an odd result that I’m left baffled.

Alienation with rabbits?

Having expressed some qualms about Lennart Nordenfelt’s characterisation of everyday mutual understanding (it is too intellectual and too much akin to the world of a private detective) I was struck by an experience a day later which did seem to fit his description.

I went to see the most recent David Lynch film: Inland Empire. More so that Mulholland Drive, it seems to resist narrative interpretation. Whilst (parts, perhaps, of) scenes ‘hang together’ as the simulacra of rationally structured actions, any momentary sense of knowing what is going on is swiftly fractured. Unlike meaningless activity, it seems to demand interpretation. It ‘sprongs’ the spider-senses, so to speak, but to no, immediate at least, avail. One is left both instinctively deploying one’s faculty for empathy and finding it frustrated.

That said, there is much to be enjoyed about the film, not least the surface structure and appearance.

Alienation

I’d meant to spend Sunday afternoon catching up with various things I need to read, including Lennart Nordenfelt’s Rationality and Compulsion (OUP 2007) but went instead for a walk along the low ridge of hills that encloses Kendal from the West in part to try to work out why I’m just not getting on with that book.

Lennart is a charming fellow whom I met when he visited Warwick a few years ago. His style is almost self-consciously old-fashioned. He must be the last person left who describes his own linguistic-analysis-based approach to philosophy as ‘logic chopping’. There is a pleasing rigour to his approach to philosophy of psychiatry which is built upon an analysis of action, not a million miles from Bill Fulford’s work.

The new book is divided into two halves. The first summarises his approach, expressed more fully in two other books, to the philosophy of action. The second half, which I will probably enjoy more, applies this to mental illness. My qualm has something to do with the atmosphere, rather than the analysis itself, of the first half. What sent me off on my walk yesterday was the third of three niggles.

1) In what may be a throw-away remark, Nordenfelt suggests (p78) that a want to do F is a disposition to form an intention to do F. (Actually, he suggests a want is a disposition and then in the next sentence he says that if one wants F then ipso facto one will have a disposition to form the intention, which isn’t quite the identity hinted at. But I assume that is what he means.)

I think that there’s something wrong with that claim though I’m not sure I have a knock down argument. What is plausible is that if I want to do F then I will be disposed to intend to do it. (Contrary wishes may block me forming the intention to act but not negate the disposition.) But might a want just be a disposition to intend? Suppose I have a longstanding wish to be agreeable to friends when visiting them and fall in with their plans but that I have no idea what sort of thing they will want to do. If, over breakfast, they suggest we go to see the Warhol exhibition, this suggestion will, in the context, determine what I agree to, and thus intend to do. Nothing has changed about my character over breakfast - changing one’s dispositions to intend is akin to learning to like English beer which slowly transforms one’s behaviour in pubs - so my dispositions to intend are, I assume, the same as they were. Thus, in some sense, I already had the disposition to intend to see Warhol and thus had that want. But that is not something I even could have been aware of. (One might say: the genuine want at work is the longstanding want to be agreeable and it is this which selects seeing Warhol, when that is suggested. But the challenge is to derive this from the dispositions in play not to impose it on them.)

Actually, the fact that I’m trying to find an objection suggests my real qualm is deeper. It is that wants can be the sorts of things that one offers as reasons for one’s intentions. My long-standing wants concerning pizza will help rationalise my intentions to act when the new Kendal Pizza Express opens next month. But that rational answerability seems to be missing from a merely dispositional analysis.

2) More surprisingly, Nordenfelt comments at the start of the book (p4) that actions are abstract (like the number 4) and thus cannot be observed ‘with the senses’. This is surely a startling claim, seeming to undermine the very idea of witnesses to criminal acts, for example, but I’ve not been able to find much defence of it yet. I guess that the argument for it may start with the idea that actions are behaviour plus mental states and couple this with a Cartesian assumption that others’ mental states cannot be perceived with the senses. But it seems to me that the conclusion is sufficient to cast doubt on the Cartesian assumption, not the other way round.

3) The third niggle was especially striking in the context of also reading Matthew Ratcliffe’s book (mentioned before on this blog) criticising the idea that interpersonal understanding is a form folk theory. It is worth quoting Nordenfelt’s account of understanding other people’s action at length:

“What does it mean to answer the question ‘what is this?’ in relation to actions? Assume that two persons (A and B) witness the occurrence of a behaviour performed by a man C. Assume that they witness C is waving his hand. A asks B what is going on.
B’s first task is to identify the performance as an action in the first place. The context is not legal, so B can wholly concentrate on the issue of intentionality. Does this behaviour issue from some intention of C’s? B’s task is one of interpretation. The answer is not self-evident since the intention in question, being a mental event, is not observable. B has to find evidence for assuming the existence of the intention. Different methods for this exist. If C is approachable for questioning one can simply ask him what he is doing. This is a recommendable procedure in many instances. However, it is not waterproof. C may lie about his intentions… A second task is therefore to put C’s behaviour in a context. Where does the waving take place? Is there a human being in the neighbourhood to whom the waving can be directed? Is there anybody else doing the same thing as C?
Further observation by B may detect the following circumstances. C is standing together with a number of other people, all waving their hands, in front of a building. In a window on the upper floor of the building a man is standing looking at all the people outside. It is evident that the group outside are calling this person’s attention to something. Thus, the primary question can be answered: C’s behaviour is intentional. It is an action.
Preliminarily, B can now identify C’s action as an action of waving.” (p69-70)

This strikes me as a very odd view of understanding. If one had to do all this work merely to understand that C is a part of a crowd waving, one would be a very unusual kind of person. It is, I think, a mad view.

Now, of course, it may not be an account of everyday phenomenology but rather a reconstruction of how, if challenged, one might justify one’s normally seamless understanding. But that is not how it is presented and I fear that by starting with such an ‘alienated’ conception even a piece of reconstructive epistemology will be misleading.

My worry, in other words, is that the dryness of a kind of analytic philosophy may not merely be an impediment to its popularity but may also distance it from the very phenomena it is trying to understand.

Categorial unity

A few weeks ago I was invited to a small conference to mark the translation into French of John McDowell’s Mind and World. (My single chapter summary of Mind and World is here.) It was the third time I've had the chance to give a talk on McDowell to McDowell. One aspect of the oddness is that whilst, obviously, one addresses him as ‘John’ in the surrounding banter of a conference (anglo-american philosophy is informal), there seems to be something arch about referring to him in a paper as ‘John’. On the other hand, referring to him as I did in my presentation as ‘the author of Mind and World’ was probably worse, though there was an excuse.

Being these days a fully naturalised philosopher of psychiatry, I turned up with a power point presentation to talk to. But of course, no one else did. Nearly everyone read a paper script. (Jim Conant, an honourable exception, gave a very clear and entertaining off the cuff presentation for about an hour.) Still, the disruption of getting a projector and laptop set up in the middle of proceedings seemed hugely rude. It was like being invited to dinner and insisting on arriving with a karaoke machine.

My excuse for keeping ‘John’ and ‘the author of Mind and World’ distinct was that McDowell announced a key change to his earlier views. The central claim of Mind and World is that experience itself has a conceptual shape. Only so can one reconcile the transcendental role of the world via experience in rationally constraining thought with the idea that only something already conceptually shaped can be a (rational) reason for a thought. But, if I understood him, he now thinks that there is something right about the following challenge (though the example is Conant's). In the face of experience of one’s hotel room, for example, one might frame any of the following judgements: ‘There are middle sized dry goods before me’, ‘There is a bed, chair and desk before me’ and ‘There is the kind of furniture one finds in a hotel before me’. So, the challenge runs, if experience (on which judgements are made) itself has a conceptual shape, which particular conceptual shape does it have? McDowell now grants that experience is not ‘discursively conceptually shaped’. It is merely apperceptively or intuitionally conceptually shaped. My problem, before and since, is simply not understanding what this amounts to.

Anyway, today I’m puzzling over something McDowell has published this year in a debate about tacit knowledge with Dreyfus. I have the bad feeling that this is the clearest expression I’ll find of the new view:

“What is important is this: if an experience is world-disclosing, which implies that it is categorially unified, all its content is present in a form in which, as I put it before, it is suitable to constitute contents of conceptual capacities. All that would be needed for a bit of it to come to constitute the content of a conceptual capacity, if it is not already the content of a conceptual capacity, is for it to be focused on and made to be the meaning of a linguistic expression. As I acknowledged, that may not happen. But whether or not a bit of experiential content is focused on and brought within the reach of a vocabulary, either given a name for the first time or registered as fitting something already in the subject’s linguistic repertoire, it is anyway present in the content of a world-disclosing experience in a form in which it already either actually is, or has the potential to be simply appropriated as, the content of a conceptual capacity.” McDowell, J. (2007) 'What Myth?' Inquiry, 50: 338 - 351

Correction

Sitting in the Sun Hotel, Lancaster, with Gloria Ayob after a reading group I had a sudden enthusiasm for the view that to be a good enough philosopher (in a rough and ready, journeyman sort of way) requires two key things. One should have some sort of philosophical personality or roughly consistent approach (it is just too hard to defend strict reductionism in one area and relaxed naturalism in another). And one should be able to correct one's work. There's a sense in which the latter is just what one learns in writing essays for a masters degree. One learns to ask whether it is clear what a paragraph is doing and if not, even if one is fond of its elegant turns of phrase, one should delete it and try again. (In truth I'm rubbish at this. I can spot the motes in others' eyes but not the beams in mine.) But I think the real attraction for me of the idea is that it's more than just that and, instead, lies at the heart of philosophy. This morning I realise that this stems from reading Thomas Bernhard's great Wittgensteinian novel Correction. But since central also to that book is the thought that correction, as a kind of life-long activity, also amounts to a form of madness I should probably revise my advice to young philosophers.

The new philosophy of psychiatry

Natalie Banner and I published a review of 7 of the books in the OUP book series, International Perspectives in Philosophy and Psychiatry, in the South Africa based free access electronic journal Philosophy, Ethics, and Humanities in Medicine a few months ago. We've had a reply, I see. The main focus of disagreement seems to be that whilst we saw grounds for optimism in the various new developments in the field (including the book series, the journal PPP, the internal conference series, my own institute at Uclan etc), the reply sees only grounds for pessimism in the thought that philosophy has 'left the building' of psychiatry.

Having had some experience of teaching medical students at Warwick (one of whom once said: "Your course is hard because we're not used to thinking; in a year's time we can be GPs following NICE guidelines and we'll never need to think again") I can see how a philosophical sensitivity may not be high on many young psychiatrists' agendas trying to pass exams and get on. In truth, this is part of what the WPA programme on psychiatry for the person is reacting to /against. But I still prefer to see some good in a popular reaction amongst other psychiatrists against the absence of philosophy in practice. Perhaps the growth of interest in philosophy by psychiatrists in the UK at least (note the rapid growth of the RCP philosophy group) is a grass roots reaction against the pressures towards scientism in some areas of clinical practice.

The World Psychiatric Association Institutional Program on Psychiatry for the Person

I’ve just been to a three day conference organised by the World Psychiatric Association to attempt to come up with practical ideas for their Institutional Program on Psychiatry for the Person.

Juan Mezzich, President of the WPA has been pushing both the idea of comprehensive diagnosis and the idea of an ‘Idiographic (Personalised) Diagnostic Formulation’ for the last couple of years and wants there to have been progress made during his term of office. But I had some sense of the difficulty from the way that preliminary discussion of basic ideas expanded to leave very little time for actually trying to draft some kind of guidance or protocol or whatever.

One interesting sign of the difficulty was this. Robert Cloninger presented a scientific model of factors which both promote positive mental health and also protect against mental illness (although one of his more interesting general points was that these do not simply stand in a reciprocal relationship). But he got considerable criticism from part of the audience, especially Richard Williams, for somehow ignoring the person.

Over coffee he (Cloninger) expressed indignation over the fact that, surely, he was putting the person at the heart of things. It seemed to me that the underlying contrary worry was that a ‘psychiatry for the person’ should concentrate on placing patient or service user voices at the heart of things and thus adding even a scientifically well grounded theory of personality – couched obviously in analysts’ rather than agents’ categories – didn’t address that issue.

There were a couple of other themes: much disagreement on the value of making formal diagnoses at all for a high proportion of mental health care; and also at least some suggestion that the real challenge the service user movement was offering to psychiatry was to take the pathology out of conceptions psychopathological experience. Who knows what will actually come of the work, though.

Journal acceptances and rejections

Having finished books this year and last (the co-authored Oxford Textbook of Philosophy and Psychiatry and a single authored Essential Philosophy of Psychiatry), I’ve decided to concentrate on writing papers for a bit. It means I can be rather more flexible in subject matter and it means that the proof reading and amateur copy editing stage is more ‘little and often’. So far one paper - ‘Why the idea of framework propositions cannot contribute to an understanding of delusions’ - is due to come out in Phenomenology and the Cognitive Sciences and another, on idiographic judgement, is being considered by Medicine, Health Care and Philosophy.

But, of course, submitting papers to journals brings with it inevitable rejections. I’ve just had a pure philosophy paper on McDowell and Wittgenstein turned down which is hard not to take personally. So I need to look at the reasons for rejection and think whether to resubmit it to the same journal (they expressed mild interest in that) or another. But it’s best to put it to one side for a couple of days first to get a bit more objectivity.

Folk psychology

The reading group at the Philosophy Department at Lancaster University – one stop up the railway line from Preston – is reading Matthew Ratcliffe’s (expensive) book ‘Rethinking Commonsense Psychology’. Although we’ve just read the first two chapters which are basically preparatory, the idea that talk of ‘folk psychology’ by philosophers and cognitive scientists isn’t the harmless shorthand it is taken to be is interesting. It makes me feel guilty about all the times I’ve just used the phrase without thinking.

It also seems to me to be plausible that philosophers have over-intellectualised mutual understanding. In a paper written with Bill Fulford, Richard Gipps argued a few years ago that accounts of delusion suffered the same fault.

But because he aims to argue against all versions of folk psychology (including accounts in which folk psychology is a theory which is only tacitly known), Ratcliffe has a tricky case to make. He will have to argue that his favoured approach, which draws on a phenomenological tradition, not only is a better description of the surface of human practices but also of the underlying generalities. We’ll see.

At the last meeting one student expressed the worry that so far we’d given the author ‘a kicking’. It is strange - but obvious on reflection - to think that the philosophical culture of respecting authors precisely by criticising them might seem alien to newcomers to it.