The philosophy of the social aetiology of mental illness

I've been asked to contribute to an initiative to develop training in the area of the social aetiology of mental illness for a Canadian initiative called SAMI. Here is an outline.

The philosophy of the social aetiology of mental illness

A proper understanding of the social aetiology of mental illness requires an understanding of causation; its connection to laws of nature; the contrast between a causal explanation and an understanding based on reasons; and the issues raised by attempting to reconcile meaningful factors within causal models. Additionally, it prompts an assessment of the role of understanding individuals and how this relates to general law-like understanding.

1: Aetiology and problem of understanding individual causes

The practical problems of establishing the aetiology of illness and disease are compared to the principled problem identified by Hume of seeing causal connections in even the best possible circumstances. Hume’s general response is sketched. An initial link is forged to issues of validity in psychiatric taxonomy and the rise of EBM.

Main readings:
Rizzi, D.A. (1994) ‘Causal reasoning and the diagnostic process’ in Theoretical Medicine 15: 315-333
Hume, D. (1975) Enquiries Concerning Human Understanding, (Oxford: Oxford University Press sections II and III pp17-24.

2: The link between causation and laws of nature

Building on the first topic, the relation of causes and laws of nature is set out. This raises the question of distinguishing lawlike generalities from merely accidentally true generalisations. The role of laws in underpinning scientific explanations is also set out.

Main readings:
Mackie, J.L. (1993) ‘Causes and conditions’ in Sosa, E. and Tooley, M. (eds.) Causation, Oxford: Oxford University Press: 33-50
Papineau, D. (1987) ‘Laws and accidents’ in MacDonald, G. and Wright, C. (eds.) Fact Science and Morality, Oxford: Oxford University Press:189-218

Davidson, D. (1995) ‘Laws and cause’ in Dialectica 49: 263-279

3: Reasons vs causes

Whilst within natural science causes are best understood in the context of a system of natural laws which also connect to causal explanation, understanding using reasons fits into a different kind of conceptual structure. The distinction between the ‘space of reasons’ and ‘realm of law’ is explored via the notion of rule governed activity. This suggests that understanding is fundamentally distinct from causal explanation.

Main readings:
Winch, P. (1988) The Idea of a Social Science and its Relation to Philosophy, London: Routledge chapter 3 pp66-94
Bolton, D. and Hill, J. (1996; second edition 2003) Mind Meaning and Mental Disorder, Oxford: Oxford University Press

4: Meaning and social constructionism

The claim that mental illness has a social aetiology has both more and less radical forms. One route to a more radical account is via the claim that mental states and thus mental illnesses are socially constructed. Arguments for and against this claim are discussed. The less radical claim that mental illnesses are socially caused but not socially constituted is examined.

Main readings:
Sabat, S.R. and Harre, R. (1994) ‘The Alzheimer’s disease sufferer as a semiotic subject’ Philosophy Psychiatry and Psychology 1: 145-160
Thornton, T. (2005) ‘Discursive psychology, social constructionism and dementia’ in J. Hughes, S. Louw and S. Sabat (eds) Dementia: Mind, Meaning and the Person Oxford: Oxford University Press: 123-141

5: Fitting meanings into aetiological structures

The distinction between reasons and causes suggests that one can seek either to understand mental illness or to explain it causally via aetiology. But it is plausible to think that psychiatry can and should aim to do both: to fit meaningful factors into aetiological models. This session explores three general approaches to this: via the reduction of meanings to causes, via the idea of intentional causation and via a more subtle local accommodation as exemplified in Brown and Harris’ Camberwell study of the aetiology of depression.

Main readings:
Bolton, D. and Hill, J. (1996; second edition 2003) Mind Meaning and Mental Disorder, Oxford: Oxford University Press
Brown, G. W. and Harris, T. (1978) Social Origins of Depression, London: Tavistock
Thornton, T. (2009) ‘On the interface problem in philosophy and psychiatry’ in Bortolotti, L. and Broome, M. Psychiatry as Cognitive Neuroscience, Oxford: Oxford University Press: 121-136

6: Idiographic versus nomothetic understanding

In addition to the idea that mental illnesses can have social aetiology there is a further idea that person centred care requires a particular kind of understanding of the experiences and particular social context of individuals. The WPA, eg., calls for a psychiatry for the person to include idiographic understanding. But if so, what is idiographic understanding, does it threaten diagnostic validity and how does it relate to narrative understanding?

Main readings:
Windelband, W. (1980) ‘History and natural science’ History and Theory & Psychology 19: 169-85.
Phillips, J. (2005) ‘Idiographic Formulations, Symbols, Narratives, Context and Meaning’ Psychopathology 38: 180-184
Thornton, T. (2008) ‘Should comprehensive diagnosis include idiographic understanding?’ Medicine, Healthcare and Philosophy 11: 293-302

Key written resources

Fulford, K.W.M, Thornton, T. and Graham, G. (2006) The Oxford Textbook of Philosophy and Psychiatry Oxford: Oxford University Press chapters especially Part III
Fulford, K.W.M. (Bill) and Thornton, T. (forthcoming) ‘The role of meanings and values in the history and philosophy of the science of psychiatry’ in Basant Puri, B. and Treasaden, I. 9eds) Psychiatry: an evidence-based text for the MRCPsych, London: Hodder Arnold, Health Sciences
Thornton, T. (2005) ‘Discursive psychology, social constructionism and dementia’ in J. Hughes, S. Louw and S. Sabat (eds) Dementia: Mind, Meaning and the Person Oxford: Oxford University Press: 123-141
Thornton, T. (2007) Essential Philosophy of Psychiatry Oxford: Oxford University Press
Thornton, T. (2008) ‘Should comprehensive diagnosis include idiographic understanding?’ Medicine, Healthcare and Philosophy 11: 293-302
Thornton, T. (2009) ‘On the interface problem in philosophy and psychiatry’ in Bortolotti, L. and Broome, M. Psychiatry as Cognitive Neuroscience, Oxford: Oxford University Press: 121-136