AAPP 24th Annual Meeting

AAPP 24th Annual Meeting
The Biopsychosocial and Other Models for Psychiatry

SATURDAY and SUNDAY MAY 5 and 6, 2012

THE CROWNE PLAZA HOTEL
INDEPENDENCE A
SECOND FLOOR
PHILADELPHIA, PA, USA

Program

Values Based Practice, Social Policy and the Service User identity

This is a first draft of a paper I am writing with my colleague David Morris, as the result of a chance coffee whilst banished from our building during a fire alarm/practice. We are both, in Bill Fulford's phrase 'critical friends' of VBP (very much more for it than against it) and this paper reflects that.


NB a later, better second draft is here.


Introduction

‘Values Based Practice’ (VBP) might be the name of any approach that paid due and serious attention to the role of values alongside facts in good healthcare. But it has also become the name of a particular approach to working with diverse values in healthcare pioneered by the psychiatrist and philosopher KWM (Bill) Fulford. In this paper, we will take it to mean the latter.

Although drawing on a substantial philosophically framework, VBP is, itself in one key respect, theoretically minimalist. That is, aside from some framework values, the violation of which would undermine the very possibility of VBP, the work of managing diverse values is not determined or dictated by antecedent principles. Its ‘principles’ are more pointers or reminders. Nor is it even driven by the goal or telos of a right outcome but is instead guided by the idea of following a good process. The task of managing a legitimate diversity of values is left to a process of discussion by those who have a stake in the outcome, a discussion the shape of which is left deliberately open-ended. Whilst there are some pointers to guide the debate, there are few ground rules.

But whilst it is plausible that the application of VBP to clinical decisions with particular identified patients or health service users, and a particular team of health professionals provided by the contingent circumstances of care, can be theoretically minimalist (though whether it can be as minimalist as it is taken by Fulford to be is open to question [see Thornton 2011]) its application to policy development cannot escape some substantive antecedent commitments.

A key question concerns the identity of service users in the context of policy development. By contrast with the case of clinical decision making, this identity cannot be taken for granted. But ‘not taking it for granted’ means, in this case, that it cannot be settled prior to some judgements about relevant values, judgements thus prior to and outside the application of VBP. At the same time, we will also caution against conceiving of the service user identity in the policy case on the model of that of clinical decision making. At the risk of slipping into jargon: the service user identity should not be thought of essentially, or exclusively. It is an identity relative to context.

Values Based Practice and clinical decision making

Values Based Practice stands in opposition to an implicit or inchoate traditional view of the relation of facts and values in medical care. On this traditional view, medical diagnosis is a matter of getting the facts right independent of any values. Values come into play in guiding – alongside good evidence based medicine – treatment and management. And when they do, they are codified in a set of principles, a proper understanding of which form a kind of moral calculus.

VBP rejects both of these aspects of the traditional view. Values are implicated in diagnosis as well as treatment. And any moral principles to which we might appeal are insufficient to guide good practice. The arguments for the first element need not concern us in any detail here [see Thornton 2007: 62-73; Thornton 2011]. But they have to do with the idea that illness in general is an evaluative notion. Illness is bad for the sufferer and that notion of badness is essentially evaluative. (Thus VBP is committed to the failure of programmes to reduce the notion of illness to value-free biological notions such as proper function and it failure. But, first, there is grave doubt as to whether the pattern of explanation in which functions are deployed really is value-free [See Thornton 2000]. Second, even the foremost contemporary philosopher of psychiatry who defends the use of failure of function to capture the idea of disorder explicitly combines that with the value, harm, to analyse illness and disease [Wakefield 1992, 1999].)

The second step to articulate Values Based Practice is the rejection of both the sufficiency and the fundamental importance of moral principles in guiding medical practice. The first follows from a feature which is present even in Tom Beauchamp and James Childress’s attempt to relate medical ethical reasoning to a set of principles [Beauchamp and Childress 2001].

Principles of Biomedical sets out four general principles to guide medical ethical reasoning: autonomy, beneficence, non maleficence and justice.

As is familiar, these four, which do not derive from any single higher principle, can conflict. Beauchamp and Childress describe two methods for dealing with such conflicts: specification and balancing. Specification is a way of deriving more concrete guidance from the fairly abstract higher level principles. It ‘is a process of reducing the indeterminateness of abstract norms and providing them with action guiding content. For example, without further specification, do no harm is an all-too-bare starting point for thinking through problems, such as assisted suicide and euthanasia. It will not adequately guide action when norms conflict.’ [Beauchamp and Childress 2001: 16]

Balancing and complements specification thus: ‘Specification entails a substantive refinement of the range and scope of norms, whereas balancing consists of deliberation and judgement about the relative weights or strengths of norms. Balancing is especially important for reaching judgements in individual cases.’ [Beauchamp and Childress 2001: 18]

Neither balancing nor specification simply unpacks the content of the principles themselves. Nor, like deductive nomological explanation in the physical sciences, do they combine general principles with particular circumstances in a deductive argument. Both require an extra element of judgement. Thus even according to the Four Principles approach, the four principles are not sufficient for medical ethical judgement.

Values Based Practice goes further than this, however. Although it concedes that there can be sufficient agreement about some values that they can codified to provide the basis for ethical codes and guidelines and other agreed elements for any thinking about healthcare, these remain just a small part of the values that have to be taken account of in guiding medical practice which include individual preferences, desires, wishes, firmly held faith and convictions and so forth.

By stressing this multiplicity, it stresses the standing possibility of disagreements and clashes in thinking about particular circumstances. But if values are ubiquitous and if, agreed framework aside, disagreement is both to be expected and legitimate, how can the process of assessing the competing ‘pulls’ of different values be managed? To repeat, within the framework, guidance by principles is of limited use. There are three key suggestions.

First, rather than aiming to arrive at the right outcome in a conflict, VBP aims instead at there being a good process. That is, it rejects the idea that a particular accommodation of values might be the right result in any particular context in favour of a method. Correctness, if it applies at all, applies to the method followed. Fulford summarises this idea thus: ‘conflicts of values are resolved primarily, not by reference to a rule prescribing a ‘right’ outcome, but by processes designed to support a balance of legitimately different perspectives (the ‘multi-perspective’ principle)’ [Fulford 2004: 206].

Second, ‘communication skills have a substantive rather than (as in quasi-legal ethics) a merely executive role in clinical decision-making (the ‘how it’s done’ principle)’ [ibid: 206]. This again reflects the idea that correctness attaches not to an endpoint but to a process. Thus there is equal stress on methods of raising awareness of values by attention to language use (the ‘values-blindness’ principle) and for improving knowledge of other people’s values (the ‘values-myopia’ principle).

Fulford characterises VBP using ten principles or pointers.

Ten Principles of Values Based Practice

1: All decisions stand on two feet, on values as well as on facts, including decisions about diagnosis (the ‘two feet’ principle)

2: We tend to notice values only when they are diverse or conflicting and hence are likely to be problematic (the ‘squeaky wheel’ principle)

3: Scientific progress, in opening up choices, is increasingly bringing the full diversity of human values into play in all areas of healthcare (the ‘science driven’ principle)

4: VBP’s ‘first call’ for information is the perspective of the patient or patient group concerned in a given decision (the ‘patient-perspective’ principle)

5: In VBP, conflicts of values are resolved primarily, not by reference to a rule prescribing a ‘right’ outcome, but by processes designed to support a balance of legitimately different perspectives (the ‘multi-perspective’ principle)

6: Careful attention to language use in a given context is one of a range of powerful methods for raising awareness of values (the ‘values-blindness’ principle)

7: A rich resource of both empirical and philosophical methods is available for improving our knowledge of other people’s values (the ‘values-myopia’ principle)

8: Ethical Reasoning is employed in VBP primarily to explore differences of values, not, as in quasi-legal bioethics, to determine ‘what is right’ (the ‘space of values’ principle)

9: In VBP, communication skills have a substantive rather than (as in quasi-legal ethics) a merely executive role in clinical decision-making (the ‘how it’s done’ principle)

10: VBP, although involving a partnership with ethicists and lawyers (equivalent to the partnership with scientists and statisticians in EBM), puts decision-making back where it belongs, with users and providers at the clinical coal-face (the ‘who decides’ principle)

Despite these pointers, however, Values Based Practice is theoretically minimalist. That is not to say that it is not based on theoretical considerations. It draws heavily on Fulford’s analysis of the evaluative nature of diagnosis which in turn is based in the ordinary language analysis pioneered in Oxford in the 1950s and 1960s, especially Hare’s early work on the logical properties of value terms, in his Language of Morals [Fulford 1989; Hare 1952]. But that theoretical articulation is used to defend a theoretically-light approach to forming value judgements.

By contrast with what Fulford calls ‘quasi-legal medical ethics’ in which value judgements are derived from a rich body of principles or the equivalent of case law, VBP leaves them to a process of exploration, self- and other-knowledge and discussion. It accepts ‘dissensus’ as a likely outcome. It is a liberal approach to the values in question. Aside from the framework values, all and any values have equal merit prior to the process of local debate.

But that theoretically minimalism is made possible in part by taking one thing for granted. As the fourth pointer says: VBP’s ‘first call’ for information is the perspective of the patient or patient group concerned in a given decision (the ‘patient-perspective’ principle). That principle militates against a slippage of discussion into a paternalist imposition of values on, or against, the patient or service user. But it assumes that the question of who is the patient or service user can be decided independently of the application of VBP to value judgements. This is a reasonable assumption in the case of clinical decision making where the identities of patients, clinicians and other members of a healthcare team are fixed by local contingencies.

In clinical decision making, Values Based Practice can start from the particular patient and his or her clinical team. Thus the question of who is the patient or service user can, to a first approximation, be taken for granted prior to the application of VBP. But that is not true to anything like the same extent in cases to which VBP may be extended and applied: the investigation and evaluation of social policies concerning healthcare.

Values based practice, social policy and service user identity: the underlying logic

In the case of the application of Values Based Practice to a particular patient and their pre-existing clinical team, the question: who is the service user is not, typically, a pressing problem. But what of the case of the development of new health policies?

The problem in a nutshell is this. Any practical proposed health or social care policy would have a number of effects or consequences, both positive and negative. A policy designed to reach members of a community unwilling to report their mental health problems, for example, might have such people as its service users. But if it addressed them by addressing families, then healthy family members might also be count as service users. And if the aim were to improve social inclusion within the community, other members of the community might count as service users. Given that VBP prioritises the ‘patient or patient group concerned in a given decision (the ‘patient-perspective’ principle)’ this raises the question: who should count as the patient or service user in such a case?

This is not to say that such a question is unanswerable. But answering it will involve assessing the competing claims of different potential groups for priority. Since that is an evaluative (as well as a factual) matter it might have been thought that it could be settled by an application of Values Based Practice. But it turns out that VBP presupposes a prior answer to it. In other words, the question of service user identity is an evaluative matter which, whilst vital, cannot be addressed by VBP as it is applied to clinical decision making.

Recognising that there is a difference between the two cases is however helpful. In the clinical case, the question of identifying the service user identity can be taken for granted for practical, contingent reasons. That is not true of the policy case. But it might be assumed that identifying the service users in the latter case can be modelled on the former through a slippage between the idea of identifying service users to the idea of a service user identity. So the relevant service users for a proposed mental health policy might be thought to be the community of service users, those who take to on that as their identity.

There are, however, reasons to be wary of the very idea of a service user identity which we will now outline.

The contingent perils of a service user identity

We will outline four reasons to be cautious of the idea that a community of service users can be picked out through a service user identity.

First, the very idea of a service user identity, based on shared experience could, ironically, limit relationships with other disadvantaged communities whose own complementary claims could be an resource. To privilege the collective voice of common interest over other perspectives and communities may encourage such communities to turn inwards.

Second, it circumscribes the context within which individual capabilities can be understood and appreciated. Behind the case for equity of opportunity is an implicit argument for the recognition of capability. The right to participate is driven by an assertion of personal capability to participate. A categorical approach to defining community may place limits on the way in which its members and their diverse capabilities, both individual and shared, will be expressed and perceived externally, thereby limiting the effect of that aspect of empowerment concerned with the proper recognition of what people can do. This links to the third problem.

Third, in practice, the right to be equally valued irrespective of difference is likely to be realised only in a social context in which the capabilities of people with disability are recognised and the potential for defining people principally in terms of disability are eradicated. The positive perception of disability necessary to actions that support empowerment are associated with the idea that the nature and value of an individual’s activity should be seen as a function of their multiple identity. A service response to the needs of people with disability which incorporates their role as citizens with contributory assets alongside that of service users with needs, is conditional on the notion of multiple identity being understood by public agencies. This understanding may not be best served by retaining, as the basis for service organisation, a model of community characterised by a singular definition of membership especially in a service environment governed by a contemporary concern with community health and civic engagement.

Fourth, the potential for individual recovery, whether defined at the level of the individual or at a population level, is usually calibrated against an assessment of the response of other people. For example, how successful a person with a mental illness might be in holding down a job in an open plan office  is likely to depend on an  assessment made of the anticipated or actual response of office colleagues (‘the work community’), while policy on employment for people with mental health problems is likely to take this into account, deploying study data (or not!) in which examples of such individual experience is aggregated as an evidence base for the existence, and therefore policy relevance, of stigma and discrimination as factors to be considered in service model development.   It is important therefore to give these external social accounts some descriptive weighting in order to advance social recovery prospects and, to the extent that such discourse is conducted within the conceptual framework of ‘the community’ (which is the case for policy and practice in public mental health as well as that for services), it is important to provide for an understanding of community perspectives associated with ‘the other’ that has some equivalence to those associated with that of illness experience.

Service user centrality and theoretical minimalism

As we outlined in the first section, when Values-Based Practice is applied to individual clinical cases, it is theoretically minimalist. With the parties to a clinical decisions identified, VBP imposes a background of shared values – necessary for it to function at all – but then leaves the management of rational and legitimate disagreement about values to a discussion in which highlighting the values involved, including hidden and implicit values and communication skills play a central role. By adopting a form of theoretical minimalism, VBP can avoid having to settle contentious global debates about competing moral theories and approaches. Providing that there is sufficient agreement about framework values, VBP can leave the discussion of competing values to a local context. The particular participants can examine their values relevant for the particular decisions concerned.

Such discussion is not, however, entirely free. A safeguard against paternalism is the ‘patient-perspective’ principle: the ‘first call’ for information is the perspective of the patient. But, as we have argued, the combination of this principle and theoretical minimalism cannot be carried over in to the context of policy development. Identifying the claims of groups to count as service users, to count as having more say than others, cannot be taken for granted. If not, it must itself be subject to a value-laden debate and judgement. If VBP is identified with a minimalism, then this issue cannot be settled by VBP alone. If it is not so identified, then the application of VBP to policy debate will call for a more structured approach to weighing the opinions and values of those who may be affected. The cost of the application is giving up minimalism. Some values will have more values than others.

There is, however, a benefit from this cost. In the previous section, we drew attention to some contingent but typical dangers from approaching the question of the identity of service users in the policy case with the same simple mindedness which works for the clinical case. If one thinks of service users as those picked out by having a service user identity – as a particular community fixed prior to potential policy developments – then this will encourage the isolation and permanence of that community. But if instead, identifying the service user community or communities depends on the policy under debate and its particular consequences, these dangers can be diminished.

To count as a service user – relative to a particular policy – will depend on fitting a role, or characteristic. This follows from the idea that so counting will flow from an argument which will have to be couched in general terms such as why having such and such a role puts one in a position to have an expertise in so and so. Thus a sufferer from a mental illness may also be a tax paying citizen, a family member, a carer, a member of a particular ethnic grouping etc. Thus the individual can properly count as a member of any number of differing communities relevant to a policy initiative and thus merit a number of different voices.

Bibliography

Beauchamp, T.L. and Childress, J.F. (2001) Principles of Biomedical Ethics Oxford: Oxford University Press
Fulford, K.W.M. (1989) Moral Theory and Medical Practice Cambridge: Cambridge University Press
Fulford, K.W.M. (2004) Ten Principles of Values-Based Medicine. in Radden, J. (ed) The Philosophy of Psychiatry: A Companion New York: Oxford University Press, 205-34
Hare, R.M. (1952) The Language of Morals Oxford: Oxford University Press
Thornton, T. (2000) ‘Mental Illness and Reductionism: Can Functions be Naturalized?’ Philosophy, Psychiatry and Psychology 7: 67-76
Thornton, T. (2006) Judgement and the role of the metaphysics of values in medical ethics. Journal of Medical Ethics, 32, 365-370
Thornton, T. (2007) Essential Philosophy of Psychiatry Oxford: Oxford University Press
Thornton, T. (2011) Radical liberal values based practice’ Journal of Evaluation in Clinical Practice 17: 988-91
Wakefield, J.C. (1992) ‘The Concept of Mental Disorder: On the Boundary Between Biological Facts and Social Values’ American Psychologist 47: 373-88
Wakefield, J.C. (1999) Mental disorder as a black box essentialist concept. Journal of Abnormal Psychology 108: 465-472

A temporary entry on concepts, propositions, truth and occasions

In ‘Meaning’s role in truth’, Charles Travis says that whilst the words uttered impose a condition on truth, different occasions impose different standards for satisfying that condition. That way of putting makes it seem that there is always the same condition (fixed by the albeit plastic meaning of the words involved in expressing it) and the occasion of its utterance provides a different standard (though not merely weaker and stronger, of course) for it to count as met.

It would be helpful to shed more light on quite how what is fixed – for example by word meaning – and what varies, according to occasions of utterance, is apportioned in Travis’ picture.

Here is one such indication. In ‘To represent as so’, Travis criticises one element of Frege’s thinking.

For Frege, a concept is a function, namely, one from objects to truth values. (See Frege 1891.) If words ‘Sid grunts’ decompose into an element ‘Sid’, which names an object, and an element ‘grunts’, which names a function from objects to truth-values, then the whole, ‘Sid grunts’, names the value of that function for a certain argument, namely, Sid. Which is to say that it names a truth-value: true if Sid grunts, false if he does not. Which is to say that for parts jointly to play these roles is, ipso facto, for them to decide a unique and determinate truth condition for their whole. Mutatis mutandis for propositions, of which words ‘Sid grunts’ could be but one instance, or expression. [Travis 2011: 172]

According to this view, if an element in a proposition (which has pride of place in both Frege’s and Wittgenstein’s thinking) has the role of naming an object or naming a concept its contribution to the truth condition and thus truth value of the whole is fixed by that alone.

Inspired by the later Wittgenstein’s deployment of language games, Travis considers two different contexts for the sentence ‘The room is dark’. In one, it is used to say that books cannot be found by vision alone. In the other, it indicates that undeveloped film can be removed from a canister.

One might correctly say of either game that in it ‘is dark’ names (speaks of) being dark. But the role it plays in naming this differs from the one game to the other. In the one game, but not the other, it contributes to a condition on being as said which is not satisfied if, where whether to remove film turns on whether the room is dark, removing film is not the thing to do. So if a move consists (on an analysis) of parts, for each of which there is a such-and-such it names, those facts about the move are compatible with any of indefinitely many mutually exclusive conditions on correctness (answers to the question when things would be as thus said). [ibid: 173]

So if we think – with Frege – of words naming objects and concepts, still a suitable combination of objects and concepts does not fix the condition under which the result is true, contra the earlier summary of Frege.

That words name such-and-such determines no unique contribution which is that which such words make to conditions on the correctness of the whole they thus are part of. Such is just part of what naming is. It holds equally for naming in the context of a move in a language game, and naming in the context of a proposition. The fact of my speaking of being dark is compatible with my saying any of many things in, and by, doing so. There are many different things, each of which being dark may, sometimes correctly, be taken to be (or come to). Being dark admits of understandings. [ibid: 173]

So the fact that words name such and such is fixed across occasions but its role in the truth of the whole varies between occasions of utterance. Returning to the earlier truism, Travis suggests that the following is the correct thing to say:

It is on an application of a concept to an object, on an occasion, that one says the object to be thus and so. The rest of the truism then holds. The concept as such admits of many applications, each excluding others. So it alone cannot assign an object, in being as it is, a truth value. [ibid: 173]

Sticking with the case of the room being dark, it seems that the same concept is named by ‘dark’ in the different language games, but it has a different application. The concept remains the same across occasions, but its application not, and it is the application which matters to truth. The same concept, I think, admits of ‘understandings’, which correspond to the fine grained applications. I think that the same applies to another Travis phrase for part of the conceptual: ‘a way for things to be’.

What of propositions? These could be common between different occasions but with different applications. Or they could be fine grained: distinct between occasions. But given the connection between propositions and truth, and given the connection between occasions of utterance and the truth of sentences, propositions look to be fine grained (unlike concepts). (Cf also ‘A proposition makes a demand on the world: to decide, in being as it is, the proposition’s fate—true or false. The proposition fixes a way for the world to decide this—if the proposition is that the setting sun is red, then what about the world would make this so or not.’ [ibid: 218]. This, I think, is evidence for my interpretation.)

There’s an added complication in that Travis is using Wittgenstein to correct Frege and so it’s hard to know how much is invested in preserving the idea of propositions rather than exploring word use in language games. But in ‘The proposition’s progress’ there is both a clear suggestion that they still find a place in Travis’ own approach and on the above question:

Propositions are one device for carving up exposure to risk. Language games are another. Such games are used in the Investigations to make a particular point, as above. This is not to banish the notion proposition. In suitable circumstances I may say to you, ‘Pia said that there is wine on the rug’, where this admits the response, ‘And is there?’. We may then go on to discuss ‘the proposition that there is wine on the rug’. What proposition is this? When would it be true? I mentioned it in words ‘there is wine on the rug’. Things would be as they are according to that proposition when they would be as those words speak of things being. When that would be is fixed by the operation of parochial equipment on my words in just the way described, above, for Pia’s. The above model of representing finds just this application here. Such a proposition, one might say, is what it is to us. Nor does it thereby speak of a way for things to be which admits of no divergent understandings. (Cf. §§429-465.) [Travis 2011: 215]

The one thing which is confusing here is the last line. It almost sounds as though the proposition admits of divergent understandings. But my hunch is that different propositions are the results of divergent understandings of utterances.

Travis, C. (2011) ‘The proposition’s progress’ in Objectivity and the Parochial, Oxford: Oxford University Press pp 193-228

Travis, C. (2011) ‘To represent as so’ in Objectivity and the Parochial, Oxford: Oxford University Press pp 165-192

Innocence in Travis’ ‘Frege’s target’

I hope that setting out my own stumbling reading of Charles Travis motivates others to do rather better. ‘Frege’s target’ concerns knowledge of grammar a la Chomsky and McDowell’s account of knowledge which requires having a particular kind of mind (such as knowledge of other’s meanings and of moral value or the good life). Both general issues are approached via a criticism of empiricism which would make such knowledge impossible (and thus instead has to force it into a reductionist mould or deny that the world contains as many facts as we might have supposed).

As anti-empiricists, Chomsky and McDowell differ, however, in that whilst both think that knowledge (more than which empiricists would allow) requires having a particular kind of mind or subjectivity, the subject matter for Chomsky can be allowed to depend on, or itself be shaped by, that subjectivity. McDowell cannot allow that and this presents a prima facie problem. How can it be that the truths a thinker thinks might depend on features of their subjectivity without collapsing into a crass subjectivism? The answer, you won’t be surprised to hear, is a form of occasionalism.

In passing the points that characterise empiricism here are these:

[F]irst of all, a position arrived at a priori. It’s guiding notion, put one way, is that we are universal thinkers: we enjoy no cognitive capacities, so see nothing of the world, that would not be shared by any thinker with our sensory sensitivity to the stimuli that impinge on us (such things as light, sound, pressure).

Second, for a given domain, the empiricist will claim to identify those procedures, or abilities, which are the knowledge-yielding ones with respect to that domain. What these are is, from the empiricist perspective, something to be arrived at a priori. They will be just those capacities enjoyed by any thinker at all with relevant sensory sensitivities.

Third, the empiricist will hold that we can know a fact in the relevant domain only where that fact is provable, or ascertainable (with sufficient certainty) from privileged facts by application of the specified knowledge-yielding procedures.

Fourth, an empiricist may claim that there are facts in the relevant domain only insofar as these are derivable from privileged facts according to the principles defining the correct operation of those knowledge-yielding procedures. Typically, such an empiricist will hold that the facts in the chosen domain are far fewer, and less interesting, than we would have supposed. [Travis 314-7]

This is initially a surprising way of describing empiricism insofar as Epistemology and Metaphysics 101 goes. But the centrality of experience of the traditional Ep&Met view has to be fleshed out with some substance and Travis’ account dovetails with Quine whose views of knowledge of language is one of the two key foci of the paper and is a helpful foil to McDowell’s position

So back with the question raised above: How can it be that the truths a thinker thinks might depend on features of their subjectivity without collapsing into a crass subjectivism? I’ll drop some numbers into the quote of how the problem is set up.

Trivially, a statement is true just when things are the way they are according to it. That suggests, innocently enough, that a statement’s truth depends on precisely two factors [1]: first, how things are according to it; and, second, how things are. Innocence ends if one supposes that one can specify how things are according to a statement—which way it speaks of things as being—in such a way that the truth of any statement which speaks of things as that way can depend only on whether that is, in fact, a way things are. [2] Let P be a way a statement might thus represent things. Then, accepting that idea, [3] we may still innocently allow that the way given thinkers think decides whether some one of their statements stated that P, or, say, that Q, where that is another such way for a statement to represent things.

[4] But one cannot, accepting this idea, allow that, where a statement spoke of things as being P, whether it thus stated truth depends on how a particular (sort of) thinker thinks. [5] For what thinkers could thus decide, in thinking as they do could only be, within this framework, how things were: whether that which is so according to any statement which states P is so. That would be mind-dependence of the worst sort. Yet, with the end of innocence in place, anti-empiricism is under pressure to say just that. [6] For, given the role it assigns to sensibilities, it seems, where thinkers think in terms of, say, things being chairs or not, still, for all that, whether things are as they say (on some occasion) in saying such-and-such to be a chair depends in further ways on how they are designed, or equipped, to think. [ibid: 377-8]

So 1 is innocent: a statement’s truth depends on the two factors one would expect. 2 introduces an idea. If there is some slippage between a statement and how it might represent things, so if there is a way of thinking of the statement without appeal to the occasion of its use, we might label one way things might be P. And it remains innocent that what makes P what a statement states rather than Q a matter for features of the speaker.

So the problem comes with 4. ‘But one cannot... allow that, where a statement spoke of things as being P, whether it thus stated truth depends on how a particular (sort of) thinker thinks.’

But why would we? We’ve already allowed those features of subjectivity to fix whether it was P or Q stated in a given statement. Thereafter, why are we not back with the innocence of 1? The answer is 6: ‘it seems, where thinkers think in terms of, say, things being chairs or not, still, for all that, whether things are as they say (on some occasion) in saying such-and-such to be a chair depends in further ways on how they are designed, or equipped, to think.’

At this point I can’t help thinking that if we’ve bought into the significance of occasionalism, its need at this point might seem obvious. But I’m not there yet. A little earlier we have this helpful vignette:

Sid buys a DIY chair kit. On bringing it home he discovers that it is much more difficult to assemble than he had imagined. It remains a neatly stacked pile of chair parts in his spare room. One day, someone, pointing at the pile, asks, ‘What’s that?’ ‘It’s a chair’, Sid replies, ‘I just haven’t got around to assembling it yet.’ On a later occasion, Sid and Pia, with guests, find themselves a chair short for dinner. ‘There’s a chair in the spare room’, Sid says helpfully. But there is still only the pile. Recognisably, Sid spoke truly the first time, falsely the second. It just takes a different way of thinking of being a chair to see the truth of that first thing from the way it takes to see the falsehood of the second. Such contrasting ways of thinking are a common everyday part of our way of dealing with the world. [ibid: 336]

Given our understanding of the requirements of a chair in a hurry at a dinner party, the chair kit is not a chair. It is not true to say that there is a chair, on that understanding, in the spare room. If this is described sufficiently to explain – in yet another context – so that Sid’s comment, and its falsity, is clear to an audience, could that articulation of the content of the utterance not be called say P by contrast with the Q of the first understanding (where chair as kit is fine)? With that in place, why can’t we say 3 again? I’m not getting the problem. I would be much less puzzled if the very idea of labelling understandings as P and Q were supposed to be the end of innocence (though, in a context, occasionalism should not threaten mere labelling). But the key link seems dark. I will press on with the paper on psychologism and see whether it helps.

Travis, C. (2002) ‘Frege’s target’ Royal Institute of Philosophy Supplement 51: 305-343

An aspect of Travis’ ‘Meaning’s role in truth’

Travis summarises the main claim of ‘Meaning’s role in truth’ as follows:

What words mean imposes a condition on their saying, on a speaking, what is so. Different occasions impose different standards for satisfying that condition. Something about what truth is makes occasions matter to such standards. Deflationism cannot recognize such elements in truth. [Travis 1996: 461]

If I follow, the picture is something like this. Word meaning exerts a general constraint on what one can say in using them. So, for example, because of its meaning, the word ‘round’ means round and utterances made using it will speak of being round.

The words “is round”, in meaning what they do, speak of being round. In fact, I suggest, for them to speak of that is just for them to mean what they do. For English words to speak of being round comes to just this. If you use them as meaning what they do, you will thereby speak of being round. At least, on any occasion of your so speaking, that is something you would then be doing. So if you want to speak of being round, e.g., so as to call something round, or describe it as round, a way of achieving your aim in speaking normal English is to speak the words “is round” (in a suitable construction). [ibid: 455]

But that is only part of the story because of occasionalism. The constraint that meaning imposes does not itself determine the truth condition of an utterance in such a way as to connect to a bit of the world. (I wonder whether the constraint meaning imposes would be enough to state correct instances of the T-schema. But if so, such instances would still leave open how or when the conditions described on the right hand side were realised.)

Consider the sentence “The ball is round”, and two cases of its use. Case A: What shape do squash balls assume on rebound? Pia hits a decent stroke; Jones watches. “The ball is round”, she says at the crucial moment. Wrong. It has deformed into an ovoid. Jones did not say the ball to be as it was, so spoke falsely. Case B: Fiona has never seen squash played. From her present vantage point the ball seems a constant blur. “What shape is that ball?”, she asks. “The ball is round”, Alf replies; truly, since that it is the sort of ball a squash ball (and this one) is. It is not, e.g., like a very small rugby ball. [ibid: 454]

So whether the sentence is true of a particular ball at a particular time depends on something in addition to the meaning of the words. It depends on the occasion of its use. In the summary quote with which I began, Travis puts this point by saying that whilst the words uttered impose a condition on truth, different occasions impose different standards for satisfying that condition. That way of putting makes it seem that there is always the same condition (that fixed by essentially plastic meaning) and the occasion provides a different standard (though not merely weaker and stronger, of course) for it to count as met. This may be deliberate for a reason I’ll mention shortly.

Given occasionalism, it is not surprising that to know what the conditions are that are needed for an utterance to be true depend on the occasion of the utterance (recall the two squash ball cases). But Travis thinks that this undermines deflationism about truth and it is not immediately obvious why this might be so. The heart of deflationism is that instances of the T schema (or an equivalent with propositions) captures all there is to truth aside from issues of compendious endorsement and such like. So given occasionalism, one might think that the plasticity of meaning stops such instances being very helpful because the condition stated on the right hand side, is fixed only on an occasion-relative understanding. But then, one might modify the deployment of the T-schema to say that the sentence named on the left hand side, on a particular occasion-relative understanding, is true on the condition set out by a sentence used on the right hand side on the same occasion-relative understanding. That might still serve the purposes of deflationism. So we’d need more of an argument. But Travis offers more. He heads off this thought (connecting to a proposition-based deflationism) which perhaps is the reason for the way he approaches what is fixed and what varied mentioned above.

One might further think: which understanding words bear depends on the circumstances of their speaking; when things would be as said to be on a given understanding does not. Understandings, so conceived, extract content from circumstances. Circumstances play no further role in determining conditions for truth. Deflationism, and its use of “proposition”, depend on exactly that idea... [ibid: 460]

So the idea Travis rejects takes the work of occasions to be done once an understanding of a utterance has fixed the claim it makes about the world. Once that is fixed, nothing more is needed to fix how the world must be for it to be true, or not be for it to be false. That might support deflationism. But it is not Travis’ picture:

But here is another picture. Understanding requires sensitivity. Understanding words consists, in part, in sensitivity to how they fit with the circumstances of their speaking. Part of that is sensitivity to how they need to fit in order to be true. So adequate sensitivity requires grasping what truth is, and how that notion applies in particular cases. [ibid: 460]

This is where my understanding of the paper lapses. My hunch is that for occasionalism to undermine deflationism the following would have to be the case: fixing the understanding that words have on an occasion, and thus whether they are true of some circumstance, would itself have to presuppose truth, or some feature of truth. That seems to fit with Travis’ words here: ‘Part of that is sensitivity [underpinning an understanding] to how they need to fit in order to be true’. But I am not sure that I follow the crucial thought – if I am at all on the right track – that this sensitivity presupposes truth. The action must take place in section V.

But, there, the central example is of understanding the utterance that ‘the oven is hot’ in the context of pizza making. In that context it is reasonable to think that if the oven is merely 140C, then the utterance is false. The context enables a reasonable perception of what is being said when that phrase is used. But why does this presuppose a substantial notion of truth? He says:

These perceptions of occasions are perceptions of what it would be, on them, for a given description to describe truly, or for words which give it to state truth; to provide information which is correct. Their structure thus reveals some ingredients in truth, or what we are prepared to recognize about it. Part of the idea of truth is that a description (of something), to be true, must satisfy a general condition different in kind from conditions to the effect that what is described as thus must be  as thus described: it must serve all the purposes that must be served (for truth) on that occasion, by having all the uses it ought in serving them. Part of this idea is that, for a description, and an occasion (on which there are facts as to what that description would describe truly), there are definite purposes truth demands be served, and uses which truth demands the description have in serving them. [ibid: 462-3]

If I follow, the idea seems to be that the occasion-relative understanding must presuppose some notion of the description being used truly in that context (given one’s knowledge of the requirements of pizza cooking). But I am not sure that this changes anything from the general worry that one cannot combine truth conditional semantics with a deflationary approach to truth. There are two familiar approaches to that: deploy a non-truth conditional approach to meaning (like Horwich) or simply deny that either project is reductionst (like McDowell). Neither is simple, but I am not clear why occasionalism changes this.

Travis, C. (1996) ‘Meaning’s role in truth’ Mind 105: 451-66

See this entry on ‘A sense of occasion’, this on ‘Reason’s reach’, this on ‘The twilight of empiricism’, and this on the discussion of rule following in Thought’s Footing.

The Inaugural Edgington Lectures - John McDowell on the Epistemology of Perception

THE EDGINGTON LECTURES

Professor John McDowell on the Epistemology of Perception

On March 2nd–3rd 2012, John McDowell will give two public lectures at Birkbeck College (London). The lectures will be given in the Birkbeck Main Building Room B33, Malet St., London, WC1E 7HX.

To register, email: edgingtonlectures@gmail.com

Friday 2nd March 18:15–20:00 PERCEPTION : OBJECTS AND CONTENTS

Saturday 3rd March 16:00–18:00 HOW PERCEPTION YIELDS KNOWLEDGE

The Saturday lecture will be followed by a reception in the Birkbeck Council Room, Main Building.

My rough notes on the lectures are here.