Monday 1 September 2014

Quick thoughts on contesting Jaspers and ununderstandability

Aline M.P., who is working on a PhD on delusion, and I had one of those interesting PhD supervisions today which made me regret the lack of time to go very carefully over some key texts. In this case, Jaspers’ General Psychopathology. And thus my summary of our rather swift conversation may reveal some key ignorance on my part but I found it really helpful to talk through the strategic issues even if they refer as much to a logically possible Jaspers rather than the actual one (so what follows is an alloy of Aline’s and my thinking today although blindspots reflect badly only on me, as supervisor).

The irony of recent debate about the definition of delusion is, familiarly, that the standard definition varying a little across versions of the DSM has long been thought inadequate. That is, it isn’t news to argue against it. In fact, the main elements can be found in Jaspers who both puts it forward as a preliminary way to direct attention in the right general direction but also dismisses it with the comment:

To say simply that a delusion is a mistaken idea which is firmly held by the patient and which cannot be corrected gives only a superficial and incorrect answer to the problem. Definition will not dispose of the matter. [Jaspers: 93]

In its place, he emphasises instead ununderstandability as the criterion of primary delusions. If anything is, this is the definition of primary delusion in General Psychopathology. So if we are reading Jaspers critically, this might be a focus for assessment. But it faces a problem. If Jaspers uses ununderstandability to define primary delusions then contesting that status is not denying an empirical, synthetic claim but contesting an analytic claim.

So one possible response Jaspers could offer any critic is this: for any experience which is understandable, he can deny that it is a primary delusion and claim that his opponents are talking about the wrong experiences precisely because delusions are defined to be ununderstandable. (Cf trying to falsify ‘bachelors are unmarried’ by looking for married bachelors would suggest merely that one did not know what a bachelor was. Of course this may not be a useful word / concept) This begins to suggest that the claim is not falsifiable.

This thought raises a question or two. Why does it seem as though Jaspers is saying something interesting and contentious in that claim? And what are philosophers such as Sass doing when he seems to be trying to refute/falsify Jaspers?

Our first thought today: Jaspers starts by using the DSM style criteria and then goes on to say that the real criterion is ununderstandability. Thus it is tempting to hear him to be saying: ‘of the things picked out by the DSM criteria, actually they are ununderstandable’. Now that is substantial, empirical, falsifiable, synthetic etc etc. If so having both of these potential definitions of delusion is, despite appearances, important even if illicit. It gives the illusion that Jaspers is making a bold claim about the world rather than telling us of a terminological decision he has adopted. (Note that his official position is that delusions are those mental states that are ununderstandable and, further, that such states do not fit the DSM criteria.)

That also suggests one way one might interpret Sass and other philosophers who aim to make delusions intelligible etc. They also may be relying on the DSM criteria and saying, of what satisfies them, that they can be understood. If so, they are not strictly disagreeing with Jaspers but suggesting a different meaning for the word ‘delusion’ than his official position allows and then showing how such delusions can be understood.

In fact it seems that Sass does something slightly different. He assumes that everyone will agree that what Schreber experiences really are delusions however delusions should be defined. (In effect, this is an ostensive definition of delusions: the sort of thing Schreber writes about.) He then argues that we can understand them.
In the face of Sass (or, say, a two factor theorist) Jaspers might concede that he does succeed in shedding light on delusions in some way but that he does not provide proper understanding of, say, an empathic form and that that is what he was ruling out.

The problem with this move is that the more concrete he is about empathy, ie the more specific his views about what it is are, the more likely critics (eg Sass) are to reply: “Well who cares about empathic understanding? We have given a more general way of getting understanding.” But the more general Jaspers’ view of understanding (whether or not he uses the word empathy), the less likely he is to be able to make this initial reply to his critics.

A more likely response Jaspers could make to such critics is to argue that they have not, in fact, demonstrated understanding on any plausible view of it. This allows him to agree that they are discussing primary delusions (however they conceptualise them*) but for him to defend his main claim of ununderstandability against them. The main backing for this is that in Sass’ case, we do not understand the nonsensical solipsism after all (it being nonsensical). (And for two factor theorists, we really don’t understand the move from a lack of a sense of familiarity to a claim about robotic replacement even given the idea that delusional people are a bit quick with inferences. Adding these two factors together still provides no understanding of someone holding the delusion.)

(*Typing this now, I’m less happy about it. The question of under what Fregean sense they do think of delusions seems significant/substantial. A descriptive sense milked from the DSM would inherit its flaws, though it would be difficult to think that it is flawed: to think of delusions identified via the DSM criteria that they somehow did not instance the criteria that specified them in the first place. A demonstrative would still need a sortal which, in this case, will introduce difficulties: eg. that paradoxical mental state which does not fit the constitutive ideal of rationality.)