Monday 27 October 2014

Robert Audi against doxasticism

I caught a talk by Robert Audi at the end of last week (the sort of thing that just seems to happen in Durham). Since I am giving a talk on a related subject a little later in the term I will try to summarise very briefly the motivations for some of what philosophers think about in this area in pretty basic terms (not that my own understanding rises much above the basic).

First, though, his abstract.

Doxasticism: Belief and the Information - Responsiveness of Mind
Our beliefs are a map of our world. They shape our hopes, direct our desires and intentions, and structure our values. They are as multifarious as their propositional contents, but their objects are not limited to propositions. They may be directly about the world of our experience—thus causally connected with external objects—or, directly or indirectly, may concern elements internal to the mind. Beliefs also differ psychologically: in strength, depth, influence on behavior, and accessibility to consciousness. They differ normatively in how well-grounded they are in rationality and in justifiedness. Philosophers have written widely and informatively about belief, but there remains an aspect of the topic that needs further analysis. It concerns the conditions under which an information-bearing state—say a perception or the recalling of some past event—yields belief. This paper opens with a distinction between belief and a psychological condition easily conflated with belief, illustrates the tendency of philosophers to overlook this distinction, and offers a positive conception of the mind’s information-responsiveness that does not require as much belief-formation—doxastic uptake, if you like—as has been commonly supposed to be produced by perception and other experiences. This conception is clarified by a partial sketch of the natural economy of mind. The paper then considers whether the economical view proposed requires abandoning the venerable belief-desire conception of intentional action, and, in the concluding section, suggests some ways in which intellectual responsibility is both clarified and extended by the overall work of the paper.

I am sitting in a Wetherspoons pub in Durham which took a little finding. I had to look. So wandering around with my eyes open was an active project. I did that. But what did I gain as a result so as to know where the pub is? Well, on one approach, I gained a series of visual (and other) experiences and they told me where the pub is. (Readers may or may not find that phrase fishy.) But, surely, the thought goes, they can only do that if they have some sort of ‘tellable’ content, some sort of representation of how the world is nearby. Hence, experiences are representational states, representing how the world is. What sort of state is a representational state? Or, what is such a state like? Well one candidate is belief. And hence the idea that seeing is believing: one of Audi’s targets.

But that is to go a little quick. Another intuitive way of thinking about experience is that it is of how the world seems. We experience the appearance of things. That is not yet to say the terrible thing that Descartes seems to want us to say: we experience only the appearance and not the reality of things. (That way sceptical madness lies. It may instead be, however, that in the appearance, we take in how things are. Appearances need not be misleading.) But it is enough to suggest that seeing isn’t necessarily believing. And hence the middle period McDowell suggests that experiences are invitations to believe. Still, on McDowell’s then picture, the invitations are themselves representational states. They just don’t have the force of beliefs. But if endorsed, the resultant belief just has the very same content as the experience, the invitation to believe. (A further question: what sort of thing are beliefs? What are they like? Well as Sellars suggests in the Myth of Jones, we might think of them as akin to explicit linguistic judgements. Hence experiences as (invitations to form) beliefs as linguistic judgements.)

If I heard him correctly, Audi thinks something similar to that. Criticising overly intellectual philosophy of both action (requiring, eg., a concept of intention of any agent acting on an intention, including small children with no abstract concepts) and of linguistic meaning (any communicating speaker has to have nested communicative intentions, a la Grice), he argued that there was much less belief around than some philosophers assumed. In fact, in many circumstances, a disposition to believe is all that is available and all we need. As a concession, he suggested we might call a disposition to believe a ‘virtual belief’.

There is a different direction we might take if the idea of experiences telling us anything seems fishy (following Austin and Travis). It is to load all the belief-like content into a response made by a subject to their experiences and deny that the experiences themselves are representational states. They are barely states at all. Audi might have believed that but, when I asked him, did not seem to and suggested that the visual ‘percept’ carried a kind of content, just not a belief-like one. Sub-belief-like content could then be anchored in or carried by the experience (well this is how I understood him).

That left me surprised by one of his other key belief-reducing moves. The intention-in-action of entering a shop to buy a paper, or of playing a complex piece of music, could be carried, he suggested, by a ‘script’. These were not structures of beliefs but involved a kind of responsiveness to the situation. In the music case, this eliminated the worry that one somehow has to anticipate every note one will later play.

Now it seems to me that a subject still needs to ‘entertain’ or conceive of playing a piece of music in some way if their playing is not extemporising though I agree it seems wrong to think that the whole piece of music comes before their mind in some sort of explicit belief-structured anticipation. But Audi suggested that this conception might be carried by an indexical ‘this piece of music coming…’.

Such a response seems more plausible in the playing than before (though even in the playing, the later playing is still to come but may be interrupted). How, in the latter case, can they point to the as yet non-existent piece? (The obvious resource unavailable to Audi is an object-independent descriptive thought with no indexical component. That seems belief laden, however.) But I wonder whether what seems to me to be merely a superficial plausibility stems from a difference between the pragmatics of conversation and the metaphysics of thought. The pianist might say ‘the next piece of music...’ and play it. Or she might say that and then, distracted, accidentally play the wrong piece. The hearer is in no position to distinguish the cases but the pianist is. In the latter case she did not play the piece she was thinking of. Thought and utterance-as-heard come apart.

I was surprised that beliefs were eliminated in the perception case in favour of something representational and present (the precepts of visual experience) but by something not yet present in the case of intentional action. It did not seem symmetric.

(Noone of the importance as Robert Audi needs a reference from me. But I was struck by the way in which, in a spirit of Let’s do the whole thing right here in the barn! he volunteered to return a couple of hours later to talk to any graduate students with further interest in this or any other topic. Above and beyond!)

'Autonomy and the End of Life' one-day conference

"A one-day conference exploring the philosophical and ethical implications of end of life decisions.
Thursday 23rd April 2015
Venue: University of Essex, Southend Campus

The conference is free to attend, but seating is limited, so advance registration is required. To register please go to:

Developing as a Compassionate Practitioner
This new CPD course has been developed by colleagues in the School of Health and Human Sciences.

Following the publication of the Francis Report (Mid Staffordshire NHS Foundation Trust 2010) concern about the quality of care in the NHS has become the subject of significant media and professional attention. However the reality of health and social care practice for practitioners is often determined by the need to produce specific outcomes and demonstrate recovery rates. This can lead to the depersonalisation of clients as staff endeavour to complete tasks and paper work, losing sight of the person they are working with. Finding ways to develop the ability of health care professionals to deliver compassionate care despite the challenges of their working environment is therefore essential.

By combining an introduction to mindfulness and self-compassion with direct application to health and social care practice the course aims to develop your capacity as a professional to deliver compassionate care. By making you more aware of the present moment experience and improving your ability to identify and deal more compassionately with your own emotional needs you will become more confident in practice and more emotionally resilient to the challenges of your work. Becoming more mindful and compassionate towards yourself will mean you can form better professional relationships and be able to incorporate the needs of your patients in their care giving much more effectively.  

The course will take place over three Saturdays in the Spring term. It is part of the HHS CPD programme, so is an assessed module. However, if you can take part in the course as a non-assessed participant if you are interested in the topic, but don’t require the examination result.

Details of the programme, fees and how to apply are on the HHS website:

Best wishes,

Becky Parsons
Project Officer

The Essex Autonomy Project"

Saturday 25 October 2014

My brother's eulogy for my father: Grahame Thornton

It may seem odd to put my brother, Simon’s, funeral oration for my father on my, albeit merely approximately, philosophical blog. But there are two reasons. First, I simply want it by me now*. But second, and more of a general rationale, this: The negotiation of our experience of the death of those we love through reflection on them seems to me to be one of the highest expressions of our broader rationality. It is one of the trickiest things we are called on to think and feel our way through in the space of reasons.

My brother's eulogy for my father: Grahame Thornton

“I would like to say a few words about my father Grahame Thornton from a personal point of view. I have picked out three things that seem important to me because they show something of the kind of man he was.


Firstly, his sense of humour.

In the last few days, many people have been kind enough to offer words of appreciation about Grahame, and most of those have mentioned his humour: saying that he was always joking, a great tease, someone with "a puckish sense of fun", or "a delightful and funny man, always with a tale to tell." And this is something I will always remember about him.

The strange thing is that despite the importance of humour in his life, dad was not particularly skilled at telling jokes. One of his favourites was the rather politically incorrect joke in which a man with no arms and no legs is sitting at a bus-stop, and when the bus arrives, the driver opens the door and calls to the man: "Hello Bill, how are you getting on?".

Although Dad loved this joke, he could never quite get it right. In one version of the punch-line, he had the bus driver call out to the man the friendly, but utterly unfunny remark: "Hello Bill, how are you doing?".

Determined not to make the same mistake again, and to include something about "getting on", dad prepared carefully for the next telling of the joke. Unfortunately this time he made the opposite mistake, turning the driver's words into: "Hello Bill, how are you going to get on?"

There were other joked he loved and told frequently, but which nobody else found funny. But for obvious reasons there seems little point repeating these now.

Instead, his real sense of fun showed itself in the countless practical jokes and small intellectual challenges he practised on those around him.

When Tim and I were boys, Dad entertained us and some friends one Halloween by filling the house with ghosts which he made from sheets draped over pieces of furniture, step-ladders and so on. We walked nervously through the dimly-lit house, unmasking one after another of dad's ghosts, all the time wondering where exactly he was, until we came to the attic stairs; at the top there was another sheeted white figure but this time, we could see the tip of dad's shoe poking out from the bottom of the sheet. We crept up the stairs; the figure remained motionless. One of us, bravely, took hold of the shoe, and to our horror it came away in his hand. At this point, with a terrifying roar, dad burst out of the cupboard at the foot of the stairs scaring us boys out of our wits.

But his pranks did not always take such dramatic forms: on one holiday in Wales, Mum, Tim and I took a trip on the narrow-gauge Tal-y-llyn steam railway, and we arranged that dad would drive to the other end of the line to collect us. The train went slowly through the many small stations, more slowly in fact than a car. So it was that Tim and I noticed, and before long most of the other passengers on the train had also noticed, the strange, bearded man sitting on every station platform when the train arrived, apparently engrossed in his copy of the Guardian.

No Christmas or birthday present from Dad came without a tag written like a crossword clue, with some cryptic hint about the nature of the gift inside. The presents themselves were often elaborately wrapped to conceal their true identity until the last minute. When I was 16, my parents gave me a watch for Christmas. A small item in itself, it came in a large, heavy parcel, with a thick legal textbook included to give is a misleading weight.

Sometimes dad's humour took a more literary form. Once, for a colleague of his who was in pursuit of a woman who had rejected his advances, dad wrote a pastiche, modern version of Andrew Marvell's poem "To His Coy Mistress". I never saw this work, but I have read enough of dad's doggerel verse to be sure that it would have been richly witty and that he would have put far more effort into it than the situation really deserved.

This kind of thing all seemed quite natural to us as we grew up, but looking back, I realise how much enjoyment, how much fun he gave to Tim and me and our friends and to others who knew him, and how much delight he took in doing so.

[Intellectual curiosity]

The second thing I want to illustrate about dad is what I think of as his intellectual curiosity. As several of his former colleagues have testified, Grahame certainly had a very deep knowledge of some subjects, particularly in the area of property law. But he also had at least a superficial knowledge of an astonishingly wide range of topics.

Dad was always interested to learn more: he read widely, he liked to meet new people, he enjoyed "working a room", he wanted to know all about our jobs, and the organizations we work for, he even attempted to read Tim's philosophical works (which are beyond me), and sometimes he liked to experiment. Nowhere was this more obvious than in the kitchen.

In the late 1970s, when the building company he had co-founded in Cleckheaton was not doing particularly well, dad found himself with more time on his hands, and he used this to help around at home, and to develop his own, highly experimental brand of cookery.

For example, observing that rhubarb is highly acidic, he wondered whether it could be improved by being mixed with an alkaline substance, so he combined it with precipitated chalk and served it stewed with custard. To his surprise he discovered that the acidity is partly what makes rhubarb interesting; Grahame's "neutralised" rhubarb was, I regret to say, barely edible and largely indistinguishable from slime.

There were other memorable culinary failures.

I will not forget "liver elephants", a kind of dumpling which he made one Sunday lunchtime from minced liver and breadcrumbs, whose unappealing grey colour and texture resembled chunks of elephant skin. These were not popular with the rest of the family. Needless to say, he only made them once, but liver elephants featured in our lives again when Tim as a teenager had some friends round for the evening, and Grahame, with characteristic playfulness, decided to set up a pretend Italian restaurant to feed the lads, whose painstakingly translated menu featured "elefanti del fegato". Fortunately nobody ordered them.

There were some notable successes: I was a particular fan of Grahame's range of economical, calorific, spiced puddings, of which Mij once recalled: "They were all just variations on bread".

But his piece de resistance, namely his recipe for curried fish a la martini, has, alas, perished along with him.

It is worth noting that these culinary experiments continued until late in his life. When Mij was in hospital earlier this year, we visited her one evening and left Grahame making soup with his grand-daughter Kirstin. On the way home, I sent Kirstin a text message to ask how dad was doing and how the soup was coming on. She replied: "Okay, he seems to be adding some things at random." I knew then that he was fine.

[At the End]

Earlier I mentioned the poet Andrew Marvell. One of the poems which I know dad liked was Marvell's "Horation Ode upon Cromwell's Return from Ireland", in which the poet describes the execution of King Charles I, and comments admiringly on the composed way that the king went to his death:

He nothing common did, or mean,
Upon the memorable Scene:
But with his keener Eye
The Axes edge did try.
Nor call'd the Gods with vulgar spight,
To vindicate his helpless Right,
But bow'd his comely Head
Down, as upon a Bed.

If I have been light-hearted, perhaps even frivolous, so far in describing my father's life, it is partly in order to celebrate it, which I think it deserves, and partly to prepare myself to describe the manner of his leaving it.

Because this is the third thing I want to talk about.

In the last few months Grahame's health declined and the practicalities of life without Mij became increasingly difficult for him; still he remained stubbornly independent, continuing to live at home in Park Mount Avenue, despite plenty of advice to the contrary. Though deeply saddened by the death of Mij, he did not give way to self-pity, but got on with life as best he could, even dreaming up some ambitious new schemes, such as his rather alarming plan to take up jam-making.

Several people who visited Grahame in hospital in his last week commented that he was still joking and still a gentleman, eating like a horse and endearing himself to the hospital staff.

When Lesley, Catriona and I saw him on the Saturday he was sharp and perfectly composed; he asked about the family, still as interested as ever to know about other people. How was Catriona enjoying her new school? Delighting in her description of a drama audition. How was Kirstin's football team doing? Commiserating about their recent defeat. He passed on news about other friends who had visited him. It was a cheerful visit; there was laughter, perhaps rather too loud for a hospital ward, and we left him in good spirits.

The next day he was in a more serious mood; he took care to explain to me who he wanted some of Mij's possessions to be given to; he requested the music to be played at his funeral, and he said some words about his career of such modesty that I will not repeat them. Then, after asking for help to perform a final act of kindness for a friend, he lay down, and a few minutes later, with so little fuss that I did not at first realise it was happening, he died.

Since then the words of Marvell have come back to me often, because they seem so fitting: He nothing common did, or mean/Upon that memorable Scene.

I think this last scene will stay in my memory for a long time, because it showed me something I had rarely seen before in my father: a calm, dignified acceptance of his fate.

Those of us who survive Grahame have much to be thankful for; the ridiculous jokes, the memories of happy times together, the love which he obviously felt for us.

His loss is, as we knew it would be, a heavy blow. But I think the blow is softened by the way it fell. He did not suffer physical pain or, I believe, mental anguish, and at the end he was prepared. If such a thing is possible, Grahame died a good death, and I think from this we can take some comfort.”

(*Having written it, the familiarity of this phrase or thought bugged me. I now realise that it is a channel of this: ‘You can take all those, but leave me Thoreau till I go. I need him by me now.’)

Monday 20 October 2014

Abstract on transcultural psychiatry

For personal reasons, my mind is fogged at the moment and whole draft papers, approaching completion, seem to be stuttering towards their ends. And hence I think I need to write a series of fresh abstracts to help me tighten and commit to them. So here is the first for a chapter on transcultural psychiatry.

DSM-5 introduces an emphasis on non-Western cultural idioms of mental distress but without making explicit the relation between these and the psychiatric scientific aspirations, such as for their reliability and validity, of the rest of the taxonomy. This paper outlines three possible views of the nature of transcultural psychiatric taxonomic concepts which would render them different from but not incompatible with the rest of the taxonomy. But I argue in the second section that establishing the correctness of any one is none too easy. Two influential approaches to the nature of the concept of disorder – Wakefield’s harmful dysfunction analysis and Fulford’s failure of ordinary doing – can be pressed, with merely minor tweaking, to support any of the a priori models of transcultural concepts. In the final section I examine one such idiom: khyal attacks or khyal cap or wind attacks, a syndrome found among Cambodians. I argue that this does not fit any of the ways of ‘domesticating’ variation from standard DSM-5 categories and that this suggests that the very idea of transcultural psychiatric diagnostic concepts fits uneasily with the rest of DSM-5.

Thursday 16 October 2014

Causality, Teleology and Explanation in Social Sciences

I came across a seminar given by Prof Ricardo Crespo (IAE Universidad Austral) in the IAS building last night organised by the Centre for Humanities Engaging Science and Society (CHESS) on Causality, Teleology and Explanation in Social Sciences.

The abstract ran:

This paper argues that four analytical levels may be found in social sciences, including economics –namely, a) a statistical descriptive level, b) a causal explanatory level, c) a teleological explicative level and d) a prescriptive teleological level. Typically, social sciences only consider levels a) and b). The exclusion of level c) may lead to viewing behaviors that do not respect theories such as the rational choice theory or the expected utility theory –theories which adopt “instrumental rationality”—as “anomalies”. Including level c) entails considering “practical rationality” and makes those anomalies reasonable. The paper adopts Aristotle’s causality notion and teleology as a theoretical framework. The first section introduces these notions, while the second section explores contemporary conceptions of causality and teleology. The third section applies the former theories to the analysis of social sciences –specifically, economics—and looks at Carl Menger’s classification of economic disciplines.

There is real challenge in giving seminar presentations to interdisciplinary audiences. I think that Ricardo, a charming and amusing Argentinian philosopher of economics, was torn between a more concrete presentation on the philosophy of economics - crucially, how a normative notion of final cause changed the kind of accounts available - and a thorough account of the relation between his Aristotle-influenced account and modern philosophical discussion of normativity, teleology and functions. So, as sometimes happens, the talk fell a little between stools.

But I wondered how such a view might work. For simplicity, one might concentrate not on the four levels of the abstract but the contrast emphasised in discussion between efficient causes and final causes with the latter connected to talk of teleology and functions. Given that passing mention was made to philosophers who were reductionists or eliminativists about functions, reducing them to merely efficient causes, what might be claimed by stressing the importance of teleology and final causes in a discipline such as economics? 

My diagnostic thought ran something like this. Imagine that someone only ever offered accounts of phenomena in efficient causal terms, explanations, we might say. That might capture the full explanatory ambitions possible for worldly happenings. But still, there would be something missing from the account from the perspective of someone who also thought of the world in normative terms, of what the right or correct or ideal thing to happen was. Given that I am an IAS Emergence fellow, I could say that the normative emerged from the efficient causal history of happenings. To someone who also wanted such normative understanding, mere efficient causality is only part of the story. But I am not sure that that is news to anyone, that we need a philosophy presentation to say that. (I could be wrong about economic theory, of course, but I doubt it given the talk I have overheard in pubs of rational choices and rational choice theory.)

But post Darwin, there is a further possible disagreement. If one thinks that reductionists about – apparent, we should now say - teleology aim to show how the pattern of intelligibility of normative notions can be fully captured or explicated in causal efficient terms then the addition of normative notions to an efficient causal story is not an addition of kind after all. The addition is merely a neat shorthand for notions fully capturable in the former account. So in insisting on teleological notions one might be announcing a disagreement with the possibilities of such reductionism. One might be saying that any teleological addition is irreducible. (If so, though, I would expect the argument to focus on just this point. Why, eg., is Milikan wrong to claim that logic will become an empirical science?)

Note two ways of reading the reductionist ambition. It might aim merely to show how efficient causal processes can track normative one, independently understood. Or it might aim to explain the latter concepts. I take Milikan to be aiming at the latter, more ambitious project. She wants to show that the very teleological concepts are really disguised efficient causality concepts. A more modest reading would return us to the position outlined a little earlier: we can render unto Caesar teleological concepts whilst showing how they add nothing to the history of happenings in the efficient causal history-of-happenings' own terms.

But Ricardo's stress not on teleology and normativity in general but on final causes makes me suspect he has another thought in mind. I wrote, above, that accounts of phenomena in efficient causal terms might capture the full explanatory ambitions possible for worldly happenings. Now one might accept that but think that some further insight is offered through normative understanding. Jaspers seems to think this. Davidson too, though he struggles to hold onto the idea given his other commitments. But perhaps the stress on final causes suggests a picture in which the addition is not just another way of seeing patterns, the point, for example, of construing happenings as doings, but a distinct and competing way in which things come about at all. Such causes do not emerge from but perhaps compete with efficient causes. That seems a really interesting and premodern idea.

Tuesday 14 October 2014

The Shock of the Real: which welfare interventions work for whom?

At the end of last week, I took part in a seminar organized in Durham by Jeremy Clarke and Nancy Cartwright concerning the connection between unemployment and mental illness and the contrast between two governmental approaches. The Department for Work and Pensions sees the cause as a moral problem of worklessness and approaches it punitively. The Department for Health sees the underlying cause as a form of illness and thus approaches it medically. This was set out less crudely in one of the briefing papers thus:

“In recent years the UK has embarked on two policies simultaneously: welfare reform and improving access to talking therapies for depression. It is widely understood that both policy problems are linked – if we are going to reduce welfare dependency we need to support claimants whose primary problem is depression; and – if we are going significantly to increase investment in therapies to treat depression we need to realize cost-savings that will also reduce the burden on welfare spending. What is not known is whether the approach favored by the Department for Work and Pensions – crudely, first get people back to work with benefit sanctions as a stick (Freud, 2007) – or the approach favored by the Department for Health – crudely, first offer them CBT with ‘happiness’ as a carrot (Layard & Clark, 2014) – is the best approach for reversing the trend: rising numbers of people with depression as the single biggest welfare claimant group who become and remain jobless (OECD, 2014).
Both policies are necessary but neither on its own will solve the problem. And if badly combined could exacerbate matters. The Treasury in any case may trump them in its determination to cut welfare spending by £30bn. Thus, the challenge for evidence-based policy making is urgent.”

A background assumption of the seminar was that it was highly likely that there were a number of causal factors interacting. The assumption – ascribed to Richard Layard – that there is a single main factor was unwarranted. Thus practical intervention would have to find some way to deal with this complexity. (Nancy Cartwright outlined some of the difficulties of justifying the application of even good RCT based evidence to particular populations in particular cases and the various ways in which complex causes interact negatively and positively.) An illustration of problems for a single, simple, medical-only approach was that typically there is a 50% fall off of those referred for IAPT services actually reaching them. Typically only 50% who went to the first session went further. And only 50% of people who complete a course of CBT are helped by it. Thus an IAPT / CBT only approach looks likely only to help 12.5%. Surely, therefore, some sort of multi-factorial approach is necessary.

Seminar participants were charged with thinking about an alternative approach which would deploy a range of ‘interventions’, starting with referral routes, the initial judgements or ‘diagnosis’ of key workers, choices for interventions and so on. Jeremy Clarke hoped it would be possible to articulate a kind of decision making model to deal with the causal complexity and thus underpin a rational process without over simplifying it. He gave an example of a model for decision making widely used by the police.

I was completely convinced by the background rationale for the seminar and of the likely complexity of the practical problem but rather less sure of the right response to it. First, as a fan of the situation specific, tacit dimension to good (clinical) judgement, I am not at all sure of the point of a decision making model. As Matthew Ratcliffe pointed out, there is a strong tradition in psychiatric diagnosis of thinking that the modern criteriological approach is only part of the story. I’m reminded of some of the things Mario Maj says about the DSM and schizophrenia (I think it carries over to depression and unemployment related misery).

One could argue that we have come to a critical point in which it is difficult to discern whether the operational approach is disclosing the intrinsic weakness of the concept of schizophrenia (showing that the schizophrenic syndrome does not have a character and can be defined only by exclusion) or whether the case of schizophrenia is bringing to light the intrinsic limitations of the operational approach (showing that this approach is unable to convey the clinical flavour of such a complex syndrome). In other terms, there may be, beyond the individual phenomena, a ‘psychological whole’ (Jaspers, 1963) in schizophrenia, that the operational approach fails to grasp, or such a psychological whole may simply be an illusion, that the operational approach unveils. [Maj 1998: 459-60]

In fact, Maj favours the former hypothesis. He argues that the DSM criteria fail to account for aspects of a proper grasp of schizophrenia: for example, the intuitive ranking of symptoms (which have equal footing in the DSM account). He suggests that there is, nevertheless, no particular danger in the use of DSM criteria by skilled, expert clinicians for whom it serves merely as a reminder of a more complex prior understanding. But there is problem in its use to encode the diagnosis for those without such an additional underlying understanding:

If the few words composing the DSM-IV definition will probably evoke, in the mind of expert clinicians, the complex picture that they have learnt to recognise along the years, the same cannot be expected for students and residents. [ibid: 460]

Maj’s criticism that the DSM criteria do not capture a proper, expert understanding of the diagnosis of schizophrenia raises the question of how or why that could be the case.

So I worry about the development of a model of decision making in this case, too. The police model may work because it lacks substantive codification. ‘Measure three times and cut once’ is good advice - a good warning to be careful - but not a piece of wood/shelf specific substantial guidance of what measuring its length correctly involves.

My sub-group was charged with thinking about a way of dealing with a multi-factorial causes in a diagnosis of the problem for particular clients. But guided by the practical experience of service provision by one of us, it seemed to me that there was a principled way of avoiding the tricky problem of trying to codify a response to complex causes. Why not, instead, take a leaf from the recovery model and ask what would need to be done – what causal intervention - to promote the conception of flourishing of each client. That could start with something like Nussbaum’s Aristotle inspired list of the universal aspects of human flourishing even if each had to be realized in specific ways. The complexity of retrospective causal reasoning could be replaced by still complex but surely clearer prospective causal reasoning. 

JC asked whether we thought one could then go back to look for the historic causes of a client’s state. But although one might be able to, one virtue of a recovery orientated approach is that seems merely of academic interest.

Freud, D. (2007). Reducing dependency, increasing opportunity: options for the future of welfare to work: An independent report to the Department for Work and Pensions.
Layard, R. & Clark, D.M. (2014). Thrive: The Power of Evidence-Based Psychological Therapies London: Allen Lane.
Maj, M. (1998) ‘Critique of the DSM-IV operational diagnostic criteria for schizophrenia’ The British Journal of Psychiatry 172: 458-460
OECD: Singh, S. & Prinz, C. (2014). Mental Health and Work: United Kingdom. OECD Publishing.

Sunday 5 October 2014

Two short thoughts after the death of my father

My brother called me an hour ago to tell me that my father, Grahame, had died quite suddenly, albeit in hospital, in front of him. He had complained of feeling ill and then suddenly stopped being alive. (I want to pause in this parenthesis to stress, and to wonder at, the inadequacy of saying or rather using, as we tend to, uneasy metaphors implying continuation, such as that he has shuffled off this mortal coil, that he is an angler on the lake of darkness. No, the simply not being rules out all this nonsense. And I recoil from the very thought so just expressed. I write it but cannot - yet dare to - think it.) Despite worrying fairly constantly about, and thus almost anticipating, his death for the last few months, especially since my mother died, the news came as a shock. Sitting here now I feel terribly... (everyone can fill in the obvious gaps which start ‘alone’ and move more self-pitying).

Having lost one parent recently (and to lose two really does seem a kind of carelessness as though it must have been something we did) I know a little of what is to come. First an interchange of numbness and pain (much unpredictable keening I'm afraid) then later an acceptance of the fact but a kind of illness or sickness and lack of vim and later still, surely, some sort of normality (I had not reached that stage yet after Mij).

But the reason for writing two short thoughts down right now on something as public as a blog is the desire to throw a bottled message into the sea to say that knowing this is no help at all in the moment. Later, through a pattern of thought and slowly changing feeling, in which reasons (not, unnaturally, shorn of affect (both of those commas are necessary)) play a role, it will/must be possible to get better. But there seems to be no shortcut to that right now. There's nothing now to think (ie that it would be right or good to think). Reason seems to let me down. And this is a pity since I need to decide, for example, how to pass this evening, what to do best to cope and then the next day.

Second, I am appalled to find that my thoughts turn instinctively away from my father and back to me. I think about thinking about him. Talking to a colleague recently about how the death of my mother had caused me (as an unexpected brute symptom) to like myself rather less, he gently asked me whether it was right ever to aim at such self-liking. Surely better, he argued, for the self to be a transparent medium through which to engage with the world directly. That seems right but the fact that, in the immediate experience of grief and loss, I wonder about how I will feel is a poor indicator of my real grasp of that thought.

(Later: I posted my brother's eulogy for my father. I found myself unable to add anything.)