Against explanatory minimalism in psychiatry

My anti-John Campbell paper is out in a very preliminary form with Frontiers of Psychiatry, just a couple of days after being accepted.

Interesting (and worth bearing in mind in the future) that one gets to see who reviewed it.

So thanks to:

Daniel D. Hutto, University of Wollongong, Australia
Dawa Ometto, Utrecht University, Netherlands

Kendler’s ‘Toward a limited realism for psychiatric nosology based on the coherence theory of truth’

Some of our philosophy and mental health students have been looking at Kenneth Kendler’s paper ‘Toward a limited realism for psychiatric nosology based on the coherence theory of truth’ prompting me to look at it. It is odd. I think my confusion is more psychological than philosophical, however.

The paper unleashes the meta-induction. Most past theories have proved to be false and most theoretical terms did not successfully refer. Thus, by induction, most of our current theories will prove to be false and have non-referring theoretical terms. What makes this a particularly poignant argument is that it deploys a form of inference widely assumed to play a key role in science against science. Kendler summarises this thus:

In discussions for and against scientific realism, strong support for the instrumentalist position has come from what has been called the ‘pessimistic induction’ (PI) argument (Psillos, 1996). Considering the history of scientific theories in any particular discipline (e.g. astronomy, genetics, physics, psychology), over time, older theories have continuously been replaced by newer ones. This in fact often defines scientific progress. Thus, sitting in the present, we can look back at earlier theories, since replaced, and see entities and processes referred to by these theories that are no longer considered to be real. For example, planets do not travel in epicycles as they circle the earth, ether does not exist and inheritance is not (typically) Lamarckian in nature. [Kendler 2015: 1115]

He then goes on to list a number of non-referring theoretical terms from the history of science originally set out by Larry Laudan. This then motivates an application of the meta-induction to psychiatry. Kendler comments:

Anyone with a smattering of knowledge of psychiatric history would have little problem in creating a list of 12 abandoned psychiatric disorders that at one time were widely used and considered true but are no longer considered useful and would perhaps be judged to be ‘false’. One such list would be: (i) paraphrenia; (ii) neurasthenia; (iii) phrenzy; (iv) periodic hallucinatory insanity; (v) drapetomania (Cartwright, 2004); (vi) monomania (Esquirol, 1845); (vii) lypemania (Esquirol, 1845); (viii) demonomania (Esquirol, 1845); (ix) anxiety-happiness psychosis (Leonhard, 1979); (x) cataphasia, (Leonhard, 1979); (xi) confabulatory euphoria (Leonhard, 1979); and (xii) hysteria. The PI argument applied to current psychiatric disorders argues strongly against what might be called a ‘hard’ realism model for psychiatric disorders. [ibid: 1116]

In the face of this Kendler makes two suggestions. The first is that whilst particular diagnostic categories may prove mistaken, the idea that there are some real psychiatric illnesses looks more secure. ‘we can be much more confident about the existence of the liquid than the particular bottles in which it is now residing’. Strangely there does not seem to be much of an argument for this and to defuse the meta-induction. I am sure he is right but I think we need to be told why the inductive inference can rationally be expected to fail on this point. Earlier, in an apparent spirit of fairness, Kendler mentions Putnam’s no miracles argument for scientific realism. But he does not mention it again nor does he investigate whether it could apply to some areas of science but not others nor how it intersects with the meta-induction.

Second, he suggests that we should adopt a particular view of truth with respect to psychiatric theory.

The standard approach to truth is the ‘correspondence theory’, which assumes that a statement (or theory) is true if it corresponds to a stable, mind-independent reality. This is a plausible way to think about the elements of the periodic table, but it is poor way to think about psychiatric disorders. [ibid: 1117]

Again, there is no diagnostic move to explain why the Periodic Table is exempt from the meta-induction and hence merits a correspondence approach. But:

For psychiatric disorders, we need a less ambitious version of reality. A humbler approach can be found in the coherence theory of truth. This theory postulates that something is true when it fits well with the other things we know confidently about the world. [ibid: 1117]

And then a little later we have the application of this to psychiatry:

What do we mean in this metaphorical space when we want to say that a diagnosis is ‘real’? Before answering that, let’s consider the simpler question: ‘What do we mean in this metaphorical space when we want to say that one diagnostic concept is more real than another?’ Here, the answer is simple. To be more real means to be connected to more already existing pieces and/or to be connected by stronger strings. So what then do we mean to say a diagnosis is real? We might say it is ‘pretty well’ connected with the other pieces, that it is ‘pretty well’ integrated into our accumulating scientific data base. In other words, a diagnosis is real to the degree that it ‘coheres’ well with what we already know empirically and feel confident about. [ibid: 1117]

The idea seems to be that some areas of reality and some claims as to truth are governed by one kind of truth and others governed by another. Note that this isn’t saying that the kinds of facts vary – which one might think for, say, the facts expressed in moral claims by contrast with natural scientific claims – so much as that the kind of truth varies. A redundancy theorist of truth, for example, might, also for example, think that understanding or grasping moral facts requires a special design of mind whilst grasping physical facts does not. Different ontologies, same conception of truth. This is not Kendler's way. The benchmark for psychiatry is just lower/humbler than for chemistry. What it is for something to be true in psychiatry is not just differently constituted (for example in a mind-dependent way) but actually easier. To call something true for psychiatry should involve less than for chemistry.

But the reason my confusion is more psychological than philosophical is that I cannot believe that Kendler really believes any of this. That is, that saying that schizophrenia exists is somehow making a quite different kind of linguistic move (disciplined differently as a move) than saying plutonium exists ie measured against the world differently. Surely he doesn’t think that one can just pick theories of truth willy nilly? In reply to a suggestion (by PZ) that this worry presupposes a hostility (by me) to a coherence theory of truth, I do not think so. I would be happy to take a coherence theory seriously - I used to be a Davidsonian, after all - but not a pick and mix attitude to theories of truth. Surely if one thinks a coherence theory is true then it sets the standard for truth, punkt. It doesn't set what one concedes is a lesser standard.

And against what standard could a theory of truth be ‘humbler’? Is the truth of the coherence theory of truth itself a matter of correspondence or coherence? My hunch is that talk of ‘humbler’ implies that Kendler thinks that the truth of this meta-question is really truth as correspondence. But that in turn suggests that truth generally is really correspondence and the local adoption of coherence isn’t serious. It’s just a way of speaking.

If so, I don’t understand why anyone would think that serious worries about the validity of disease categories could be lanced by playing with theories of truth. So at the psychological level, I cannot believe that Kendler really believes in a mere coherence theory of truth and hence I cannot see how that could thus provide genuine solace for real worries about psychiatric taxonomy. That all seems too easy. So why did he write it?

Kendler, K. (2015)‘Toward a limited realism for psychiatric nosology based on the coherence theory of truth’ Psychological Medicine (2015), 45, 1115–1118

Steve Hyman's Loebel Lectures

At the end of the third Loebel lecture by Steve Hyman, the motivation for some of the more radical sounding claims from the second lecture became clearer. The more radical claims included the idea that because decision making processes are subserved by unconscious processes, our sense of agency for such decisions is misleading. (At the workshop I glossed his 'not veridical' as simply false. He flirted instead with incomplete. But I think that 'false' captured the intuition.)

One slide from the second lecture went as follows:

The eliminativist view (self, minds agency as illusion) misses important facts.

Evolution seems to have invested a great deal in our capacity-limited serial processor (consciousness) that serves as an important connector with parallel processing unconscious systems.

Impairment in sense of agency: a toxins stressor

Sense of being controlled: psychosis

Impairment in recognition of minds: autism spectrum

Yet from a neuroscience view, intuitions of eg. of agency, are not veridical. Rather they are proxies for unconscious processes.

Now this starts with a softening move in the comment about evolution. Further, in three cases, a lack of a sense of autonomy or sensitivity to others' agency is pathological. But there is that robust final comment that intuitions are not veridical but proxies for something else.

And this suggests a different reading of the earlier comment about evolution as having provided us with a useful fiction rather than a truthful awareness. Steve suggested I had him right on this.

One example he gave, again before today, was that of unconscious grasp of grammatical rules. He reamarked:  "When I am talking, I am not thinking 'now I need a verb'. These systems are not accessible by introspection."

But in my own talk earlier, I argued that the was no problem with high level intentional actions and context coming together to guide lower level basic actions and these being underpinned by motor capacities whose working is not available to consciousness. To take the industry standard example, crossing the road may lead to ironwork-avoiding action but also draw on unconscious adaptation of footfall to cope with slippery leaves. Or to use Steve's own example, in giving a talk about agency I may need to say something about crossing the road. But expressing / exercising that thought can simply draw on unconscious knowledge of grammar. I don't see any threat to agency here. 

(It would be revisionary of an understanding of agency that did require that no part of an action was not available to consciousness. But surely there is no reason to think that that is widely held?)

However, today's lecture concerned addiction and offered a kind of Pavlovian story of how dopamine plays a role in training the brain to attend to the scene at hand, as marking that something in the scene is better than expected. This role is then usurped by drugs that mimic that function. The thought as then that because the biochemical explanation explained how it could be that plant extract chemicals could overcome human free choice, this was the correct causal story of what happened. But it is typically not a story that is available to, or even consistent with the rationalising stories told by addicts.

So that was the real context for the rest of the worry that agency is a myth sold to us for evolutionary advantage but not for truth. But it leaves open a much more modest almost disjunctivist possibility. Agency goes wrong in the case of addiction, to be sure, and knowledge of the predicament also goes wrong. That's the bad disjunct. But in the good, there is no inference from the presence of something unconscious to agency's myth.

Commentary as pre-prepared anticipation or incoherent ad lib?

I am about to go and listen to the second of the 2015 Loebel lectures in Oxford for which I am one of a happy handful of commentators. After the lecture there will be a dinner with my fellows, the distinguished speaker Prof Steve Hyman and the organisers. After that, I doubt that my philosophical brain will be at the height of its powers. (My numbskulls pack up early these days.)

So this prompts the question: should I have guessed what will be said this evening and pre-prepared my commentary due tomorrow (even then, in advance of the final concluding lecture)? Or should I wing it on the morning?

The third option - the Caol Isla option (see 1:55mins-) - is not to be repeated.

I guess, as I sip a pint of Oakham Citra, I have already implicitly made my choice. But I fear that neither option escapes a charge of rudeness.

The harmony of thought and reality in McDowell and Wittgenstein

I gave a talk in Utrecht last week and revisited an old interest. How different are McDowell’s and Wittgenstein’s accounts the ‘harmony of thought and reality’, in Wittgenstein’s phrase? I now think them utterly different and hardly attempting to answer the same question at all, to scratch the same itch. Perhaps the following sketch is now too unfair to McDowell.

We can set the scene with some passages from the middle of the Philosophical Investigations. (In my experience, this is a good way into thinking there is a problem here, needing some sort of response.)

I see someone pointing a gun and say “I expect a report”. The shot is fired. - Well, that was what you expected; so did that report somehow already exist in your expectation? [Wittgenstein 1953 §442]

Or is it just that there is some other kind of agreement between your expectation and what occurred; that the noise was not contained in your expectation, and merely supervened when the expectation was being fulfilled? - But no, if the noise had not occurred, my expectation would not have been fulfilled; the noise fulfilled it; it was not an accompaniment like a second guest accompanying the one I expected. [§442].

Was the thing about the event that was not in the expectation too an accident, an extra provided by fate? - But then what was not an extra? Did something of the shot already occur in my expectation? - Then what was extra? for wasn’t I expecting the whole shot? [§442]

“The report was not so loud as I had expected.” - “Then was there a louder bang in your expectation?” [§442]

“The red which you imagine is surely not the same (the same thing) as the red which you see in front of you; so how can you say that it is what you imagined?” [§443]

Now I don’t want to speak for the details of these thoughts, but they suggest to me at least the following problem. How can we account for the connection between the expectation and what fulfilled it given both that we don’t want to say that everything in the shot was ‘in’ the expectation and it seems that if what is in the expectation isn’t the very shot then the expectation cannot actually be about the shot that fulfils it? For any content-laden/intentional mental state, what is the connection between it, something mental,  and what it is about, something which may be part of the history of actual happenings but then again may not come about?

Generalising from expecting and imagining to thoughts (for convenience) there is, I think, a dilemma.

• If the content of true thoughts are constituted the very facts they are about or by some sort of direct and possibly spooky relations to worldly facts, what are the contents of false thoughts? (Such direct relations seem fine for experiences, if we assume experiences have contents and are about things, or for perceptually mediated beliefs but what about future directed thoughts such as expectations?)
• If the contents of false thoughts are free-standing internal states (pictures?), how does (true) thought ever bear on / connect to worldly facts? (Cf if understanding a rule is an inner state, how does it connect to later correct moves?) Free standing mental items seem to be no better candidates for carrying thoughts than the ten black suits hanging in my wardrobe. Suits are not about anything.)

McDowell highlights a debt from Mind and World to a Wittgensteinian trusim which, despite being a trusim, prompts the above dilemma.

I find it helpful… to reflect on a remark of Wittgenstein’s. ‘When we say, and mean, that such-and-such is the case, we - and our meaning - do not stop anywhere short of the fact; but we mean: this - is - so.’ [Wittgenstein 1953 §95] Wittgenstein calls this a paradox. That is because, especially in conjunction with the fact that “thought can be of what is not the case”, it can prompt a reaction in which our minds boggle over what seems a miraculous power of thinking in the most general sense, in this case meaning what one says, to “catch reality in its net”. But Wittgenstein also says, rightly, that the remark “has the form of a truism”. We can formulate the point in a style Wittgenstein would have been uncomfortable with: there is no ontological gap between the sort of thing one can mean, or generally the sort of thing one can think, and the sort of thing that can be the case. When one thinks truly, what one thinks is what is the case. So since the world is everything that is the case (as he himself once wrote), there is no gap between thought, as such, and the world. Of course thought can be distanced from the world by being false, but there is no distance from the world implicit in the very idea of thought. [McDowell 1994: 27 italics added]

This sets up the solution that McDowell develops in Mind and World. But I think that it is guided by a number of other prior assumptions.

• A denial of the ‘master thesis’: ‘that whatever a person has in her mind, it is only by virtue of being interpreted in one of various possible ways that it can impose a sorting of extra-mental items into those that accord with it and those that do not.’ [McDowell 1998: 270]
• Disjunctivism: perceptual experience is not limited to a highest common factor between veridical and illusory experience. Developed as an interpretation of Wittgenstein’s criteria. ‘To paraphrase Wittgenstein, when we see that such-and-such is the case, we, and our seeing, do not stop anywhere short of the fact. What we see is: that such-and-such is the case.’ [McDowell 1994: 29]
• The rational constraint constraint: intentionality is only possible if there is a rational constraint between world and thought.
• Theory building a la Sellars’ Myth of Jones. Just as Jones theorises about mental states on the basis of utterances, so McDowell is happy to theorise about experiences on the same model. I realise that the word ‘theory’ here may seem unkind.

This gives an argument for the Mind and World picture which runs as follows:

1. The very idea of mental states having content requires their rational friction (not merely causal contact) with the world.
2. Our only understanding of rational relations requires both relata have conceptual structure.
3. Since experience provides the friction it must have conceptual structure (passively drawn in).
4. And since experience is – because of the rejection of the master thesis - a kind of direct openness to the world (by contrast, a self-standing configuration in the inner realm) then the world itself must have conceptual structure.

In sum:

In a particular experience in which one is not misled, what one takes in is that things are thus and so. That things are thus and so is the content of the experience, and it can also be the content of a judgement: it becomes the content of a judgement if the subject decides to take the experience at face value. So it is conceptual content. But that things are thus and so is also, if one is not misled, an aspect of the layout of the world: it is how things are. Thus the idea of conceptually structured operations of receptivity puts us in a position to speak of experience as openness to the layout of reality. Experience enables the layout of reality itself to exert a rational influence on what a subject thinks. [McDowell 1994: 26]

There are a number of objections raised to this. I’ll list some:

• Which concepts passively structure experience? All of them? (Contrast the question for active judgement.)
• How can representationalism be combined with disjunctivism? If one thinks that experience has a representational content akin to a kind of unendorsed belief-content then it is tempting to think that both true and false experiences have the same content. But then how can that be reconciled with disjnuctivism which holds that veridical experiences are of a different nature to non-veridical experiences. In recent writing McDowell seems to concede this for the content of the experience but instead distinguish between two ways in which that content is had by the experience. If so, however, the having of the content must be available to the subject otherwise the position falls prey to the very same objections McDowell directs against highest common factor accounts of experience (and 1970s Wittgensteinian accounts of criteria and Brandom).
• Is this idealistic? The world = set of true Thoughts. (‘my exploitation of Wittgenstein’s truism... can indeed be reformulated by saying thought and reality meet in the realm of sense.’ [McDowell 1994: 180]) We could grant McDowell his wish to call the world this, or this the world - some men when they hear the bagpipes wail... - but what of the world of things rather than facts?
• Unpacking the content of experience as either looking like, or looking as if both fail. (Travis himself locates content only in responses to experience.)

McDowell has retreated from the Mind and World picture in papers such as 'Avoiding the Myth of the Given'. Now the same content is no longer mirrored from thought to experience to world. Thought and world may be the same but they are mediated by a different form of content (intuitional rather than propositional) with only a subset of the concepts available to judgement. But the resulting picture is far from the truism and seems instead aimed at explaining it.

When one thinks truly, what one thinks is what is the case. So since the world is everything that is the case (as he himself once wrote), there is no gap between thought, as such, and the world. Of course thought can be distanced from the world by being false, but there is no distance from the world implicit in the very idea of thought. But to say there is no gap between thought, as such, and the world is just to dress up a truism in high-flown language. All the point comes to is that one can think, for instance, that spring has begun, and that very same thing, that spring has begun, can be the case. That is truistic… [McDowell 1994: 27]

The truism is explained by the idea that a harmony of thought and language can itself be explained by the idea that the world has the same conceptual structure as thought. German Idealism explains the harmony. Idealism is the price for the explanation.

To repeat, I think that I am now overstating. I’m sure he would say that it doesn’t aim to explain the harmony but rather to restate it. Still it is hard to read the conceptual structure of the world as mere truism. (Or rather, one can if one reads the world to be just the set of true thoughts. But that then raises the conncetion between that world and the world of things. And yes, I know, that the later stages of Mind and World citing Evans on non-descriptive senses claim to have solved this. But I don't see it.) So let’s look back at Wittgenstein, continuing from where I left off.

“The red which you imagine is surely not the same (the same thing) as the red which you see in front of you; so how can you say that it is what you imagined?” [§443]

But haven’t we an analogous case with the propositions “Here is a red patch” and “Here there isn’t a red patch”? The word “red” occurs in both; so this word cannot indicate the presence of something red. [§443]

And this harks back to an earlier comment which introduces the phrase ‘the harmony of thought and reality’:

The agreement, the harmony, of thought and reality consists in this: if I say falsely that something is red, then, for all that, it isn’t red. And if I want to explain “red” to someone, in the sentence “That is not red”, I do it by pointing to something red. [§429 underline added]

The most obvious difference between McDowell and Wittgenstein here is that McDowell uses truth and agreement to discuss harmony relegating – in accord with disjunctivism – falsity to a subsidiary role where thought can be distanced from reality. By contrast, Wittgenstein takes the harmony to consist in something present in the case of falsity. This leads up to the positive account.

One may have the feeling that in the sentence “I expect he is coming” one is using the words “he is coming” in a different sense from the one they have in the assertion “He is coming”. But if it were so how could I say that my expectation had been fulfilled? If I wanted to explain the words “he” and “is coming”, say by means of ostensive definitions, the same definitions of these words would go for both sentences. [§444]

But it might now be asked: what’s it like for him to come? - The door opens, someone walks in, and so on. - What’s it like for me to expect him to come? - I walk up and down the room, look at the clock now and then, and so on. - But the one set of events has not the smallest similarity to the other! So how can one use the same words in describing them? - But perhaps I say as I walk up and down: “I expect he’ll come in.” - Now there is a similarity somewhere. But of what kind?! [§444]

It is in language that an expectation and its fulfilment make contact. [§445]

What looked like a substantial question about connections is answered by reminders about individuation. We reuse the same language to ascribe propositional attitudes and the facts that satisfy them. Nothing ‘makes possible’ the normative connection between thought and world. There really isn’t any harmony or agreement between thought and reality given that thought is possible at all. I can only conclude that Wittgenstein and McDowell have quite different assumptions about what needs to be solved here. For McDowell, a prior misleading assumption about empiricism and - in this context - disjunctivism queers the pitch.