Introduction
Perhaps the most influential model of psychiatric kinds is the mechanical property cluster model of psychiatrist Ken Kendler and philosophers Peter Zachar and Carl Craver, itself developed from the philosopher Richard Boyd’s homeostatic property cluster model [Boyd 1991; Kendler et al 2011]. It seems to be a plausible fit to the kind of kinds found in the Diagnostic and Statistical Manual. Less strict than many models of natural kinds, it serves as a plausible account of the inductive inferences that psychiatric kinds can support. The model serves to vindicate psychiatric taxonomy.
But there is a contrasting account of kinds that has been developed to fit psychiatry by the philosopher of science Ian Hacking: looping or interactive kinds. These promise provide a more nuanced support of psychiatric taxonomy. To assess the very idea of looping kinds I will first provide an overview of the context, then look to what looping might comprises and then argue that there is nothing here in logical space.
Looping kinds and social constructionism
Hacking starts his paper ‘Making up people’ with the following question drawing on Arnold Davidson.
Were there any perverts before the latter part of the nineteenth century? According to Arnold Davidson, ‘The answer is NO… Perversion was not a disease that lurked about in nature, waiting for a psychiatrist with especially acute powers of observation to discover it hiding everywhere. It was a disease created by a new (functional) understanding of disease.’ Davidson is not denying that there have been odd people at all times. He is asserting that perversion, as a disease, and the pervert, as a diseased person, were created in the late nineteenth century. Davidson’s claim, one of many now in circulation, illustrates what I call making up people. [Hacking [1986] 1991: 161]
He goes on to connect both Davidson and his own work to Foucault: ‘there is a currently more fashionable source of the idea of making up people, namely, Michel Foucault, to whom both Davidson and I are indebted’ [ibid: 164].
Foucault’s account of the history of mental illness and hence the latter’s constitution as mental illness turns on two key socio-political shifts. In the seventeenth century there occurred a ‘Great Confinement’ in which alongside beggars, criminals, layabouts and prostitutes, the mad were separated from productive members of society using facilities that had previously been used to segregate lepers. Whereas previously, the mad had been tolerated as eccentric within society and even displayed in royal courts, they were now removed from the view of productive society.
The necessity, discovered in the eighteenth century, to provide a special regime for the insane, and the great crisis of confinement that shortly preceded the Revolution, are linked to the experience of madness available in the universal necessity of labor. Men did not wait until the seventeenth century to ‘shut up’ the mad, but it was in this period that they began to ‘confine’ or ‘intern’ them, along with an entire population with whom their kinship was recognized. Until the Renaissance, the sensibility to madness was linked to the presence of imaginary transcendences. In the classical age, for the first time, madness was perceived through a condemnation of idleness and in a social immanence guaranteed by the community of labor. This community acquired an ethical power of segregation, which permitted it to eject, as into another world, all forms of social uselessness. It was in this other world, encircled by the sacred powers of labor, that madness would assume the status we now attribute to it. [Foucault 1989: 54]
Later, according to Foucault, there was a second transformation at the end of the eighteenth century in which the mad were now confined in hospitals under the supervision of medical doctors. But Foucault’s claim is less that these changes were responses to the nature of mental illness as that the idea of mental illness, by contrast with a broader notion of madness and social eccentricity, was a response to broader social and economic forces.
[T]he constitution of madness as a mental illness, at the end of the eighteenth century, affords the evidence of a broken dialogue, posits the separation as already effected, and thrusts into oblivion all those stammered, imperfect words without fixed syntax in which the exchange between madness and reason was made. The language of psychiatry, which is a monologue of reason about madness, has been established only on the basis of such a silence. [Foucault 1989: xii]
The historian Andrew Scull offers a similar story [Scull **]. According to him an intellectual battle in the nineteenth century between a moral view of mental illness and a medical view was decided by in favour of the latter by social and political factors. Crucially, the growth of capitalism required a distinction be drawn between those who genuinely could not work in factories but deserved support and those, perhaps malingers, who chose not to work. A medicalised view of mental illness and its management fitted the bill.
On this family of approaches, the very notion of mental illness was invented as a way to help structure society in support of the rise of capitalism. This – contested – historical account offers reason to think that the apparently real and worldly property of ‘having a mental illness’ is not after all such an objective matter [for a very critical opposing voice see Shorter **]. Rather, it is, in part at least, a projection onto the world of the needs of (capitalist) society. We call people ‘mentally ill’ so as to impose social and political structures on them, not because we are responding to a real division in nature. Of course, there must be some behavioural and experiential differences that serve as the prompting for the projection but in some sense they do not naturally comprise illness features. Calling them an ‘illness’ – on the understanding of illness as a medical condition – is not just responding to prior biological or medical facts.
This account has been contested. Edward Shorter summarises it and his rejection of it thus:
Dominating the field for the past two decades have been scholars who doubt the very existence of psychiatric illness, believing it to be socially constructed. These writers have attempted to trivialize the illnesses of the inmates and to make the case that capitalist society was venging itself on the patients for their unwillingness to work, for a Bohemian lifestyle, or even for a revolt against male authority. Thus society’s growing intolerance of deviance is said to have led to the confinement of ever greater numbers of ‘intolerable’ individuals. It is astonishing that this interpretation could have achieved such currency as there is virtually no evidence on its behalf. [Shorter 1997: 54]
It will be helpful, in order to contextualise Hacking’s looping kinds to offer an exaggerated, sharp distinction between what I will call ‘debunking’ and ‘non-debunking’ social historical accounts of natural scientific disputes. I will do this using an example from the recent history pf physics, which has, as a matter of fact, been much discussed by in the social history of science [**].
In the 1980s it was claimed by one laboratory that nuclear fusion reaction could take place in test tube conditions at room temperatures. Other laboratories were not able to replicate the results. There was ongoing dispute for a while. Now it is generally accepted that the initial results were mistaken. Why not?
On a debunking social history of science approach, there is a story to be told about the social and political organisation of competing laboratories and how some were more able to publicise and impose their views, eventually shutting out competitor views. And hence the debate came to an end with the claims about nuclear fusion that are now accepted: namely that it is not possible under everyday conditions. Our accounts of the relevant physical facts are thus explained using those resulting beliefs and merit the label social ‘constructionism’.
On a non-debunking or vindicatory account, all of the above may be true except the last sentence. There is also a further explanatory fact in addition to the social historical account. If asked why we no longer believe in ‘cold’ nuclear fusion, on this approach it is explanatory to say: cold nuclear fusion is impossible. We no longer believe in it partly because it does not happen. That physical fact stands at the start of all sorts of evidential chains. It explains why the experiments that seemed to suggest it were possible were not replicated. A vindicatory social historical account is an explanation of the social factors that enabled a physical or natural scientific fact to come into view.
What makes a debunking or social constructionist social historical account debunking is that physical or natural scientific facts are not deployed to explain our beliefs about them. The explanation runs the other way. The explanans are social-historical not physical or natural scientific.
I have suggested an interpretation of the family of approaches to the history of mental illness mentioned above in which the proper explanation of the increase in diagnosis and medical treatment of mental illnesses is not greater understanding of these pre-existing conditions. Rather, the locution ‘there really is such an illness’ is given what limited truth it has by the social historical story about the rise of capitalism.
This stark contrast is made more complex by the caveat mentioned above: that there must be some behavioural and experiential differences that serve as the prompting for the ascription ‘mental illness’. On a debunking account, there is a mismatch between the differences as described in the social historical account and the kind ascribed. On the vindicatory account, the social historical account explains how a sensitivity to underlying kinds correctly reflected in the ascribed kinds came about.
This is the background to Hacking’s looping or interactive kinds. Hacking attempts to offer a middle ground between a vindicatory and a debunking story. Looping kinds stand in contrast to natural kinds. In The Social Construction of What? much the same contrast is made using ‘interactive kinds’ and ‘indifferent kinds’ [Hacking 1999]. Looping or interactive kinds are meant to be in some sense less objective than natural kinds. They inherit something of the debunking story. At the same time, they are real kinds.
Looping?
Why ‘looping’ or ‘interactive’? Because the existence of the label directly affects those subjects who fall under it.
‘Interactive’ is a new concept that applies not to people but classifications… that can influence what is classified… We are especially concerned with classifications that, when known by people or those around them, and put to work in institutions, change the ways in which individuals experience themselves—and may even lead people to evolve their feelings and behavior in part because they are so classified. [Hacking 1999: 103–104]
Hacking claims that the very existence of such a kind can ‘make people’ ie make people into kinds. In the paper ‘Making up people’, one example is multiple personality disorder (MPD).
I claim that multiple personality as an idea and as a clinical phenomenon was invented around 1875: only one or two possible cases per generation had been recorded before that time, but a whole flock of them came after. [Hacking [1986] 1991: 162]
The existence of the diagnosis MPD, eg., has an effect on people in such a way as to make people fit the diagnosis. Hacking does not offer a clear a priori account of looping kinds. He says: ‘
I do not think that there is a general story to be told about making up people. Each category has its own history [Hacking [1986] 1991: 168]
But the nature of the looping is something like this:
(1) Introduction of the concept of multiple personality along with the associated label.
(2) Certain people are classified as having multiple personality or as falling under that kind and are treated accordingly.
(3) Some of these people come to identify with the kind multiple personality (whether consciously or not).
(4) These people (or some of them) become further distinguished from other people, often acquiring new properties.
(5) The kind multiple personality comes to be associated with a new set of properties, which leads us to modify our concept of multiple personality or the theoretical beliefs associated with it. [Khalidi 2010: 337]
Problems
Despite both the intuitive attraction of looping or interactive kinds and despite the various historical accounts Hacking and others have offered using this notion, I do not think it serves as a plausible way to shed light on psychiatric kinds.
First, as a number of critics have pointed out, there can be feedback effects on the things that instantiate natural kinds [Bogen 1988, Cooper 2004]. As Cooper agues: ‘the characteristics of domestic livestock change over time because particular animals are classified as being the ‘Best in Show’ and are used in selective breeding–sheep and pigs would now look very different if it weren’t for our classificatory practices’ [Cooper 2004: **]. So the key question is how such feedback occurs for looping kinds. The key suggestion Hacking makes links this to Elizabeth Anscombe’s book Intention [Anscombe 2001*].
Anscombe stresses the idea that an action is the action it is in virtue of the description under which it falls. Consider an example suggested by the philosopher of action Donald Davidson.
A man moves his finger, let us say intentionally, thus flicking the switch, causing a light to come on, the room to be illuminated, and a prowler to be alerted. [Davidson 1980: 53]
In the details of the example, flicking the switch, turning on the light and illuminating the room are all intentional. They are all appropriate descriptions of the man’s action. But without knowing it, he has also alerted the prowler. But while he did that, it was not his action. He did not set out to alert the prowler. Thoughts of the prowler played no role in his motivation. On Anscombe’s account, briskly mentioned by Hacking, actions are constituted as the actions they are by the descriptions under which they fall.
Having a way to think about the world opens up possibilities of action. A cat, unaware of how lights work, could never – as an action – turn on a light. Only those who know its rules can attempt to avoid an offside trap in football. Knowing the rules opens up a space of actions. So one way a kind might ‘loop’ is by introducing a social role and rules. Given the kind MPD, an actor eg., can now act having MPD.
This idea can also generate a distinct distinction between natural and human kinds following Peter Winch [Winch **]. The rules that govern social interaction, unlike the physical laws that govern the movement of billiard balls, are known and intentionally followed by those they govern, who thus act in accord with their own conception of the rules. Billiard balls, by contrast, do not intentionally follow the laws of Newtonian mechanics. So social ‘science’ is, at the very least, different from natural science. Winch argues this disbars the very idea of a social science.
But this idea does not fit the cases of looping Hacking mentions in which it is not so much that new ways of acting are proposed by new social and linguistic rules in the way that players might adapt to a new version of the offside rule. The phenomena Hacking exposes seem much less self-conscious. They seem more like sub-conscious placebo or perhaps nocebo effects. An Anscombian account of action sheds light on what it would be to act as if one had MPD but would not explain why more people chose to ‘play by these rules’.
Shorn of the explicit link to action explanation and Anscombe then the arguments by critics of Hacking such as Cooper that the existence of natural classifications can lead to changes in those entities picked out undermine the idea that ‘looping’ is of any metaphysical significance.
In The Social Construction of What? Hacking attempts to perform a shotgun wedding of looping or interactive kinds and natural or indifferent kinds. He suggests that the looping kinds of mental illnesses might be found to be neurological kinds in the way that water was found to be a chemical kind H2O. His suggestion is that while the stereotype for a kind might be looping, its underlying nature might have an underlying essence. It is far from clear how the latter aspect does not undermine any metaphysical significance of ‘looping’.
What can be concluded? What makes a debunking sociological account debunking is that physical facts never explain, they are always explained. Perhaps the problem of Hacking’s account is that it attempts not to have to choose between a kind of vindicatory history of psychiatry in which mental illnesses are discovered by mainly nineteenth century German psychiatrists and a Foucauldian sceptical story in which the same illnesses were ‘made up’ to serve some other purpose. Perhaps we do need to look closely at the details of every historical case. Some kinds will be real. Others will be fake. None will be looping.
References
Anscombe, E. (2000) Intention, Cambridge,Mass.: Harvard University Press
Bogen, J. (1988) ‘Comments on “The Sociology of Knowledge about Child Abuse”’, Nous, 22: 65-
Boyd R (1991) ‘Realism, antifoundationalism and the enthusiasm for natural kinds’ Philosophical Studies 61: 127–148.
Cooper, R. (2004) ‘Why Hacking Is Wrong about Human Kinds’, The British Journal for the Philosophy of Science, 55: 73-85.
Davidson, D. (1980) Essays on Actions and Events, Oxford: Oxford University Press.
Foucault, M. (1989) Madness and Civilisation, London: Routledge
Hacking, I. [1986]: ‘Making up People’, in T. C. Heller and C. Brooke-Rose (eds), 1986, Reconstructing Individualism: Autonomy, Individuality, and the Self in Western Thought, Palo Alto, CA: Stanford University Press, pp. 222-36. Reprinted in M. Biagioli (ed.), 1999, Science Studies Reader, New York, NY: Routledge, pp. 161-**
Hacking, I. (1999) The Social Construction of What?, Cambridge, MA: Harvard University Press.
Kendler KS, Zachar P, Craver C. (2011) ‘What kinds of things are psychiatric disorders?’.Psychol Med. 41: 1143-1150
Khalidi, M. (2010) ‘Interactive Kinds’ The British Journal for the Philosophy of Science, 61: 335-360.
Shorter, E. (1997). A History of Psychiatry: from the era of the asylum to the age of Prozac, New York: John Wiley and Sons.
Winch, P. ([1958] 1990). The Idea of a Social Science and its Relation to Philosophy, London: Routledge
