Disordered Minds/Minding Disorder


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Prometheus Seminar Series
Disordered Minds/Minding Disorder
The Philosophy of Psychiatry
Bryan Miller — JHU Philosophy Dept.

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  • A broad notion of philosophy as “love of wisdom”—Its what philosophers do. But not just philosophers do it. Continuous with science—conceptual analysis may proceed by looking to how things in the world are Natural kinds as opposed to social constructs—would these classes exist even if there were no humans around to classify as such i.e., oak trees would be a class but things weighing more than 25 kg would not be.
  • Look to mental disorders and the findings of psychiatry in order to shed light on philosophical issues.
  • Address issues from phil science—laws, explanation, demarcation, evidence—in psychiatry. Explore the central concepts of psychiatry. Also may be considered part of philosophy of mind insofar as it deals with the mind-brain and makes reference to topics such as belief, perception, cognition.
  • These are questions about what makes a discipline a science instead of a pseudo-science—problems of objectivity, progress, theory-underdetermination—and these are problems for sciences in general.
  • What are commonly posed as problems for psychiatry as a science are problems that all sciences must address. Just because one way of understanding psychiatry fails, does not mean psychiatry fails. A science of ghosts is not a science if there are no ghosts.
  • Potentially nothing!
  • Cure mental disorder by helping one come to terms with unconscious drives. Difficult to say what would show psychoanalysis to be wrong. Desire for the science of mental disorder to be more objection and worry that interpretation is too subjective.
  • Here we have a denial that there are mental disorders. Instead, we have problems with living and/or neurological problems. The problem is that there do seem to be true mental disorders that are not problems in living.
  • A mental mechanism that is naturally selected because it is adaptive in our past environments. Depression mechanism—triggered in certain circumstances where depressive behavior may have proven beneficial. However, such a mechanism may malfunction—it may cause depression even when the circumstances are not appropriate from the point of view of evolutionary history—This would be malfunctioning mechanism. Society determines whether the state resulting from the malfunction is harmful or not.
  • It’s a philosophical question which position best captures mental disorder—i.e., the job of conceptual analysis which looks to the world (this is not armchair conceptual analysis)for relevant findings and guidance. And, it may turn out that no account captures all of the intuitively obvious cases of mental disorder—this would suggest that the class ‘mental disorders’ is not a natural kind.
  • Mature = somewhat successful. Mature sciences tend to investigate categories that support scientifically interesting inductive generalizations.
  • Causal mechanism in Dogs is (perhaps) the dog-genome and this explains why all members share property cluster. Note that this requires a lot of philosophical work to say what a natural kind is—i.e., What is a cause? What is a natural kind?
  • If psychiatry is a science, then the categories it investigates should support inductive generalizations. We want to be able to investigate a few instances of a category and project what we learn to all members of the category.
  • Depression—similar symptoms from different causes. Role of intervention and a proper taxonomy (classification scheme).
  • To appreciate the problem, we will consider the case of delusions. Delusions, some claim—often implicitly (and this commitment is revealed by how they investigate the class)—constitute a natural kind. There are counterexamples to all of these properties but this is to be expected since o property from the cluster is supposed to be necessary. Nonetheless, we might wonder whether there is a common causal mechanism in delusions. If not, this would suggest the class does not constitute a natural kind.
  • Real self: self as an existent thing. Vs. Fictive selves : “explanatory fictions”, “centers of narrative gravity”. Fictive self as representative or speaker of the person. Use MPD to suggests a particular view—the fictive self view.
  • Philosophers are interested in what beliefs are. That is to say, what conditions must a state meet to be a belief? Can look to states that are prima facie similar to beliefs (i.e., delusions) to see what traits they have.
  • It may be that most disorders are just outliers on a continuum
  • Disordered Minds/Minding Disorder

    1. 1. Bryan Miller JHU Philosophy Dept.
    2. 2. <ul><li>Minding Disorder: Philosophy’s role </li></ul><ul><ul><li>Address issues deemed to be “meta-scientific” </li></ul></ul><ul><ul><ul><li>Is psychiatry a science? Are there laws of psychiatry? </li></ul></ul></ul><ul><ul><ul><li>Are mental disorders natural kinds? Or social kinds? </li></ul></ul></ul><ul><ul><li>Help tidy-up potential conceptual confusions </li></ul></ul><ul><ul><ul><li>What is a mental disorder? </li></ul></ul></ul><ul><ul><ul><li>Categorization of disorders? </li></ul></ul></ul>
    3. 3. <ul><li>Disordered Minds: Psychiatry’s role </li></ul><ul><ul><li>The self </li></ul></ul><ul><ul><li>Belief states </li></ul></ul><ul><ul><li>Perception & Cognition </li></ul></ul><ul><ul><li>Human nature </li></ul></ul><ul><ul><li>Cognitive architecture </li></ul></ul>
    4. 4. <ul><li>What is philosophy of psychiatry? </li></ul><ul><ul><li>Applied philosophy of science </li></ul></ul><ul><ul><ul><li>Philosophy of physics </li></ul></ul></ul><ul><ul><ul><li>Philosophy of biology </li></ul></ul></ul><ul><ul><ul><li>Philosophy of social sciences </li></ul></ul></ul><ul><ul><ul><li>Philosophy of psychology </li></ul></ul></ul><ul><ul><li>philosophy of mind </li></ul></ul>
    5. 6. <ul><li>A branch of psychology? </li></ul><ul><li>A branch of medicine? </li></ul><ul><li>Is it a science? </li></ul><ul><li>What demarcates science from non-science? </li></ul>
    6. 7. <ul><li>It is, at the least, reasonable to think that psychiatry is a science. </li></ul><ul><ul><li>Of course, whether it is will depend on the nature of the phenomenon—mental disorders—that psychiatry is concerned with. </li></ul></ul><ul><li>“ What is a mental disorder?” </li></ul>
    7. 8. <ul><li>Schizophrenia </li></ul><ul><li>Bipolar Disorder </li></ul><ul><li>Depression </li></ul><ul><li>OCD </li></ul><ul><li>Autism </li></ul><ul><li>Alzheimer’s </li></ul><ul><li>Capgras Syndrome </li></ul><ul><li>Cotard syndrome </li></ul><ul><li>Alcohol/drug addiction </li></ul><ul><li>Depression </li></ul><ul><li>Sociopathy </li></ul><ul><li>ADHD </li></ul><ul><li>Cortical Blindness </li></ul><ul><li>Drapetomania </li></ul>What do all these things have in common?
    8. 9. <ul><li>Mental disorder is the behavior resulting from an underlying cause (the unconscious) </li></ul><ul><ul><li>“ Unconscious mechanisms drive conscious experiences and behavior and can be revealed and rendered intelligible by the psychoanalytic technique of interpretation.” </li></ul></ul>
    9. 10. <ul><li>Thomas Szasz </li></ul><ul><ul><li>Mental disorders are not true “disorders” because there are no accompanying lesions </li></ul></ul><ul><ul><li>Mental disorder as “problems in living” </li></ul></ul><ul><ul><li>Diagnosis as a means of power and control </li></ul></ul><ul><ul><li>*Note: As far as I know, Szasz is not a scientologist! </li></ul></ul>
    10. 11. <ul><li>Mental disorder has a normative as well as an objective component </li></ul><ul><ul><li>Harm Conditions </li></ul></ul><ul><ul><li>Dysfunctioning mental mechanism </li></ul></ul>
    11. 12. <ul><li>Mental Disorders are neuropathologies </li></ul>
    12. 13. <ul><li>If psychiatry is a science, then the categories it investigates should support inductive generalizations. </li></ul><ul><li>We want to be able to investigate a few instances of a category and project what we learn to all members of the category. </li></ul><ul><li>Only certain categories/classes support scientifically interesting inductive generalizations—natural kinds. </li></ul>
    13. 14. <ul><li>What is a natural kind? </li></ul><ul><li>A Natural kind is a class that has a property cluster that result from some causal mechanism(s). </li></ul><ul><li>The mechanism(s) which causally sustain the relevant property cluster can be considered the defining feature of a natural kind. </li></ul>
    14. 15. <ul><li>Psychiatry ought to only investigate mental disorders that are natural kinds. </li></ul><ul><li>DSM-IV categories of mental disorder are symptom based—categories are based on symptom-clusters. </li></ul><ul><li>These categories are often treated as though they are natural kinds, kinds that should be scientifically investigated and that possess underlying causal unity. </li></ul>
    15. 16. <ul><li>The problem: </li></ul><ul><ul><li>Many DSM IV categories are probably not natural kinds!!! </li></ul></ul><ul><li>What’s the big deal? </li></ul><ul><ul><li>Investigating non-natural kinds may stall progress. </li></ul></ul>
    16. 17. <ul><li>DSM-IV: Delusion </li></ul><ul><ul><li>A false belief </li></ul></ul><ul><ul><li>The belief is based on incorrect inference about external reality </li></ul></ul><ul><ul><li>Entrenched and rigid. </li></ul></ul><ul><ul><li>The belief is not one ordinarily accepted by other members of the person's culture or subculture (e.g., it is not an article of religious faith). </li></ul></ul>
    17. 18. <ul><li>Some delusions are probably caused by motivational factors employed for coping. </li></ul><ul><ul><li>e.g., erotomania </li></ul></ul><ul><li>Some delusions are likely caused by cognitive/perceptual impairments. </li></ul><ul><ul><ul><li>e.g., Capgras </li></ul></ul></ul><ul><li>* Suggests various causal mechanisms. </li></ul>
    18. 19. <ul><li>Bottom-up: abnormal experience that then modifies belief system. </li></ul><ul><li>Top-down: start with modified beliefs that “give rise” to strange experiences. </li></ul><ul><li>* Suggests various causal mechanisms. </li></ul>
    19. 21. <ul><li>Origins: “Division of emotional labor” </li></ul><ul><li>Gives rise to multiple personalities? </li></ul><ul><li>Fictive selves vs. Real Selves </li></ul><ul><li>Are multiple personalities the same as multiple selves? </li></ul><ul><li>Do neurotypicals only have one self? Is it a Fictive self </li></ul>
    20. 22. <ul><li>What is the relation between delusions and beliefs? </li></ul><ul><li>Delusions do not integrate well and are not sensitive to updating in the face of new evidence. </li></ul><ul><ul><li>Does this suggest that delusions are not beliefs? </li></ul></ul><ul><ul><li>Or does it suggest our previous notions of belief are too strong—i.e., no account of beliefs consistent with empirical data suggests the strict conditions that are often imposed on beliefs. </li></ul></ul>
    21. 23. <ul><li>If most disorders are just deviations from the norm along a continuum then we learn something about human nature. </li></ul><ul><ul><li>Most people have multiple personalities. </li></ul></ul><ul><ul><li>Most people have obsessive-compulsive tendencies in certain domains. </li></ul></ul><ul><ul><li>Most people have delusions. </li></ul></ul><ul><ul><li>Most people experience depression. </li></ul></ul><ul><li>We need to keep these facts in mind if philosophical claims hinge on alleged features of human nature (i.e., descriptive ethics, theories of rationality). </li></ul>
    22. 24. <ul><li>How tightly linked are cognition and perception? </li></ul><ul><ul><li>Top-down accounts of delusions suggest that cognition can influence perception. </li></ul></ul><ul><ul><li>How much influence can the physiological component of depression have on agency and cognition? Do depressives perceive, or conceive, the world differently </li></ul></ul><ul><ul><li>What can we learn about the content of mental states from mental disorders such as delusions? </li></ul></ul>
    23. 25. <ul><li>Do mental disorders tell us anything about the cognitive architecture of the human mind-brain? </li></ul><ul><ul><li>Can we infer dedicated modules from observed mental disorders? </li></ul></ul><ul><ul><li>Can we infer that certain cognitive processes are not modular; rather, that they are domain general? </li></ul></ul>
    24. 27. <ul><li>Coming in April!!! </li></ul><ul><li>Questions? Email: [email_address] </li></ul><ul><li>Keynote Speaker </li></ul><ul><ul><li>Prof. Pascal Boyer </li></ul></ul><ul><li>Why obsessive people and religious people perform rituals </li></ul>
    25. 28. <ul><li>Delusions are (probably) not a natural kind: What Samuels missed about realization, Bryan Miller </li></ul><ul><li> In “Delusions as a natural kind” Richard Samuels argues contrary to theorists such as Peter Zachar (2000) and Nassir Ghaemi (2004) that delusions probably do constitute a natural kind. Samuels supports his claim, the natural kind thesis (hereafter, NK thesis), by showing that several objections to it are mistaken. One of the strongest objections that Samuels must face is the heterogeneity objection, the claim that the NK thesis is false because delusions are realized by a number of heterogeneous neural and/or cognitive states. Samuels’ response to this objection notes that this only shows that delusions are multiply realizable and that this fact is consistent with and supportive of the NK thesis. In this paper, I argue that Samuels’ response to the heterogeneity objections fails to support the NK thesis insofar as it employs a form of realization that does not give rise to natural kinds. I conclude by remarking on how the failure to secure the natural kind status of delusions might be problematic for a special case of delusions—namely, religious delusions. </li></ul><ul><li>Dworkin on the Moral Psychology of Abortion, Jonathon Hricko </li></ul><ul><li>In his book Life’s Dominion, Ronald Dworkin argues that, though defenders of the pro-life position may say that they object to abortion because they believe that it violates the rights and interests of the fetus, they actually object to it because they believe that it violates the intrinsic value of the fetus. Dworkin attempts to reach this conclusion by arguing that the former belief is incoherent. I will draw an analogy between the abortion debate and the conjunction fallacy in order to argue that Dworkin cannot reach his conclusion by means of the arguments he gives. The fact that a belief is incoherent is no reason to conclude that people do not hold that belief. Just as the probability rankings that people assign to a set of statements is an empirical issue, so is what people think about abortion, and so an empirical investigation is necessary to determine whether Dworkin’s conclusion is correct. </li></ul>
    26. 29. <ul><li>Religion, Rationality, and Altruism, John Waterman </li></ul><ul><li>Religion is puzzling from an evolutionary perspective. Religious ritual and belief have clear adaptive costs in time and effort, but they don't have clear compensating benefits. By any right, natural selection should have eliminated them long ago. Instead we find religion is a human universal. How should we explain this? An age old, if now unpopular, view explains that religion’s worth derives from promoting morality. Costly Signaling Theory, an adaptationist approach gaining currency among cognitive scientists of religion, updates this view. It argues religious beliefs and rituals are adaptations integral to the evolution of human altruism. The theory claims the adaptive benefits of religion accrue by mitigating the threat narrow self-interest poses to cooperative behavior. In this essay I argue that Costly Signaling Theory fails as an explanation of the evolution of cooperation in populations with unrelated individuals. Using the framework of evolutionary game theory, I show that religious belief and religious ritual are neither necessary nor sufficient for eliminating the underlying adaptive instability of cooperative behavior. I conclude with a discussion of the evolutionary relationship between religion and morality, and by considering a pending question for both adaptationist and spandrelist theories of religious cognition. </li></ul><ul><li>Between Adaptations and Spandrels: Cognitive science and evolutionary psychology of religion, Derek Leben </li></ul><ul><li>Many psychologists, anthropologists, and biologists currently attempt to explain religion as not only a biological-cognitive product, but as an evolutionary adaptation. This paper will discuss the adaptationist argument as well as the supposed alternative, that religion is a useless ‘by-product’ of other cognitive systems (‘spandrelism’). It will be argued that the adaptationist argument is not effective, due to a failure to distinguish beneficial uses from ‘proper’ evolutionary functions, as well as a much wider variety of evolutionary causes than simply an adaptation or spandrel (kluge, exaptation, co-opted mechanism). Other cases such as language and moral appraisal will also be considered for comparison. </li></ul>
    27. 31. <ul><li>Bayne, T. and Pacherie, E. (2005). “In defence of the doxastic conception of delusion,” Mind & Language , 20 (2): 163–188. </li></ul><ul><li>Bermúdez, J. (2001). “Normativity and rationality in delusional psychiatric disorders,” Mind & Language , 16 (5): 493–457. </li></ul><ul><li>Bermudez, J. and Cahen, A. (2008). Non-conceptual Mental Content. Stanford Encyclopedia of Philosophy. </li></ul><ul><li>Bortolotti, L. (2009) Delusions. Stanford Encyclopedia of Philosophy. </li></ul><ul><li>Boyd, R. (1999). Homeostasis, Species and Higher Taxa. in Species: New Interdisciplinary Essays. Wilson, R. (ed.) Cambridge: MIT Press 141-186 </li></ul><ul><li>Boyer, P., & Lienard, P. (2006). Why ritualized behavior in humans? Precaution systems and action-parsing in developmental, pathological and cultural rituals. Behavioral&Brain Sciences , 29, 1–56. </li></ul><ul><li>Cartwright, N. et al .(200?) Philosophy of Science: Laws. </li></ul><ul><li>Craver, C. F. (2007). Explaining the brain: Mechanisms and the mosaic unity of neuroscience. Oxford: Oxford University Press. </li></ul><ul><li>Devitt, M. (1994). The Methodology of Naturalistic Semantics. The Journal of Philosophy . Vol. 91: 10, pp. 545-572. </li></ul><ul><li>Dretske, F. I., 1981, Knowledge and the Flow of Information (Oxford: Blackwell). </li></ul><ul><li>Fine, C., Craigie, J. and Gold, I. (2005). “Damned if you do, damned if you don't: The impasse in cognitive accounts of the Capgras delusion,” Philosophy, Psychiatry & Psychology , 12: 143–151. </li></ul><ul><li>Fodor, J., (1974), ‘Special sciences, or the disunity of science as a working hypothesis’, Synthese 28: 77-115. </li></ul><ul><li>Fodor, J., (1978), &quot;Propositional Attitudes,&quot; The Monist 61: 501-523. </li></ul><ul><li>Friedlander, L., Desrocher, M., 2006. Neuroimaging studies of obsessive–compulsive disorder in adults and children. Clin. Psychol. Rev . 26 (1), 32–49. </li></ul><ul><li>Gilleen, J and David, A.S. (2005). The cognitive neuropsychiatry of delusions: from psychopathology to neuropsychology and back again. Psychological Medicine , 35: 5-12. </li></ul><ul><li>Ghaemi, S.N. (2004). The perils of belief: Delusions reexamined. Philosophy, Psychiatry, and Psychology . 11:1, 49-54. </li></ul><ul><li>Griffiths, P. E. (1997). What Emotions Really Are: The Problem of Psychological Categories. Chicago: Univ. Chicago Press. </li></ul><ul><li>Griffiths, P. E. (1999). Squaring the circle: natural kinds with historical essences. In R. A. Wilson (Ed.), Species: New Interdisciplinary Essays (pp. 208-228). Cambridge, M.A: MIT Press. </li></ul>
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    29. 33. <ul><li>Samuels, R. (2009). Delusions as a Natural Kind. in M.Broome & L. Bortolotti (eds) Psychiatry as cognitive neuroscience: philosophical perspectives . Oxford University Press. </li></ul><ul><li>Simpson, H. et al. (2006) Are there reliable neuropsychological deficits in obsessive–compulsive disorder? Journal of Psychiatric Research, Vol40:3, p 247-257 </li></ul><ul><li>Szasz, Thomas. The Myth of Mental Illness: Foundations of a Theory of Personal Conduct (New York: Harper and Row, 1974.) </li></ul><ul><li>Wakefield, Jerome C. &quot;The Concept of Mental Disorder: On the Boundary Between Biological Facts and Social Values.&quot; American Psychologist 47, no. 3. (1992): 373-88. </li></ul><ul><li>Wakefield JC: Spandrels, vestigial organs, and such: a reply to Murphy and Woolfolk’s “The harmful dysfunctional analysis of mental disorder.” Philo Psychiatr Psychol 2000; 7:253–269 </li></ul><ul><li>Woodward, J., and C. Hitchcock (2003) ‘‘Explanatory Generalizations, Part I: A Counterfactual Account,’’ Nouˆs 37: 1–24. </li></ul><ul><li>Zachar, P. (2000). Psychiatric disorders are not natural kinds. Philosophy, Psychiatry, and Psychology . 7:167-182. </li></ul>
    30. 34. <ul><li>Which account of mental disorder seems most correct? Why? </li></ul><ul><li>If there is essentially a normative component to mental disorder, does this threaten the status of psychiatry as a science? </li></ul><ul><li>Can mental disorder ever be valuable? </li></ul>