Disorder of intentionality: Could it provide a global bio-psycho-social framework for psychopathology?From Functional Semantics to speech acts in clinical practice and psychotherapy

 

Frédéric Advenier

 

Introduction

 

Firstly, I’d like to thank both you very much, Dr. Bolton and Dr. Hill, for your book.***

Your work has helped me to discover the philosophy of mind and to work on my project, with Pierre-Henri and his team.

I’m a psychiatrist and practice in an outpatient clinic in the suburbs of Paris.***

My fundamental questions are simple, and reflect my perplexities.

They are rooted in my everyday practice:

We usually account for our practices either by covering general theory, or with “a-theorical” data.

But in my everyday life, I’ve seen that the work of a psychiatrist is to listen and to respond, to open up a dialogue, to converse with the patient. ***

These conversations can be concluded by prescribing drugs, a hospitalisation, giving certificate or other things, but for the most part, psychiatrists reflect and analyze what has happened during the conversation.

Our questions are, for instance:

 

This leads me to ask these questions: ***

 

These questions seem to me very important to clarify.

They are the first step of our Phd.

The second step will be an empirical work, an analysis of videorecorded encounters between patients and psychiatrists, but we have to be guided with clear ideas… and mine are not yet completely clear!

One of our main intuitions is that during a psychiatric conversation, a mind takes care of another mind; a mind understands and explains another mind.

It’s a “mind-talk”.***

We can clarify this intuition with concepts from the philosophy of mind, pragmatics and sociology.

I’m trying to clarify them by applying some of the concepts covered in your book.

But this leads us to 3 questions that I would like to ask you, during my presentation.

 

 

The idea of Functional Semantics

 

With Functional Semantics (FS), can we account for major “constraints” of the therapeutic conversation?

 

Let me first restate what appear to be your positions on that topic: ***

 

 

With FS, I understand that we can correlate an action with a concept or cognition.

It is a logical connection.

We could see FS as a regulator of intentional activity or like fitness, in order to adapt and accord our action to another human action.

 

What about Pragmatics?

 

The work of a psychiatrist is perhaps an investigation of those informational contents and their links with a functional system and plan of actions and interactions.

A psychiatrist achieves this investigation through a dialogue with the patient.

The notion of speech acts can be useful to describe our work.

We can assume that, during the dialogue, informational content is mediated by speech acts.

This is the main problem.

Speech acts are complex and not primarily informative.

They are not informative when analyzed in isolation.

We can describe speech acts with a:

 

Speech acts are directed to someone.

They depend on the physical circumstances and the semantic context.

We do not completely master the effects of our speech acts.

Locution and illocution can be conventional but not really the perlocutionary dimension. There is no rule to produce a specific effect; for instance threatening somebody…

 

During a psychiatric conversation, the two protagonists are not simply trading information.

With their words and attitudes, the patient, for instance, is complaining to the psychiatrist of something.

He or She could be waiting for something from the psychiatrist, who can be afraid, amused or distressed by this.

During the conversation, the psychiatrist tries to be empathic with the patient, but they have to make a diagnosis and reached for the right treatment.

They do this for instance by testing a response to a question; by indirectly observing the modification of the patient’s discourse after one of their remarks.

I don’t know what kind of speech acts it might be! It is probably an important point to investigate.

A psychiatrist could pay attention to the concordance and the discordance of those 3 dimensions of speech acts.

He or She could try to state them with the patient, to correct them.

But, the information emerges during an interaction; it can be isolated and idealised after that.

 

So, in the production of information in this dialogue, we are in a tension between one point that is the objective, cognitive, logical content, mediated by illocutory and locutory dimensions of speech acts that could be regulated with convention. The second point is the empathy, the perlocutory effects that we don’t master.

 

The perlocutory effect refers to the empathy.

 

My first question is: ***

 

1. In the FS hypothesis, how can we account for the empathic dimension of a dialogue?

 

There is certainly room for an evolutionary explanation, there is also room for your specific post-wittgensteinian version of empathy/Gewissheit. But do we see some intuitive connection between the pragmatics of emotions in the clinical interview and what you call empathy?

 

Sociology of Practice

 

We’re coming up against a second problem, which is highlighted by sociological studies.***

The two protagonists are not entirely free to fix the rules of the conversation.

There are external constraints.

The status in the institution of the patient and the psychiatrist, the role that they should endorse, and the situation of the encounter determines a priori way of attitudes and responses.

The type of information is partially defined by these constraints.

The patient should complain of abnormal somatic perceptions.

The psychiatrist should encode information in a theorical knowledge in order to diagnose and to begin a suitable treatment.

 

My second question is: ***

2. In FS, informational contents should be described only in reference to a cognitive regulation of intentional activity or in link with the evolutionary theory (p.155), but why not with according to institutional constraints?

For, what is needed by a coherent pragmatic standpoint on patient/psychiatrist communication is rather, in my opinion, such an institutional background, and not a remote control cognitive/evolutionary background.

 

We’re coming up against a third problem: the problem of the creation of a rule.

A therapeutic conversation could be seen as the creation of new and specific rules of discussion, new informations. (For instance…)

This does not necessarily implicate a recovery or the creation of an establishment of a normal function.

How can we account for this situation with FS? My third question is:***

3. How could we articulate the normative distinction that undermines informational content and plan of actions and your definition of the creation of the rule (p.167)?

 

“ The rule is made in practice, in the activity itself, as opposed to being given in advance, in acts of minds, or in pictures, formulae, tables and another expressions of rules” (p 167).

 

Conclusion

 

This resonates with my proposal that we should actively pay attention to the pragmatic content of speech-acts in psychiatric practices (be they clinical/descriptive or explicitly psychotherapeutic ones)

Did you have such possibility in mind?

 

So my questions are related to how to accounting for a practice and how to integrate complex concepts in to an empirical work.

 

References

BOLTON D. & HILL J., Mind, meaning and mental disorder, Oxford University Press, 2005

OGIEN A., Le remède de Goffman ou comment se débarrasser du Self, http://cesames.org/Textes%20et%20documents/goffman%27sself.pdf, 2005.

OGIEN A., Le raisonnement psychiatrique, Réponses sociologiques, Méridiens Klincksieck, 1985.

GRICE P., Logique et conversation, Communications 1979 ; 30 : 57-72.

LABOV W., Therapeutic Discourse: Psychotherapy As Conversation, Academic Press, 1977.

CICOUREL A., le raisonnement médical, Seuil, 2002.

 

Thank you for your attention and your answers.

 

 

Extracts: Functional Semantics: meaning in terms of systemic functions (§4)

 

“Given an intentional specification of the function of a system, of what it (its response) is “meant to achieve”, we can define what counts as success or failure, and hence define other normative distinctions. If, on a particular occasion a system fails to achieve its function, it has made an error somewhere along the line intentional specification of systemic function can be derived from evolutionary theoric considerations, or in the basis of intentional behavioural evidence alone” (p.152)

 

“In summary, the proposed account of correcteness or error in information content runs as follows: A system S emits a certain response R, regulated by information carrying state Si with particular content. The response (we assume) is meant to achieve a particular result, typically some change in the environment to a condition Cr. The response is appropriate to achieving Cr if the initial condition of the environment is Ci. In this sense the response is appropriate to it being the case that Ci. The informational state Si is then true if Ci is in fact the case, and is otherwise false. Wether the state is true or false will then (tend to) show up in the success or otherwise of the behaviour to which it gives rise” (p.154)

 

“…two version of FS. One defines content and the true/false distinction by reference to the role of information-carrying states in the regulation of intentional activity; the other by reference to a certain type of environmental cause of such states, namely, their normal causes as defined by evolutionary theory” (p.155)

 

“Attribution of meaningful content rests on behavioural criteria. The behaviour in question is essentially interactive: it already has intentionality. Hence explanations that invoke meaningful states are effective in the prediction of action. Such predictions attribute propensities to follow rules: the behaviour which they predict is essentially subject to normative descriptions: correct/incorrect, appropriate/inappropriate, successful/unsuccessful” (p.156)

 

“Psychological generalizations and their predictions in particular cases allow for the possibility of system failure. They are typically qualified by provisos to the effect “if all other things are equal”, by so-called ceteris paribus clauses, which include particularly explicit or implicit reference to “normal’ functioning.” (p.158)

 

“The proposal is that reason-giving explanation is causal: it is what causal explanation comes to look like in the case of action of rational agents.” (p.161)

 

“Rather, meaningful generalizations functions as expressions of norms of appropriateness (rationality) for particular kinds of cognitive-affective states, their causes and effects. They concern norms for specific cognitive sub-systems: trust, fear, grief, anger, curiosity, rationality, and so on. In these contexts the laws are “logical”- “psycho-logical”- rather than empirical.” (p.164-165)

 

“The rule is made in practice, in activity itself, as opposed to being given in advance, in acts of mind, or in pictures, formulae, tables, and other expression of rules” (p.167)

 

“[those generalizations] assume the role more of methodological propositions for the investigation of specifics, as opposed to being empirical, generalizations that summarize individual instances.” (p.168)

Meeting with Dereck BOLTON & Jonathan HILL, Pierre-Henri CASTEL

4th of June 2008

 

Disorder of intentionality: Could it provide a global bio-psycho-social framework for psychopathology?

From Functional Semantics to speech acts in clinical practice and psychotherapy

 

Frédéric ADVENIER

 

What are the specificities of a psychiatric and psychotherapeutic conversation? What are their norms or rules?

 

Functional Semantics (FS):

 

 

- Informational Contents could be mediated by speech acts (locutionary, illocutionary, perlocutionary)

 

Questions:

 

1. In the FS, how could we account for the empathic dimension of a dialogue?

2. In FS, informational contents should be described only in reference to a cognitive regulation of intentional activity or in link with the evolutionary theory (p.155), but why not with institutional constraints?

3. How could we articulate the normative distinction that undermines Functional Semantics and your definition of the creation of the rule (p.167)?