An account of Mind, Meaning and Mental Disorder from the philosophy of medicine’s point of view.

Steeves Demazeux


 

I would like to briefly examine the implications of your philosophical position in light of the philosophy of medicine’s perspective.  In particular, I would like to compare your position with those of two completely different philosophers: the American philosopher Christopher Boorse, and the French philosopher Georges Canguilhem.  I think the contrasting accounts of these two philosophers are of great interest to evaluate your position.  Despite the importance of their respective theories, I think it’s worth noting that none is cited in your book.  I would like to interpret this fact on the basis that their main work stand both below the scope of the new “mature” cognitive paradigm you aim to propose.  Moreover, I would like to interpret this fact as a sign of the new way of considering pathological phenomena you aim to introduce.  By citing their work, I will attempt to highlight some tension, maybe constructive, maybe ambiguous, between two key concepts of your work: the concept of function and the concept of intentionality. 

***

Christopher Boorse’s position has many common points with your own.  Let me first summarize Boorse’s position in a few words before discussing it further.  In several papers between 1975 and 1977, Christopher Boorse has tried to resolve the difficulty of applying medical vocabulary to mental diseases. His solution consisted in a well-known distinction between two concepts, disease and illness -- the former being descriptive and value-free, the latter having to cope with social norms.  Although he eventually discarded this distinction in order to strengthen his value-free description of disease, the main line of his argument still appears to me very relevant.  As he said, mental illness will never be “just like any other illness”, since the question of the insight and the undesirability of the disorder by the patient will unfortunately remain controversial in psychiatry.  Despite the fact that he is aware of this specific difficulty that applies to mental illness, Boorse is well-known as an “unrepentant naturalist”.  He has sought to give a scientific and value-free account of mental disease as a matter of dysfunction.  Notably, he has been one of the first to stress the fact that a renewed comprehension of the biological notion of function would be very significant for a contemporary approach toward mental diseases.  In his 1976 paper, What a Theory of Mental Health Should Be, he gave a straightforward argument in favor of the autonomy of psychiatry. I will focus only on two main ideas.

First, he vigorously claimed that “apart from a theory of the structure and functions of the human mind, virtually all assertions about mental health are either misuses of language or flatly conjectural” [1] . This quotation implies that for Boorse the only way to legitimize the use of medical vocabulary in psychiatry was to clearly define mental dysfunction, and correlatively mental function. Furthermore, it implies explicitly that mental disorders should be ascribed only on the basis of a conception of mental order.

As a second point, it’s worth noting how Boorse in this paper is confident in philosophy of mind’s new perspectives on tackling psychiatric issues.  Particularly, he based his argument on those of Davidson, Putnam, and Fodor in order to support the idea that psychiatry could be a genuine and autonomous branch of medicine. Theoretically, his argument has two components.  First, one needs to make room for the possibility of mental causation.  Secondly, one needs to conceive the possibility of certain mental causations to be described as typical of the functioning of the normal human mind. To grant him these two points, as he noted, is sufficient to justify the whole project of establishing any theory of mental health.  It’s also of interest that, in his 1976 paper, Boorse is very liberal concerning the form such a theory of mental health should take. Notably, he states that “formally speaking, psychoanalytic theory is the best account of mental health we have” [2] . The reason is the following: “It closely follows the physiological model by positing three mental substructures, the id, ego and superego, and assigning fixed functions to each” [3] . Yet, Boorse will later rather rely more on evolutionary psychology and cognitive sciences to achieve this plan.

 

Nevertheless, it’s important to see that, despite several difficulties which have been at many times highlighted, and despite the specific standpoint of conceptual analysis, his project share with your own project two important theoretical features concerning psychopathology. Indeed, you share with him both a fundamental opposition to the reductionist medical model championed by Guze, as well as an attempt to go beyond the philosophical dualism which is so embarrassing in psychiatry. And like him, you stress the notion of function to achieve this project.  Moreover, your work has with his own a common ground concerning the notion of function, since Boorse, as you know, has always  supported a “goal-directed” conception of function, that is : one doesn’t need to abandon teleological ascriptions when we describe biological processes. I know you’re not really a proponent of a strictly dysfunctional analysis of mental disorders, particularly in its amended version by Wakefield, since it appears to you to be too much restrictive because it tends to neglect interpersonal and functional strategies for coping.  And yet, from a theoretical point of view, I think there are several common philosophical intuitions between your work and Christopher Boorse’s own. I would like to briefly list three fundamental points of agreement:

*   A dependant relationship between order and disorder;

*   A teleological account of the notion of function;

* A systemic point of view linked to a rather broad biological interpretation of psychological processes.

 

Of course, the main difference between Boorse’s work and yours is likely that Boorse’s functionalism still neglects the intentionality of biological systems and still supports a quite mechanistic conception of biological and even psychological processes. Your functional semantic conception of causality aims to take into consideration the specific flexibility of biological processes.  One can understand this idea of specific flexibility with the key concept of your book: intentionality. Now, I would like to turn to Canguilhem’s conception in order to delve deeper into this specific point.  

***

Canguilhem’s work has been very influential in the French medical thought. I think it is very interesting to contrast Canguilhem with Boorse, insofar as Boorse appears to be the best modern proponent of the so-called “Broussais’s principle” criticized by George Canguilhem in Le normal et le pathologique (1943/1966). François Joseph Victor Broussais was a French physician of the nineteenth century who claimed that physiological and pathological phenomena were essentially identical, and that they could differ from each other only by a degree. In fact, Boorse doesn’t say anything else in his Biostatistical Theory.  Indeed, for him, the normal is the natural: we can give an objective definition of it as a fact, and furthermore we can give an account of pathological phenomena as quantitative departures from the normal range of functioning. George Canguilhem’s point of view is completely different.  We can say that his whole position consists precisely in a criticism of the Broussais’s principle. For Canguilhem, the relation between physiology and pathology, between order and disorder, is not as simple as we might think.  In particular, for him, there isn’t any logical priority of physiology over pathology.  One of the main reasons of this claim is the broad and opened conception of physiology he embraces.  Such a conception relies on that firm evidence that physiological science should always be seen as an applied physiological science.  As he says:

“If we consider physiology to be the science of normal human functions, then we would have to accept that this science relies on the following postulate that normal man is a ‘man of nature’ […] But perhaps human physiology is always more or less an applied physiology, e.g. a physiology of work, a physiology of sport, of leisure, of life at high altitudes, etc., meaning a biological inquiry of man in cultural situations that generate various threats” [4]

 

The idea is that the “man of nature” is an abstraction which drives us to neglect the importance of the fundamental interplay between the organism and its environment, and particularly its cultural environment.  I think we can observe in your work a similar attention to this specific aspect. I would like to compare Canguilhem’s quotation with this one from your book:

“Once it is clear that intentional processes pervade biological systems, then biological psychiatry will expect to refer to disciplines such as anthropology and social psychology without abandoning the biological stance” [5]

 

What appears to me here in both cases is a common attempt to uphold a comprehensive account of physiology and biology. You do so by stressing the intentional nature of biological processes; Canguilhem did so by emphasizing what he called the normativity of biological phenomena. So, what is the common ground between your conception of intentionality and the Canguilhem’s conception of normativity?  That’s a question I find relevant for someone who tries to have an overview of your work. By “normativity”, Canguilhem means the fact that life establishes norms by itself [6] . Although this conception has sometimes been criticized as a form of vitalism, it shows a great attention to the specificity of vital phenomena. The idea conveyed by the term ‘normativity’ is that -- I quote -- “life is polarity” [7] . Hence biology is a science like any other, and in particular is not reducible to physics and chemistry.

Between Canguilhem’s conception of biological normativity and your own account of intentional causality in both biological and psychological processes, I would like to highlight three common philosophical intuitions:

 

* First, the intentionality ascription, as well as the normativity conception, is akin to a kind of relativism. Indeed, as you wrote, “knowledge of intentionality involves observer-relativity [8] . It implies that in psychiatric knowledge, and perhaps in the whole biological and psychological knowledge, we can at best reach partial generalizations, and not any strict scientific law. This sounds similar to the well-known Canguilhem’s quotation:

“One does not scientifically dictate norms to life” [9]

Hence, the consequence is the following: there can’t be any exact science of pathology. 

* Secondly, it’s quite surprising that, as a defense of his position, Canguilhem used an argument that is quite similar to yours.  He claimed that there must be a kind of continuity from the normativity of basic biological processes to the higher-order normativity of human consciousness, and he denied that this conception relies on a disguised dualism or anthropomorphism:

“We consider ourselves to be as vigilant as anyone else as to the danger of anthropomorphism. We don’t ascribe a human content to vital norms, but we wonder how we could explain the essential normativity of human consciousness if it were not, in one way or another, embodied in life events” [10]

 

* Thirdly, Canguilhem, as I said before, asserted relentlessly the importance of taking into account that the organism fits with its environment.  His favorite illustrative examples were taken from complex regulatory systems, as blood pressure regulation, thyroid functioning, endocrine conditions, etc. He always stressed the plasticity and flexibility of biological processes against a mechanistic and deterministic account of them. Meanwhile, he conceded easily that biological processes can’t be modified at will.  This passage is quite enlightening:

 “If we agree on the functional plasticity of man, according to the vital normativity inside him, we must admit that it is not a purely individual flexibility. To posit, with many reservations, that physiological human features are relative to human activity doesn’t mean that any individual could modify his glycemia or his metabolism at will, or solely by changes in environment. One can’t modify in few days what it takes the species several thousand years to achieve” [11] .  

 

According to this quotation, one might think that the normativity’s conception is rather close to your conception of intentionality. There are conventionalized rules – Canguilhem would say, in his own words, “norms” – that are always opened to revision and modification. That’s the main reason why, Canguilhem said, we can conceive a biological pathology, but not a physical or a chemical pathology.  I think this point matches up rather well with your distinction between causal and functional semantics. 

 

Let’s come to some questions in conclusion.  I will raise three questions:

1) I’ve tried to introduce two conflicting positions in order to shed a particular light on your work. I feel that the originality of your work consists in your attempt to accommodate, or perhaps to go beyond the two quite antagonistic conceptions of health and diseases, embodied in Boorse’s conception of function and in Canguilhem’s conception of normativity. It’s not my purpose here to drive you to swear allegiance for the one or the other. Nevertheless, I should ask you this question : to which position do you think your book is the closest?

 

2) It’s a quite general question and I would go on with two more specific questions. First, do you think your conception of intentionality has much to do with the goal-directness conception of biological processes in Boorse’s work -- standing on a rather epistemological point of view --, or with the biological normativity supported by Canguilhem -- standing on a rather ontological account -- ? In other words, would you subscribe to the life’s polarity view of Georges Canguilhem?

 

3) Lastly, does your account of the “intentionality of diseases”, which sounds rather similar to Canguilhem’s view than Boorse’s, imply that mental diseases should always be seen throughout coping strategies? Furthermore, and to paraphrase Canguilhem’s words, doesn’t it imply that the pathological state can finally be said normal, “insofar that it expresses a connection with life’s normativity”?



[1] Boorse, C. (1976). What a Theory of Mental Health Should Be. Journal of the Theory of Social Behavior , 6 (1), p. 81

[2] Ibid., p. 78

[3] Ibid.

[4] Canguilhem, G. (1943), Essai sur quelques problèmes concernant le normal et le pathologique, In Le normal et le pathologique, Paris, PUF, 1966, pp. 204-205.

[5]  Bolton, D., Hill, J.,(1996),Mind, Meaning and Mental Disorder, Oxford University Press, p. 274.

[6] Canguilhem, G. (1943), Essai sur quelques problèmes concernant le normal et le pathologique, In Le normal et le pathologique, Paris, PUF, 1966, p. 77.

[7] Ibid., p. 79.

[8]  Bolton, D., Hill, J.,(1996),Mind, Meaning and Mental Disorder, Oxford University Press, p. 99.

[9] Canguilhem, G. (1943), Essai sur quelques problèmes concernant le normal et le pathologique, In Le normal et le pathologique, Paris, PUF, 1966, p. 153.

[10] Ibid., p. 77.

[11] Ibid., p. 113.