Philosophy of mind and mental disorder: Trouble in cultural sciences?
Pr Bolton and Pr Hill, your book is written in the hope that natural sciences will help us, better than cultural sciences, to deal with mental disorder. But you think that a causal explanation of mental disorder can’t be led on the basis of a non-intentional causality. I would like to explore with you the project of a cognitive psychiatry, which implicates a naturalized intentionality. I will do it according to my own works, concerning the French psychiatry of the nineteenth century.
1/ The philosophical foundations of psychiatry
First of all, I would like to underline one of the main motive of your book, because of its worth, and in the same time, the questions that it raises. Mind, meaning and mental disorder rests on a fact: the philosophical foundations of psychiatry have been neglected. As you point it out: “The former debate did not concern primarily the concept of disorder, nor, a related point, psychiatry in general. The latter debates certainly were about psychiatry and the notion of ‘mental illness’, but their problems were social, political, and historical, not primarily philosophical” (p21). Your book has been written to correct such an omission, and I’m very sensitive to the pertinence of your report and proposals. Nevertheless, I’m less convinced by your solution. Your plan is to apply post-empiricist epistemology to psychology and clinical psychology (p39), and I think that it leads us right back to the conflicting relations between philosophy and science, which often formed the subject matter of some debates of history of science. Of course, I will here limit my intervention to mental medicine, and more precisely, the way the problem rose in France.
In France, the psychiatry of the nineteenth century inherits some theories of the mind, especially from Locke and Condillac, which fit in with, respectively, empiricism and sensualism. In his Treatise on insanity, Philippe Pinel (1745-1826) takes on this legacy and claims it. But he examines them closely, and puts them through the riddle, because he thinks that the clinic of mental illness, which he is beginning to prepare the ground, allows appreciating the interest of philosophies of mind. Therefore, he reverses the relation of subordination: the psychiatric knowledge is not depending on theories of mind, but can help to review them. So, the nascent psychiatry questions the nature of the relation that it can remain on philosophy, and assesses the value of what it borrows from its time. The stake is nothing but the rational autonomy of psychiatry.
It turns out that you radically part, on this point, with Pinel. I quote you: “The starting point of this book is the assumption that theories of the mind need to provide an account of order and disorder, which have been traditionally the domain of psychology and psychiatry; and that psychology and psychiatry need to understand the nature of their explanations, which is the province of the philosophy of mind and philosophy of science” (p. xiv).
Obviously, you don’t only suggest that philosophy may contribute to clarify the kind of explanation that psychology and psychiatry give from mental disorder. You go much further, and we can wonder if you also don’t dispossess psychiatry of its prerogative. Your argument, if I’m right, is as follows: as mental is equivalent to intention, the scientific explanation of mental disorder is a matter for intentional causality. So, it clearly appears that you don’t only want to study the philosophical foundations that psychiatry has historically developed; you intend to give to psychiatry its correct philosophical foundations. Hence, doesn’t such a programme bring up back to Pinel, and the way that he discusses the nature of relation between psychiatry and philosophy?
My first questions, also, turn on the weight of your philosophical postulates:
- Isn’t, in your view, the nature of what is a mental disorder totally determined by the kind of explanation the naturalized theories of the mind can provide?
- Can still psychiatry contest the value of the theories of the mind? In other words: can science not totally depend on philosophy?
2/ Mental disorder as a psychological defect
The way you choose to define the philosophical foundations of psychiatry is notably a means to put forwards valid arguments against the project of Guze’s naturalized psychiatry. You conceive the cognitive psychiatry as an alternative to his ontological reductionism and what its motive is: the non-intentional causality. The mental disorder has to be thought in the intentionality level: “insofar as intentionality is the defining characteristic of mind, all mental disorder involves breakdown of intentionality” (p280).
Again, your book leads me to a difficulty which with the first psychiatrists have been confronted. Pinel refuses, contrary to Antoine Bayle (1799-1858), to reduce mental disorder to a non-intentional causality and what is its rest: a mental disorder conceive as a psychological defect reactive to cerebral lesions, leading to death. Bayle, indeed, intends to present his discovery of general paralysis as a model for mental medicine. So, what’s a lunatic, in such a view? I quote him: “Pushed by a cause that chains up their intelligence and their will, they don’t know what they do, nor where they go, and don’t have conscience of their existence” (p34).
Pinel is of the opinion that lunatic isn’t a demented person, because lunatic is dominated by his passions. He isn’t mentally much less alert by lesions, but driven by passions. Through the rhetoric of passions, psychiatric rationality is the concern for intentionality:
1) All passions are passions of something: a) any passion has an object (lover passion, religious passion…); b) any passion encloses presence of other people: the others cause my sorrow, raise up my love, excite my anger…
2) Mental disorder, when located to the level of passion, takes note of these intentional dimensions. Lunatics aren’t demented persons, because they don’t spend their “life to wander, without goal and intention” (p40). Lunatics fit their actions to their beliefs; they adjust their behaviour to their passions.
Pinel thinks that mental medicine isn’t only the accountancy of psychological defects attributable to cerebral lesions, because his point of view is very pragmatic. 1) As a psychiatrist seeing everyday some lunatics in asylum, he takes note of their extreme sensibility to the way they are treated, to the cares they receive, to their relationships… 2) As a medico-legal expert, he notices that lunatics are able to take care of intentions of alienist who are commissioned to evaluate the nature of theirs mental disorders: lunatics are able to hide their troubles, they can put off the scent. Demented persons can’t do this.
Pinel’s experience teaches him the sensibility of human beings to their historical and social context, just as well to their material conditions of existence. His assumption is that social reign is not less natural than organic reign. That’s the philosophical foundations of his moral treatment.
So, the moral treatment shows the weight of intentionality in the mental medicine’s rationality, and it gives an account of the disagreement between Pinel and Bayle. In a sense, you seem to join Pinel, when you oppose to the thesis of Guze, who “looks forward to a time when psychology and psychiatry will be replaced by neuroscience” (p273). Nevertheless, you don’t follow him no more on his main thesis: causes of mental disorder are the most often “moral”, that is to say linked with culture and society, and finally the ‘artificial’ passions which appear because of the growing complexity of civilization. Pinel takes into account of the cultural sciences, because of the twofaced nature of human beings. That’s the main part of his “philosophical medicine”. But you don’t: it’s essential to your plan that psychiatry becomes a part of natural sciences, and that biological sciences are as “equally natural” as physics and chemistry. Therefore, your goal is to determine the nature of causal explanation in psychology and psychiatry, in order to have a definition of what is a mental disorder. My question is about the order of priority of such a proposal:
- Don’t we need to know firstly what is a mental disorder on the moral and cultural levels, to know consequently what must be a correct explanation in psychology and psychiatry?
We can easily see, through your arguments, that your philosophy of science and your philosophy of mind determine more than the nature of a causal explanation in psychology and psychiatry. They determine, in my view, the nature of order and disorder themselves, because in the post-empiricist epistemology, trouble in intentionality can’t be nothing else but a “failure”, an “error”, a “persistent disarray” (of thought or action). I’m not sure to understand what it really means, and I suspect that it’s more complicated than it seems. As I can face it, it’s a very suggestive proposal, because of its intuitive content (if the lunatic fails to take reality into account, his actions can’t be successful). But:
- Doesn’t post-empiricist epistemology compel us to conceive mental disorder as a psychological defect, as “radical failures of intentionality” (p280)? Doesn’t it make us unable to consider mental disorder outwards the modality of breakdown, and at the same time, mental health outwards the modality of success and victory?
3/ What is disturbed?
As we have seen, psychiatry, from its birth, tried to define mental disorder according to its intentional nature. That’s the idea, at least, of Pinel, and that’s why, in his view, mental medicine has to take note of the intentional dimension of lunatics’ behaviour. His descriptive paradigm is commanded by the purpose to integrate the moral dimension (ways of life, habits, values and ideals on which lunatics settle their existence) of human life into the definition of mental disorder. Hence, the importance of accuracy as regards of description, in the Pinel’s psychiatry: it’s the (necessary and sufficient?) condition of knowledge. All things considered, to know what is disturbed, we need to know what is disturbed. Doesn’t the inflation of the descriptive method in psychiatry drift away from this requirement?
Since Anscombe has written Intention, we know that we can’t evoke an action without speaking of its description. To determine what is in disturbed, we must give a right description of what’s it all about in mental disorder. If we accept this assumption, the large descriptions seem to be useful than the narrow ones, because of their abilities to tell us exactly what is in disorder. So, I would like to do the link with the dispute which actually – and for some years, in fact – dominates the French debates:
- As you insist on the nature of causal explanation to the detriment of the descriptive method, don’t you participate, in your own manner, to weaken the clinical subtleties, that is the fine grain descriptions made with the help of moral/social/cultural vocabulary?
Your book do interests me because it takes up the challenge of intentionality in mental disorder. It questions me, nevertheless, about the way you deal with intentional causality in the framework of naturalized epistemology, because of the consequences on the nature of disorder, and through it, of mind. That’s what surprised me, reading your book: disorder in intentionality finally causes trouble in the cultural sciences. So, I think the main problem is connected with the nature of mind. Hence, my last question:
- Is it not the case that naturalized epistemology lead to give preference over instrumental action, the one which is made with a view to…? Then, doesn’t it reduce the mind to these intentional processes whose function is to planify the action?