(4) Philosophy and psychopathology Flashcards
What was the Ship of fools (15th)?
exclusionary practice: sending mad people away in ships.
What happened to ‘mad people’ in the 17th century?
17th: The Great Confinement - unreasonable” members systematically locked away and institutionalized.
What happened to ‘mad people’ in the 18th century?
18th: Madness (vs Reason) - having lost what made them human (i.e. reason), they became animal-like and therefore treated as such.
What happened to ‘mad people’ in the 19th century?
19th: madness was regarded as a “curable” mental illness (e.g. Pinel, Freud).
Foucault’s argument: 1.Early Middle Ages
Parallel between the medieval isolation of lepers and the modern isolation of madness
–Both lepers and the mad were objects of fear and repulsion; isolated in houses designed more for separation from society than for cures; used as joint signs of divine justice and mercy; and in some cases, funds and institutions originally meant for lepers came to be used for the mad.
Foucault’s argument: Late Middle Ages and early Renaissance
the mad led an ‘easy wandering life,’ madness having been recognized as part of truth.
Foucault’s argument: Mid-17th Century
The Age of the Great Confinement- exclusion and confinement were distinctive features of the Classical Age’s attitude toward madness
Foucault’s argument:19th century
posits a transition to madness as mental illness - Tuke and Pinel “invented” mental illness
The classical experience of madness: 1st level
1st level: Confinement as an economic policy meant to deal with problems of poverty (e.g. begging and unemployment)
- Getting a large class of idle, potentially disruptive people off the streets and putting them to work in a controlled environment
- Success? a failure - it hid but did not eliminate poverty
The classical experience of madness: 2nd level
2nd level:(Calvin) religious basis for the ethical centrality of work: those confined were not regarded as the neutral objects of unfortunate economic processes, but as moral troublemakers worthy of society’s condemnation and punishment.
-Implicit in the Classical condemnation of “unreasoning” behaviour was a deep restructuring of moral categories mad =animal “madness is assimilated to the broader category of unreason” It is detention rather than treatment of the mad that is characteristically Classical
How was psychiatry founded?
- psychiatry was founded on a false epistemology: illness diagnosed by conduct but treated biologically.
- challenge the core values of a psychiatry which considers mental illness as primarily a biological phenomenon, of no social, intellectual or political significance.
What are the two central contentions of psychiatry?
- The specific definitions of, or criteria for, current psychiatric diagnoses or disorders are vague and arbitrary, leaving too much room for opinions and interpretations to meet basic scientific standards.
- Prevailing psychiatric treatments are ultimately far more damaging than helpful to patients.
Criticisms of psychiatric authority
- inappropriate and overuse of medical concepts and tools to understand the mind and society;
- scientifically and/or clinically ill-founded system of categorical diagnoses (e.g., DSM) & stigmatization
- unexamined abuse or misuse of power over patients who are too often treated against their will;
- compromise of medical and ethical integrity because of psychiatrists’ financial and professional links with pharmaceutical companies and insurance companies.
Wakefield: The concept of mental disorder
- Sexual, racial and sexual orientation biases in diagnosis
2. Psycho diagnosis is often used to control or stigmatize socially undesirable behaviour that is not really disordered
Drapetomania (1851)
- a sickness of the mind that makes you want to run away.
- affects only black people
- does not seem to affect whites
- especially common in the American South in the early 1800s.
What happened to Homosexuality in 1973:
American Psychiatric Association removes homosexuality from DSM
-WHY? the weight of empirical data, coupled with changing social norms and the development of a politically active gay community in USA
What happened to Homosexuality in 1986:
Diagnosis was removed entirely from DSM. The only hint of ego-dystonic homosexuality in the revised DSM-III occurred under Sexual Disorders Not Otherwise Specified, which included persistent and marked distress about one’s sexual orientation (American Psychiatric Association, 1987; see Bayer, 1987, for an account of the events leading up to the 1973 and 1986 decisions).
-Q: Why is it important to understand the concept?
-A: For constructing “conceptually valid” diagnostic criteria that are good discriminators between disorder and non-disorder
The myth of the myth of mental disorder?
“Mental disorder” is an evaluatory label that justifies the use of medical power to intervene in socially disapproved behaviour.
Disorder as a pure value concept
-“Disorder is a value concept, and social judgments of disorder are nothing but judgments of desirability according to social norms and ideals”
WHO (1946/1981) defined health as
“a state of complete physical, mental and social wellbeing” - assumes that disorder is any deviation from a desirable and ideal state
Failures to define mental disorder led to pragmatics: Taylor (1976) :
“A disorder consists in part of the “attribute of therapeutic concern for a person felt by the person himself and/or his social environment”
many treatable conditions are not disorders
(e.g. distress due to normal vicissitudes of life, pregnancy, see also DSM-III-R for treating marital conflicts, adolescent-parent conflicts, etc)
Disorder as statistical deviance
- Physical and mental disorders: statistical deviance.
- The criterion is purely objective and scientific (see Sir H Cohen (1981) “disease as “quantitative deviations from the normal”)
Disorder as biological disadvantage
- The mind has evolved like other body-parts to serve a function.
- Important evolution-derived general criteria: lowered survival or lowered reproductive fitness
- Translates the earlier statistical deviation account into a biologically disadvantageous deviation account
- Disorder is anything that reduces longevity or fertility
Is Disorder as biological disadvantage correct?
- A1: No. A condition can reduce fertility, without causing real harm. In addition, some real harms (e.g. chronic pain) may not reduce fertility.
- A2: Different fertility rates between populations defined by racial, ethnic, economic, sex, personality and other variables (e.g. Black male in 90s US)
- definition does not distinguish between disadvantage due to dysfunction of internal mechanisms vs. harmful environment.
- the fact that certain mechanisms have been selected because they brought biological advantages in the past does not imply that a certain mechanism malfunctions if there is reduced fertility/ longevity NOW
Disorder as unexpectable distress or disability
- Unexpectable distress or disability - incorrect classification of greater than average normal responses as disorders
- -Many unexpectable conditions cause distress or disability but are not disorders
Wakefield: Disorder as a harmful dysfunction
- “The concept of disorders must include a factual component to distinguish them from other dis-valued conditions. Facts alone are not enough; disorder requires harm, which involves values.
- Thus both facts and values are involved in the concept of disorder”
What is natural function?
- Hemple (1965) “Each organ has many effects, most of which are not its natural functions. For example, the heart has the effects of pumping the blood and making a sound in the chest, but only pumping is a natural function.”
- “A natural function of an organ is an effect of the organ or mechanism that enters into an explanation of the existence, structure or activity of the organ”
What is dysfunction?
- Dysfunction is the failure of a mechanism to perform its natural (i.e. independently of human intentions) function!
- Mechanisms were naturally selected
- Thus, an evolutionary perspective is needed for understanding psychopathology
- Dysfunction is a purely factual scientific concept.
Why dysfunction is not enough?
- Why? Natural functions of internal mechanisms were determined by selective pressures in radically different environments.
- Selective pressures have changed - a breakdown in the natural function of a mechanism may not have the negative consequences that once had
- e.g. male aggression
- Only dysfunctions that are socially disvalued are disorders
Wakefield: A condition is a disorder if and only if
- (a) the condition causes some harm or deprivation of benefit to the person as judged by the standards of the person’s culture (the value criterion),
- and, (b) the condition results from the inability of some internal mechanism to perform its natural function,
- wherein a natural function is an effect that is part of the evolutionary explanation of the existence and structure of the mechanism (the explanatory criterion)
Dennett’s three levels 1. Physical stance:
the level of physics and chemistry (mass, energy, velocity, and chemical composition).
-“When we predict where a ball is going to land based on its current trajectory, we are taking the physical stance.”
Dennett’s three levels 2. Design stance:
the level of biology and engineering (purpose, function and design)
-“When we predict that a bird will fly when it flaps its wings, on the basis that wings are made for flying, we are taking the design stance”
Dennett’s three levels 3. Intentional stance:
the level of software and minds (belief, thinking and intent)
- “When we predict that the bird will fly away because it knows the cat is coming, we are taking the intentional stance”.
- “Mary will leave the theatre and drive to the restaurant because she sees that the movie is over and is hungry”
