Reductionist Dualism?

[toby jones]

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I remember being fairly puzzled by something my abnormal psychology lecturer said in class all the way back when I was an undergrad. Was fairly tempted to write it off as nonsense, but now I find that it recurrs.

In her new book (available online) Rachel Coopers cites the DSM IV as follows:

'The DSM-IV notes that there seems to be much that is "physical" in "mental" disorders, and much that is "mental" in "physical" disorders, but then it goes on to condemn any attempt to distinguish mental and physical disorders as a "reductionistic anachronism of mind body dualism".

http://www.springerlink.com/content/j410388784556182/fulltext.pdf

This is the bit that worries me 'a reductionistic anachronism of mind body dualism'. In particular: The pairing of 'reductionism' and 'dualism'. You see, in philosophy 'dualists' are aka 'anti-reductionistic' and 'reductionists' are the paradigmatic 'anti-dualists'. One simply can't be a reductionist dualist on pain of contradiction.

And yet my abnormal psychology lecturer seemed to think that 'reductionistic dualism' was rife in psychiatry (in particular) and in some areas of neuropsychology as well. In fact, she said something about how 'somatoform disorders are less prevalent now because of the rise of reductionist dualism'.

What to make of this?

I shall attempt something diagnostic...

PHILOSOPHY

CARTESIAN DUALISM - There are two distinghishing features of Descartes view that any (decent) first year philosopher will tell you. The first is that Descartes is a SUBSTANCE dualist. There is matter on the one hand and immaterial mind/soul stuff on the other. This is to distinguish Cartesian dualism (two substances) from other (more reputable) forms of dualism such as property dualism (two kinds of properties). Where property dualism might possibly be true philosophical consensus is that substance dualism is false. The second is that Descartes is an INTERACTIONIST dualist. He accepted that matter can cause changes to mind (as when a wack on the head with a plank renders someone unconscious) and that mind can cause changes to matter (as when my intention to raise my aim results in my arm being raised). This is to distinguish Cartesian dualism (interactionist) from other, non-interactionist forms of dualism (such as epiphenomenalism or Leibniz pre-established harmony). Of course Descartes had the rather silly idea that the pineal body was the seat of the mind / matter interaction, but philosophers think that there was more that was silly about the notion of material substance and immaterial substance interaction than that...

PSYCHOLOGY / PSYCHIATRY

CARTESIAN DUALISM - While philosophers tend to look back on Descartes view and remember him as being hopelessly misguided in positing this non-material soul stuff, psychologists and psychiatrists seem to focus on a rather different aspect of Descartes view. If we look at what went before Descartes we had the rather widespread belief that there was a lot about human beings that couldn't be understood mechanistically (scientifically). It was thought that hearts couldn't be undersood mechanistically, for example. Descartes was rather revolutionary for his time in maintaining that the human body and the human brain could be understood mechanistically. Descartes basically proceeded to shrink the soul (that lay beyond scientific understanding) as something that effected changes only by way of this tiny little neural structure - and psychologists and psychiatrists seem to remember him for that rather than remembering him as the ass that didn't do away with the whole damned thing - as the philosophers do.

There seems to be another aspect to usage of the term 'dualism' in psychology / psychiatry, however. And this seems to be what the DSM (and my psychology lecturer) were getting at.

METHODOLOGICAL DUALISM

Now I'm just talking out of my ass doing my best to understand what people are trying to say. Now philosophers tend to focus on the INTERACTION that Descartes maintained held between the mind and the body (this is what distinguishes his view from Leibniz view and from epiphenomenalism). Psychologists and psychiatrists tend to focus on their being a radical divide, however. The idea behind methodological dualism seems to be that we can proceed to study physical processes (brain, body) while totally ignoring the mental processes. And conversely, we can proceed to study mental processes (e.g., psychodynamically) while totally ignoring neurological / bodily processes.

And the consensus seems to be (the PC view at any rate) that that is a bad idea. We should think a little more... Well... Like Descartes with respect to the interaction.

REDUCTIONISM - PSYCHOLOGY / PSYCHIATRY. This seems to be a METHODOLOGICAL view rather than an ONTOLOGICAL view. The idea seems to be that we can proceed to study the brain / body while totally disregarding the mind. So... The reductionist view is that we jolly well should get on with doing that. I guess the typical take on 'reductionism' is that one is a biological reductionist. Of course it could go the other way and one could be a mental reductionist if one thought that one could study mental processes in the absense of physical / neural processes. I guess some psychoanalysts might be inclined to this view.

REDUCTIONISM - PHILOSOPHY. Reductionism in philosophy is an ontological thesis. The idea of doing serious metaphysics is to come up with a list of how many different kinds of basic stuff there are. The thought is that once you have the basic kinds of stuff fixed then you have fixed all the other kinds of non-basic stuff for free. So... On day one God fixed the distribution of physical stuff (as studied by physicists) and then he rested. The thought is that he didn't need a day two to fix the distribution of chemical stuff and a day three to fix the distribution of biological stuff. The thought of reductionism is that mind is NO SUBSTANCE OVER AND ABOVE THE KINDS OF STUFF STUDIED BY PHYSICISTS. Hence we get to our contradiction... Dualists (as an ontological thesis) deny reductionism by maintaining that while God could well have fixed the state of the physical world on day one God still had more work to do. On day two he had to fix the state of the non-physical stuff, you see.

So... If we read the philosophers as saying
'Cartesian Dualism1 contradicts reductionism1'
and we read the psychologists / psychiatrists as saying
'Cartesian Dualism2 implies reductionism2'
and we read 1 as ontological / metaphysical
and we read 2 as methodological
then people are just talking past each other really...
Aren't they???

So... Back to my abnormal psychology lecturers claim.

'Somatiform disorders are less prevalent now because of the rise of cartesian reductionist dualism'

If she is making a methodological claim then we can read her as saying:

'somatiform disorders are less prevalent now because of the rise of people studying neurobiology in the absense of mental/psychological causal mechanisms' then that might possibly be true. Controversial. But might possibly be true.

Whereas if she means to say that more people believe in an immortal soul in this present age compared with the age of Descartes...
And if she means to say that dualism is a form of reductionism in the metaphysical sense...

Then she really would be talking nonsense.

Why can't people just all agree on a standard terminology and stick to it? Sigh...

 

[watto]

Have you read Gerald Edelman? I just finished Second Nature and am starting in on his earlier work and primary references. His dualism-challenging work on neural Darwinism is so promising, and a paradigm shift, really. I am having a hard time understanding his argument against evolutionary psychology, other than that it is not far-reaching enough for his needs. In Second Nature, the chapter on abnormal psychology is so brief...largely because the research into specific disorders using Edelman's theories probably doesn't exist (yet).

 

[whopper]

Its wierd.

Where is the exact line dividing the physical vs the mental aspects? There is no set rule and sometimes, where the lines blur, there are problems between differing departments.

I've always had an interest in figuring out if there is a circuit in the brain that explains the soul.

 

[toby jones]

> Have you read Gerald Edelman?

No, but I think I've heard the name. Did he do some work on the expression of emotions across culture?

> His dualism-challenging work on neural Darwinism...

I'm not sure what 'dualism' means anymore... Do you mean that he challenges the software/hardware distinction (some neuroscientists are hostile to it, for example)? Or do you mean that he argues that the mind and brain interact (because change to mind can cause changes to matter and vice versa)?

> I am having a hard time understanding his argument against evolutionary psychology

I don't know what his line is (or what his arguments are). There is a lot that has been done in response to Evolutionary Psychology (that is 'EP' - with Capital Letters). While there is some good work that is being done along broadly evolutionary lines Evolutionary Psychologists (with Capital Letters) seem to commit themselves to the following (probably false claims):

- The mind is massively modular. Paradigmatic examples of modular processes include language processing and perceptual processing. There are about six different features of modules (which can probably come apart) but they are meant to be fast, automatic, process a narrow range of stimuli, there is meant to be more communication within a module than between modules (so some degree of information encapsulation), and I forget the rest. While most agree that language processing and perceptual processing are modular many have disputed the claim that most of our mental processing is like that. In particular, there might be a 'general processor' or 'central system process' that can take the output of most modules as input and reason across modalities (for example)

- The mental functions were fixed back in the plastacine (I think I got the time period right - the point is they were fixed long ago at any rate). Hence you get explanations of phobia as an adaptive response to our PAST environments (and a maladaptive response to PRESENT environments). One problem here is that surely neural plasticity / adaptiveness to new environments is one function that would have been promoted by evolution by natural selection.

There are other committments, but I forget. Is this at all along the lines of what you have been reading or have I just gone off on a side-issue??

 

[toby jones]

> Where is the exact line dividing the physical vs the mental aspects?

The best thing I've seen on this (with respect to the philosophy distinction and the psychology / psychiatry distinction) is in a fairly recent article in a journal called 'Philosophy, Psychology, and Psychiatry' (PPP) 'What is Mental about Mental Disorder?'

http://muse.jhu.edu/journals/philosophy_psychiatry_and_psychology/v013/13.2brulde01.pdf

(Access via muse subscription - you should have institutional access).

In philosophy the three main candidates for distinguishing the mental from the physical are (in no particular order):

1) Subjectivity (only I can experience my particular pain and a particular pain must be experienced by someone)
2) Qualia (the felt quality of experience, the 'something it is like' to have them)
3) Intentionality (aboutness or directedness. Thoughts are thoughts ABOUT something and experiences are experiences of (or about) something. They have representational content where they represent something other than themself.

Paradigmatic instances of mental states in philosophy include the experience of pain and seeing red. But of course having a pain and being colour blind are not MENTAL disorders and hence the distinction that is relevant for psychology / psychiatry seems to be different from the distinction that philosophy is trying to capture.

Terminology once again, sigh.

Some have argued that the current distinction between neurology and psychiatry is merely a matter of historical accident. Others feel that there is a principled distinction lurking. In particular (here are two attempts to capture it)

1) A mental disorder has mental causes. Paradigmatic example: Psychosomatic disorders. Trouble is that paradigmatically physical disorders can have mental causes, too, as when my stressing causes me to have a heart attack.

2) A mental disorder has mental symptoms. Paradigmatic example: Mood disorders. Trouble is that paradigmatically physical disorders can have mental symptoms, too, as when someone with HIV depressed about that.

> I've always had an interest in figuring out if there is a circuit in the brain that explains the soul.

Is the soul the same as the mind, do you think, or is it something else? One way to figure that out might be to think of the properties that you think the mind has, and then think of the properties that you think the soul has, and then see if the properties on the different lists are the same.

E.g., remembering. Feature of the mind or feature of the soul? (If you want to have memories in heaven you might want to make that a feature of the soul... But maybe you want it to be a feature of the mind as well).
Conscious experiencing.
Thinking.

And so on...

Once you have listed the mental / soul processes that you are interested in... I guess then what we want to know is... Whether one area is crucial (necessary and sufficient??) for those processes? If you have such diverse mental / soul processes in mind as speaking, understanding, remembering, thinking, dreaming, imagining, experiencing colour sound taste smell... Then I don't think you are going to find a single area, no.

Dynamic models with feedback loops (HOT - higher order thought) theories of consciousness are most promising, I think. There might be something in common to conscious experiences (not sure it will be occilations at 40Mhz) but there might well be something... Depends what you mean by 'circuit' (e.g., does it need to be localized or can it have highly abstract properties in common)??

 

[watto]

After reading your two posts, I am itching to get the most recent Edelman book into your hands. You would love it. Pretty brief read, about 260 pages, with lots of excellent references if you want to read the papers quoted in the text. Edelman won the Nobel for 1972 for his work in immunology. His work tracing evolutionary mechanisms in his own field led him to extrapolate into the realms of philosophy and psychology. He currently heads the Neurosciences Institute I believe in the La Jolla area and is working on brain-based devices that use neural substrates in an effort to examine processes of consciousness. Crazy stuff, and definitely on the margins now but possibly setting the stage for the way we study the mind in the near future.

> His dualism-challenging work on neural Darwinism...

I'm not sure what 'dualism' means anymore... Do you mean that he challenges the software/hardware distinction (some neuroscientists are hostile to it, for example)?

His argument is that the mind is based in matter. As he states regarding trying to do better than substance or property dualism, "We can do better, but we cannot do it by assuming...that the structure and biology of the brain are incidental and not central to the enterprise."

Regarding consciousness, he is quick to point out his theory that it is a process, not a substance, and a process that arises by the interplay of neural connections that arise via Darwinian processes. The theory of neuronal group selection begins 1) developmentally due to growth factor signaling, selective apoptosis, etc, followed by 2) experiential selection with selective strengthening or weakening of synapses as a result of behavior and subsequent formation of neuronal groups, and then 3) reentry, or linking of these neuronal maps.

I highly recommend "Second Nature," it's a good starting point for his work.

 

[toby jones]

I was thinking of Ekman rather than Edelman.

> He... is working on brain-based devices that use neural substrates in an effort to examine processes of consciousness.

Ah.

> His argument is that the mind is based in matter.

So he is a materialist rather than a dualist.

> "We can do better, but we cannot do it by assuming...that the structure and biology of the brain are incidental and not central to the enterprise."

I guess it depends on what the enterprise is. There are some good reasons for being a property dualist - but they are considerations that are fairly foreign to psychology and psychiatry.

One version of Leibniz Law: If A has a property that B lacks then A cannot be identical to B.

Neural process A has the property of being in my head.
Pain B has the property of being in my toe.
Therefore, by Leibniz Law a neural process cannot be identical to a pain.

(One can of course deny one or both premisses in which case one isn't forced to accept the conclusion. These are the sorts of considerations that motivate dualism, however).

Zombie argument.

Imagine a possible world that is a molecule for molecule duplicate of this world - down to the last sub-atomic particle. You have a counter-part on this world (as I do) and your counter-part behaves as you do (says the things you do, does the things you do, etc). Now here is the crucial part... Even though this possible world is (by stipulation) an exact duplicate of the distribution of matter in this world and the laws of nature in this world etc... Surely it is possible that WHAT IT IS LIKE TO BE your counter-part twin is like nothing at all (which is to say that the EXPERIENCE of your counter-part twin is like your experience when you are in a dreamless sleep). The idea is that... Conscious properties are NOT entailed by physical structural / functional properties of our world.

Not everybody has zombie intuitions, but this is one of the main driving intuitions behind being a property dualist.

If we pretend for the sake of argument that we can study mentality in abstraction from neurology then what kinds of research projects can we get up off the ground?

- AI. The whole assumption behind (hard) artificial intelligence is that we can make a material object of a different kind of stuff (e.g., silicon chips instead of neurones) that will instantiate mental processes similarly to how we instantiate mental processes (e.g., thinking, remembering, communicating, information processing, experiencing). Strictly speaking, AI theorists are functionalists (x is conscious if x plays the consciousness role / function). Functionalism is compatible with either dualism or materialism.

And that is just one... If we really grant property dualism:

- The contents of consciousness. We can study the content of experiences (e.g., to represent that something is coloured entails representing that something is red. To represent that something is red entails representing that something exists. Etc).

Thanks for the book reccomendation, though. I will have a look one day (though a bit time pressured at the mo).

He should give you a job in sales 🙂

 

[chippedogic]

Interesting thread, sadly there are no true answers to the 'mindbody' paradigm at this time. I try not to subscribe to a reductionist approach, but feel that one cannot seperate the mind from body, thus a 'mindbody'. Through interactions, dialectuals, and other similar sorts are the environment and 'mindbody' existing. A 'mindbody' does not exist without communication, either within itself or environmental. David Abrams is an interesting anthropologist turned ecological-psychologist that goes into these issues in systemic connections between mindbody, environments, and cultural bound behavioral patterns.

Have you heard of artificial life and/or artificial death? Chris Langton has interesting takes on aspects of consciousness and environmental systemics/dialectuals with 'mindbodys'.


ps
I am going to get a hold of that recommended Edelman book.

 

[howelljolly]

Im dumb.

I've got a bachelors in psychology with a minor in philosphy.... plus, two years of work and three years of med school that has rotted my brain.

Can anyone point me in the right direction with some suggested readings on this topic?

 

[watto]

Im dumb.

I've got a bachelors in psychology with a minor in philosphy.... plus, two years of work and three years of med school that has rotted my brain.

Can anyone point me in the right direction with some suggested readings on this topic?

"Second Nature" by Gerald Edelman!😛
He includes a decent primer at the start, covers Decartes, William James, the behaviorists, then launches into the neuroscience.
Went to a lecture last night by Antonio DiMasio, at USC, regarding consciousness and the mind--he echoed some of the tenets of neural Darwinism as well...it's fast becoming part of the vernacular I suppose.

 

[howelljolly]

"Second Nature" by Gerald Edelman!😛
He includes a decent primer at the start, covers Decartes, William James, the behaviorists, then launches into the neuroscience.
Went to a lecture last night by Antonio DiMasio, at USC, regarding consciousness and the mind--he echoed some of the tenets of neural Darwinism as well...it's fast becoming part of the vernacular I suppose.

You went to a lecture by Antonio Damasio?!?! Well color me green. Ive read Damasio, and some Koch... and I still don't know what you and Toby are talking about.

Thanks though, I'll pick up some Edelman.

 

[toby jones]

I wasn't quite sure what kind of stuff you were interested in learning about. Evolutionary psychology? Tooby and Cosmides is the classic reference. The Evolutionary Psychology program has come under some fierce criticism, though. Some of it is known as 'the modularity debate'.

The following looks quite good (I might just give it a read):

http://www.anth.ucsb.edu/projects/human/evpsychfaq.html

But I wasn't sure what you were interested in, in particular.

 

[howelljolly]

I'm interested in cognitive neurobiology in general. I havent done any reading in the last 2-3 years, outside of med school. But I had an interest in neuroscience's answers to very basic philosophical questions; especially about perception, conscousness, ego, and recently, religious belief.

I didnt actively persue those topics, but I got a kick out of it when they came up in my reading.

I was really interested in your original posting because, what it made me think about was complex philosophical answers to basic psychological questions. What you were saying was really on point with what I was looking for as an undergrad, but never actually found.

So, it got me thinking about the interface between psychiatry and philosophy, and what's been written about it lately.

 

[toby jones]

'Graham and Stephens (1994) distinguish three different ways of doing philosophical psychopathology. The first draws on clinical literature to support positions in the philosophy of mind, the second studies the ethical and experiential dimensions of psychopathology, and the third, part of the philosophy of science, looks at methodological issues in the science of psychopathology. Most of this book is at home in the third of these three bodies of thought. The book is a piece of philosophy of science, and it tackles three problems in the science of mental illness. One problem is that of a correct taxonomy and two problems are about how to understand the taxa. I ask how to conceive mental disorders in a methodologically fruitful way and how to explain them, as well as how we should classify them'.

"Psychiatry in the Scientific Image"

http://mitpress.mit.edu/catalog/item/default.asp?ttype=2&tid=10687

The relation between science and philosophy is very controversial. The work that some philosophers do it more along the lines of logic or mathematics. Sometimes it is hard to see what that project has to do with science. The work that other philosophers do is naturalistic, or more scientific, however. Different philosophers show more or less willingness to read and learn about the findings of the scientists. If one is scientifically inclined it can be hard to even begin to motivate the 'rationalist' project. I guess that the problems that some of those philosophers are grappling with are problems that are fairly far removed from anything that science could discover. (E.g., you don't try and figure whether some mathematical theorim is true by looking to the world).

Often the problems that philosophers are grappling with are different from the problems that scientists are grappling with and that can lead to a whole heap of talking past. For example, philosophers are interested in mind and matter with respect to metaphysics. Most psychologists / psychiatrists fail to understand the philosophical motivations for being a dualist (because they haven't been trained in the problems). This can lead to their making bold claims about its truth or falsity - because they simply fail to understand the problems that motivate the positing of either one or two kinds of stuff / property / process.

Similarly, philosophers often make a complete botch of philosophy of science because they don't pay enough attention to the scientists. Analytic philosophy of science is most remembered for its logical positivism which only served to alienate the special sciences (all but physics) from looking to analytic philosophers for help with their problems. Some are trying to make amends... But it is hard work.

I guess I'm more interested in the methodological problems these days. This just came out, and I find it really very interesting.

http://philosophyofbrains.com/2007/06/21/explaining-the-brain-is-out.aspx

The thing with interdisciplinary work is that one runs the risk of ****ing things up from both ends. Can be hard enough doing just one thing properly.

There are more and more people doing naturalistic philosophy of mind (looking at phenomenon like synasthesia, delusions, hallucinations etc to tell us something about the right theory of mind). There are also more and more people doing naturalistic philosophy of science (looking at what the special sciences are up to and trying to understand what the problems are in order to attempt to give them a hand).

Good work is rare (as is often the case).

And... Philosophy of psychiatry is a very new field indeed. Philosophy of psychology is a little bit older.

This is a good resource for philosophy of psychology / mind / consciousness / cognitive science / psychology etc...

http://consc.net/mindpapers/

 

[toby jones]

We need a distinction between intension and extension.

The intension of 'water' is the watery stuff that falls from the skies and fills the lakes. The drinkable, potable stuff. The stuff that looks like water and sounds like water and tastes like water. It is (something like) our idea of water and / or our beliefs about it.

The extension of 'water' is the nature of the watery stuff that falls from the skies and fills the lakes etc. Its nature (the extension) is to be discovered by science.

It is possible for the intension and the extension to come apart.

For example, lets imagine this place called 'twin earth' which is on the other side of the solar system. Now, on twin earth there is something that plays the watery role (has the same intension as water). That is just to say that there is stuff that fills the lakes and oceans and that is drinkable and potable etc.

Now... On earth, scientists found out that the extension of water was H2O. That is to say that the intension guides us to the stuff and the nature of the stuff (the extension) is H2O.

Now... On earth, we tend to say that water IS H2O.
Now... Identities are necessary. That is to say that if 'water is H2O' is true then it is necessary that 'water is H2O' which is another way of saying that water is H2O on all possible worlds.

So it follows that the stuff on twin earth is not water - as the stuff on twin earth is not H2O. It doesn't matter that they have stuff that has the same intension as our water (stuff that falls from the skies) that stuff is NOT water as that stuff is NOT H2O. Now if we found that the black tarry stuff that the twin earthians pave their roads with was made out of H2O then the correct thing to say about that is that they pave their roads with water!

Water is a 'natural kind term'. Which is to say that when the intension and extension come apart 'water' tracks the extension.

Now lets imagine another twin earth. This time it is a qualitative duplicate of this world but lets imagine that its fundamental nature is different. In particular, there aren't any biological beings on this twin earth. There are counter-parts of me and you, but these beings are made of silicon instead of being made of brains.

Now... Does it seem possible to you that those beings have conscious experiences?

If you think they do have conscious experiences then it follows that consciousness is not identical to a biological process. It seems that in the case of water when the intension and the extension come apart the term 'water' tracks the extension. Science study's extensions.

But in the case of consciousness... It seems that when the intension and the extension come apart the term 'consciousness' tracks the intension.

So... The upshot of this is... That consciousness is not to be identified with a biological process. Even if we find out that consciousness is correlated with biological processes on earth - consciousness isn't to be identified with biological processes because identities are necessary. But... There is nothing necessary about consciousness being a biological process. Whereas with water there is something necessary about water being H2O.

This is a fact about our terms...

We could talk about consciousness1 that tracks the intension...
We could talk about consciousness2 that tracks the extension...
Scientists talk about consciousness2 for the reason that science can't help us with consciousness1. But then when scientists talk about what they have found about consciousness... Or when scientists talk about what they think about consciousness... the philosophers will wonder what on earth that has got to do with the consciousness1 that really interests the philosopher.

And THAT is the hard problem of consciousness...

 

[solumanculver]

Hi Toby,

It's always really interesting to read psychological/scientific accounts of consciousness. They're generally distinguished by a complete lack of relevance to anything that resembles "consciousness", in the philosophical sense.

I spend a lot of time studying neuroscience and philosophy, which I guess you must do as well... In general I don't think that there's any place for consciousness in science... and definitely not medicine.

There's simply no observable thing called "consciousness" for us to make a scientific theory about... unless each scientist is supposed to observe their own consciousness as their single data point... which is deeply flawed, to say the least.

As for intensions and extensions... have you read Chalmers' "the foundations of two-dimensional semantics"? It's amazing how much real-world stuff can hinge on a semantic theory... Most of the philosophical arguments that I make (to myself...) are based on the two-dimensional framework, and I think that, in general, a lot of philosophical questions can be approached really effectively with it.

Luckily for you, (and me, I suppose), all of the problems in the philosophy of psychiatry are "easy" problems.

I suppose this is a question from another thread, but what do you consider to be the correct way to approach finding a definition for "disease"? If one can be found that includes all things like the flu, and sprained ankle, but omits Schizophrenia, and another can be found that includes all the psychiatric diseases, which one means "disease"? Or does it matter anymore?

Physicians do things other than treat disease... they also give actresses larger breasts and smaller noses... If schizophrenia turns out "not to be a disease" under some definition, then do psychiatrists fall under the same category as plastic surgeons? Or is there any systematic correlation between medical treatment and disease at all?

When people make arguments that psychiatric diseases are not diseases, what is their social agenda? To keep psychiatric patients from being treated? To keep them from receiving disability? To prevent medication but not psychotherapy? Aren't they just playing semantic games in any case... since we don't have a definition of disease to begin with, it can't be said with certainty that "X is not a disease"... if X falls into our a priori conception of disease, then we just need to find an intension that maps to a set including X and we'll have validated the intension with respect to X... Now just find one that does it for all diseases.

Do we really need a definition like that though? An intension is a function... You put in a world as an argument and you get out the set of things that meet the description in that world... But not every function can necessarily be defined analytically... look at qualia terms, we have a word "pain" that in our world maps to "qualia we call pain"... it's not specifiable, but it's still an unambiguous function... If we can identify, line-by-line what we mean by the set of all diseases, we can just say that the word "disease" maps to that set... and whatever property is held exclusively in common to that set will be the intension, but as long as we know that it's well-defined do we really have to translate that exact property into English?

 

[toby jones]

If suffering is necessary for disease (which it probably isn't)
And if suffering requires the capacity for consciousness1 (which it probably does)
Then the capacity for consciousness1 would be necessary for disease.

(Though perhaps plant diseases show us that suffering isn't necessary after all)

I'm not sure how consciousness1 will tie in to psychiatry... Have no clue.

> what do you consider to be the correct way to approach finding a definition for "disease"? If one can be found that includes all things like the flu, and sprained ankle, but omits Schizophrenia, and another can be found that includes all the psychiatric diseases, which one means "disease"? Or does it matter anymore?

I think that we are less interested in what concept of disease that we currently have... And more interested in what concept of disease we should have. What determines what concept of disease we should have? Well, it depends on what it is that we want to do with our concept of disease. A lot of people say that you shouldn't ask 'what is x' questions in the absence of understanding the role that x plays in various projects.

> Physicians do things other than treat disease... they also give actresses larger breasts and smaller noses...

Yes. So diseases aren't simply whatever doctors treat.

> When people make arguments that psychiatric diseases are not diseases, what is their social agenda?

Well... You would have to read them to find out. I actually think that many of the anti-psychiatrists were patients rights activists. They might well be wrong - but I don't think they are obviously so. There are extremists to be sure, but there are similarly some biological reductionist extremists (and strangely enough biological reductionism is actually rather compatible with anti-psychiatry - the anti-psychiatrists would just say that they should call themselves 'neurologists' or 'neuroscientists' studying 'neuroscientific disorder' is all).

Sometimes it amounts to empirical claims. About how medication is causing brain damage. About how medication isn't terribly effective.
Sometimes it amounts to ethical claims. About how schizophrenics etc are morally responsible for their actions and we should do away with the insanity defence. (Of course you don't need to be an anti-psychiatrist to think so. Colin Ross specialises in treating DID and he maintains that the instanity defence should be done away with, too).


> since we don't have a definition of disease to begin with, it can't be said with certainty that "X is not a disease"...

Well there might be a certain amount of fuzziness, but it is still not the case that anything goes. The pen on my desk is not a disease. And no experiment could convince me that it was! We tend to focus on the dispute... But dispute is only possible against a general background of agreement.

I think that we need to get clearer on the role that 'mental disorder' plays in a variety of projects (scientific, clinical, legal, moral) etc. I don't know whether these will turn out to be different concepts or the same concept. I'm most interested in the scientific and clinical projects, to tell you the truth. I think that these are probably slightly different aspects of the same concept...

I think that what the debate is often about is parity of treatment / care. That seems to be the main thing hanging on the issue. If addiction is regarded as a mental disorder then the idea is that people should be entitled to treatment for their addiction (and perhaps not morally condemned, perhaps we should feel sympathetic for their affliction, perhaps we shouldn't hold them morally responsible for actions performed in the grip of their addiction etc). If schizophrenia or depression requires life sustaining treatment just like how diabetes does then it would seem to be just as unethical to withold treatment for mental disorder as it would be to withold treatment for diabetes. (This is of course a crazy analogy as treatments for schizophrenia and depression are NO WHERE NEAR as effective as maintenence treatment for diabetes). But anyhoo, that seems to be the thought.

And on that understanding... You would think that the status of mental disorder as disease would be something that is in the interests of:

a) The consumers who want the treatments
b) The consumers who want the sick role
c) The clinicians whose livlihood depends rather on getting some of that health insurance etc funding

And I guess you see why anti-psychiatrists who counter that

a) The treatments are more likely to harm than help in the long term and there are alternatives that are less harmful eg increased social support
b) That people need to take responsibility for their own actions and we need to stop being paternalistic at the expense of their autonomy
c) That that is just too bad.

Have some interesting points to make...

Which concept should we adopt? Seems to depend on what progress we can make on different treatments... And seems to depend largely on ethical considerations around responsibility and the like.

 

[solumanculver]

If suffering is necessary for disease (which it probably isn't)
And if suffering requires the capacity for consciousness1 (which it probably does)
Then the capacity for consciousness1 would be necessary for disease.

I'm not buying anything remotely like this... Does that mean there is no disease in a zombie world? Disease is supposed to be practical category.

I think that we are less interested in what concept of disease that we currently have... And more interested in what concept of disease we should have. What determines what concept of disease we should have? Well, it depends on what it is that we want to do with our concept of disease. A lot of people say that you shouldn't ask 'what is x' questions in the absence of understanding the role that x plays in various projects.

I'm not sure about this... "Disease" isn't a natural category anyway because it relies on normative judgments. So why don't we just come up with a description that maps to both colon cancer and schizophrenia?

They might well be wrong - but I don't think they are obviously so. There are extremists to be sure, but there are similarly some biological reductionist extremists

Well... what is a "biological reductionist extremist"... In any case, you're going to have to explain to me again how mental illness could fail to be reducible to biology... it supervenes on biology, it can be treated with biological means... Is this some kind of strong emergentism?

the anti-psychiatrists would just say that they should call themselves 'neurologists' or 'neuroscientists' studying 'neuroscientific disorder' is all

Psychiatrists do treat "neuroscientific disorder"... That's what psychiatry is.

About how medication isn't terribly effective.

But it is really effective...

Of course you don't need to be an anti-psychiatrist to think so. Colin Ross specialises in treating DID and he maintains that the insanity defense should be done away with, too.

Well the insanity defense has nothing to do with science anyway... Whether the mentally ill are morally responsible for their actions is not a scientific question.

 

[toby jones]

> "Disease" isn't a natural category anyway because it relies on normative judgments. So why don't we just come up with a description that maps to both colon cancer and schizophrenia?

We could do. Some people would like to do that. Other people resist this move, however (e.g., the anti-psychiatrists). Should we adopt a concept of disease that includes both mental and physical disorders or should we adopt a concept of disease that includes physical disorders but excludes mental disorders? That is controversial. Why should we adopt one of these concepts over the other?

> what is a "biological reductionist extremist"...

Someone who thinks that mental disorders are to be identified with somatic disorders. Anti-psychiatrists agree that if mental disorders are to be identified with somatic disorders then they really are disorders. The two views also seem to agree that if mental disorders turn out not to be identifiable with somatic disorders - then they aren't really disorders.

> In any case, you're going to have to explain to me again how mental illness could fail to be reducible to biology... it supervenes on biology, it can be treated with biological means...

http://forums.studentdoctor.net/showthread.php?t=483851

Mental disorders could fail to be reducible to biology for the same reason that biological disorders could fail to be reducible to particle physics.
There is supervenience in both cases,
But which level provides the most robust causal information is still up for grabs.

> Psychiatrists do treat "neuroscientific disorder"... That's what psychiatry is.

Though the neuroscientific basis for mental disorders is unknown. Sure there are studies that are suggestive, but often the results aren't replicated. Why think that the disorder is more appropriately regarded as 'neuroscientific' than as 'environmental' or as 'genetic' or as psychological' or as 'particle physical'? or as 'chemical'?

We can do a 'yes drug interventions are successful in psychiatry' 'no they aren't' back and forth until the cows come home. Psychiatric drug interventions aren't as effective as a lot of medical interventions like anti-biotics, immunisations, surgeries etc, though. Psychiatry is a relatively unsuccessful science (when compared with other sciences). Partly because it is so young... And partly because theoretically it is still quite underdeveloped.

> Whether the mentally ill are morally responsible for their actions is not a scientific question.

But psychiatrists get to give expert testimony as to mental state - which juries use to decide issues of LEGAL responsibility. If someone is disordered then they are legitimately entitled to take up the sick role, whereas if they aren't disordered then they are not. That is why malingering provides an interesting case... It is in the DSM... But it doesn't count as a disorder so much as a 'non-disorder that is important to take into account when doing a differential diagnosis'. There are also issues around whether people with factitious disorder are entitled to obtain the sick role... I think these are important questions... Do you think science is irrelevant for determining the appropriate answer to them?

 

[solumanculver]

Should we adopt a concept of disease that includes both mental and physical disorders or should we adopt a concept of disease that includes physical disorders but excludes mental disorders? That is controversial. Why should we adopt one of these concepts over the other?

I don't think there's a principled difference between the two... I think that anti-psychiatrists are confused about their own views. I don't think that there is a coherent way to distinguish between schizophrenia and alzheimers that could allow the one to be a disease but not the other.

Mental disorders could fail to be reducible to biology for the same reason that biological disorders could fail to be reducible to particle physics.
There is supervenience in both cases,
But which level provides the most robust causal information is still up for grabs.

I don't think so... all mental disorders are proximately caused by neural states (forget about neural "disorders"). Make the neural state go away, and the disorder goes away. Could be that the easiest way to do this is psychotherapy, could be a drug... but unless we're going to fundamentally change our ontology both psychotherapists and psychopharmacologists need to center their treatments on the empirical study of the brain...

Though the neuroscientific basis for mental disorders is unknown. Sure there are studies that are suggestive, but often the results aren't replicated. Why think that the disorder is more appropriately regarded as 'neuroscientific' than as 'environmental' or as 'genetic' or as psychological' or as 'particle physical'? or as 'chemical'?

All of those things contribute to mental illness by affecting the brain, but the state of the brain itself is the proximate cause of the disorder. We could spend our time categorizing all the ways a person could get a "scrape", by tree or by carpet or whatever, but the abrasion on the skin is the only thing we need to treat... If somebody acquired some psychosis through a viral, or genetic, or purely environmental way... the proximate cause of the psychosis is something in the brain that we can usually treat with antipsychotics.

We can do a 'yes drug interventions are successful in psychiatry' 'no they aren't' back and forth until the cows come home.

Well there are no absolute cures, but medication is the only way to treat schizophrenia, for instance. You're probably not going to talk a person out of catatonia, either.

But psychiatrists get to give expert testimony as to mental state - which juries use to decide issues of LEGAL responsibility.

That's true, but I don't think that it really has anything to do with psychiatry itself. Forensic psychiatry is just another thing that you can do with a medical degree that's not practicing medicine... Whether it's good or not is a social question, not a scientific one.

There are also issues around whether people with factitious disorder are entitled to obtain the sick role... I think these are important questions... Do you think science is irrelevant for determining the appropriate answer to them?

Well, "sick" is not a categorical term... it's a matter of degree... Yeah, having a factitious disorder is more "sick" than not having one... probably not as "sick" as AIDS. And then what about pre-hypertension, or whatever? How sick a person has to be before we let them be "legally" sick? I don't know. But it's definitely not a scientific question. Let scientists describe conditions, and then judges can determine which conditions get you off the hook for doing a crime...

 

[toby jones]

all mental states are proximally caused by neural states...

that is fairly controversial. but if one thinks that, one might also be tempted to think that neural states are proximally caused by states of physical particles.

> We could spend our time categorizing all the ways a person could get a "scrape", by tree or by carpet or whatever, but the abrasion on the skin is the only thing we need to treat...

Yeah. That is interesting... Some grains of analysis might be relevant for some causal claims whereas other grains of analysis aren't so relevant.

> If somebody acquired some psychosis through a viral, or genetic, or purely environmental way... the proximate cause of the psychosis is something in the brain that we can usually treat with antipsychotics.

There is much controversy over how effective anti-psychotic treatment is. Seems to help mostly with the positive symptoms (for example). Sedating someone also seems to help mostly with the positive symptoms. One might well wonder how effective pharmaceutical interventions really are. I'm kind of reminded of the guys who maintained that they had located the cause of the rats running the mazes when what they had actually done was located the part of the brain that was responsible for their being able to move their hindlegs. Anti-psychotics were initially praised as being a 'chemical lobotomy'. The idea being all the benefits of a lobotomy with the added benefit of being reversible. We might now wonder quite how reversible it is, however. With the rebound syndromes and the tardive dementias and dyskinesias...

If you want to teach someone how to cook you will have more luck with showing them how rather than with messing around directly with their brain.

Similarly if you want to teach someone how to act 'normal'...

> but medication is the only way to treat schizophrenia, for instance.

That is controversial. People have done work with respite housing. The idea is that episodes pass...

You know... Like how colds often take 7 days to go away...
And how anti-biotics often take 7 days to properly kick in...
(How much good are the anti-biotics doing really???)
It is controversial.

> Forensic psychiatry is just another thing that you can do with a medical degree that's not practicing medicine... Whether it's good or not is a social question, not a scientific one.

But whether a certain person is or is not morally responsible for their actions... Isn't there a fact about this? Couldn't a jury be said to get it right or get it wrong? I thought that psychiatrists (for some ungodly reason) were supposed to have expert knowledge that was relevant to this...

 

[billypilgrim37]

Toby, you say that things are controversial the way my wife says my cooking sucks: its automatic. Everything is controversial with the right audience. But all audiences aren't equal, and I can only imagine the audiences to which you are referring are becoming increasingly irrelevant as this thread progresses.

There's nothing controversial in the neuroscience community in saying that, de facto, any mental state has a corresponding neural state. If it doesn't, well, that's what we call magic. I don't know what your irrelevant fascination with particle physics is. Mapping mental states to neural states is not some slippery slope to particle physics. The former is a useful way to pursue neuroscience, and the latter is silliness that doesn't have any bearing on anything psychiatrists are going to be doing in the next 50 years. If I were smoking some 420, I could see why it might be an interesting discussion. But every time you mention particle physics, I start hearing Bill Hicks punchlines in my head. It's not interesting, I can't see what sort of insight you're trying to extract from it.

If you want to teach someone to cook, you show them how, not mess with their brain? To warp your analogy, well, good luck teaching someone to cook when the voice in their head is telling them to take their 5-year old daughter's face and smash it on the hot burner. It's not that social support and job training and family education and various therapies aren't important treatments for schizophrenia.

To riff, given research showing that tropic factors may account for the clinical response we see in much of our treatments, I expect to find out that the reason why our medications work is because they facilitate new, more adaptive neural pathways. So, your distinction between "showing someone" and "messing with their brain" is probably a false dichotomy.

Respite housing? Episodes can pass, yes, but that does nothing to further prevent the irreversible cognitive decline that follows each episode. We medicate to prevent further episodes and further cognitive decline. That's not to say that psych and social treatments should not be present as well. And that's not even to say that schizophrenia is actually the homogenous disease we pretend it is...

And PLEASE don't make antibiotic analogies with people who have spent intense periods of time studying microbiology and pharmacokinetics and pharmacodynamics. It's like me saying, "yeah, like that one philosopher dude said to the other philosopher dude, man, it's like, totally crazy."

 

[toby jones]

> There's nothing controversial in the neuroscience community in saying that, de facto, any mental state has a corresponding neural state.

Sure. What is controversial is the precise nature of the relationship between mind and body. The crucial things seem to be
1) Whether the identity is type-type or token-token (looks like the later when the former is needed to justify biological reductionism)
2) The best way to intervene in order to change behavioural output (e.g., whether it is more effective to intervene relatively directly on the brain by way of psychosurgery and / or medication, or whether it is more effective to intervene in a less direct way (e.g., gene therapy / environment therapy / talk therapy etc. The answer might be different in different cases.

> Mapping mental states to neural states is not some slippery slope to particle physics.

The idea was that particle physics is to neuroscience as neuroscience is to cognitive psychology. Not a perfect analogy, of course, but I think that there is a relevant similarity. The idea is basically that just because cognition supervenes on neurology that doesn't make neurology OBVIOUSLY the best way to intervene to alter cognition. Just like how just because neurology supervenes on particle physics that doesn't make particle physics OBVIOUSLY the best way to intervene to alter neurology.

This is just to say that it is up for grabs which level is going to be the most appropriate for delivering the most effective interventions for problematic behaviour / verbal behaviour.

> If you want to teach someone to cook...

The idea here is that even though one must effect neurological changes in teaching someone how to cook it doesn't follow that the most 'direct' approach is best. I think that even when the 'final science' comes in it will still be better to teach someone how (social intervention) than to attempt to get that knowledge in by way of medications / psychosurgery / more direct neurological manipulation.

This is all by way of questioning some of the assumptions that neuroscience is somehow more 'fundamental' or 'scientific' or 'obviously the best way to intervene'. We simply don't know which level the best interventions are going to turn out to be at at the end of the day. I know a lot of people put their hopes / faith in neuroscience, but even if neuroscience is the proximate cause - that doesn't mean that treatments effecting that more directly are going to be more successful than treatments that effect that less directly.

> your distinction between "showing someone" and "messing with their brain" is probably a false dichotomy.

If we grant that neurology needs to change in order for psychology (behaviour / verbal behaviour etc) to change...
Then the relevant distinction here is between 'more direct' (neurological) intervention and 'less direct' (social / environmental) intervention.

> Episodes can pass, yes, but that does nothing to further prevent the irreversible cognitive decline that follows each episode.

The 'Kindling theory' of mental disorder is controversial.
An alternative suggestion is that it is the psychotropic medications that are responsible for the neurological decline as the brain adapts to attempt to counter the medication - sometimes in ways that seem very hard to reverse (e.g., the development of tardive dyskinesias and dementias).

One consideration in support of the latter theory over the former theory is that Nazi Scientists dissected many a schizophrenic brain looking for neurological abnormalities. Their concept of schizophrenia was probably more inclusive than ours. They had microscopes and gross neurological difference (such as enlarged ventricles) would have been apparent to them. This was before the rise of anti-psychotics, of course. The joke was 'it is easy to spot the brains of people with schizophrenia. They are the ones that look normal'. So how come... We are finding gross brain differences (that would have been observable to them with the technology that was available to them) now, all of a sudden? The second theory explains that, the first doesn't (though of course alternative explanations are possible).

> We medicate to prevent further episodes and further cognitive decline.

I'm just saying that the best way (most effective way) to prevent further episodes and prevent cognitive decline is still up for grabs.

The point of the anti-biotics analogy was 1) The over-prescribing of medication. and 2) The faith that clients / consumers / patients place in the medications. Also to consider that 3) The faith is often misplaced as the person doesn't get better (much) faster than they would have if they didn't take the medication - but they attribute their getting better to the medication. A big difference might be that Doctors are well aware of the costs of over-prescribing anti-biotics (though that doesn't necessarily work to curb prescribing practices appropriately - especially when the patient is demanding). With psychiatric medications... The extent of the harmful side-effects can take up until... Well... The medication is out of patient before the harmful side-effects are acknowledged and prescribing practices alter... Once the next 'wonderdrug' has come along...

It was just to say that there might be a worthwhile analogy (in the above mentioned respects) between psychotropic medication and anti-biotics. Of course psychotropic medication and indeed anti-biotics have their appropriate uses - and do really assist at times. But AS MUCH as the hype??? Unlikely, methinks.

Hope this helps clarify what I'm trying to say.

 

[yeti00]

"Of Two Minds"

http://www.amazon.com/Two-Minds-Ant...bs_sr_1?ie=UTF8&s=books&qid=1200014398&sr=8-1

Just FYI if anyone wants even MORE reading. Incredibly relevant to this thread 🙂