Monthly Archives: January 2021

Perspectivism and psychiatric diagnoses

I recently had published (in the European Journal for the Philosophy of Science) an article defending psychiatric diagnoses (click for the open access article). I aimed to use a philosophy of science named scientific perspectivism to position psychiatric diagnoses as being between realism and relativism, that is, between psychiatric diagnoses being mind-independent entities out there waiting to be found and them being arbitrary conventions. I will outline my motives for writing the article in this blog post.

Psychiatric diagnoses have been described as being arbitrary, inventions and made-up. My article aims to defend psychiatric diagnoses from such claims by responding to one issue which motivates such claims. Historians and sociologists often provide detailed studies of how various social conditions and theoretical position lead psychiatrists to conceptualise psychiatric diagnoses in particular ways. If one set of social conditions, theoretical assumptions or methodological practises is present then psychiatrists will conceptualise psychiatric diagnoses within a range of ways but if a different set of social, theoretical and methodological factors is present then psychiatrists will conceptualise psychiatric diagnoses within a range of different ways. These factors do not determine which concepts psychiatrists formulate but they do influence and constrain which psychiatric diagnoses are formulated. For example, views about what constitute good mothering or good health could influence psychiatrists, as could theoretical factors such as whether psychology is seen to largely stem from underlining biology or from social interactions with the environment, as could whether focus goes upon finding statistical commonalities across many individuals or qualitative studies of individual people. This leads to the concern that psychiatric diagnoses reflect the opinions of psychiatrists, which have been heavily shaped by these factors, rather than reflect reality. Psychiatric diagnoses would not be real and instead only be the product of the wider social, theoretical or methodological factors in fashion in a particular period.

As a philosopher, I feel such an understanding potentially misses out something important. As a philosopher, my natural inclination is to say, yes, such factors can influence psychiatrists but the question of whether a scientific claim reflects reality is separate to question to why scientists believe that particular claim. A philosopher might tell these historians and sociologists that they have successfully documented the views that psychiatrists hold upon what exist but that is different to what actually exists. As a simple example, historians can document changing views that people have held about whether the earth is the centre of the universe or not but the views that astronomers hold does not then determine if the earth actually is at the centre of the universe. It can certainly be argued that psychiatrists being influenced changing social, theoretical and methodological factors make it unlikely that the psychiatric diagnoses they formulate reflect reality, but strictly speaking that is a point about how likely it is that psychiatrists are describing reality (an epistemological point) rather than a question of what exists (an ontological point). 

However, as much as I am a philosopher, I also do historical research on psychiatry and I think philosophers need take history seriously. I accept scientists are constrained by the historical context they work in but at the same time I also think that we should try to divide scientific claims into true, partly true and false. To do this I draw upon a philosophy of science named scientific perspectivism. This offers a more nuanced notion of truth and reality than either a common sense notion of ‘what things are really like’ or some form of essentialism. Following scientific perspectivism, I instead favour some sort of middle ground between ‘how things really are’ and the notion, seemingly favoured by some historians and sociologists, that all claims about truth (in psychiatry at least) are dependent upon wider social and historical factors. My motive for this is believing that some claims can be more truthful than others, some claims describe the external world better than others, yet no claim actually describes as it is independent of our perspective.

One motive for my stance is that without it the legitimacy of science is potentially at threat. For example, if the beliefs of psychiatrists are constrained or heavily influenced in the era in which they work then their views seem to be the product of many subjective, rather than scientific, factors. Why should their beliefs have any higher legitimacy to the beliefs held by anyone else? Might psychiatry be literally on no better foundation than mere opinion and is no better established than the opinion of a random member of the public? Now, historians and sociologists typically do not endorse such a negative view of psychiatry but it is not clear to me what stops their position entailing such negative conclusions. As such, whilst I want to take seriously the influence of social factors on psychiatry, I think we need still try and establish which claims are more truthful and which are less truthful. In the article I employ a philosophy of science to try and establish how philosophers can retain a non-trivial notion of truth whilst also respecting the influence of social, cultural, theoretical and methodological factors on psychiatry.