Category Archives: Methodology

Reviewing Re-Thinking Autism

Autism, Causation, Classification, Disease Entity, Methodology, Validity, , ,

Re-Thinking Autism contains, to my knowledge, the most sustained attack upon the diagnosis of autism found within a single book. The editors claim it is the first book in the field of critical autism studies. It contains 17 different papers which are grouped into three areas, namely ‘What is autism’, ‘Deconstructing autism’ and ‘Challenging Practice’. The editors see critical autism studies as focusing on two questions. Firstly, is the diagnosis of autism valid and secondly, is it useful. Most articles are very critical of the diagnosis of autism. Since I felt I benefited immensely from being diagnosed with autism I was probably always going to have reservations. However, in the spirit of engaging with the critical autism studies movement, I will suggest that the book did not address some important questions and issues which would significantly help any attempted challenge to autism.

In relation to validity, multiple articles criticised the scientific foundations of autism. Some give an useful overview of the very heterogeneous causal underpinnings of autism. Whilst this is a very relevant point when assessing autism I feel the consequences were insufficiently explored. There were relatively few details about why the causal heterogeneity makes autism deeply flawed and in need of replacement. Some articles contain statements that autism is not a biological entity or a scientific entity but these are usually asserted rather than argued for. I think these claims face some challenges. Firstly, virtually all psychiatric diagnoses are causally heterogeneous. Therefore, I feel that critical autism studies scholars need either explain why autism need replacing whilst other diagnoses do not or need explicitly endorse a whole rejection of DSM type psychiatric diagnoses (perhaps in favour of person centred approaches). A few articles do seem closer to the latter approach though there are few explicit statements. Additionally, there is little discussion about why causal heterogeneity is problematic and why it makes something not a biological or scientific entity. There was also little mention of other important factors when assessing a scientific theory (such as simplicity, tractability or coherence). These are admittedly deeply philosophical questions which are debated by philosopher of psychiatry (and I was pleased to see a few articles reference philosophers of psychiatry) but I feel these are the sorts of questions which critical autism studies needs engage in. Perhaps the arguments which critical autism studies employ are fully defensible but they currently need more development.

In relation to usefulness, some articles question whether it is helpful to give people a label and other articles question whether it helps in educational settings or support settings. Some of these authors making these arguments have a wide range of experience and expertise. Consequently, I felt they had a viewpoint that was at minimum worth hearing. That said, there was very little input from people diagnosed with autism (only one author was described as being autistic). Very few of the reasons why I find being diagnosed so useful were mentioned. Of course, being autistic does not make me automatically correct on this issue. Perhaps my positive feelings about how useful being diagnosed was are based upon flawed reasoning. Despite this, it would have been good if the book engaged in reasons why some autistic people find being diagnosed so useful even if only to then challenge those reasons.

I feel the biggest problem was a lack of alternatives being outlined. If autism is deeply flawed then what should replace it? Even some vague suggestions (i.e. split it up, add subtypes, merge it with other diagnoses) would have been helpful if I am to assess whether an alternative to autism would be preferable. Additionally, outlining alternatives would give an easier route to challenge autism. There would be no need to argue autism is deeply flawed, rather, there would instead be the easier task of arguing that autism can be useful but an alternative diagnosis is even more useful.

It is worth nothing that the articles are quite diverse and so the degree to which these criticisms are applicable to any given article will vary significantly. Additionally, I felt around a quarter of the articles were pretty good (these were usually the ones which critically analysed autism rather than wished to replace the diagnosis).

To conclude, I felt many articles avoided important questions which are relevant for assessing scientific concepts. I would like to see the critical autism movement engage more with philosophy of science and philosophy of psychiatry. Also, it would be more helpful if criticisms of autism were also accompanied by actual concrete suggestions for alternatives to autism. Despite this, I am glad I bought it and read it. If you want a single book which contains multiple different criticisms of autism then this is the book to go for. I suspect I cite multiple articles from this volume (admittedly, mainly to criticise).

Report on the Philosophy of Psychiatry Work in Progress Day, Lancaster University, 2nd of June 2017

Causation, Classification, Methodology, Philosophy

The 2nd of June saw the annual Philosophy of Psychiatry Work in Progress Day. This has been going on for longer than I have been at Lancaster and is the fifth one I have presented at. There was good attendance and it went smoothly, an enjoyable day of seeing papers from multiple perspectives in the philosophy of psychiatry. I shall give a summery of the talks below.

Rachel Cooper (Lancaster) presented on “Intentional actions, symptom checklists, and problems with cross-cultural validity”. She discussed standardised tests for personality disorders and how they included intentional actions. She then discussed how intentional actions are often given different interpretations in different cultures, creating problems for such standardised personality tests.

Marcin Moskalewicz (Oxford) presented on “Ipseity, self-consciousness, and the problem of time in schizophrenia”. He outlined ways in which time is perceived and explained how altered self-consciousness in schizophrenia can lead to an altered sense of time.

Moujan Mirdamadi (Lancaster) presented on “Death-consciousness and Depression in Iran”. She discussed the Iranian focus upon death and described how she felt this influenced some of the descriptions she received from her qualitative study of depressed Iranian patients.

Ian Hare (UEA) presented on “Qualitative Methods: a Philosophical Toolkit for Cognitive Psychiatry”. He outlined how qualitative studies can be used to gain greater descriptive understanding of a diagnosis and this can be used to provide a firmer basis for constructing psychological and psychiatric theories.

Rachel Gunn (Birmingham) presented on “The Delusional Experience as a Breakdown in Affective Framing”. She described how experience of delusions was not just purely mental but also involved many physiological and experiential changes. She then suggested that this means non-cognitive therapy approaches could be of value.

Dan Degerman (Lancaster) presented on “If you’re not psychiatry, you’re antipsychiatry – Exploring how American psychiatrists perceive their critics”. He outlined how psychiatrists perceived anti-psychiatrists and how they often labeled critics with many divergent views as anti-psychiatrist. He then suggested this can unfairly devalue psychiatric patients, who often have valuable concerns over psychiatry, thereby reducing their political agency.

Anneli Jefferson (Birmingham) presented on “Mental disorders and brain disorders – an obsolete distinction?”. She looked popular and influential arguments against seeing mental disorders and brain disorders which employ a hardware-software analogy. She criticised this argument on causal grounds then looked at counter arguments to her claims.

Joel Kruger (Exeter) presented on “Unworlding and Affective Externalism in Schizophrenia”. He discussed notions of the external mind, how perception and cognition can involve parts of the external world, and used it to understand notions of breakdown of affective scaffolding in schizophrenia and the sense of unworlding it leads to.

Victoria Allison-Bolger presented on ” ‘A thing like the ocean’ – using metaphor in understanding psychoses”. She discussed how many psychiatric diagnosis did not fit typical notions of a good classifications and suggested this means we should modify notions of good classifications to fit the diagnosis rather than make diagnosis fit our preconceptions about what is a good classification.

Gloria Ayob (UCLan) presented on “Personal autonomy and serious psychopathology”. She discussed the difficulties and possibilities of attaining a value neutral notion of serious psychosis. She tried to see if the Liberal notion that everyone should be free to believe what they wish providing it does not harm anyone could fit the notion that some people have deluded views of the world.

Finally, I presented on “Causal Structures vs Causal Mechanisms: Implications for RDoC”. I will outline these ideas in the future.

Overall, an enjoyable day with a lot of paper presented on interesting and diverse areas. The workshop typically runs every year, usually in May, June or July, and it would be worth looking for the announcement of the 2018 workshop next year.

Reviewing Philosophical issues in Psychiatry III: Nature and Sources of Historical Changes

Methodology, Progress, Realism, ,


This is the third book in the series, started in 2008 and then the second volume in 2012. All three volumes have been edited by Kenneth Kendler and Joseph Parnas, bringing together contributions from psychiatrists, philosophers of psychiatry and historians of psychiatry. Each volume takes the same format, an overall introduction by one of the editors and then individual papers grouped by themes. Each paper is fronted by a brief introductory article by one author, then the main article by another author and then a commentary by a third author. This means each book contains an immense number of articles (43 in the case of this volume) despite only being 380 pages long. The introductions and commentaries are almost always worth reading, often making significant points in their own right which are not present in the main article they are discussing. This makes the book an excellent source for a multiplicity of viewpoints and, since sometimes the introductions and commentaries disagree with the main article, diverging points of view. If you wish to find an academic expressing a philosophical viewpoint on psychiatry, or multiple academics expressing contrary viewpoints, then turning to one of these volumes is a good idea.

Of the three volumes, this one is the most diverse in approach, mainly because it closely integrates philosophy and history. It has three sections. The first discusses ontological, epistemic and methodological issues relating to changes in psychiatry, relating to issues like why does psychiatry keep changing, are these changes for the better, what sort of changes should we aim for, etc. Secondly, what specific broad changes have occurred in psychiatry, such as development and decline of psychoanalysis, operationalism and genetic explanations. Thirdly, philosophically informed histories of specific diagnosis, such as schizophrenia, depression and autism. All three sections are worth reading, though how much you will get out of each section will likely vary considerably on your specific interests. As someone interested in questions of belief in psychiatric classifications, I primarily found the first section useful. I think psychiatric diagnosis can potentially merit belief even if there is not one fixed, eternal true set of psychiatric diagnosis – the causes of mental illness change, mental illnesses manifest differently as social settings change and our values which we use to interpret mental illness change. Though not all articles in this section addressed these specific issues, I found they gave much to think about on such question and offered some novel approaches and novel possible solutions to such issues.

Though I could comment on many articles (and may do so in future blog posts), the one which most interested me is by German Berrios. This articles challenges a long standing approach in philosophy of psychiatry. Generally, most mental illnesses are seen as separate from their environment. Internal biological and psychological causes (potentially set off by environmental causes) produce symptoms which express themselves in a social context. So on this model, the social context is not itself a cause of the symptoms but is a cause of how the symptoms are expressed, i.e. the symptoms interact with a social environment. However, Berrios challenges this, arguing the social context is itself part of the symptom, the social context cannot be separated out as something the symptoms interact with but are themselves part of the causal process. This makes causation in psychiatry much more complicated but I think much more realistic. It makes mental illness less static, less fixed, more embedded within the environment, rather than viewing mental illnesses as fixed and static yet malleable in how they are expressed. At a minimum, it raises important questions about how we should think about causation in psychiatry, where we should put the boundaries between things, their causes, and the environment in which they causally manifest in. At minimum, Berrios shows an alternative way of parsing up that equation and argument is needed to take the symptom manifesting in social context approach as superior to social context as part of symptoms.

Science and its use for philosophers

Methodology, Philosophy, Science

Really nice quote about the relationship between philosophy of science and philosophy more generally: “As long as there was no such subject as ‘philosophy of science’, all students of philosophy felt obligated to keep at least one eye part of the time on both the methodological and the substantive aspects of the scientific enterprise. And if the result was often a confusion of the task of philosophy with the task of science, and almost equally often a projection of the framework of the latest scientific speculations into the common sense picture of the world … at least it had the merit of ensuring that reflection on the nature and implications of scientific discourse was an integral and vital part of philosophical thinking generally. But now that philosophy of science has nominal as well as real existence, there has arisen the temptation to leave it to the specialists, and to confuse the sound idea that philosophy is not science with the mistaken idea that philosophy is independent of science” Wilfrid Sellars (quoted in an article from the book What is Philosophy?, C. P. Ragland, Sarah L. Heidt (editors)).

Much has changed since 1956 when Sellars wrote this but it raises an important issue. I’ve long believed we need closer merge science and philosophy, and whilst many philosophers do not integrate science in their work, plenty do. This is positive. However, I’m often concerned that when philosophers do use science to further their arguments, they often take scientific evidence too concretely, as something which either logically supports their argument or does not. Generally, however, scientific theories are models that describes idealised probabilities. They do not easily function as premises which entail logically valid arguments or function as clear counterarguments. Rather, they function more analogously to risk factors, scientific claims being individual sources of evidence which push an argument in one direction or another. Sellars claims general philosophers paid more attention to the methodology of science. I wonder if this is lacking today. Whilst it is great that philosophers not infrequently turn to science to support their arguments, those philosophers should realise how tentative, how heavily inferential and how probabilistic many scientific claims are. When philosophical claims rest upon such scientific claims then the strength of those philosophical claims is reduced. I think this is generally the case and philosophy would be better to recognise this. Just like scientists, philosophers employing science need both knowledge of science and knowledge of methodology of science.