Category Archives: Realism

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


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.

Realism vs… coherence? Relativism?

One of my philosophical interests is establishing if psychiatric classifications are real. This question has many, many dimensions and I feel it is often portrayed in untenable terms. A useful starting point is: what does it mean for a scientific thing (an electron, Newtons laws) to be real? (Note some interesting subquestions: are scientific things real in different ways to non-scientific things? Is there one overarching notion of real for all sciences or would psychiatry need a different notion of reality to physics). Here is an interesting and potentially useful diagram:

Realism Antirealism
[Note that I found this on Twitter [https://pbs.twimg.com/media/CJlcwSXUAAAc9Wq.jpg:large], I do not know who the author is but I did not create it].

It gives an interesting perspective on how various elements interrelate. I do not fully agree with it. Should correspondence and coherence be put at opposite ends of a scale? I wonder if coherence might be better put somewhere closer to the center, replacing the end of that arrow with relativism. Perhaps Psillos is correctly placed for his earlier works but I think his later writings place much greater emphasis on theoretical virtues, hence needs to go closer to coherence (but without moving too far from correspondence). Also, where would a neo-Kantian position in the style of Massimi and Kitcher go? The middle ground might seem the obvious place but I would not like to associate them with Constructive Empiricism or Instrumentalism. Anyway, the table has got me thinking and it certainly makes some interesting claims in a convenient visual form.