A proper understanding of the social aetiology of mental illness requires an understanding of causation; its connection to laws of nature; the contrast between a causal explanation and an understanding based on reasons; and the issues raised by attempting to reconcile meaningful factors within causal models. Additionally, it prompts an assessment of the role of understanding individuals and how this relates to general law-like understanding. The very idea of social aetiology for mental illness brings with it conceptual challenges. I will mention three. First, if is an aetiology then there is a causal ground for mental illness. But the paradigmatic view of a cause in the sciences brings with it natural laws. And thus we need to think what kind of laws are applicable if the aetiology is social. Second, it is a social aetiology that suggests (although this may not be true) that the social factors invoked are thought of in meaning-laden terms. If so, how do they – the proper subject perhaps of understanding - it into a lawlike form of explanation? Third, there is an ambiguity in the idea of a social view of mental illness. It might mean that social factors cause mental illness perhaps by bringing about changes in the brain – or it might mean that mental illness just is being out of step with the rest of society: a kind of lost tribe / romantic view. But the former seems boringly uncontentious (it is consistent with a narrow medical model of illness) whilst the latter cannot, strictly, be a form of aetiology. This short course draws on material from the Oxford Textbook of Philosophy and Psychiatry to develop a deeper understanding of the conceptual issues which can inform and then be informed by empirical findings. The course consists of six weekly discussions (both student-led and then lecturer-led) starting on 21 September 2011 together with six guided sets of readings drawn mainly from the Oxford Textbook. These reading sessions should take less than two hours. You should be in a position to answer the study questions for each of the six subject areas set out below. 1: Aetiology and problem of understanding individual causes The practical problems of establishing the aetiology of illness and disease (with which students will already be familiar) are approached through to the principled problem identified by Hume of seeing causal connections in even the best possible circumstances and his concern about reasoning from past to future. Hume’s general response to the first case is briefly introduced. An initial link is forged to issues of validity in psychiatric taxonomy and the rise of EBM. 2: The link between causation and laws of nature Building on the first topic, this session goes on to explore the role of laws of nature to back up causal relations. It addresses the relation between saying that had there not been a spark, then there would not have been a fire and being committed to there being general laws linking sparks and fires. In trying to characterise what laws tell us about both the actual world and at least a limited range of other possible words, it touches on the question of how to distinguish lawlike generalities from merely accidentally true generalisations. Thus it suggests that, in general at least, an aetiological model of illness connects to the existence of medical laws of nature governing human functioning.
Within natural science, causes are arguably best understood in the context of a system of natural laws which also connect to causal explanation. But the idea of a social aetiology suggests a role for factors an appreciation of which would take account of their meanings and significance and of the rules and proprieties that govern them. That suggests that understanding is also in play. But understanding using reasons fits into a different kind of conceptual structure from nomological or law-like explanation. The distinction between the ‘space of reasons’ and ‘realm of law’ is explored via the notion of rule governed activity. This suggests that understanding is fundamentally distinct from causal explanation. But is it? 4: Social factors, meaning and social constructionism The claim that mental illness has a social aetiology has both more and less radical forms. One route to a more radical account is via the claim that mental states and thus mental illnesses are socially constructed. Arguments for and against this claim are discussed. The less radical claim that mental illnesses are socially caused but not socially constituted is examined. 5: Constitutive evaluativist externalism and Values-Based Practice If illness is constituted as illness through societal norms and values does that undermine the objectivity of illness ascription? How should disagreements about the pathological status of conditions or ways of being be decided? 6: Idiographic versus nomothetic understanding In addition to the idea that mental illnesses can have social aetiology there is a further idea that person centred care requires a particular kind of understanding of the experiences and particular social context of individuals. The WPA, eg., calls for a psychiatry for the person to include idiographic understanding. But if so, what is idiographic understanding, does it threaten diagnostic validity and how does it relate to narrative understanding? |