The philosophy of the social aetiology of mental illness
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, if 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 - fit 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 and elsewhere to develop a deeper understanding of the conceptual issues which can inform and then be informed by empirical findings.
The course consists of a short introductory session on 17 September 2014 followed by six weekly discussions (both student-led and then lecturer-led) together with guided readings drawn mainly from the Oxford Textbook. The reading should take less than two hours. There is some flexibility in later topics (hence the asterisked topics below).
0: Getting started: with whom should we pick a fight?
What does it mean to talk of the 'social aetiology' of mental illness? If one stresses its importance, with whom is one disagreeing? These two questions stand together and different answers motivate the different sessions of this module. Slides. Reflections.
1: 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.
2: 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?
3: Aetiology and problem of understanding individual causes
Starting with the idea that aetiology is, as the etymology suggests, a causal notion, this session examines the costs of thinking that mental illness has social causes. Hume identified a problem of seeing causal connections in even the best possible circumstances. One never sees one thing making another thing happen: just one thing happening and then another thing happening. On a Humean account, to say that one event causes another is to say something essentially general. Causation is underpinned by laws of nature. But is it plausible to think that there are always (in principle, that is) general laws linking past events and mental illness? If so, at what level do they operate? How well behaved are they?
4: Recovery
What is distinctive about putting recovery at the heart of mental healthcare? What does recovery add to our understanding of the nature of mental health and illness? Is there a recovery model in contrast with bio-medical or psycho-social models? What, if anything, is the connection between recovery and social justice? Is recovery an aim for medical- or healthcare or is it an essentially broader political notion?
5: Is meaning part of the natural world
It is one thing to argue, as discussed in the session on Reasons vs Causes, that we explain and we understand phenomena in distinct ways (a distinction at the level of method or epistemology). It is another to think that these mark a a fundamental worldly or ontological difference. This session highlights three responses to the apparent distinction of reasons and causes: reductionism (or reductionist naturalism), anti-reductionist naturalism and the third way outlined by Bolton and Hill in their book Mind, Meaning and Mental Disorder.
6: Spiritual experience and mental healthcare
One of the fastest growing special interest groups in the UK Royal College of Psychiatry is one on spiritual experience. This reflects growing interest in the idea of a spiritual life as a source of strength and protection for mental health. At the same time, religious experience itself can shared key features with psychopathological phenomena thus raising a question of the distinction between the two
*: 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?
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?