The distinction between reasons and causes suggests that one can seek either to understand mental illness or to explain it causally via aetiology. But it is plausible to think that psychiatry can and should aim to do both: to fit meaningful factors into aetiological models. This session explores three general approaches to this: via the reduction of meanings to causes, via the idea of intentional causation and via a more subtle local accommodation as exemplified in Brown and Harris’ Camberwell study of the aetiology of depression.
First hour
The second session of this course looked at the contrast between reasons and causes as Jaspers introduced that (already existing distinction) into psychiatry. In this session, we will think about how to accommodate that prima facie distinction into aetiological models of mental illness. In the first hour, we will look at an approach which attempts to ‘naturalise’ meaning (that is, fit nature into a plausible conception of nature) by reducing it to more basic, natural scientific terms.
From the Oxford Textbook of Philosophy and Psychiatry read chapter 24 sessions 1 to 4. This chapter introduces the idea of reducing mental content (roughly the ‘meaning’ of mental states such as beliefs or expectations) to merely causal and lawlike mechanisms. But it starts by considering a reading from a cognitive psychiatry textbook.
Ellis, A.W. (1996) Human Cognitive Neuropsychology : a textbook with readings, Hove: Psychology Press chapter 6.
The details of this chapter are not our concern today, however, but rather the view of meaning the approach presupposes. One way of fleshing this out is then provided by the readings from the empirically influenced philosopher of mind Jerry Fodor:
Fodor, J. (1987) Psychosemantics: the problem of meaning in the philosophy of mind, Cambridge, Mass.: MIT Press
If there is time you may wish to look at Thornton, T. (2007) Essential Philosophy of Psychiatry Oxford: Oxford University Press chapter 4 section 1.
When you have finished working through this material, you should have some idea of the nature of the problem of reducing mental content to more basic notions, some of the ideas and some of the criticisms. Now think about this issue. In invoking social factors it seems plausible that what sometimes matters is their meaning or significance, something for understanding rather than, or at least as well as, explanation. So:
Does the idea of the social aetiology of mental illness presuppose the success of a reductionist account of mental content?
Write down a couple of sentences on this.
Second hour
Read:
Bolton, D. and Hill, J. (1996; second edition 2003) Mind Meaning and Mental Disorder, Oxford: Oxford University Press chapter 2, section 2.1 and chapter 5 sections 5.1 to 5.6
If you have time, you may also wish to look at Bolton’s paper (in a useful edition of PPP)
Bolton, D. (1997) ‘Encoding of Meaning: Deconstructing the Meaning/Causality Distinction’ Philosophy, Psychiatry, & Psychology 4.4 255-267
Think whether Bolton (and Hill) have provided a way to accommodate the prima facie differences between understanding via meanings and explaining via laws within a single framework. Write a couple of sentences on these questions:
What is the key idea that Bolton and Hill deploy to reconcile understanding and explanation?
What kinds of objections might be made against it: think of at least one. And then think, how might one attempt to respond to such objections?
If you have time look at
Thornton, T. (2007) Essential Philosophy of Psychiatry Oxford: Oxford University Press pp153-160
This summarises my own objections to Bolton and Hill’s ideas. Having read it answer these questions (which might overlap with your answers above but may now be different).
What is Thornton’s key challenge to Bolton and Hill’s proposed reconciliation?
Can it be blocked and if so, how?
Further reflection
Read the short section at the end of Oxford Textbook of Philosophy and Psychiatry chapter 15 pp429 onwards.
This includes an extract from a well known study of depression in Camberwell with which you will already be familiar.
Brown, G. W. and Harris, T. (1978) Social Origins of Depression, Tavistock
Do you agree with the conclusions reached by the authors of the Textbook? If so why? If not, why not?
If not, what should the conclusions have been? In other words, how should we think of the kind of mixed social aetiology in the Brown and Harris study?
Now look at
Thornton, T. (2009) ‘On the interface problem in philosophy and psychiatry’ in Bortolotti, L. and Broome, M. Psychiatry as Cognitive Neuroscience, Oxford: Oxford University Press: 121-136
How does this compare with the view in the Textbook?
Standing back now try to answer these questions:
Outline three distinct possible views of the social aetiology of mental illness, ie three distinct philosophically based models of how meaning-laden social factors might be incorporated into an aetiological account.
Assess their strengths and weaknesses using a few phrases.
Which model is closest to the actual practice of psychiatry?