Introduction

Concerns about the medicalization and pathologization of some social problems, the unnecessary medical intervention towards certain disadvantaged groups or the massive use of drugs such as antidepressants have joined the critical voices that already, since the 1960s, questioned some of the medical practices and interventions in psychiatry. At the same time, both in social epistemology and psychology, some authors have analyzed how psychiatric patients are usually victims of silencing or low assignment of credibility-epistemic injustice-which leads not only to a worsening of their social situation, but, in addition, to various problems of diagnosis or explanation of disorders. These problems have prompted intense debate in philosophy and psychiatry about the nature of psychiatric disorders and whether values, institutions, and social conventions should play a role in their identification, diagnosis, and explanation. The project presented here aims at conceptual clarification of the nature of psychiatric disorders. We will investigate to what extent the analytical tools of so-called regulative or mindshaping theories in philosophy of social cognition allow us to articulate a plausible theory of what a psychiatric disorder is. Through this theory based on recent contributions on the attribution of mental states and the normative character of the configuration of psychological states, we will try to account for the different aspects involved in the debate while promoting a particular view of two specific phenomena: delusions and depression.

Description

As a medical practice, the most widespread view within psychiatry has tended towards naturalistic positions that insist that psychiatric disorders are biologically based abnormalities whose nature is independent of any human conception or activity. However, the cultural variability of some disorders, the implicit reference in diagnoses to certain norms or canons of normality or the fact that the symptomatology of some disorders is closely connected to their respective contexts has motivated the emergence of more constructivist positions. These positions claim that mental disorders are somehow social constructions or, at least, dependent on social facts. At the same time, several attempts have appeared to articulate intermediate positions between these two extremes that understand disorders as objective properties or phenomena that are only conceivable in relation to human activities or as impairments affecting basic rational operations, although not reducible to neural disorders.

The use of philosophical theories on social cognition and the attribution of mental states for the elucidation of some psychiatric phenomena is not new. However, in recent years, a group of so-called regulative or mindshaping theories have appeared that have emphasized several important aspects of the mental that had been overlooked in the debate on social cognition and that seem to be also particularly relevant to the discussion on the nature of psychiatric disorders: 1) Attributions of mental states are not descriptive but evaluative in character. 2) Attributions are influenced by the evaluative and normative expectations of the ascribing subject.

The aim of this project is to analyze how these aspects can help to elucidate the nature of psychiatric disorders in general but also of two particular phenomena: delirium and depression. First, the nature of mental state ascriptions is the cornerstone of studies of some types of delusions, especially those related to beliefs such as Cotard's syndrome in which patients claim to be dead. Therefore, regulative theories can approach the phenomenon from a new perspective. Second, mindshaping theories have already been extrapolated to other mental processes such as metacognition, which seem to be closely related to psychiatric phenomena such as depression, in which aspects related to social identity and how we perceive ourselves are involved in addition to our agency.

OBJECTIVES

The objectives of this project are articulated through 3 hypotheses:

O1. Mental disorders are abnormalities that produces a disability or impairment in the person's ability to regulate his or her behavior and cognition in a socially recognizable or justifiable manner and which cause harm or potentially harmful consequences to this person or to others. The proposed theory is elaborated from regulative views on social cognition according to which our ability to deal with the social environment strongly depends on the production and maintenance of different shared norms and values that help us to regulate our own and others' actions in a way that makes us socially recognizable. Thus, being mental creatures means being able to regulate one's behavior in a socially recognizable way-for example, by meeting the expectations generated by the values and norms that populate our social niche or by reacting appropriately to the attitudes of others.

O2. What distinguishes everyday cases of self-attributions of mental states from clinical cases such as delusions are the systematic inability to integrate justifications for certain feelings, emotions, or proprioceptive perceptions. For example, in the case of Cotard's syndrome delusions there appears to be a failure to incorporate the feeling of disembodiment with information provided by the social and non-social environment, leading the agent to attempt to make sense of that feeling through the belief that one is dead.

O3. Some central aspects of depression can be understood as an impoverishment of agency and the ability to promote one's values and preferences. Agency and the capacity to regulate one's behavior in accordance with expectations generated by one's preferences and values must be understood in relational terms. That is, understanding that agents' identities are formed in the context of social relations and are shaped by a complex of intersecting social determinants.