Monday, November 17, 2008

Report on the NEH Summer Institute on Mind, Self, and Psychopathology

Patricia Ross (also a member of the Executive Council of AAPP) and I were both participants in the 1998 NEH Summer Institute on Mind, Self, and Psychopathology. After it, we were interested in reflecting on the experience, so we wrote a report, but didn't make any great efforts to publish it.

Patricia Ross is a Research Associate at the Minnesota Center for Philosophy of Science at the University of Minnesota.

Report on the NEH Summer Institute on Mind, Self, and Psychopathology, led by Jennifer Whiting and Louis Sass, Cornell University, Ithaca, NY 1998


We relate out experience as participants at the 1998 NEH Summer Institute on Mind, Self, and Psychopathology, and our reflections on the lessons to be learned. This seminar was an important attempt to generate discussion of the connections between Anglo-American philosophy and psychiatry. It brought together participants from many different realms with experts in both philosophy and psychiatry. We discuss the strengths and weaknesses of the Institute. We focus especially on the difficulty in achieving productive dialog between researchers from widely disparate fields, because of a lack of mutual agreement about both methodology and also what has been shown empirically in psychiatry. We suggest that it would be helpful for future such seminars to narrow their focus of study or else for participants to discuss directly what methodological procedures would be best for the group as a whole.

I. The Purpose of the Institute
In the summer of 1998, a diverse group of individuals came together at Cornell University to learn about and discuss issues at the nexus of philosophy, psychiatry and psychology. We were among the approximately twenty-six participants in this NEH Summer Institute. Our intention here is to share with you our impressions of this interdisciplinary venture, our thoughts concerning the particular questions that were addressed and what reservations we have regarding this type of work.

At the time of application, the institute was described to us as an attempt bring together Anglo-American psychiatry and psychology on the one hand and analytic philosophy on the other, in order to promote "the sort of dialogue recommended by [Karl] Jaspers but sadly lacking in our [Anglo-American] tradition". We were thereby selected to "engage with a variety of experts representing a wide range of views and approaches in addition to our own". Specifically, the hope was to enable productive interaction between Anglo-American psychiatry, often characterized by its anti-theoretical bent, and the dominant form of philosophy in the US, i.e. that in the Anglo-American tradition, often labeled “analytic.” The format of the institute was to have two different guests each week leading on the topic of their expertise. The schedule turned out to be as follows (roughly):

Richard Moran (Harvard)
Self-knowledge and Irrationality

Ulrich Neisser (Cornell)
Models of the Self
Jennifer Whiting (Cornell)
Personal Identity and Multiplicity
Judith Armstrong (U of Southern California)
Multiple Personality
Katherine Loveland (U Texas Med. School)

Peter Hobson (Tavistock Clinic and University College London)
Josef Parnas (University of Copenhagen)

John Campbell (Oxford):
Louis Sass (Rutgers)
Wittgenstein and Schizophrenia

James Conant (Pittsburgh)
Wittgenstein and Freud

The Institute met in the mornings, five days a week, for six weeks. Afternoons and evenings were free with optional small group meetings scheduled for this time. These optional groups focused on particular issues, including multiple personality, autism, schizophrenia, philosophical approaches to self-constitution, psychoanalysis, and the body. A small writing group met as well with the purpose of reading drafts of papers and providing constructive criticisms. Reading for the morning sessions was assigned beforehand; when possible the visiting speakers for that week would attend the small group relevant to their expertise. These smaller groups often enabled more sustained, wide-ranging discussion. For instance, the multiple personality group was able to devote time to careful discussion of some themes in Ian Hacking’s recent book Rewriting the Soul, and the autism group read Simon Baron-Cohen’s Mindblindness.

We Institute participants were a diverse group. The authors’ own training was in Anglo-American philosophy of psychology, science and ethics. A few other participants had somewhat similar backgrounds to us. Others had different philosophical backgrounds, with several rooted in the continental phenomenological tradition. Nearly half the group was non-philosophers. This half consisted of psychologists with various forms of expertise, historians and literary theorists.

2. The Six Weeks of the Institute
The first two weeks of the Institute were dedicated to an examination of some general topics that the organizers believed to be relevant to framing future discussions of psychopathology. In the first week, Richard Moran discussed the philosophical problem in trying to understand irrationality. The problem might best be captured by seeing that our understanding is commonly taken to be constrained by the demands of rationality. There are limits to how irrational a person can be before she ceases to be interpretable at all. This idea, especially important in the work of Donald Davidson, has been important in philosophers’ attempts to understand self-deception. Moran set out the issues carefully and methodically; too slowly for some. He ended with the background to his own work on self-knowledge. Still, we had not yet come close to any sustained discussion of psychopathology.

During this first week we also heard from Ulrich Neisser. Neisser has a reputation as one of the more thoughtful psychological theorists of our time. The notion of the ecological self is interesting as well as important to many areas of psychological research - from child development to music theory. The plan, apparently, was to present his theory for use in later discussions of psychopathology. While Neisser did present us with detailed accounts of each of his five types of selves, his presentation seemed to lack in just the sorts of details that might make it relevant to our future discussions. For example, we never got a clear idea of how these different selves relate to or are integrated with each other. Moreover, the rationale for positing any one particular category of self was never given. Whatever empirical grounds there might be for positing these five categories of self was not offered up either. As a result, it was very unclear why this division was meant to be helpful to our thinking. Rather, Neisser's account came off as being merely a way for him to catalog a number of different psychological theories and experiments.

The second week continued much like the first. We briefly moved closer to the discussion of psychopathology (multiple personality disorder in particular), but then returned to the more general philosophical questions intended to provide some framework for future discussions. In fact, the foray into discussions of psychopathology, while tantalizing, was due to a couple of last minute cancellations on the part of individuals scheduled as discussants. The net result was that week two was disorganized and fit less well with the plan of the Institute as a whole.

In this week we had one day when Ulrich Neisser discussed false memory syndrome. He turned out to be strongly partisan in the dispute, basically favoring the skeptical views of Elizabeth Loftus, and having very little interest in the possibility that multiple personalities might exist. Jennifer Whiting brought the discussion back to philosophical concerns with her examination of theories of personal identity. There is a large literature addressing the question of what makes a person numerically the same individual over time, and whether the answer is dependent on factors such as cultural circumstances or personal preferences. Whiting raised numerous interesting questions concerning this subject, especially concerning whether we should be looking for a universal theory of personal identity, or whether it makes sense for different people to have different theories, depending on their values. Often our intuitions about whether a person remains numerically the same in unusual cases of personality change, personality disintegration or dissociation will change depending on whether we describe the change from a third-person, onlooker, point of view, or from the point of view of the subject of experience about to undergo, or having undergone the changes in question. In cases of multiple personality, we find difficulty in finding an adequate vocabulary to even describe the changes in a theory-neutral way. This was especially clear when it came to the question of whether two alters of a person with multiple personalities can literally be said to perceive each other’s experience. This raised general issues such as whether it is an a priori requirement that persons should be able to have first-person access to their own mental states.

While the motivation for raising such questions seems clear in retrospect, especially after the discussions in the ensuing weeks concerning multiple personality disorder (MPD) and schizophrenia, the connection was not made at the time. For this reason, some participants found it hard to see the motivation behind much of this discussion and it most likely lacked the overall impact on our discussion that it could have had.

It was only in the third week that the philosophy and the psychopathology started to come together. Judith Armstrong joined us at this time and shared with us not only her clinical experience but also her thoughts concerning the theoretical issues surrounding MPD. One of the main philosophical questions that arises in this context concerns how to understand the alleged multiplicity of personality while recognizing the existence of only one body. MPD challenges philosophical conceptions of how to individuate persons. Armstrong's insistence that MPD both exists and does not exist as a disorder, while seemingly contradictory, really helps to see the inherent problems with the philosophical questions that are being asked. While the experiences of the MPD patient are obviously organized in the form of one body suggesting that the multiplicity somehow lacks reality, Armstrong maintains that as a clinician charged with the job of reducing suffering and increasing the social functionality of the patient, the most promising approach is to start from the reality of the personalities. Her summary of the disorder - that there is nothing that it is like to be an MPD patient over and above what it is like to be one of the alters - nicely summarizes why, from a third-person point of view, the only point of entry to understanding the disorders is through an assignment of reality to such alters. However, on the question of whether the reality of the disorder is thereby determined, Armstrong remains agnostic.

Treatment cannot wait for the solution of difficult metaphysical problems. While the interaction of Armstrong and Whiting during this week worked well because it brought multiple perspectives together, it became clear that many of the standard assumptions about MPD in the philosophical literature surrounding personal identity turn out to rest on atypical cases or diagnostic criteria that have little descriptive value. Armstrong's presentations made it clear how to formulate the philosophical questions and, moreover, how practical concerns have a role to play in formulating the answers to such questions.

The fourth week on autism was valuable for similar reasons. There is a smaller philosophical literature on this topic, and it is less clear what the major philosophical questions are. It soon became apparent that maybe the primary question, both philosophical and clinical, is whether the extremely broad range of conditions that are now classified under the heading of autism really share something in common at their core. The diagnostic manuals may be able to reliably delineate a group of symptoms, but this does not guarantee that they correspond to a natural kind. The difficulty here seems to depend largely on finding which symptoms are the most telling ones about the condition, and this in turn depends on the etiology of the disorder, which is largely unknown. Kate Loveland and Peter Hobson each presented the results of experiments that they had performed, explaining the hypotheses they were testing and the speculations that the results prompted. Loveland’s presentation tended to be more evenhanded following closely the phenomenology of autism, while Hobson, who was more philosophically inclined, had more of a theoretical perspective to press. Both views differed from that of Simon Baron-Cohen, who has gained some philosophical attention with his view that autism is a form of “mindblindness,” and it became clear that this hypothesis, while potentially valuable in some cases, was unlikely to serve as a general explanation of autism.

Schizophrenia was the topic of the fifth week. The speakers, Josef Parnas and John Campbell, presented us with two very different approaches to understanding schizophrenia. Parnas began the week with a brief history of the concept of schizophrenia as well as some neurophysiological and developmental facts about the disorder. He then turned to his own views about the developmental pattern of schizophrenic symptoms, which he is currently writing about with Louis Sass. Concentrating on the phenomenology of the disorder, he argued that schizophrenia typically involves a diminishing sense of agency, or self and a discontinuity of conscious experience. At the same time, the schizophrenic becomes hyper-reflexive whereby the structure of intentional acts is distorted. Since all conscious life is centered around intentional acts, which under normal conditions bring about unity of the senses, the schizophrenic loses this unity. Parnas describes this, using a term of Merleau-Ponty's, as having the intentional arc disturbed.
In dramatic contrast, John Campbell suggested that the phenomenology of schizophrenia is largely irrelevant to its explanation. Instead, taking an idea of Frith (1992), he argued that some of the symptoms of schizophrenia could be better explained at a more sub-personal level, as a defect in the monitoring of the thinking process. This disagreement is not the same as the long standing one between psycho-dynamic vs. brain disease models of schizophrenia, although there are striking similarities between the debates concerning the place of phenomenology in the explanation of the disorder.

The interactions between Parnas and Campbell during this time proved to be quite stimulating. One aspect of their discussions concerned the recognition of three levels of understanding schizophrenia - the phenomenological, the computational and the neurological. Each was concerned to express the limitations he felt existed for a particular level in providing an adequate explanation of schizophrenia. Parnas took the position that reduction of the phenomenal level to the neurological level is just to re-describe things at the lower level. However, such a re-description does not teach us anything about the phenomenal first-person perspective. Campbell, however, maintained that the phenomenal level cannot provide causal explanations of the disorder and that some appeal to cognitive processes is needed for such explanations.

The final week was devoted to a wider discussion of the interrelation of schizophrenia and philosophy. Louis Sass discussed Ludwig Wittgenstein, exploring the idea of understanding schizophrenia in terms of Wittgenstein's account of solipsism. Many of the ideas he explored had been previously examined in his book The Paradoxes of Delusion: Wittgenstein, Schreber and the Schizophrenic Mind. Sass was particularly interested in exploring his idea that schizophrenia can be understood in a non-pathological sense. James Conant then devoted some time to replying to and criticizing Sass’s proposal. In particular, he was interested in criticizing Sass's idea that since one can read Wittgenstein's Tractatus as exhibiting schizophrenic phenomena, we can take this as a reflection of the author's mental state. Conant ended the week with some discussion of psychoanalysis and philosophy of mind.

3. Lessons to be Learned from the Institute
There are many comments we could make regarding particular features of the Institute. However, we wish to focus our attention on some conclusions concerning such multi-disciplinary work in general that might be drawn from our experiences. One of the main ways in which this multi-disciplinary endeavor differed from other such endeavors lies in the lack of clarity about what exactly the issues are that need to be addressed. For example, inter-disciplinary work in other sciences such as physics or biology addresses well-defined theoretical or conceptual issues. All parties involved in these discussions are quite familiar with the subject matter under consideration. However, as became clear early on in our discussion, it is not yet entirely clear just exactly what the issues are when it comes to the intersection of philosophy and psychopathology. It may be the case that there are conceptual and theoretical concerns that require philosophical reflection, however it also may be the case that the questions to be answered are simply empirical questions which will be answered with more empirical research. The exact nature of the problems remains an open question.

One of the reasons for this may be that the study of psychopathology, itself, resembles a pre-paradigmatic science -- to borrow from Thomas Kuhn's now famous account of the stages of science. Pre-paradigmatic science is characterized by the lack of and search for an overall theory to guide research, a methodology that delineates the acceptable ways in which research will be done and well-defined puzzles, or problems, that remain to be solved. During this stage of a science, almost anything goes. Multiple theoretical frameworks exist for understanding the phenomena, all of which are given fairly equal credence. Vastly different methods are used in the study of the subject matter and no one method seems to obviously provide a more useful way of proceeding. Perhaps, because of this, the Institute also lacked any guiding methodology or clearly defined problems to address. This, alone, is not necessarily a bad thing. However, it does suggest that progress may require focusing on such foundational questions within psychopathology (such as an overall theory to guide the research) before pursuing any particular question about specific disorders.

This multiplicity in approaches was all the more evident among the participants at the Institute. The problem may have been that our different approaches were incommensurable and that we had difficulty finding a common language. However, it seems to the authors that we as a group did for the most part understand each other: what we were unable to do was agree with each other’s starting assumptions and methodologies. This was a major stumbling block, and meant that exchanges of productive dialog were rare during the six weeks.

Attending the Institute was highly educational in providing us with a wealth of information about psychopathology that is not easily available from psychiatry textbooks. It gave us the highly welcome opportunity to interact with peers and experts with interests similar to our own. The connections we made will be important in helping to form a community in the growing world of philosophy of psychiatry. In these respects, the Institute was invaluable. To an extent, the stated aim of the Institute was achieved: there was some productive dialog between philosophy and psychiatry. But we, the authors, felt that the dialog was often far from ideal. We were left wondering how it could have been improved.

One possible suggestion for how to proceed from here is to have people from different background working together on some of the issues we addressed. The institute presented a wide array of approaches, but each was similar in that it came from one perspective. The clinicians and psychologists presented us with their clinical and scientific findings and their speculations about the best interpretations of their research, together with ideas on directions for future research. The philosophers stuck to their respective philosophical terrain. The Institute could have benefited greatly from some interaction among our presenters prior to the institute such that diverse ideas and approaches were integrated when presented.
More generally, we recognize that when thinkers from many different domains come together for dialog, there is bound to be some struggle in achieving mutual respect and helpful conversation. One approach to this is to simply hope that high standards across the disciplines and professional courtesy can be relied on to create the right conditions. However, our experience suggests that this is too optimistic. It may be that in interdisciplinary contexts such as that of the NEH Institute, it would be useful to address the differences in styles of thought more directly, and lay down some meta-level directives for methodology at the start, or narrow down the goals of the group. For if both the methods and the goals of the group are highly diverse, it will be hard to achieve any rapprochement between the participants. The frustrations experienced at the Institute are often shared by the wider group of people working on philosophical issues in psychiatry, for example at interdisciplinary conferences. One of the major challenges to be faced by philosophy of psychiatry is how to make these interactions more intellectually profitable. We hope that our experience at the Institute will enable us to recognize and negotiate this challenge more successfully in the future.

Baron-Cohen, S. 1995. Mindblindness: An Essay on Autism and Theory of Mind. Cambridge: MIT Press.
Frith, C. 1992. The Cognitive Neuropsychology of Schizophrenia. Cambridge: MIT Press.
Hacking, I. 1995. Rewriting the Soul: Multiple Personality and the Sciences of Memory. Princeton: Princeton University Press.
Sass, L. 1993. The Paradoxes of Delusion: Wittgenstein, Schreber and the Schizophrenic Mind. Ithaca: Cornell University Press.
Wittgenstein, L. 1922. Tractatus Logico-Philosophicus. London: Routledge and Kegan Paul Ltd.

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