Thursday, April 30, 2009

New Art

A relatively rare non-philosophy post.

I wandered around some Chelsea galleries yesterday, as I regularly do, before going to Pat Kitcher's talk on Kant on theoretical and practical reasoning at CUNY (which didn't inspire me to go and read more Kant).

The previous times I've been around the galleries this year, I was uninspired. But for some reason, this time, there were several exhibits that impressed me a great deal, so I thought I'd mention them.

At Margaret Thatcher Projects (not the British ex-PM) there was another showing of Robert Sagerman's work. This one had the title "On and On: Inquiries into Indeterminacy." (In fact it starts today, but I saw it up. I had seen his work there previously, and I'd liked it a great deal then. Looking at his work on the web, his works look rather dull, but when you see them close up, the thick three dimensional use of paint is stunning. You can see it better on the Marcia Wood Gallery page.

It was fun to see John Water's Rear Projection show at the Marianne Boesky Gallery. Nothing very stunning there, but it was refreshingly silly.

The piece The Sound of Silence by Alfredo Jaar at Galerie Lelong was, in sharp contrast, very depressing. The main work was a sculpture and film installation. The 8-minute film was about famine, South African aparteid, the suicide of a photojournalist, and the ownership of images by one of Bill Gates' companies. There's an interview with the artist in the latest issue of The Brooklyn Rail.

At P-P-O-W there was quite a strange installation: Bill Smith's Intuitive Visualization of the Unseen. You walk through a black curtain into a room with hanging sculptures. There's a sign saying that the way to experience the main item, "an epidemiological model of the perfect infectious disease (evolved growth system)," is to lie on the floor and look up, but I chickened out of that. But it was a very intriguing network of wires in spherical form, and then the lights went down, to show that the joints were luminous. It was both surprising and amazing as a visual effect, completely changing the experience of the object. It felt a bit like being Jodi Forster during her trip to another galaxy in Contact: well, just a little. It was certainly on the psycedelic side.

The highlight of the afternoon was Dustin Yellin's Dust in the Brain Attic at Robert Miller. His website is at but I had trouble viewing it: I found Opera worked a little better, but still with problems. The gallery website works fine though. There are biological themes, as with Bill Smith's work, but this reminded me more of the Bodies exhibit in New York (I realize there is controversy about the morality of the possible use of the cadavers of Chinese political prisoners there). The works by Yellin included anatomical depictions of the human body using paint in layers of glass fused together, based on CAT scans and magnetic resonance imaging. They were visually fascinating, and I loved the artistic use of science, raising the questions of the meanings of the information we get from modern scanning. These works were also quite playful, with, for example, an extraterrestial landscape. I especially liked that while the images looked three dimensional from the front, they gradually disappeared as you moved to the side, showing empty glass.

Saturday, April 25, 2009

Review of Rachel Cooper: Psychiatry and Philosophy of Science

Forthcoming in Philosophy in Review. Volume XXIX no. 2 (April 2009). Pages 19-21.

Rachel Cooper Psychiatry and Philosophy of Science. McGill-Queen’s University Press 2007. Pp. 240. US$90.00 (cloth ISBN-13: 978-0-7735-3386-8); US$27.95 (paper ISBN-13: 978-0-7735-3387-5).

This book surveys four main issues: the nature of mental illness, psychiatric explanation, relations between different psychiatric theories, and the role of values in psychiatric theory and practice. Each of these issues has two chapters devoted to them, and this provides readers with an overview of how central theoretical questions in psychiatry are approached in philosophy of science, broadly construed. Inevitably in such a book, Cooper devotes single chapters to topics on which others have written whole books, and so she often goes quickly, not pausing for details. Yet at some points she does take the trouble to spell out the arguments in some detail, and she often presents her own perspectives and occasionally presents original research. Her writing is consistently clear and straightforward, and chapters are structured logically. This is a rich and much needed book that will serve as an introduction to one side of philosophy of psychiatry, which amply demonstrates how its debates are deeply connected with those in related areas, and how interesting the area is. It would be appropriate for upper level undergraduate courses, graduate courses, and will be helpful to professional philosophers and mental health care professionals wanting to orient themselves in the current literature.
Cooper starts out, as many others do, by addressing anti-psychiatry, with a survey of Foucault, R. D. Laing and Thomas Szasz. While she defends the view that mental illness is real and psychiatry is a legitimate enterprise, she is surprisingly sympathetic to many of the claims of its critics, and suggests that there is much of value in their work, and that they are not as radical as they often seem to be. Her characterization of early Foucault as ‘W. V. Quine plus history’ is indeed helpful, and Cooper shows that a historical perspective on psychiatry is important in understanding the field, even though most current philosophy tends to be ahistorical in its approach to psychiatry.
The next chapter compares Boorse’s biological account, Fulford’s action-based account, and Aristotelian accounts of disorder. She argues that none of these is successful on its own, but that a ‘messy’ account that combines different theories could do the trick. She cites her own previous suggestion that takes elements from the Aristotelian approach that a disorder must be a harm for a person in some sense, and adds that the sufferer both could reasonably have expected to be better off and could in principle be treated medically, if not at present, then at some point in the future of medicine. She also cites Reznek’s claim that a condition is pathological ‘if and only if it is an abnormal bodily/mental condition that requires medical intervention and that harms standard members of the species in standard conditions’ (40). Both these ideas face the challenge of providing a non-circular definition of ‘medicine’, in non-ad hoc ways that justify the special status of medical disorders in our society.
The chapter on natural kinds argues that mental disorders can be scientific kinds, even if they do not have essences. She summarizes much of the literature and focuses Hacking’s objections; she argues that the concept of natural kind is broad enough to include the phenomena he describes of temporally transient disorders and looping effects in the relation between the medical description of disorders and people having those disorders. Cooper resists the worries of Dupré that categorizing people and their problems will lead to conservative politics by saying that ethics cannot drive metaphysics. She does not address some pragmatist approaches that do precisely that, viz. allow ethics to influence our decisions about how to conceptualize human problems. Given that pragmatist approaches to categorization have gained a good deal of support in recent years, this is an unfortunate omission.
One of the most original chapters makes an argument that individual case histories can be explanatorily helpful because they help us simulate other case histories by providing us with scaffolding. Cooper sketches a portion of simulation theory and explains her suggestion with some examples. This is an interesting idea that deserves further attention given the importance of narratives in clinical psychology and the tendency of those who support the ‘scientific approach’ to dismiss narratives as secondary to a scientific understanding.
In the first chapter on relations between theories, Cooper argues that in the psychological sciences there are different paradigms competing at the same time, and although Kuhn said that different paradigms are incommensurable, it is possible to achieve genuine communication between different approaches if enough effort is made. The second chapter in this section asks if reductionist theories are incompatible with our ordinary understanding of people. Cooper examines dualism, identity theory, functionalism and anomalous monism and concludes that most psychiatric explanation is largely independent of these theories. Only eliminative materialism is genuinely incompatible with standard psychiatric explanation involving propositional attitudes. Both these chapters are rather quick and rough in their arguments, but the conclusions are plausible.
The final two chapters address the role of ethics. The first of these spells out the ways in which psychiatric science can be value-laden, and it does so very effectively by using the example of how race was treated in the American Journal of Psychiatry between 1844 and 1962. From this, Cooper shows how values shape the scientific project from start to finish. She proceeds to critically evaluate suggestions for how to avoid the problems of bad values infecting science, including making science value-neutral, making sure science is laden with good values, and adopting standpoint epistemology. She finds each of these proposals limited, and suggests that the best bet is to get a diverse body of researchers and to encourage debate about the science. The second chapter is far more specialized, addressing recent problems for psychiatry and medicine generally in the conduct of randomized controlled trials of new treatments. Cooper argues that large corporations have become so involved in these trials that the public has lost its trust in psychiatry, especially with regard to medication. She argues that the methods for policing scientific testimony have broken down, and in order to repair them, new regulations and initiatives need to be introduced. Again, as with most of the rest of this book, Cooper’s arguments here are interesting and plausible.

Thursday, April 23, 2009

Recent Papers Relevant to Philosophy of Psychiatry

"From Descartes to Desipramine: Psychopharmacology and the Self"
Ian Gold, McGill University and Lauren Olin, McGill University
Despite the remarkably widespread use of the new generation of antidepressants, almost everything we know about their effects comes from animal studies and clinical trials in which the sole parameter of interest is depressive symptomatology. Almost nothing is known about the effects that antidepressants have on cognition, affect, or motivation when used over a period of months or years. Nor do we understand what effects, if any, antidepressants have on what we think of as the self. In this article, we argue that neither psychiatry nor philosophy, in their current state, are well equipped to think about these issues. In order to explore this idea, we consider the neurobiology of romantic love and its relation to antidepressant neurochemistry. This case study, we suggest, supports the view that antidepressants are very likely to have significant effects on personhood as well as the suggestion that we are in need of new ways of thinking about the self and its pathologies.
Key Words: antidepressants • DSM-IV • philosophy • self • SSRIs
Transcultural Psychiatry, Vol. 46, No. 1, 38-59 (2009)

and, at the more empirical side,

"Pedophilia, Hebephilia, and the DSM-V"
Ray Blanchard, Amy D. Lykins, Diane Wherrett, Michael E. Kuban, James M. Cantor, Thomas Blak, Robert Dickey and Philip E. Klassen
The term pedophilia denotes the erotic preference for prepubescent children. The term hebephilia has been proposed to denote the erotic preference for pubescent children (roughly, ages 11 or 12–14), but it has not become widely used. The present study sought to validate the concept of hebephilia by examining the agreement between self-reported sexual interests and objectively recorded penile responses in the laboratory. The participants were 881 men who were referred for clinical assessment because of paraphilic, criminal, or otherwise problematic sexual behavior. Within-group comparisons showed that men who verbally reported maximum sexual attraction to pubescent children had greater penile responses to depictions of pubescent children than to depictions of younger or older persons. Between-groups comparisons showed that penile responding distinguished such men from those who reported maximum attraction to prepubescent children and from those who reported maximum attraction to fully grown persons. These results indicated that hebephilia exists as a discriminable erotic age-preference. The authors recommend various ways in which the DSM might be altered to accommodate the present findings. One possibility would be to replace the diagnosis of Pedophilia with Pedohebephilia and allow the clinician to specify one of three subtypes: Sexually Attracted to Children Younger than 11 (Pedophilic Type), Sexually Attracted to Children Age 11–14 (Hebephilic Type), or Sexually Attracted to Both (Pedohebephilic Type). We further recommend that the DSM-V encourage users to record the typical age of children who most attract the patient sexually as well as the gender of children who most attract the patient sexually.
Keywords DSM-V - Ephebophilia - Hebephilia - Paraphilia - Pedophilia - Penile plethysmography - Phallometry - Sexual offending - Sexual orientation - Teleiophilia
with 7 letters from various others and a reply from Ray Blanchard

There's also an editorial in the January 2009 issue of the American Journal of Psychiatry, "Child Psychiatry Growin’ Up" by Daniel S. Pine, M.D., and Robert Freedman, M.D. that is important but causes me some concern.
They discuss recent research, and especially fMRIs done on children, and conclude:
"These findings support the hypothesis that children’s relative lack of neural response to adverse or fearful stimuli predicts deviant adult behavioral profiles. Eventually, this information may be used to predict long-term outcomes and to tailor treatments individually targeted toward underlying neural dysfunction associated with different forms of behavior disorders. The consonance of the imaging findings in children with those from laboratory animals may provide models for discovery of new neurobiological treatments."
The assumption that neurological studies mandate neurobiological treatments strikes me as problematic.

And there's yet another new issue of PPP out. It's a special issue, on "Phenomenology, Behaviorism, and the Nature of Mental Disorders: Voices from Spain," edited by Marino Pérez-Álvarez and Louis A. Sass. Table of Contents at

Monday, April 13, 2009

News items

A few things came to my inbox in the last week.

From the latest issue of Medicine, Health Care and Philosophy Volume 12, Number 2 / May, 2009

The ethics of self-change: becoming oneself by way of antidepressants or psychotherapy?
Fredrik Svenaeus


Should or should not forensic psychiatrists think about free will?
Gerben Meynen

A very fancy website using the Adobe Flash Player for the
12th International Conference for Philosophy & Psychiatry 2009
on the generic topic of "Understanding Mental Disorders." October 22-24, 2009, Lisbon, Portugal.
(Personally I am not a fan of sites that make it impossible to copy their text.)
The deadline for abstracts is very late: 30 August 2009. Presumably this means that that notification of acceptance of abstracts is also very late. I'd normally expect to book airline tickets and make hotel reservations in August for an October conference. Maybe it is a safe bet that most abstracts will be accepted.

And finally, a call for papers:
Vol. 4, No. 1: IJFAB Special Issue: Feminist Perspectives on Ethics in Psychiatry
Guest Editors: Jennifer Hansen, Nancy Potter and Jennifer Radden
Deadline for Submission: March 1, 2010
I'll skip the rather long text, and just give the contact info:
For more information, please contact Jennifer Hansen:

Thursday, April 2, 2009

Another new issue of PPP

The issues of PPP are coming fast and furious now. Hot on the heels of the last, I just received 15(2), June 2008. At this rate, the journal dates will start to match the calendar dates. This one is so new, it is not yet listed on the PPP website at Project Muse.

It is a special issue devoted to the toic of "Values-Based Medicine, Evidence-Based Medicine." It's good to see PPP occasionally delve into the broader area of Philosophy of Medicine. It makes sense then that the editors (Wifstad, Falkum, Ayob and Thornton) are European, where the tradition of philosophy of medicine is strong. I have only browsed the issue, but one notable feature is that it breaks from the standard format, with one section on values-based medicine with five papers, another on evidence-based medicine with four papers, and then four commentaries that address general themes rather than single papers. There are no replies to the commentaries. Given my comments in the previous post on the inherent limitations of the peer commentary approach (which is especially apparent in the American Journal of Bioethics), it is good to see the PPP editors mixing it up and trying new ideas.

Wednesday, April 1, 2009

PPP Issue on Vice and Disorder

In the latest issue of PPP, John Sadler has put together a "philosophical case conference" on vice and the classification of mental disorders, which will be a great resource for future discussion of the area.
His target piece features discussion of some of the issues of classifying vice, by which he means criminal behavior and immoral attitudes. He sets out three cases. The first is a 12-year-old boy who is disobedient and troublesome, defying authority and lying. He gets diagnosed with conduct disorder. The second is of a mother who presents her mother who presents her child as ill and having breathing difficulties. It turns out that the mother smothered her child. She has a complicated case history, with a troubled past. The third case is Jeffrey Dahmer, who received diagnoses of Asperger's, paraphilias, alcohol abuse, depressive disorder not otherwise specified, and personality disorder not otherwise specified. The rest of the paper sets out some of the issues in dealing with the vice-mental disorder relationship in DSM-UV-TR, under the headings of "Inconsistencies in How Wrongful Conduct is Classified," "Impoverishment of Some Criteria Sets for Vice-Laden Disorders," "Hierarchical and Comorbidity Issues," and "Metaphysical Ambiguities." The main theme is that DSM-IV-TR is not consistent and is not clearly formulated when it comes to the relation between vices and disorders. The paper does not set out a theory of what this relation should be.

There is an unusual number of peer commentators for this target paper:
Jeffrey Geller (U Mass Medical School)
Gwen Adshead
Nancy Nyquist Potter and Peter Zachar
Christopher Heginbotham, University of Central Lancashire
Michael First
Christopher Williams
Lloyd Wells (Mayo Clinic)
Stephen Morse
It is a diverse collection of responses. I'm a little disappointed that there was not more discussion of the cases. Geller writes about some of the history of the topic. Adhead expands on the discussion of Case 2, which was her example in the first place. Potter and Zachar give a rather general discussion. Heginbotham gives a brief discussion of the cases and proposes an approach rooted in the social model of disability. First gives a more extensive discussion of the topic and the cases, allowing that vices can also be indicative of disorders. Williams sketches some issues in identifying the causes of behavior. Wells endorses an approach that mixes medicalization and moralization, and discusses this in several cases of his own. Morse emphasizes the difficulty of examining the issues in the absence of quite well developed theories of what counts as a mental disorder and a theory of morality.

Adshead complains about the "muddling" of social, psychological, and legal discourses, as if it were possible to keep them separate, but she is open to the possibility that vice and disorder need not be mutually exclusive. Yet even here, she seems to think that the mental disorder itself could not explain violence to others completely, and that one needs other elements in the explanation. She is especially sensitive to the danger that explaining an action with a diagnosis would take away a person's sense of agency. Adshead gives the impression that she needs a more fully fledged theory of action and mental disorder in order to avoid conceptual problems. Most of the other authors embrace the fact that the moral and the medical overlap, and that people can responsible for their symptomatic behavior even when they have mental illness.

With this and all the other commentaries, it is clearly impossible for them to set out a detailed view about such a complex area. So they are able to raise a few points but one does not get a strong sense of deep engagement with issues raised by the target article, and none of the authors sets out anything like the robust theories that Morse says are needed. This is all to the good, meaning that there is still plenty of work to be done in this area. Sadler ends with the suggestion that it might be possible to do without some theories, by taking a pragmatic stance. This is an idea that I'm sympathetic with, but I'm not sure that it is possible to bypass the theories altogether, and justifying the pragmatic stance without the theory is going to take lots of discussion, if not theorizing.