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.

1 comment:

Rob said...

I've read Boorse and Fulford. I think the idea of specifying the necessary and sufficient conditions of mental disorder may be like using a hammer when you need a screwdriver. Mental disorder really is messy. If I've learned one thing in this business, it's often best identified by resemblance to other cases of disorder encountered. You get to know them by their taste and smell, as it were. I think many mental health practitioners would agree.

If so, where is the later Wittgensteinian account of mental disorders as more like games, identified by family resemblance rather than by logic. It may end up being a less precise account, and perhaps even a bit circular, but precision is worth sacrificing when you get closer to the truth.