Friday, August 28, 2009

Kant on mental disorder

Patrick Frierson
Kant on mental disorder. Part 1: An overview
History of Psychiatry 2009 20: 267-289
Kant on mental disorder. Part 2: Philosophical implications of Kant’s account
History of Psychiatry 2009 20: 290-310

http://hpy.sagepub.com/content/vol20/issue3/

I didn't even know that Kant had written anything directly on mental illness, so this pair of papers is especially welcome.

Wednesday, August 19, 2009

Review of Scanlon's Moral Dimensions: Permissibility, Meaning, Blame

Forthcoming in Philosophy in Review. Vol. 29 no. 4. Pages 58-60.

T. M. Scanlon Moral Dimensions: Permissibility, Meaning, Blame. Cambridge, MA: Harvard University Press 2008. Pp. 227. US$29.95 (cloth ISBN-13: 978-0-674-03178-4).

Following in the steps of What We Owe to Each Other (Harvard University Press 1999), this new, slimmer volume will garner plenty of attention in moral philosophy. It consists of four interconnected chapters, the last, on blame, substantially longer than the others, and an especially substantial contribution to the literature.

The first chapter criticizes the doctrine of double effect, arguing that it rests on a mistake about the role of intention in the permissibility of actions. The doctrine makes the following sort of contrast: in wartime, while it would be wrong to bomb an enemy with the intention of killing civilians in order to demoralize the populace in order to bring about a swifter end to the war, it would be morally permissible to bomb a military target such as a munitions factory, knowing that doing so would result in the deaths of an equal number of civilians. The contrast is between what we intend to achieve and what results from the foreseen but unintended effects of our actions. Scanlon holds that while the agent’s intentions may be relevant to the moral assessment of some actions, they are not directly relevant. Scanlon’s first criticism of the doctrine is that it is implausible to hold that the moral permissibility of a decision to bomb a munitions factory and thereby kill a number of civilians depends on one’s intentions. He argues that it is not the intention that matters directly in central cases, but rather what one does and whether one’s actions violate moral principles. He makes this argument by drawing a distinction between the deliberative use of a principle to decide whether an action is ethically permissible, and its critical use to assess how the agent made his or her decision. It is possible that a person’s (or organization’s) intentions will have an effect on how they carry out their actions, and how they would react in the case of changing circumstances. But when the action itself is fixed, and the effects of the action are known, then in assessing its morality, we need to look at the moral principles that apply. The distinction between intended effects and unintended but foreseen effects has no direct relevance, according to Scanlon.

The arguments in this first chapter are hardly conclusive, as they rest largely on unargued intuitions. Scanlon’s opponents can insist that how we understand what an agent did crucially depends on what her intentions were. Scanlon has not provided enough analysis of the concept of an action, or indeed of the sources of moral responsibility, to show his opponents’ view is incoherent. The main value of this first chapter lies in its statement of an alternative view, and Scanlon is right in saying that once one adopts that view, the claims of the doctrine of double effect look ‘bizarre’ when applied to familiar cases of trolley problems and of sacrificing one person to harvest her organs to save the lives of five other people. However, we also have strong intuitions that one’s intentions are relevant in assessing the permissibility of one’s actions, and Scanlon needs to show that his view has a place for these intuitions, in order to avoid having his own view look bizarre too.

The second chapter goes further in setting out an argument for his position. Scanlon agrees that intentions are indeed central in determining what action a person has performed, but he insists that it is the action and not the agent’s intent or understanding of morality that is crucial to the action’s permissibility. Scanlon provides an array of cases where he agrees that a person’s intentions make a difference, such as when a person who apparently does good is actually acting out of selfish or dishonorable motives. However, he argues that these cases can be explained by considering what he calls the ‘meaning’ of the actions. The meaning of an action does depend on the reason the agent did it, but it is not the same thing as the reason. One action can have different meanings for different people, but Scanlon emphasizes his view that the meaning is not purely subjective. People can be mistaken about the meaning of an action for them; they are not fixed by a person's emotions or beliefs, but instead depend on context. For example, Angela may regard Tom's action as a betrayal, but the actual meaning of Tom's action for Angela may in fact be different. To help explain his specialized conception of meaning here, Scanlon gives plenty of examples. Whether he succeeds in clarifying his concept of meaning is debatable.
The third chapter attempts to understand the idea that we should not treat people merely as a means to an end. Scanlon endorses a sense in which treating a person as an end can be used as a general criterion of moral rightness, but shows that this is different from the sense in which we generally mean that it is wrong to use people. He makes a strong case for this, and the chapter will be especially useful to those who work on the morality of using people.

The final chapter, on blame, draws on some distinctions from the prior chapters, but it largely stands alone. It not only has the most innovative and interesting claims of the book, but is also much clearer and supplies a stronger more sustained argument. On his view, blame is not simply an evaluative attitude or an emotion; rather, when one blames another, one judges her blameworthy and, crucially, takes one’s relationship with her to be impaired; one’s attitudes towards the blamed person change. To blame a person is not the converse of praising them; rather, it is closer to the converse of being grateful to another person. It follows, with some further argument, that it is reasonable to blame people for actions even in cases where they could not have done otherwise.

Paradigms of blaming on this account will be in cases where the blamer has a close personal relationship with the person she blames, and Scanlon focuses on blame in friendships and families. He spells out what dispositions are required for people in a good moral relationship. Yet it is possible to blame someone whom one has not met personally. To explain this fact, Scanlon holds that one has a relationship with everyone. Naturally, since one does not have a personal relationship with that person, the impairment in the relationship is different from the blame that occurs between close friends.

Scanlon argues that his account of blame explains several features. (a) Not every wrong action is blameworthy. For example, lack of ambition is a fault of character, but is not blameworthy in itself. (b) The blameworthiness of an action does directly depend on the intentions with which the action was performed, because the agent’s reasons constitute his attitude towards others. (c) We apply blame to young children differently, because of the inequality of the relationship between adults and children, in which adults are teaching the children to become good. Scanlon’s approach to blameworthiness is distinctive in focusing on the relationship between people, and particular actions are relevant insofar as they bear on those relationships. Indeed, blame can be independent of any particular blameworthy action. He acknowledges that this may be in tension with some common understanding of blame, but he argues that our ordinary intuitions are mixed, so no coherent theory can match them all.
People do not normally choose their characters, but since on Scanlon’s view our relationships with them are largely based on their character, this lack of choice does not mean that we should not blame them. The fact that a callous killer had a terrible childhood may alter the way we treat her, but it does not make her exempt from blame. Scanlon considers arguments that we should not hold people morally responsible for their actions when they lack choice about their nature, but maintains that such views rest on the idea that there is a real self that would be uncovered under the right circumstances, and he can make little sense of this. He emphasizes that we have to base our relationships with people on how they actually are, not how they might have been under different circumstances. Whatever the causes of their current attitudes, those are the ones that constitute their relations with other people.

One could retain many of Scanlon's insights about blaming but reject his claim that the change in relationship is partially constitutive; instead one could say that blaming expresses an evaluative attitude towards a person’s action that causes changes in our relationship with her.

Nevertheless, the great value of his proposal is his emphasis on the importance of relationships in understanding blaming. This brings ethics closer to addressing our everyday interactions with colleagues, friends and family. Scanlon’s writing style can make it difficult to pin down exactly how his arguments are meant to go or how they relate to other, well-known positions in this area, since he does not give much discussion of the relevant literature. Nevertheless, this book, and especially the chapter on blame, deserves and will repay careful study.

Christian Perring
Dowling College

Thursday, July 30, 2009

Recent popular media

This week there was an excellent show on BBC Radio 4 in their Mind Changers series, hosted by Claudia Hammond on David Rosenhan's famous Pseudo-Patient Study reported in "Being Sane in Insane Places." It features interviews with his colleagues and discussion about the implications and validity of the experiment.
http://www.bbc.co.uk/programmes/b00lny48

I see next week there is a Radio 4 show on DSM-V, which promises to be interesting.
http://www.bbc.co.uk/programmes/b00kf117

While on the topic of Radio 4, it's worth mentioning that All in the Mind remains the best (and maybe only) radio show about mental health in either the USA or the UK.
http://www.bbc.co.uk/programmes/b006qxx9

As the debate over the secrecy of the process of creating DSM-V heats up, Christopher Lane's recent piece in Slate, Bitterness, Compulsive Shopping, and Internet Addiction: The diagnostic madness of DSM-V, gives a quick summary.
http://slate.com/id/2223479/

If you search blogs and news for 'dsm-v' you'll find plenty of commentary. The Psychiatric Times blog has lots of helpful info.
http://psychiatrictimes.blogspot.com/

Monday, June 15, 2009

Ethics and Values in Contemporary Psychiatry

This one passed me by, but I just stumbled on it.

Ethics and Values in Contemporary Psychiatry
Harvard Review of Psychiatry, Volume 16 Issue 6 2008
http://www.informaworld.com/smpp/title~db=all~content=g906687978

Interesting ToC: in particular, I noted:
The Use of Palliative Sedation for Existential Distress: A Psychiatric Perspective Zev Schuman-Olivier; David H. Brendel; Marshall Forstein; Bruce H. Price Pages 339 – 351
Character Virtues in Psychiatric Practice Jennifer Radden; John Z. Sadler Pages 373 – 380
Off the Radar: Truth Telling in Psychiatry Nancy Nyquist Potter Pages 381 – 387

I look forward to reading the papers: unfortunately my college library only gets access to them when they are a year old, so I'll have to wait.

Wednesday, June 3, 2009

APA NEWSLETTER ON PHILOSOPHY AND MEDICINE

2 new articles in the APA NEWSLETTER ON PHILOSOPHY AND MEDICINE of particular interest:

"Classifying Dysthymia," by Jennifer Radden

"Nosologic Validity and the Intuitively Accessible View of Natural Kinds," by Claire Pouncey

Volume 08, Number 2 Spring 2009
Available online at http://www.apaonline.org/documents/publications/v08n2_Medicine.pdf

Friday, May 8, 2009

Recent publications

An article and a journal issue:

A role for ownership and authorship in the analysis of thought insertion
Lisa Bortolotti and Matthew Broome
Phenomenology and the Cognitive Sciences
Volume 8, Number 2 / June, 2009
Abstract Philosophers are interested in the phenomenon of thought insertion because it challenges the common assumption that one can ascribe to oneself the thoughts that one can access first-personally. In the standard philosophical analysis of thought insertion, the subject owns the ‘inserted’ thought but lacks a sense of agency towards it. In this paper we want to provide an alternative analysis of the condition, according to which subjects typically lack both ownership and authorship of the ‘inserted’ thoughts. We argue that by appealing to a failure of ownership and authorship we can describe more accurately the phenomenology of thought insertion, and distinguish it from that of non-delusional beliefs that have not been deliberated about, and of other delusions of passivity. We can also start developing a more psychologically realistic account of the relation between intentionality, rationality and self knowledge in normal and abnormal cognition.
http://www.springerlink.com/content/145j2111842wpv7h/

And another issue of PPP: that's 3 in 2 months.

Philosophy, Psychiatry, & Psychology
Volume 15, Number 4, December 2008
http://muse.jhu.edu/journals/philosophy_psychiatry_and_psychology/toc/ppp.15.4.html

Target articles:
Delusions, Certainty, and the Background
John Rhodes and Richard G. T. Gipps
pp. 295-310
with commentaries by Giovanni Stanghellini and S. Nassir Ghaemi

The Concept of Mental Disorder: A Proposal
Alfredo Gaete
pp. 327-339
with commentary by Richard G. T. Gipps

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 http://www.dustinyellin.com/ 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.