AAPP Bulletin

At the request of James Phillips, the editor of the AAPP Bulletin, I've put the 4 most recent issues online. They are at http://alien.dowling.edu/~cperring/aappbulletins.html

There is excellent work in there:

• in Vol 13(1), there is a Symposium on “Toward a Philosophical Structure for Psychiatry,” by Kenneth S. Kendler, M.D., with several commentaries and a reply to each by Kendler.
• in Vol 14(1), there is a Symposium entitled "Philosophy and Psychiatry: Reading and Writing from One Side of the Divide—Or the Other," with a target piece by Jennifer Hansen, several responses, and the replies by Hansen.
• in Vol 15(1), there is a Symposium on "Psychiatric Disorders: A Conceptual Taxonomy" by Peter Zachar, Ph.D., and Kenneth S. Kendler, M.D., with several commentaries and a reply to each by Zachar and Kendler.

Hopefully now that they are available online the work here will get wider exposure and can be useful to other researchers and teachers.

As an aside, it is worth emphasizing that membership of AAPP gets you a subscription to PPP and helps to support the main international organization devoted to scholarship in philosophy and psychiatry.

Philosophy and Psychiatry in the Media

I forgot that I had these up online: 4 of my columns for the AAPP Bulletin on "Philosophy and Psychiatry in the Media", from 1999 to 2001.

Here they are.

BBC Radio 4: State of Mind

State of Mind is a series on BBC Radio 4 that traces the history of mental health treatment in the UK since the 1950s. There have been three episodes so far: Total Institution, Altered States, and Community Care? I was particularly impressed by the second show, Altered States, which in its discussion of antipsychiatry and critical psychiatry. There were clips from an old intereviewith R.D. Laing, and then it had an interview with Phil Thomas, (pictured), co-author of Postpsychiatry, and he talked about his involvement with Sharing Voices (Bradford). Radio 4 already has one long running show that focuses on mental health issues, All in the Mind, and its Science section has in recent years had many other programs that focus on psychology and mental health. It also has programs that address medical ethics: Inside the Ethics Committee is nearly all medical ethics and The Moral Maze often looks at medical/psychological issues. Many other programs on Radio 4 give a reasonably thorough discussion of controversies in psychiatry and psychology.

Apart from admiration for the work of Radio 4, this also highlights the lack of thorough and sustained investigation of such issues by radio stations in the USA. NPR and affiliated companies like American Public Radio pale in comparison with their coverage of these issues. The bulk of their coverage is in short items on their daily news shows, and then interviews (and phone-ins) with authors promoting their new books. It is disappointing that there isn't more room for coverage of new developments in psychology and mental health on public radio. The main show that addressed these issues was The Infinite Mind, which seems to be on hiatus now -- and I have never lived in an area where the public radio stations actually broadcast it.

New work on moral responsibility and psychopaths

Doing some reading on moral responsibility and following some leads has uncovered a few couple of recent papers relating to psychopathy.

Paul J. Litton. Responsibility Status of the Psychopath: On Moral Reasoning and Rational Self-Governance, Symposium: Living on the Edge: The Margins of Legal Personhood, 39 RUTGERS LAW JOURNAL 349 (2008). Available Online

Absent, Full and Partial Responsibility of the Psychopaths
ZAVALIY, ANDREI G.
Journal for the Theory of Social Behaviour, Volume 38, Number 1, March 2008 , pp. 87-103(17)

I just read "Moral Address, Moral Responsibility, and the Boundaries of the Moral Community" by David Shoemaker at Bowling Green State University. Ethics 118 (October 2007): 70-108.

Shoemaker is interested in what criterion we should use to demarcate our moral community, and he takes as his starting point the work of Peter Strawson and R. Jay Wallace on the participant reactive attitudes. He calls their approach the "Moral Reasons-Based Theory" and summarizes its basic claim as follows:

MRBT VERSION 1:
One is a member of the moral community, a moral agent eligible for moral responsibility and interpersonal relationships,if and only if (a) one has the capacity to recognize and apply moral reasons and (b) one has the capacity to control one's behavior in light of such reasons.

He considers a number of cases of people who are possibly at the borders of our moral community: people with psychopathy, moral fetishism, autism, and mild mental retardation. After each case, he amends the MRBT theory, and by the end he reaches

MRBT VERSION 5: One is a member of the moral community, a moral agent eligible for moral responsibility and interpersonal relationships, if and only if (a) one has the capacity to recognize and apply second-personal moral reasons one is capable of discovering via identifying empathy with either the affected party (or parties) of one's behavior or an appropriate representative, regardless of the method of identification and (b) one is capable of being motivated by those second-personal moral reasons because one is capable of caring about their source (viz., the affected party/parties or an appropriate representative), insofar as one is susceptible to being moved to identifying empathy with that source by the moral address expressible via the reactive attitudes in both its reason-based and emotional aspects.

It's an interesting paper, but I have to say that I found the method of argument especially flawed because of its crude approach to the borderline cases. Shoemaker's discussion of psychopathy is a good one with which to make my point. He starts off, quite sensibly, saying "we need to get clear on just what the nature of psychopathy is." Fair enough. Then he proceeds to lump it together with sociopathy under the DSM-IV disagnostic catetory for antisocial personality disorder. Astonishingly, in making this reference, he cites the Answers.com website, rather than the DSM itself. In a footnote mentioning some disagreements on how to understand psychopathy, his source is Wikipedia (and he refers to the same source again later for more information about psychopaths). Shoemaker argues that psychopaths are able to recognize and follow moral rules, and he cites some philosophers (Jeffrey Murphy, Anthony Duff, Herbert Fingarette) to support his claim, and then he brings in his further evidence: fictional psychopaths, including Hannibal Lecter, Alex Delarge from A Clockwork Orange, and Eric Cartman from South Park.

It becomes clear that Shoemaker is not really interested in psychopathy as a real phenomenon, but rather whatever conceptually possible condition that will serve his purposes for his argument. Of course, he is assuming that psychopaths are not part of our moral community, which is a rather shakey assumption in real life, and is completely unsupported as a claim about his idealized concept of psychopathy that serves as his counterexample.

I find it surprising that anyone would use Wikipedia as a source of information for a scholarly paper, and especially troubling in this case because it leads to a great oversimplification and a neglect of scholarly discussion that is precisely relevant to the whole point of the paper, viz, how to understand psychopathy. It's only through understanding the psychiatric controversies over the nature of psychopathy and the responsibility of psychopaths, (as well as recent discussion in philosophy of psychiatry and neuroethics) that psychopathy can serve as a useful example for such discussion of moral responsibility.

Reciprocal Relations with Mentally Ill People

I just read Jeanette Kennett's paper "Mental Disorder, Moral Agency, and the Self" in the Oxford Handbook of Bioethics, edited by Bonnie Steinbock, Oxford University Press, 2007. (Incidentally, it is the first time I've read a whole article through Google books -- it saved me a few weeks, since I didn't have to get a copy through Inter Library Loan. Very useful.)

Kennett (pictured) here is discussing an issue I have been thinking about myself recently -- the apparent dilemma that one either treats mentally ill people as autonomous and thus subject to blame for when they are hurful and inconsiderate, or else treats them as nonautonomous, than thus as objects rather than ends-in-themselves. Either way, mentally ill people are in a bad position.

Her approach is rich, even if seems a little rambling. Her main example is Anne Deveson's son Jonathan, who she describes in her memoir Tell Me I'm Here. Jonathan had schizophrenia. Kennett says, using R. Jay Wallace, that on the standard account of moral agency, which requires that an agent be able to step back from his or her desires and examine them in the light of moral principles. She argues that Jonathan did not have that capacity. However, she gives contradictory evidence, since she points out that Deveson found notes written by Jonathan to himself saying "Don't hurt Anne," suggesting that he did regret his actions. It seems that Jonathan was able to assess his own actions at other times, but he was far less able to stop doing them. It is not so clear why Jonathan got so angry with Anne, but it does seem that he at least sometimes regretted his harmful actions. Kennett says that on standard accounts Jonathan cannout count as a responsible moral agent, but it's not so clear to me that this is true.

Kennett also talks about the visibility of the self. At first I thought this was a weak and unnecessary part of the paper, but on reflection it seems the richest part, because it is a new attempt to voice the difficult of people with mental disorders becoming objectified and invisible. She discusses Strawson's idea of participant attitudes, and the difficulties that people with serious mental illness have at being participants, as well as in planning for the future, and forming friendships. In these says, mentally ill people can become invisible. Kennett, quite rightly I think, argues that there is no neat seperation between the mentally ill person and their illness, when their illness has come to shape their identity. Obviously, she is concerned that mentally ill people can retain visibility.

The most philosophically interesting claim of the paper is that Strawson is wrong that we must take an objective stance towards people with chronic and severe mental illnesses. She says that it is not clear that there is a strong conceptual connection between occupying the participant stance and attributing responsible agency to people like Jonathan. She also points out that the participant stance is elastic. It might be available to some degree.

Kennett also focuses on the question whether a participant stance requires attributions of responsibility. She points out that one can have rich participant relationships with children -- not taking the objective stance towards them -- without holding them responsible for their actions. Using these sorts of analogies, she argues that we are not forced toward an objective stance toward the mentally ill. So the bottom line is that even if we do not hold mentally ill pepole responsible, we can still have rich interpersonal relationships with them, even if they are not a rich as with mentally well people.

The view taken by Kennett here is very appealing, and she makes a reasonable case for it. Maybe the conclusion is not very surprising to people who spend a great deal of time with mentally ill people, and Strawson's rather black and white position is quite an oversimplification. But I also think that Kennett's position is a little simplistic. Even with people with chronic severe mental illness, it may be possible for some people to have relationships with them where some mutual attitudes of holding each other responsible is possible. We can also hold people responsible for some things but not others. This is pretty clear with children and teens: they gradually grow into full responsibility. So we need to revise, or at least use with greater flexibility, the standard criterion of moral responsibility to take into account the complexities of life.

Masters Degrees in Philosophy of Psychiatry thriving in the UK

The MSc in Philosophy of Mental Disorder at King's College London has been running successfully for over 10 years now. The MA / MSc in Philosophy and Ethics of Mental Health at Warwick University (now houses in their Medical School) is still running. Now the University of Central Lancashire has a masters program in Philosophy and Mental Health.

Yet here in the USA, there are no such programs, and there's little prospect of any starting in the near future. It's disappointing that the North American educational system is so conservative, and innovation is so difficult here. My main hope is that one of the current masters programs in bioethics will start to allow for specialization in mental health issues, or possibly that the rush of interest in neuroethics will translate into new masters programs in that area.