Abstract
In the 2000s, several psychiatrists cited the lack of relational disorders (what I call “collective disorders”—disorders of groups rather than individuals) in the DSM-IV as one of the two most glaring gaps in psychiatric nosology, and campaigned for their inclusion in the DSM-5. This campaign failed, however, presumably in part due to serious “ontological concerns” haunting such disorders. Here, I offer a path to quell such ontological concerns, adding to previous conceptual work by Jerome Wakefield and Christian Perring. Specifically, I adduce reasons to think that collective disorders are compatible with key metaphysical commitments of contemporary scientific psychiatry, and argue that if one accepts the existence of mental disorders in individuals as medical, then one has good reasons to accept the existence of collective disorders as medical. First, I outline how collective disorders are reconcilable with both the harmful dysfunction model of disorder and a denial of mind-body dualism. I then identify some potential weaknesses in the main pre-existing example of a collective disorder, offering my own examples as supplements. These examples’ medical plausibility is bolstered by: (1) work in philosophy of biology on the generalized selected effects theory of function (largely from Justin Garson), and (2) work in analytic philosophy of mind on collective mentality (largely from Bryce Huebner). Finally, after offering preliminary responses to the objection that the recognition of collective disorders may lead to an overpathologization of everyday life, I spell out ways in which this recognition may have empowering effects for some would-be patients; for example, by providing substance to the notion of a “sane response to an insane world.”
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Notes
I use “disorder” in the sense of “medical disorder” as an umbrella term that covers a wide variety of forms of medical pathology and disability, including disease, illness, injury, and other medical conditions (see Cooper 2008, p. 29 for an explication of this usage). Note also that the terms “mental disorder” and “mental illness” are contested, since they, by definition, pathologize what many would instead call “mental differences” or forms of mental/neurodiversity. I do not explicitly explore this debate here, but acknowledge its importance, and use the term “mental disorder” or “psychiatric disorder” in the context of individuals merely to stand for “condition regarded as a psychiatric disorder by the American Psychiatric Association.” This choice is driven by the fact that this is (for better or worse) a much more commonly recognized term, rather than by any commitment to a derogatory view.
“Scientifically-minded” (which I will use interchangeably with the phrases “scientifically plausible,” “scientifically friendly,” and “scientific”) can be interpreted in a variety of ways. The sense in which I tend to use it here is a minimal one: a scientifically-minded psychiatry is one that rejects any appeal to non-physical entities in its research or practice. That is, it denies mind-body dualism, the theory that “the universe contains two fundamentally different types of stuff: the mental and the material (or physical).” (Kendler 2001, p. 990). According to mind-body dualism, mental states are composed of non-physical (perhaps soul-like) substances. Thus, a scientifically-minded psychiatry assumes some form of physicalism (or identity theory)—the theory that mental states are identical to physical states (usually assumed to be brain states). I take it that this sense of “scientifically-minded” accurately characterizes the dominant conception of psychiatry in the United States today. Note also that this sense of “scientifically-minded” is more minimal than the sense of psychiatry as a scientific discipline that appears in Sect. 1.1.2.
As one group of clinicians remarked: “a subtext of concern regarding the ontological status of relational disorders has haunted the discussion of relational processes for many years” (Beach et al. 2006, p. 360). And Michael First identified a similar discomfort: “A number of impediments have stood in the way of the formal inclusion of relational disorders in the DSM. These have included conceptual concerns about extending the concept of disorder from individual dysfunction to relational dysfunction...” (2006, p. 357).
At the same time, not all psychiatrists have backed or would back this effort. I presume one such individual is a speaker at the 2016 APA Annual Meeting who explicitly asserted: “mental illness is a problem within a person, not a problem family” (Choi-Kain, L. W. Presentation titled “Family interventions for borderline personality disorder in the age of EBTs.” APA 2016 Annual Conference, Atlanta, USA).
The APA defines “mental disorder” as “... a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities...” (APA, p. 20). The first sentence captures Wakefield’s “biological dysfunction” criterion; the second sentence reflects his “harm” criterion.
Alternately, it could still remain physicalist and involve a disorder of pheromones or the like, but this seems overly restrictive.
For example, Kendler describes token identity as “an identity relationship between the brain state and the mind state” (Kendler 2001, p. 993).
Also see Theiner and O’Connor (2010) for a similar strategy defending the compatibility of physicalism and collective mentality.
However, allowing the possibility that individual mental states may extend past an individual’s brain may introduce a new problem: it may make it more difficult to distinguish between: (a) collective disorders, and (b) disorders of an individual that affect mental states extending beyond the confines of that individual’s body. In brief, the primary way to avoid this complication is to recall that collective disorders necessarily involve disruptions of collective functions, whereas individual disorders necessarily involve disruptions of individual functions. Thanks to an anonymous reviewer for raising this point.
Note that even though this is metaphysically aligned with a scientifically-minded psychiatry as I have defined it, it has implications that may certainly oppose other senses of the word “scientific.” For example, if some elements of collective disorders are identical to physical substrates outside of brains, then psychiatric research involving only neuroscience will be incomplete (see Drayson 2009, p. 339; Hoffman 2016, p. 1171). However, this is not to say that collective disorders will even come close to obviating such research; individual brain states will certainly still play pivotal roles in putative collective (and individual) disorders.
In addition, Wakefield’s phrasing is ill-formed for separate reasons. I discuss those reasons in Sect. 3.3.
Although there is some uncertainty here about how to precisely specify the collective function in question, note that there is often also significant uncertainty about how to specify individual mental functions that are apparently disrupted in individual mental disorders. So this issue does not seem to be unique to collective functions.
For some reason, in this example, Wakefield implies that harm should be assessed with respect to the individuals who are part of the collectivity, rather than the collectivity itself: “The harm requirement poses no problem and is set aside in the remainder of the discussion. Virtually all individuals who seek professional help for relationship problems do so because they believe they are being harmed by the relationship” (2006, p. 424). I disagree with this application of the harm criterion: since we are assessing whether the collectivity itself is disordered, we should assess whether the collectivity itself is harmed. In the remainder of the paper, I largely leave aside discussion of the harm criterion, assuming that the dysfunctions discussed herein end up causing harm to the collectivities in question.
Whether or not it should be comfortable in the first place is the subject of a large body of work within philosophy of psychiatry and other disciplines. This is a question to which I am sympathetic, but one that would take us too far afield to explore here.
In fact, Wakefield himself acknowledges the existence of something like this category of individual functions in a different section of his paper, taking pains to distinguish them from collective ones: “... relational disorders are not dysfunctions of the mechanisms within individuals that allow individuals to enter into adequate relationships” (2006, p. 424).
Granted, this worry could benefit from further elaboration: for example, “somehow reduces” could be clarified as indicating an explanatory reduction and/or a metaphysical one. However, even absent such specifications, I believe the existence of this worry is apparent enough for the present purposes.
Of course, as Perring points out, identifying relevant collective functions with any degree of confidence is difficult. However, as I discussed above, I don’t believe this is a special problem for collective (as opposed to individual mental) functions.
What is especially interesting about this example is that the presence of what psychiatry considers an individual disorder (e.g. attention deficit disorder (hereafter “ADD”), bipolar disorder, autism, some forms of psychosis) in one of the marketing team’s members may well prevent a collective disorder: myriad studies and individual testimonies attest to distinctive creative and technical abilities that can be associated with these conditions in some contexts (Armstrong 2010; Carson 2011; Cramond 1994; Jamison 1993, 1995; Santosa et al. 2007; Walters 2011).
Another example of a collective disorder caused by a lack of diversity is “NON-DIVERSE UNIVERSITY.” Here, a university suffers from a lack of racial diversity (it is not difficult to find actual examples). Presumably one (collective) function within a university is to enable students to gain an understanding of the world beyond their own individual perspectives. Arguably, a university’s inability to expose students to diverse perspectives first-hand counts as a failure of this function. One mechanism supporting this function is the correction of racist stereotypes in a classroom discussion. For example, imagine that, in the classroom, a white student expresses a racist belief. One or more black students challenge that belief by presenting their own experience, and also by serving as counterexamples themselves. As a result, the white student understands that her original evidence was faulty, and subsequently revises her belief. This particular mechanism cannot work if there are no black students in the classroom, or if they are so outnumbered that they are hesitant to speak up. As such, this university exhibits a failure in its function of enabling its students to gain a broader perspective of the world. It is also (I presume) harmed (its graduates are less successful, which threatens its well-being by leading to eventual declines in enrollment). It therefore exhibits a collective disorder. Here, COLLAPSE is not a threat, because there are (presumably) no relevant individual disorders onto which the collective disorder might collapse. First, it is not a disorder to be one race or another. Second, the lack of diversity is not the doing of any one individual in the administration: all policies affecting racial diversity must be authored and voted upon by many individuals.
Because I have stipulated that MORAL MISMATCH involves a biologically related father and child, this collectivity presumably counts as a biological collectivity with naturally selected functions.
Presumably, all of these theories of biological natural functions stipulate that the system possessing the function in question has at least some living components. Otherwise, they would be open to strong counter-examples. For example, certain chemical functions of some rocks could contribute to the continued “fitness” or existence of those rocks over others in an otherwise barren terrain, but clearly, these rock functions do not count as biological natural functions. Thanks to an anonymous reviewer for this helpful point.
Thanks to an anonymous reviewer for this articulation.
That is, if one simply cannot accept that a company can be a biological collectivity in this sense, then one must deeply reconsider whether individual mental states are biological in this sense. Thus, if the classification of a disorder as properly medical hangs on this sense of “biological,” then one might consider the existence of collective disorders of companies as medical as a reductio against the existence of individual mental disorders as medical. I am not necessarily opposed to this possibility, but will not explore it further here.
Interestingly, this is also a foundational premise of the National Institute of Mental Health (hereafter “NIMH”)’s RDoC system, an exemplar of scientifically-minded psychiatry (NIMH, website). RDoC is a framework recently proposed as an alternative to the DSM. While DSM nosology is largely structured around “felt experiences” of patients (e.g. “depressed mood,” “irritability,” and “hallucinations”), RDoC is organized into a matrix of psychological constructs (which are presumably equivalent to Huebner’s subsystems, and include things like “negative valence systems” and “cognitive systems”) and largely sub-personal “units of analysis” like genes, molecules, and neural circuits. RDoC’s creation was largely driven by a determination to make psychiatry more scientific, and has been criticized for being too reductionistic (as just one of many examples, see Berenbaum 2013. See also Hoffman and Zachar 2017 for further references). Thus it is fascinating and perhaps ironic that the very feature of RDoC criticized for being reductionistic (its focus on constructs/subsystems and sub-personal parts of the mind/brain) is a key premise in constructing the case for collective minds.
Although they need not be, as in the case of extended mentality.
In fact, the sheer counterintuitiveness of an experiencing collectivity is famously used by Ned Block to argue against a functionalist definition of mental states (Block 1978).
One particularly striking example is how an individual’s mind persists in seeing certain visual illusions (i.e. a perception of differing lengths of two lines in the Müller-Lyer illusion) even after one knows that they are illusions (see Huebner 2014, p. 79).
Clearly, seeing this re-direction as a benefit pushes towards the “humanistic” side of the tension in psychiatry mentioned in Sect. 1.1.2. Although it is theoretically possible to treat collective disorders with pharmacological means (after all, they are realized partially by brain states of individuals within the relevant collectivities), the evidence referenced above indicates that such means may be less effective (not to mention that the sheer number of brain states realizing collective disorders will likely result in a highly disjunctive disarray, such that finding the “right” combination of drugs in the right individuals will likely involve a great deal of trial and error.)
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Association.
Armstrong, T. (2010). The power of neurodiversity: Unleashing the advantages of your differently wired brain. Cambridge, MA: Da Capo Press.
Armstrong, T. (2015). The myth of the normal brain: Embracing neurodiversity. AMA Journal of Ethics, 17(4), 348–352.
Barnes, E. (2016). The minority body. Oxford: Oxford University Press.
Beach, S. R. H., Wamboldt, M. Z., Kaslow, N. J., Heyman, R. E., & Reiss, D. (2006). Describing relationship problems in DSM-V: Toward better guidance for research and clinical practice. Journal of Family Psychology, 20(3), 359–368.
Berenbaum, H. (2013). Classification and psychopathology research. Journal of Abnormal Psychology, 122(3), 894–901.
Biegler, P. (2011). The ethical treatment of depression: Autonomy through psychotherapy. Cambridge, MA: MIT Press.
Block, N. (1978). Troubles with functionalism. In C. W. Savage (Ed.), Minnesota studies in the philosophy of science (Vol. IX, pp. 261–325). Minneapolis, MN: University of Minnesota Press.
Carson, S. H. (2011). Creativity and psychopathology: A shared vulnerability model. Canadian Journal of Psychiatry, 56(3), 144–153.
Clark, A., & Chalmers, D. (1998). The extended mind. Analysis, 58, 7–19.
Cooper, R. (2008). Psychiatry and philosophy of science. McGill: Queen’s University Press.
Cramond, B. (1994). Attention-deficit hyperactivity disorder and creativity–What is the connection? The Journal of Creative Behavior, 28(3), 193–210.
Dolnick, E. (1993). Deafness as culture. The Atlantic Monthly, 272(3), 37–53.
Drayson, Z. (2009). Embodied cognitive science and its implications for psychopathology. Philosophy, Psychiatry & Psychology, 16(4), 329–340.
Elliott, C. (1998). The tyranny of happiness: Ethics and cosmetic psychopharmacology. In E. Parens (Ed.), Enhancing human traits: Ethical and social implications (pp. 177–188). Washington, DC: Georgetown University Press.
Farber, S. (2012). The spiritual gift of madness: The failure of psychiatry and the rise of the mad pride movement. Rochester: Inner Traditions.
First, M. B. (2006). Relational processes in the DSM-V revision process: Comment on the special section. Journal of Family Psychology, 20(3), 356–358.
First, M. B., Bell, C. C., Cuthbert, B., Krystal, J. H., Malison, R., Offord, D. R., et al. (2002). Personality disorders and relational disorders: A research agenda for addressing crucial gaps in DSM. In D. J. Kupfer, M. B. First, & D. A. Regier (Eds.), A research agenda for DSM-V (pp. 123–199). Washington, DC: American Psychiatric Association.
Garson, J. (2012). Function, selection, and construction in the brain. Synthese, 189(3), 451–481.
Garson, J. (2015). The biological mind. London: Routledge.
Garson, J. (2016). A critical overview of biological functions. New York: Springer.
Gilbert, M. (1989). On social facts. London: Routledge.
Hoffman, G. A. (2012). What, if anything, can neuroscience tell us about gender differences? In R. Bluhm, A. J. Jacobson, & H. L. Maibom (Eds.), Neurofeminism: Issues at the intersection of feminist theory and cognitive science (pp. 30–55). New York: MacMillan.
Hoffman, G. A. (2013). Treating yourself as an object: Self-objectification and the ethical dimensions of antidepressant use. Neuroethics, 6(1), 165–178.
Hoffman, G. A. (2016). Out of our skulls: How the extended mind thesis can extend psychiatry. Philosophical Psychology, 29(8), 1160–1174.
Hoffman, G. A., & Zachar, P. (2017). RDoC’s metaphysical assumptions: Problems and promises. In Ş. Tekin & J. Poland (Eds.), Extraordinary science: Responding to the crisis in psychiatric research (pp. 59–86). Cambridge, MA: MIT Press.
Horwitz, A. V., & Wakefield, J. C. (2007). The loss of sadness: How psychiatry transformed normal sorrow into depressive disorder. Oxford: Oxford University Press.
Huebner, B. (2011). Genuinely collective emotions. European Journal for Philosophy of Science, 1(1), 89–118.
Huebner, B. (2014). Macrocognition. Oxford: Oxford University Press.
Huebner, B., Bruno, M., & Sarkissian, H. (2010). What does the nation of China think about phenomenal states? Review of Philosophy and Psychology, 1, 225–243.
Hutchins, E. (1995). Cognition in the wild. Cambridge, MA: MIT Press.
Jamison, K. (1993). Touched with fire: Manic-depressive illness and the artistic temperament. New York: Free Press.
Jamison, K. (1995). An unquiet mind: A memoir of moods and madness. New York: Knopf Inc.
Kaslow, F., & Patterson, T. (2006). Relational diagnosis–A brief historical overview: Comment on the special section. Journal of Family Psychology, 20(3), 428–431.
Kendler, K. (2001). A psychiatric dialogue on the mind-body problem. American Journal of Psychiatry, 158, 989–1000.
Levy, N. (2007). Neuroethics. Cambridge: Cambridge University Press.
Lewis, B. (2006a). Moving beyond Prozac, DSM and the new psychiatry: The birth of postpsychiatry. Ann Arbor: University of Michigan Press.
Lewis, B. (2006b). A mad fight: Psychiatry and disability activism. In L. J. Davis (Ed.), The disability studies reader (pp. 115–131). London: Routledge.
Manninen, B. A. (2006). Medicating the mind: A Kantian analysis of overprescribing psychoactive drugs. Journal of Medical Ethics, 32, 100–105.
Menary, R. (Ed.). (2010). The extended mind. Cambridge, MA: MIT Press.
Middleton, A., Hewison, J., & Muelller, R. (2001). Prenatal diagnosis for inherited deafness–What is the potential demand? Journal of Genetic Counseling, 10, 121–131.
MindFreedom. Mad pride campaign. Resource document. http://www.mindfreedom.org/campaign/madpride. Accessed 20 Aug 2016.
Moncrieff, J. (2016). Myth of the chemical cure. In W. Hall (Ed.), Outside mental health: Voices and visions of madness (pp. 155–162). Madness Radio.
National Association of the Deaf. (2000). NAD position statement on cochlear implants. http://nad.org/issues/technology/assistive-listening/cochlear-implants. Accessed 20 Aug 2016.
National Institute of Mental Health. Research Domain Criteria (RDoC) website. Resource document. http://www.nimh.nih.gov/research-priorities/rdoc/index.shtml. Accessed 19 Aug 2016.
Ortega, F. (2009). The cerebral subject and the challenge of neurodiversity. BioSocieties, 4(4), 425–445.
Perring, C. D. (2014). Are relationship problems disorders? In C. D. Perring & L. A. Wells (Eds.), Diagnostic dilemmas in child and adolescent psychiatry (pp. 98–108). Oxford: Oxford University Press.
Pettit, P. (2003). Groups with minds of their own. In Fred Schmitt (Ed.), Socializing metaphysics (pp. 167–193). New York: Rowman and Littlefield.
Santosa, C. M., Strong, C. M., Nowakowska, C., Wang, P. W., Rennicke, C. M., & Ketter, T. A. (2007). Enhanced creativity in bipolar disorder patients: a controlled study. Journal of Affective Disorders, 100(1–3), 31–39.
Tekin, Ş. (2011). Self-concept through the diagnostic looking glass: Narratives and mental disorder. Philosophical Psychology, 24(3), 357–380.
Tekin, Ş. (2014). Self-insight in the time of mood disorders. Philosophy, Psychiatry, & Psychology, 21, 135–137.
Theiner, G., Allen, C., & Goldstone, R. (2010). Recognizing group cognition. Cognitive Systems Research, 11, 378–395.
Theiner, G., & O’Connor, T. (2010). The emergence of group cognition. In A. Corradini & T. O’Connor (Eds.), Emergence in science and philosophy (pp. 78–117). London: Routledge.
Tollefsen, D. P. (2002). Organizations as true believers. Journal of Social Philosophy, 33(3), 395–411.
Tollefsen, D. P. (2006). From extended mind to collective mind. Cognitive Systems Research, 7(2–3), 140–150.
Vedantam, S. (2002). Doctors consider diagnosis for “ill” relationships. The Washington Post. Available from http://www.washingtonpost.com/. Accessed 8 Aug 2016.
Wakefield, J. C. (1992). The concept of mental disorder: On the boundary between biological facts and social values. American Psychologist, 47(3), 373–388.
Wakefield, J. C. (2006). Are there relational disorders? A harmful dysfunction perspective: Comment on the special section. Journal of Family Psychology, 20(3), 423–427.
Walters, S. (2011). Autistic ethos at work: Writing on the spectrum in contexts of professional and technical communication. Disability Studies Quarterly, 31(3). doi:10.18061/dsq.v31i3.1680.
Wamboldt, M. Z., & Reiss, D. (2006). Genetic strategies for clarifying a nosology of relational distress. Journal of Family Psychology, 20(3), 378–385.
Wilson, R. (2005). Collective memory, group minds, and the extended mind thesis. Cognitive Processing, 6(4), 227–236.
Wolframe, P. (2013). The madwoman in the academy, or, revealing the invisible straightjacket: Theorizing and teaching saneism and sane privilege. Disability Studies Quarterly, 33(1). doi:10.18061/dsq.v33i1.3425.
Acknowledgements
I sincerely thank Justin Garson, Bhob Rainey, Şerife Tekin, and two anonymous reviewers for their helpful feedback on earlier drafts of this manuscript.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hoffman, G.A. Collectively ill: a preliminary case that groups can have psychiatric disorders. Synthese 196, 2217–2241 (2019). https://doi.org/10.1007/s11229-017-1379-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11229-017-1379-y