A philosophical view on concepts in psychiatry

doi:10.1016/j.ijlp.2009.12.006

International Journal of Law and Psychiatry

Volume 33, Issue 2, March–April 2010, Pages 66-72

https://doi.org/10.1016/j.ijlp.2009.12.006 Get rights and content

Abstract

This essay first outlines a philosophical theory of concepts and then applies it to two areas of relevance to psychiatrists, especially forensic psychiatrists. In the philosophical theory, the respective roles of verbal and non-verbal definitions are illuminated, and the importance of the phenomenon of division of semantic labour is stressed. It is pointed out that vagueness and ambiguity of a term often result when the term is used for several practical purposes at the same time. Such multi-purpose uses of terms may explain both the current problems associated with the Swedish forensic–psychiatric concept of a severe mental disorder and some of the shortcomings of DSM-IV.

Introduction

What could, and should, philosophy do for psychiatry? A not uncommon answer to this question is that philosophers should scrutinize and analyze central psychiatric concepts, criticize these concepts if they do not fulfil their tasks in communication, and then if possible suggest improvements of them. We agree that these are proper aims for the philosophy of psychiatry. However, the tasks of conceptual scrutiny, analysis, criticism and reform – let us use the term “conceptual investigations” as a general term – can each be carried out in several different ways. This is partly due to the fact that what you take a conceptual investigation to be depends on what you think a concept is and how you think a concept works. Therefore, we have decided to allocate a fair space in the beginning of this paper to a discussion about concepts and to state our own view of what a concept and a conceptual investigation is. After that we will give two examples from psychiatry where conceptual investigations by philosophers might be of value. The first of these concerns the concept of severe mental disorder,¹ which plays a central role in Swedish forensic psychiatry and has been subject to ongoing critical discussions for years. The second example concerns the nature of the DSM-IV categories.

Section snippets

What is a concept?

Although it is a basic function of language to convey information about states of affairs that hold in the real world, and although an important function of words is to refer to real objects, the functions of language can to a remarkable degree be uncoupled from these states of affairs and objects. In short, there are false statements and descriptions of non-existing objects. The sentence “It's raining here and now”, uttered in plain sunshine does not refer to any fact, but still we clearly

Ostensive definitions

How are terms given their meaning? Definitions, in the sense of statements expressing necessary and sufficient conditions for the application of a term, undoubtedly play an important role in fixing the meaning of terms where this is needed.³

What is a concept?

The authors of this essay support a so-called realistic standpoint concerning scientific categories and dimensions. This entails that the conceptual scheme can and should mirror the real world. Depression or anxiety (to use two psychiatric examples) are hence not regarded as social or theoretical constructs but as real entities (maybe of the continuous kind) existing in the world outside theories and concepts. Our concepts are formed while we are interacting with these natural phenomena.

When are concepts different?

Laymen and experts, as well as experts from different fields, differ widely in how much they know, what they know, and what theories they have about the phenomena which their concepts apply to. This does not necessarily hinder them from communicating important facts among themselves about these phenomena. E.g., in order to prevent a suicide the psychoanalyst can warn the biological psychiatrist that her patient has a deep depression. This can work (i.e., proper decisions can be taken) even if

The division of semantic labour

To demand that members of linguistic communities always have exactly the same understanding of the words they use when exchanging information would be too much. Experts and laymen would never be able to successfully communicate if that were to be the case. This is where different depths of understanding come into play.

In linguistic communities that are not too homogeneous, the depth of understanding of common terms often varies widely, with the experts in the field usually having clear and

Meaning, knowledge and goals

Until now, we have mainly spoken of cases in which conceptual differences, if there are such, do not lead to any disagreement in practice. Of course, there are also conceptual differences that do lead to disagreement over actual classifications. We will now describe an important source of such differences and disagreement.

The basic function of linguistic tools to enhance decisions implies that our concepts – what our words mean – are often determined by our goals, what we strive to achieve.

“Severe mental disorder”

According to the current Swedish system concerning treatment of mentally disturbed criminal offenders, which has been in use since 1965, criminal offenders may be sentenced to involuntary psychiatric care as an alternative to prison. Which of these two options is chosen depends on whether the act is judged to have occurred under the influence of a severe mental disorder (SMD for short). If the answer is positive, there is a prison prohibition. However, this need not entail psychiatric care. If

The multiple roles of DSM-III/IV

The diagnostic labels in DSM-III (APA, 1980) and DSM-IV (APA, 1994) are excellent examples of terms serving several different practical functions at the same time. Our main agenda here is not primarily to point out the conceptual problems with the DSM,¹⁷ but rather to give a suggestive explanation to why the diagnostic system does not work

Concluding remarks

Conceptual analysis is much more than contemplating on one's own intuitions about the meaning of the terms in question. This is because concepts are not to be found “in the head”. Instead the conceptual analyst must study how a given term is used by people in concrete communication. Such a study should focus on two aspects. First, the analyst must look for the practical functions, the different roles the term plays in actual communication. Second, she must get acquainted with the phenomena that

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A philosophical view on concepts in psychiatry

Abstract

Introduction

Section snippets

What is a concept?

Ostensive definitions

What is a concept?

When are concepts different?

The division of semantic labour

Meaning, knowledge and goals

“Severe mental disorder”

The multiple roles of DSM-III/IV

Concluding remarks

Diagnostic and statistical manual of mental disorders

Diagnostic and statistical manual of mental disorders

Diagnostic and statistical manual of mental disorders

Brottsligheten, psykiatrin och samhället

Natural pedagogy

Trends in Cognitive Sciences

Experience with the Diagnostic and Statistical Manual of Mental Disorders and preparations for the future

The loss of sadness: How psychiatry transformed normal sorrow into depressive disorder

Psychiatric classification: The status of so-called “diagnostic criteria”