Philosophy, Psychiatry, & Psychology

Gloria Ayob Begins her commentary with the main metaphysical and ethical motivations for including the personal perspective in psychopathological assessments. The metaphysical motivation: human actions are performed for a reason. Thus, from the personal perspective, explaining human actions amounts to justifying them by appeal to individual’s reasons. However, does it follow from this peculiarity that “explanations of human behavior that appeal to empirical generalizations and those that consist in justifying an action by appeal to reasons are of entirely different logical orders” (Ayob 2013, 127) as she contends? I do not think so for two main reasons. First, in both cases, genuine explanations involve factual statements, that is, logically contingent, semantically synthetic, and epistemologically a posteriori statements. Besides, genuine psychopathological experiences and behaviors are far from invariably intentional and rational. On the contrary, severe psychopathological disturbances lying at the core of clinical psychiatry affect adversely patients’ capacity for rational thinking and behavior to various degrees. Second, in both cases, explanations can be causal, because reasons, including moral reasons, can perfectly well be genuine causes of human behavior, at least on the scientifically plausible assumption that intentional mental content is ‘encoded’ in the brain. On this assumption, it is not mysterious, at least in principle, how reasons as products of human reasoning, which is a brain process in cortical association areas can affect causally one’s motor cortex, resulting in intentional actions.

Furthermore, Ayob (2013, 128) argues that “psychological laws currently in existence consist in empirical generalizations of human behavior, which are based on observations that bracket out the justifications that people give for their own actions.” Moreover, she stresses that “when people do give justifications for their actions, they do not do so by appealing to empirical generalizations,” “so the empirical laws that constitute laws in the human sciences do not seem, by themselves, to put the personal perspective into view” (Ayob 2013, 128). I fully agree with her last point, although I fail to see its relevance to the topic of my paper. To begin with, during the diagnostic interview, patients do not systematically justify their abnormal experiences and behaviors but, at least initially, they just express their complaints and mental suffering. To be sure, conscientious clinicians should always ask their patients how they explain these experiences and behaviors to themselves (or how they understand them). This is indeed necessary for at least three important clinical reasons: first, to assess whether these experiences and behaviors are genuinely abnormal; second, to assess patients’ clinical insight; and third, to adapt flexibly the [End Page 137] case-appropriate therapeutic plans to ensure patients’ active participation in their implementation. Matters are different in the context of long-term psychotherapies of patients with severe personality disorders. I surmise that Ayob has mostly these patients in mind. Indeed, in a previous paper in this journal, she has scrutinized several objections to the applicability of evidence-based medicine generalizations to individual mental patients (‘people are complex creatures,’ ‘each person is unique,’ ‘intentional action-justification is normative,’ ‘human mental states are contentful’), finding all of them wanting. However, she identified two kinds of situations whereby valid objections could be raised, although not attributed to intrinsic features of evidence-based medicine. First, psychotropic drug treatments in cases where psychopathological conditions are determined by a person’s lifelong conception of herself and of the world around her and, second, cognitive–behavioral therapies, where the holistic character of meaning renders impossible the delineation of atomistic units of patients’ thoughts and actions without taking into account their whole web of intentional states to which they belong (Ayob 2008). I remain doubtful about the correctness of radical meaning holism, whether in the philosophy of mind and language or the philosophy of science. However, I agree with her on the necessity to address core existential issues in this class of patients in order to make lasting therapeutic progress. The phenomenological tradition in psychiatry is rich in clinical psychopathological generalizations relevant to these patients.

Ayob’s further claim that people do not appeal to empirical generalizations when they give...