Philosophy, Psychiatry, & Psychology

Philosophy, Psychiatry, & Psychology 10.3 (2003) 255-259

Illnesses and Likenesses

Richard G. T. Gipps

IN THIS RESPONSE to Neil Pickering's paper I shall focus only on what he describes as the "strong objection" to the typical use of the likeness argument. The likeness argument, to recap, has it that we can decide whether conditions such as schizophrenia, depression, or alcoholism do or do not deserve the designation of illness depending on whether they possess features which, if they occurred in physical conditions, would enable one to decide for or against the designation. To take an implausible example, if it were decided that it would be enough to describe a physical condition as an illness if it involves pain not caused through injury, then a psychological condition would be appropriately described as an illness just to the extent that it too involved such pain.

In arguing against typical deployments of the likeness argument, Pickering finds that it is only on questionable initial descriptions of psychological conditions that such conditions appear to share the features that, in physical conditions, would be taken to be indicative of illness. That is to say, theorists who deploy the likeness argument to urge either the reality or unreality of mental illnesses typically presuppose what both we and they had all along hoped would be demonstrated in their argument. In terms of the above example, we might say that a certain psychological condition can count as an illness if it involves psychic pain. The concept of psychic pain is however (so the argument would have it) contestable; there exist other descriptions that make no reference to pain and in so doing fail to provide what a user of the likeness argument would need to substantiate the claim that a conception of the condition as an illness is more than a façon de parler.

By way of arriving at this conclusion the following precondition for the applicability of the likeness argument (Pickering's "assumption" (2)) is insisted on: "That, with respect to the presence or absence of [those features of conditions which features decide whether or not the conditions are illnesses], a condition such as schizophrenia [must be] describable independently of the category it is assigned to." This can seem a quite reasonable restriction, for—it could be said—one can only win an argument if it is first allowed that there is actually something to argue about. That is, it is only if both partisans and detractors of the illness conception first accept a certain description of schizophrenia as spelling out what schizophrenia essentially involves that they can then progress to determining whether or not such a condition so described is or is not an illness.

Yet, whereas this seems like a perfectly reasonable requirement, it is I believe uncertain whether it will always capture the form of the intuitions of adherents and detractors of the illness conception—or of the form of philosophical arguments more generally. To be sure, some philosophical discussions can perhaps be reconstructed as debates about the validity of certain inferences [End Page 255] from mutually understood premises (i.e., given X, does Y follow or not?). Yet if this were the case, then genuinely interesting philosophical arguments would probably be few and far between. If we are agreed as to the precise significance of our premises, and are not furthermore just making straightforward mistakes in reasoning, it is hard to see how or why we could all fail to arrive at the same conclusions.

In the Philosophical Investigations paragraph 128 Wittgenstein wrote that "If one tried to advance theses in philosophy, it would never be possible to question them, because everyone would agree to them" (Wittgenstein 1953). Now that proposition might seem on rather weak grounds, because all one has to do to actually disprove it is merely disagree with it. But presumably Wittgenstein is rather articulating his intuition that although philosophical arguments often take the form of clashes concerning what conclusions can be drawn from what premises, most of their substance comes from a prior failure to unpack the intrinsic significance...