Abstract

In lieu of an abstract, here is a brief excerpt of the content:The Fact Value Dichotomy in Demarcating DisorderPatricia A. Ross (bio)Keywordsdemarcation, values, ontology, epistemologyHaving read numerous articles on the concept of mental disorder, I find it useful to approach new articles on the topic by first sketching out the conceptual framework within which each author places the problem. The goal in doing this is not merely to be able to compare ideas within a remarkably diverse discussion, but also to be able to uncover any presuppositions that underlie the account, as well as assumptions necessary for the argument, which may or may not be warranted. By approaching each new offering in this way, I often find that the solutions proposed depend a great deal on these undisclosed features, and that such presuppositions and assumptions are often questionable, at best, and are sometimes simply unwarranted. Brülde's discussion of mental disorder and values provides a useful example of this method.To determine how we should draw the line between disorder and nondisorder (henceforth, I refer to this as demarcation), Brülde claims that we need to address four questions. We need to determine (1) the extent to which demarcation depends on values and the extent to which it is descriptive, (2) the kinds of values we need to make use of (aesthetic, moral, pragmatic), (3) whether there is an implicit reference to some specific evaluative standard, and (4) whether the value judgments used to demarcate are ontological or epistemological. In putting forth these questions, Brülde identifies what he takes to be the generally agreed upon claim that there are two components necessary for demarcation: a factual component and an evaluative component. These components are distinct from each other and both are necessary—the demarcation cannot be made "by objective means alone," nor is it purely evaluative. Thus, demarcation necessarily involves a distinct value component, and the answers to Brülde's four questions are intended to shed light on how values are involved in determining the evaluative component of demarcation.Working under the assumption that they are distinct, Brülde sets aside discussion of the factual component to focus on the value component. He also tables the first of his four questions (the extent to which demarcation depends on values and the extent to which it is descriptive), citing an over-abundance of literature on the matter. Having thus framed the problem, Brülde turns his full attention to questions two through four, ultimately providing us with the answer that the values needed to demarcate disorders from nondisorders are of several types; mental disorder is both implicitly and explicitly an evaluative term, as well as value laden in both the ontological and epistemic senses. This [End Page 107] framing of the problem provides us with insight into the underlying presuppositions and assumptions that lead to Brülde's conclusion.The first aspect of this framework to consider is the division of demarcation into two distinct components, and the setting aside of the factual component as distinct from, and inconsequential to, the questions concerning values. By proceeding in this way, Brülde's argument rests on the presupposition that we can, and want, to consider the value component in isolation from the factual component. This presupposition raises a number of questions. Is there nothing about the factual component that may help us in our consideration of the value component, or vice versa? Does the factual component confine what we can say or know about the value component in any way. Overall, some justification is needed for accepting that there are two distinct and independent components, as well as for believing that the factual component can be disregarded in this way.Brülde also makes the (explicit) assumption that there is some internal state or process underlying all mental disorders about which we have or will gain factual knowledge that is objective. Implicit in this is the further assumption that this knowledge (regarding internal states or processes) will be all there is to say, scientifically, about the disorder—that is, knowledge concerning internal states and processes are what will comprise the "factual component." But if we can have sociological facts and psychological facts (and I think it is...