. Current debates concerning the concept of mental disorder involve many different philosophical issues. However, it is not always clear from these discussions how, or whether, these issues relate to one another, or in exactly what way they are important for the definition of disorder. This article aims to sort through some of the philosophical issues that arise in the current literature and provide a clarification of how these issues are related to one another and whether they are necessary for (...) defining disorder. I argue that the main concern in defining disorder, namely demarcation, is obscured by a number of these other philosophical issues and that a focus on demarcation gives us a means of placing these other issues in a clarifying context. (shrink)

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... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Truth Will Set You Free, or How a Troubled Philosophical Theory May Help to Understand How People Talk About Their AddictionPatricia A. Ross (bio)Keywordsveridicality of narrative, contingency of theories, belief-behavior, causal connectionConsider the following proposition: If one were to recognize the unsatisfactory implications of maintaining a certain theoretical position, one would thereby be motivated to accept a more adequate theory, which would alter one's beliefs and, in turn, (...) alter the behaviors that are based upon those beliefs. Faith in this proposition is what motivates many of us to teach. But, alas...Allison Mitchell's argument for rethinking addiction intervention—in particular, rethinking twelve-step programs—is premised on this proposition. According to her argument, addicts function with an impoverished sense of self that is reflective of a grossly simplified form of philosophical materialism. By recognizing the limitations of this philosophically unconvincing view, and by, in effect, accepting a better, more complete materialism, addicts can come to modify their self-conception. This modification is instrumental to recovery.A careful consideration of the chain of events being proposed, and the problems with it, is helpful for understanding the limitations of her argument. There are four points that I consider in turn: (1) considering narratives can tell us something about the self-conception of addicts, (2) philosophical materialism can help us to understand and explain something about an addict's self-conception and how it is inadequate, (3) this sense of self is distinct from nonusers and the way in which it is distinct helps to understand the problem of addiction, and (4) a change in self-conception with respect to materialism helps recovery and, thus, our best intervention is one based on having addicts accept a full materialist theory of the self and not a pretheoretic one. [End Page 227]With respect to the first point, it should be noted that Mitchell's overall argument does not depend on whether or not it is true that narratives of addiction tell us something veridical about the self-conception of addicts. Such narratives may simply provide us with a potential theory—a possible worlds scenario—of how addicts conceive of themselves. Mitchell points this out herself. The narratives and the interpretation that she provides of these narrative, "are meant only to highlight a certain pattern of self-expression and conception that may in fact be common in persons who use mind-altering substances; the readings do not establish any empirical matters of fact or philosophical truths, nor do they prove any conclusions about how such persons (must) express themselves or conceive their nature" (Mitchell 2006, 214).Thus, what the argument is actually concerned with are the theoretical claims about the self-conception of addicts that are garnered from these narratives. Nevertheless, because the narratives provide the starting point for Mitchell's argument, it is worth thinking carefully about the epistemic status of this body of literature. In particular, could a consideration of such literature lead us astray in our endeavors to understand how addicts might misconceive of themselves and, if so, in what way? What sort of epistemic status does this information hold?Mitchell is motivated by Wittgensteinian analyses of the relationship between thought and language. The particular idea that she employs from Wittgenstein is that every act of self-expression, whether it is verbal or written narrative, reveals something about the conceptual framework with which the author is working. Thus, one can learn about the author of a narrative—one can acquire a sense of how that individual conceives of him- or herself—by looking at the language that is employed to talk about and describe him- or herself.Mitchell enumerates some problems with this approach. She mentions that the author may fail to make his or her intended sense clear to readers; that the reader's narrative expectations determine the interpretation given to the narrative; that literary narrative may be less direct, less ordinary than everyday uses of language; and that interpreting such narrative via philosophical framework may ascribe to people positions that are more precise and sophisticated than they actually intend (p. 213).Aside from these quite serious problems, it is necessary to recognize... (shrink)

Mark Wilson, in his 1985 paper entitled "What Is This Thing Called 'Pain'?: The Philosophy of Science Behind the Contemporary Debate," proposed an account of physicalism that departs significantly from standard approaches. One of the main points of his paper was to explain the flaws in arguments claiming that psychological properties cannot be shown to be physical because of their functional nature. However, the positive proposal that Wilson makes in this article bears further examination. I argue that it not only (...) resolves many problems that have grown up around the topic of physicalism, but that the proposal itself should make us radically rethink some important philosophical questions, especially those concerning explanation and property identification. (shrink)