CONCEPTUAL BASES OF PSYCHIATRY FOR THE PERSON
Philosophy of Science Perspectives on Psychiatry for the Person
Tim Thornton PhDa and Kenneth F. Schaffner MD PhDb
a Professor of Philosophy and Mental Health, University of Central Lancashire, Preston, UK
b Distinguished University Professor of History and Philosophy of Science, Psychology and Psychiatry, University of Pittsburgh, USA
Intentional-causation, Jaspers, Methodenstreit, natural science, rules, social science, Winch
Prof. Tim Thornton, School of Health, University of Central Lancashire, Preston, Lancashire PR1 2HE, UK
Accepted for Publication: 19 January 2011
The WPA Program on Psychiatry for the Person calls for a more comprehensive approach to psychiatry in which conventional elements are combined with a specifically person centred extra ingredient. The World Psychiatric Association’s call to focus efforts on psychiatry for the person also coincides with proposals to revise both DSM and ICD taxonomies which are likely to stress the importance of improving their validity through the epistemic values exemplified in natural science. Thus the Program aims to balance a growing emphasis on the natural scientific underpinnings of psychiatry with an increased focus on the importance and role of the person.
This proposal to balance natural science with the role of the person mirrors some of Karl Jaspers’ aims a century ago. At the turn of the century in Germany, psychiatry was dominated by academic neuroscientists working under the assumption, epitomised by the German psychiatrist Wilhelm Griesinger’s famous aphorism, that ‘Mental illnesses are brain illnesses’ .
Jaspers’ response was to stress the role of understanding in addition to explanation in psychiatry. This reflected the debate, called the Methodenstreit, about the correct methods for psychology in the late nineteenth century. Should the human sciences (the Geisteswissenschaften) attempt to copy the methods of the natural sciences (Naturwissenschaften), or should they follow a distinct method or methods? Setting the development of the Program on Psychiatry for the Person against that background suggests the importance for it also of an understanding of the Methodenstreit.
Whilst empathy and phenomenology still have a role in contemporary discussion, Jaspers’ account of the possible distinction between the human and natural sciences is not influential. The most influential set of arguments for a distinction between human and natural sciences were developed in the 1960s drawing on the work of the Cambridge philosopher Ludwig Wittgenstein (1889-1951). One such influential work was Peter Winch’s (1927-98) The Idea of a Social Science .
Winch argues that there could be no such thing as a social science modelled on natural science. Human understanding cannot and should not be modelled on the natural sciences because it employs a different form of intelligibility. Winch argues that a central element of understanding meaningful behaviour is an understanding of the nature of rules. For this he draws on Wittgenstein’s discussion of rule following in the Philosophical Investigations , §§139-239. This type of rule-following action can be as simple as a patient filling out a health history form. There are rules of veracity and restrictions against wild speculation concerning past diseases involved in providing a useful form. Rules have a further important feature evident in this example. They are normative: they prescribe correct and incorrect behaviour. This is not the same as saying that most history forms are filled in at a particular time of day or night or by a particular socio-economic proportion of the patients with varying levels of usefulness. That may be discovered by empirical study. But the normative rules that characterise an event as an act of history-form completion are not provided by any such statistical generalisations. (On this point, contrast Hempel .)
With these claims in place, Winch goes on to argue that the kind of understanding usually thought to make up social science is fundamentally dissimilar to natural science.
Winch followed Wittgenstein who had a profound influence on philosophy in the UK but much less so in the USA. But similar arguments are implicit in the work of US philosophers. Wilfrid Sellars (1912-89), for example, argued for a fundamental distinction between natural scientific and normative conceptions along similar lines. Sellars distinguishes between a natural scientific view of the world (or ‘scientific image’) and the ‘manifest image’.
Sellars is not alone in taking there to be a key distinction between normative person-level descriptions and underlying natural scientific accounts. Building on Sellars’ work, John McDowell, for example, contrasts the logical space of reasons with the realm of law or of natural science . Both authors share an assumption about the central importance of the normativity of person-level descriptions. Normativity cannot be accounted for in natural scientific descriptions of the world. Thus, on Winch’s assumption that the social or human “sciences” chart the rules that shape human behaviour, there is a fundamental distinction between them and natural science.
The view that there is a fundamental distinction between the normative concepts that characterise the human sciences and non-normative concepts that underpin natural sciences has its critics. (For general discussion of this issue see .) Such an alternative view need not be strongly reductionistic  or eliminitivist [8, 9]. A pragmatic tradition in philosophy has welcomed multi-level complexity generally [10-12] and in philosophy of science  and philosophy of psychiatry
Also working with the philosophy of psychiatry, Derek Bolton and Jonathan Hill  have attempted to reconcile the normative and non-normative. Instead of distinguishing between rational reasons and causes, they distinguish between intentional and non-intentional causes. This places the hard physical sciences on one side of the divide and the equally hard biological and behavioural sciences on the other.
This is not the place to attempt to adjudicate in any full sense the century-long debate about whether there is a fundamental distinction between the natural and the human sciences. Those who argue that there is, stress the central importance of rule-governed or conceptually structured behaviour which, they argue, cannot be captured within a natural science view of subsumption under general or statistical laws. The ‘space of reasons’ is distinct from the ‘realm of law’. Those who argue that there is not a substantive distinction of kind argue either that the normativity of rules can be reduced to behaviour of biological functions which also impose a normative standard of sorts on behaviour. Or, they argue that the distinction between reasons and causes is a mistake and intentional causation is a feature of the broader natural world.
The debate described above has important consequences for whether the additional elements called for in a comprehensive model of psychiatric diagnosis are genuinely distinct in their underlying logic to the conventional and natural science-inspired diagnostic elements. If they are not distinct in underlying form then it seems possible that a comprehensive model of diagnosis might be a unified one, deploying, for example, concepts of intentional causation across the board. But if, as Jaspers assumed, there is a fundamental divide, the new elements may be needed to give a fuller picture of the human subject: a person whose experiences need understanding in meaning-laden and normative terms, as well as explanation. Clearly additional analysis and research on the perennial themes found in this debate are needed.
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