Philosophy of Mind
Naturalism, Normativism, and Hybridism are essentialist theories. They think there are a few sets of states that have to be fulfilled in order to have a disorder.
Pluralists are non-essentialists about disorder, they think there are plenty concepts of disorder and that they’re all fair. Eliminativism argues that the concepts of disorders is useless.
Naturalists believe that disorder is a physical or mental dysfunction. There are a couple definitions of the concept of dysfunction. Here we’ll use Christopher Boorse’s position. For him a dysfunction is a negative statistical deviation from the biological norm. There are biological norms. Science is a descriptive project. There are biological norms however, there are certain normative functions that we expect from our organs for them to be considered functioning. Then there are deviations from that norm. A heart needs to beat in a certain tempo and in a certain rhythm. Too slow means a negative statistical deviation and too fast is a positive. Naturalism gives us a normative anchorpoint from the statistical norm in biology.
Boorse proposed this naturalist theory for the first time in 1975. In December 1974, the american psychiatric association by vote that homosexuality should not be in DSM. Until today, most psychiatrists do not consider homosexuality to be a disorder. What’s ironic about this, is that a few months after this vote, there is this american dude who has theory about disorder which implies that homosexuality is a disorder. Modern homosexuality diminishes reproductive success. So you could say that there is a negative statistical deviation from the biological norm. Boorse still holds on to this position, despite this, because the theory in itself is quite beautiful and easy. It is not a moral claim, just that there is something biologically different with being homosexual etc.
Normativists believe that a disorder is a harmful state. It may involve dysfunction, but this doesn’t really matter. The harm that the state provides is what matters. Rachel Cooper argues that a dysfunction is simply a ’bad thing to have’. Pain is a good example of harm. We can distinguish between a lot of different kinds of harm. There is subjective harm; someone experiencing a certain state as being harmful to them, to rob them of something. Mania in bipolar disorder, at a certain point at least, people will not experience that state as harmful. If you ask them why they stayed up all night and thought up a new ideology, they’ll say that they’re better than well. At that point they won’t consider their condition to be bad. Objective harm then seems to rather be that outsiders judge that the individual in question is doing something that is harmful to themselves or someone else. Is pedophilia a disorder? We think that sexual relationships between adults and children are always bad so with this definition it would seem like a disorder. Some people with pedophillic fantasies do not consider their own condition to be harmful.
In the 1870s some psychiatrists decided that homosexuality would be a disorder, and 100 years later people decided that it is not any longer. What happened? Normativism would explain this by saying that in 1870 it was a harmful condition, it was a vice and a crime, so society thought lowly of homosexuals. It was a bad thing to be.
It has its downsides though. It is the opposite of naturalism. Anything goes in normativism, any condition is a disorder if we think it is a bad thing to have. In Uganda as well it would be a disorder to be gay. Don’t go there if you are gay, it is a capital offense. And what about arrogance, ugliness and terrorism? These are all bad to be. They are clearly harmful, are they then disorders?
We generally think that a disorder is a subset of harm, rather than equalling harm. So not very easily distinguishable.
Hybridism is when a disorder is a harmful dysfunction. Basically there needs to be a failure to perform an evolved function which harms the person or society somehow. An interesting example of this is depression. What is that? It is many things. One common ground to people who are depressed is that they consider their condition to be harmful. It seems obvious. What is the dysfunction here? How can we say there is something that ’goes wrong’, that is fails to function. Here is one story. There is an evolution of a low mood. Edward Hagen argues for the bargaining model of depression: ’I argue that the costly symptoms of depression have a function, and that function is to impose costs efficiently on other group members by withholding critical benefits, credibly signaling to them that one is suffering costs, and compelling them to provide assitance or make changes.” (Hagen, 2003).
If we couldn’t experience pain our average life span would be much less. The same may be true for low mood. It could be useful in multiple ways. Just like diahrrea and throwing up are very functional, low mood probably has functions too.
Other group members are harmed by you being depressed, the things you normally do for others you stop doing. And why do you do that? Because you are signalling to them that you are suffering costs and you need assistance. It is an evolved strategy in which you want something to change and hope that others will come to you and fix the problem because you cannot deal with the problems in front of you, either because others are putting too much work on you or because you have no idea how to solve an issue.
Professor thinks that he is wrong. He is confusing low mood and depression. Low mood is a normal reaction to life events going bad. If, however, you get extreme low mood with suicidal thoughts and some psychopathy, and this takes months and months without getting better, that is depression. Low mood is just an adaptation. What is going on in depression then is probably the function of low mood not functioning.
Dysfunctional may be better thought of in dimensional terms. Dysfunction usually goes slowly, and there is rarely a specific point at which an organ stops functioning.
Pluralists argue that disorders are more like Wittgenstein’s family resemblance. No essence, only family resemblances. Early in Wittgenstein’s life he spoke of language as something with an essence. Later in life he rather argued that you cannot ask the question ’what is language?’ because language is so many things. There are so many things you can do with it and there is so much you can do with it. Language games are about all the things you can do with language. Just like there is no essential feature to language, there is no essential feature to disorder.
This approach is vague and lazy.
It is also prone to be misused. When they made listerine ads, they mongered the idea that you had the disease ’halitosis’, that is, bad breath, needed to be treated somehow.
Though similarly PTSD, created after the Viet-nam war, helped a lot of people who came. These people could not cope with life, they had nightmares, bad episodes of anxiety, low mood etc.
Eliminativists argue that disorder is a redundant concept. Medicine’s duty is to describe, explain and treat. If medicine decides that something requires a treatment, it should treat it.
Seems rash and overly dramatic. We need the concept of disorder for something probably. To give up the concept is very hard.
What at stake in talking about mental disorders? The legitimacy of psychiatry. If mental disorders are brain disorders then neuorologists can take over. People suffering from a mental disorder can be moralised a bit, whilst people with brain disorders are not really moralised at all, they can’t help themselves is the idea.