Friday, 21 April 2017

Latest Association for the Advancement of Philosophy and Psychiatry bulletin

The latest edition of the Association for Advancement of Philosophy and Psychiatry newsletter from its secretary/editor and president James Phillips and Peter Zachar is now out.

It is a 56 page summary by the author, and set of commentaries from leading philosophers of psychiatry, on Peter's recent A Metaphysics of Psychopathology from MIT Press.

My own contribution (previously posted here) is included and Peter's response to it is one of his many responses. I will be keen to find out how he responded to my worry that in his attempt to police a boundary between what lay within and without experience, he said too much (by his own standards) about what lay outside it (again, on his own account). Curious also to find myself in the same camp as my colleague and friend Rachel Cooper.

Thursday, 6 April 2017

At the Hermeneutic Phenomenology Symposium at UCLan today

I was generously invited by my colleague Gill Thomson to sit at the back of a one day workshop on hermeneutic phenomenological social science at UCLan today. I have just listened to the first two talks, one (by Bridget Taylor) on sexuality and intimacy in couples with a dying partner and the other (Lesley Kay) on the views of childbirth in advance of experiencing it of expectant mothers. In both cases, the aim was to capture the thoughts and experiences of those concerned and hence both were clearly phenomenological, in the sense in which it applies to social science. Both were fascinating the the former was also rather moving.

Both were also phenomenological in a second sense. They actively drew on Heideggerian vocabulary and ideas explicitly in the analysis they offered. To take just one example, Bridget Taylor invoked Heidegger's discussion of technology as a particular attitude to the world, seeing it as offering resources in the form of 'standing reserve', in order to discuss the taking of Viagra. She suggested that light could be shed on the generally (in fact, entirely, in her study) negative views of it by participants by seeing it as involving a merely technological view of the body and the penis (seeing the body thus as merely a standing resource) in a way that undermined intimacy. Similar familiar notions such as being towards death, idle talk, the they etc were deployed in both sets of analysis.

It strikes me as interesting and quirky that Heidegger and a few other philosophers play this role of providing a vocabulary for social science analysis and the case for it this morning was that it seemed to work, in some cases, such as the viagra example, in quite striking ways. So it may be that the vocabulary receives a kind of justificatory support bottom up from such empirical work. But the vocabulary is obviously deployed top down. It is because Heiddegger wrote his essay 'On the question concerning technology' that that vocabulary became available and hence is now applied in social science.

And hence this suggests a question. Might there not be a tension between these two senses of 'phenomenology' in social science? That is, imposing a top down vocabulary from a dead German on the utterances of the living (most of whom will not have heard of him) might distort a neutral account of their take on the world, their experiences and thoughts. Wouldn't it be more phenomenological in the first sense to give up this vocabulary - unless that is that one's participants are Heideggerian philosophers - and simply to try to re-present the participants only in their own words? Replace Heidegger with the approach sketched by the Wittgenstenian philosopher Peter Winch?

Monday, 27 March 2017

Values and the singular aims of idiographic inquiry

I have been revising a presentation I prepared for a conference on ‘idiographic science’ in Naples last year. I still like the basic idea that idiographic inquiry is not so much a different form of judgement - in the way that I am unfashionable enough to think that understanding is a distinct form of judgement from explanation, that there is something in that distinction - but something seems amiss in the middle where I try to use Christoph Hoerl’s discussion of Jaspers on understanding. And can I really get away with saying so little as to what an idiographic interest is: an analogy with the Daily Express’s fascination with Lady Di?

Values and the singular aims of idiographic inquiry

Abstract

In response to the concern that criteriological psychiatric diagnosis, based on the DSM and ICD classifications, pigeon-holes patients, there have been calls for it to be augmented by an idiographic formulation [IDGA Workgroup, WPA 2003]. I have argued elsewhere that this is a mistake [Thornton 2008a, 2008b, 2010]. Looking back to its original proponent Wilhelm Windelband yields no clear account of the contrast between idiographic and nomothetic judgement. Abstracting from Jaspers’ account of understanding an idea of idiographic judgement based on the contrast between singular and general causal relations also fails. I argue, however, that Windelband does provide a helpful clue in his remark that ‘every interest and judgement, every ascription of human value is based upon the singular and the unique... Our sense of values and all of our axiological sentiments are grounded in the uniqueness and incomparability of their object’ [Windelband 1980: 182]. This suggests a role for the idiographic not as the content of a particular kind of judgement but rather as characterising its aim. I argue that this connects to the issue of the generalisability of small scale qualitative social science research and to the critique of ‘looking away’ in moral philosophy.

Key words

Causation, explanation, idiographic, interventionism, Jaspers, nomothetic, understanding, Windelband.

Introduction

The idea that psychiatric diagnosis or, more broadly, psychiatric formulation should include an idiographic element is explicit in publications by psychiatrists working on the WPA initiative Psychiatry for the Person. It forms part of the explicitly broad conception of diagnosis called a comprehensive model or concept of diagnosis. The Idiographic (Personalised) Diagnostic Formulation closely connects a comprehensive model with an idiographic component:

This comprehensive concept of diagnosis is implemented through the articulation of two diagnostic levels. The first is a standardised multi-axial diagnostic formulation, which describes the patient’s illness and clinical condition through standardised typologies and scales... The second is an idiographic diagnostic formulation, which complements the standardised formulation with a personalised and flexible statement. [IDGA Workgroup, WPA 2003: 55]

The role of the idiographic aspect is to complement and contrast a general approach through ‘typologies and scales’ with something personal and individual. The psychiatrist James Phillips makes this individual focus explicit: ‘In the most simple terms, a[n] idiographic formulation is an individual account’ [Phillips: 2005: 182 italics added].

But this raises the following question. If an idiographic element is to be a genuine complement to general typologies and scales, what kind of understanding of an individual does it comprise? How is it different from criteriological diagnosis, for example? Although the term ‘idiographic’ has a settled use in psychological research to refer to small scale qualitative studies, that use does not explain how an idiographic element would be a genuine complement to criteriological diagnosis in psychiatry which already aims at individuals rather than general populations.

Windelband and individuals

The distinction between idiographic and nomothetic forms of understanding was first introduced by Wilhelm Windelband in his rectoral address of 1894. Windelband, as a post-Kantian philosopher, was familiar with the debate about the relation of the human and natural sciences called the ‘Methodenstreit’, a debate which shaped, for example, psychiatrist and philosopher Karl Jaspers’ views of the importance of empathy for understanding psychopathology [Thornton 2007: 90-2]. That distinction is usually thought of as a distinction between explanation and understanding. Jaspers contrasts explanation in terms of causal connections with understanding of meaningful connections (and further subdivides understanding into phenomenology and empathy, for example) [Jaspers 1974]. This has in turn led modern philosophers, especially those in the Wittgensteinian tradition, to characterise understanding as a form of intelligibility suited for the meaning-laden actions and utterances of rational animals hence stressing its rational and normative character that ‘finds no echo in physical theory’ [Davidson 1980: 231].

In his address, however, Windelband stresses instead that the difference between nomomethetic and idiographic, whilst still a distinction in method or form of knowledge rather than subject matter, concerns the difference between general and particular.

In their quest for knowledge of reality, the empirical sciences either seek the general in the form of the law of nature or the particular in the form of the historically defined structure. On the one hand, they are concerned with the form which invariably remains constant. On the other hand, they are concerned with the unique, immanently defined content of the real event. The former disciplines are nomological sciences. The latter disciplines are sciences of process or sciences of the event. The nomological sciences are concerned with what is invariably the case. The sciences of process are concerned with what was once the case. If I may be permitted to introduce some new technical terms, scientific thought is nomothetic in the former case and idiographic in the latter case. Should we retain the customary expressions, then it can be said that the dichotomy at stake here concerns the distinction between the natural and the historical disciplines. [Windelband 1980: 175-6]

Windelband remarks that the distinction he is attempting to frame is not based on a distinction of substances: sciences of nature or natural science [Naturwissenschaften], versus the sciences of the mind [Geisteswissenschaften]. Such a distinction is hostage to the fortunes of that dualism. If the reductionist project of explaining mental properties in physical terms were successful then that contrast would be undermined.

Even with these characterisations in play, however, the distinction as so far introduced is not clear. Consider the contrast between ‘what is invariably the case’ and ‘what was once the case’. There are three problems with using this contrast to characterise a notion of ‘idiographic’. First, it threatens to slip back from a methodological distinction of how a subject matter is approached to the underlying nature of the events in question (whether, as a matter of fact, they are invariant or unique). Second, a substantive distinction does not explain in what way an idiographic understanding differs from any other sort. Third, the uniqueness of its subject matter cannot separate the idiographic and nomothetic. The gravitational forces on a mass, for example, depend in principle on a vector sum of its relation with every other object in the universe and thus some of the events described by physics are likely to be unique.

One of the clues Windelband himself offers is to suggest that history is a paradigm of idiographic sciences which ‘provide a complete and exhaustive description of a single, more or less extensive process which is located within a unique, temporally defined domain of reality’ [Windelband 1980: 174] However, this does not explain how historical explanation differs from physics, say. Windelband’s further comments about historical judgement are unhelpful. He says:

[H]istory seeks structural forms… [Windelband 1980: 178]

[I]n the historical sciences,… [thought] is devoted to the faithful delineation of the particulars… [ibid: 178]

The historian’s task… is to breathe new life into some structure of the past in such a way that all of its concrete and distinctive features acquire an ideal actuality or contemporaneity. His task, in relation to what really happened, is similar to the task of the artist, in relation to what exists in his imagination. [ibid: 178]

But the task of ‘describing structure’ is shared by some nomothetic sciences like chemistry. ‘Delineation of particulars’ is also the common aim of both idiographic and nomothetic sciences. The physics of a particular mass concerns that individual. Talk of ‘ideal actuality’ may be uniquely appropriate for the idiographic sciences but hardly sheds light on what this amounts to.

It might be assumed that using history as a paradigm suggests a connection to the other broad way of construing the Methodenstreit mentioned above as marking a distinction between explaining natural events and understanding meaning-laden events or rational subjects. But Windelband offers an example of historical understanding that is of a merely biological process, which show that this is not what he has in mind.

Consider… the subject matter of the biological sciences as evolutionary history in which the entire sequence of terrestrial organisms is represented as a gradually formative process of descent or transformation which develops in the course of time. There is neither evidence nor even a likelihood that this same organic process has been repeated on some other planet. In this case, the science of organic nature is an idiographic or historical discipline. [Windelband 1980: 176]

In summary, although Windelband coins a distinction between idiographic and nomothetic, stresses that it is a distinction of a form of intellibility rather than of types of subject matter and offers history as an example of the idiographic, it remains unclear what the distinction amounts to.

Elsewhere I have suggested that the appeal of idiographic judgement stems from a recoil from subsuming human individuals under conceptual categories – from pigeon-holing people – and hence instead attempting to understand them in other ways or other terms, a kind of ‘individualising intuition’ [Thornton 2008a, 2008b, 2010]. The problem is then to explain what novel form of judgement would address this task. If judgement in general takes a subject predicate form – s is P – then there are two elements to consider: the referential element and the predicational element.

The referential element does not seem to be a hopeful place to look to draw a distinction between nomothetic and idiographic. Consider the traditional deductive-nomological model of explanation as an example. This contains general laws (hence the name). But it also refers to particular circumstances in the explanans. Whether an adequate formal model of explanation or not, since the DN model of explanation is designed to fit paradigmatically nomothetic sciences mere singular reference to particular circumstances is not sufficient to distinguish a different form of intelligibility.

But ‘individualising’ the predicational element seems equally unpromising albeit in a different way. Such a predicate would have to be designed for a particular single element carrying with it no possible application to, and hence comparison with, other individuals. What could such a predicate be? What property would be picked out such that it could not possible apply to other cases? The closest idea seems to be a kind of name designed for specific individual (person or event). But that collapses this proposal back into the referential element of the judgement. In neither way can the ‘individualising intuition’ be satisfied through a novel form of judgement.

Singular causation

I suggested earlier that Windelband’s distinction between idiographic and nomothetic is a distinct variant of a broader discussion of the difference between human and natural sciences that in more familiar forms concerns understanding and explanation. In this section I will attempt to construct a conception of idiographic judgement by taking a version of understanding (by contrast with explanation) that stresses individual cases and then subtracting characteristically mental elements from it. Nevertheless, I will argue, the result fails to shed light on Windelband’s distinction between idiographic and nomothetic.

The distinction between understanding and explanation plays a key role in Karl Jaspers’ discussion of psychopathology although it is not carefully articulated and distinguished. Christophe Hoerl suggests that Jaspers’ contrast has both an epistemic and ontological dimension [Hoerl 2013]. Epistemically, the distinction runs as follows:

Explaining, Jaspers thinks, requires repeated experience – it is achieved by “observation of events, by experiment and the collection of numerous examples” (GP, 3 p. 302), which allow us to formulate general rules and theories. Understanding, by contrast, is achieved (if it is achieved) directly upon confrontation with a particular case. As Jaspers also puts it, “[p]sychological understanding cannot be used mechanically as a sort of generalized knowledge but a fresh, personal intuition is needed on every occasion” (GP, p. 313). We might thus say that Jaspers subscribes to a form of epistemic particularism regarding understanding. Understanding is not achieved by bringing certain facts under general laws established through repeated observation. Rather, the grasp it delivers of how one psychic event emerges from another in a particular case strikes us “as something self-evident which cannot be broken down any further” (GP, p. 303). [Hoerl 2013: 108]

Ontologically, understanding and explanation chart different aspects of reality: meaningful psychic connections and rules of causality, respectively. Hoerl points out that Jaspers suggests that the former are not causal. In this, he resembles the 1970s Wittgensteinian philosophers criticised by Donald Davidson in his ‘Actions, reasons and causes’ [Davidson 1980: 3-19]. But Hoerl objects both that this makes it ‘quite obscure what genuine epistemic gain understanding could deliver’ [Hoerl 2013: 109] and also that Jasper’s talk of events ‘emerging’ from others seems to be a causal notion [ibid: 110]. The difficulty here is a dilemma. If understanding is construed as non-causal then it risks epistemic obscurity. But if it is causal, it risks collapsing into explanation.

Hoerl suggests a reconciliation via the distinction between singular and general causation. General causation links properties. Singular causation is token causation between two actual events. He cites Elizabeth Anscombe who stresses the importance of singular causation and rejects neo-Humean nomological accounts of causation. She argues that:

[C]ausality consists in the derivativeness of an effect from its causes. This is...the common feature of causality in its various kinds. Effects derive from, arise out of, come of, their causes. For example, everyone will grant that physical parenthood is a causal relation. Here the derivation is material, by fission. Now analysis in terms of necessity or universality does not tell us of this derivedness of the effect; rather, it forgets about that. For the necessity will be that of the laws of nature; through it we shall be able to derive knowledge of the effect from knowledge of the cause, or vice versa, but that does not show us the cause as source of the effect. Causation, then, is not to be identified with necessitation. [Anscombe 1981: 136]

There is some debate about whether the distinction between singular and general causation implies that there are two distinct concepts of causation or whether some shared notion can accommodate both [Hitchcock 1995]. But the distinction between particular instances of causation and general causal conncetions between properties is clear enough to suggest a solution to the dilemma Jaspers faces. Hoerl suggests that:

When he talks about (mere) causal explanation, what he has in mind are general causal claims linking types of events. Understanding, by contrast, is concerned with singular causation in the psychological domain – i.e. with the particular way in which one psychic event emerges from or arises out of another on a particular occasion. [Hoerl 2013: 111]

This fits Jaspers claim that ‘Psychic events ‘emerge’ out of each other in a way we understand’ [Jaspers 1997: 302]

This contrast between particular and general is suggestive of Windelband’s distinction between idiographic and nomothetic. But it will not do as an account of the latter because Jaspers’ notion of understanding is restricted to the mental realm whereas Windelband suggests that it would be possible to take an idiographic approach to episodes of evolutionary history. So could this restriction be stripped away to leave something with a focus on particular cases but not restricted to the mental?

To consider this, I will sketch John Campbell’s discussion of interventionism in the context of psychiatry. Hoerl also moves from outlining his suggestion for interpretation of Jaspers to an account of Campbell. But his aim is to contrast the Anscombian idea of an effect arising out of a cause – a notion which fits Jaspers account of empathic understanding – with Campbell’s interventionism. My aim is to use Campbell to abstract from Hoerl’s suggested interpretation of Jaspers a more general notion of intelligibility which contrasts the particular and the general. Again, I will argue that it does not help shed light on Windelband.

Campbell’s discussion of interventionism within psychology and psychiatry starts by rejecting two connections which philosophers find natural: between non-mental causal connections and mechanisms and between mental causal connections and rational relations.

Campbell suggests that there is an analogy between:

1 the idea that propositional attitude ascriptions depend on the ascription of rationality to the subject, and 
2 the idea that all causal interactions between pieces of matter must be comprehensible in mechanistic terms. Both ideas express an insight – that we find it extremely puzzling when we encounter causal relations among propositional attitudes that are not broadly rational, just as we find it extremely puzzling when we encounter causal interactions between physical objects that are not mechanistic, and that involve spooky ‘action-at-a-distance’. Both ideas express a natural impulse of philosophers – to elevate this kind of point into a kind of synthetic a priori demand that reason makes on the world. This impulse has to be resisted. [Campbell 2009: 142]

Campbell concedes that, in both cases, there is a genuine insight. As a matter of custom and habit, we find an absence of material mechanisms and an absence of rational connections between mental states puzzling. But in both cases it is a characteristic philosophical error to promote this natural expectation into a justified a priori claim that the world must respect. Mere custom and habit cannot rationally sustain any such demand on how the world must be.

Campbell rejects the necessity of both physical mechanisms and rational connections in favour of an interventionist approach to causation. With respect to the latter, he argues:

Suppose you believe: 1 that this man is stroking his chin, and 2 that this man believes you need to shave. What is it for the first belief to be a cause of the second? On the interventionist analysis, it is for the intervention on the first belief to be a way of changing whether you have the second belief. So if some external force changed your belief that this man is stroking his chin, you would no longer believe that he believes you need to shave. There is no appeal to rationality here, no appeals to mechanism. [Campbell 2009: 143]

The causal connection between one state and another is underpinned in interventionist terms based on the idea that if intervening on the first belief is a stable way of bringing about a change in the second then this is sufficient for there to be a causal connection between them.

For propositional attitudes to count as causes of other propositional attitudes such as delusions, Campbell suggests two conditions have to be met. There should be ‘systematic relations between cause variables and the subsequent delusion’ and there should be a correlation between a change of the cause and a change of the effect [Campbell 2009: 146]. More generally for the causal explanation of mental states, the causal variables, which he calls ‘control variables’, should have large, specific and systematic correlations with their effects akin to the way the controls of a car systematically control its behaviour. These conditions do not require a rational connection, however.

The classical philosophical approach has been to regard propositional attitudes as part of a ‘conceptual scheme’ that we bring to bear in describing the ordinary world. This conceptual scheme is taken to have strong a priori constraints on its applicability. In particular, as we have seen, rationality is taken to be a norm with which the scheme has to comply... The appeal I have just been making to the notion of a control variable is intended to replace this invocation of rationality... [I]t is the fact that we have control variables, not the fact that we have rationality, which means that we are ‘at the right level’ to talk of beliefs and desires. [Campbell 2009: 147]

Taken together, Hoerl’s and Campbell’s accounts suggest a recipe for constructing a concept of idiographic judgement. Hoerl suggests that Jaspers’ version of understanding charts singular psychological causal relations and that singular causal relations can be construed on either Anscombian or interventionist terms. Campbell argues, on interventionist grounds, that the assumption that causal connections between psychological states must presuppose rational relations between them is mistaken as is the parallel assumption about physical mechanisms. There need be neither a physical mechanism nor a kind of psychological rational equivalent of mechanism for causation to hold in either the physical or the psychological ream, respectively.

This rejection of mechanism (either a literal physical mechanism or a rational analogue) may seem to count against Anscombe’s idea of effects arising out of, or coming of, their causes and Jaspers idea of meaningful connections. That, at least, is Hoerl’s view. But it might equally be thought that the counterfactuals underpinning interventionism illuminate rather than contrast Anscombe’s central idea of causality. Whichever is the case, the combination of singular causation and interventionism without rational or physical mechanism suggests an austere view abstracted from and hence no longer tied to the psychological realm. Hence the possibility that this might offer substance to Windelband’s emphasis on the particular rather than the meaningful. Perhaps idiographic judgement trades in singular causal relations shorn of rational relations?

Although emphasis on the singular looks to be a promising match to Windelband’s sketch of the idiographic, it will not do for three reasons. First, it would be a distinction of subject matter rather than the form of intelligibility: an ontological distinction between actual token causal relations rather than general properties. Second, that distinction does not seem a helpful way of distinguishing disciplines. For example, astronomy would count as ‘nomothetic’ when dealing general causal claims such as the behaviour of solar systems in general but ‘idiographic’ when applied to the historical behaviour of particular planets. Third, whilst interventionism does not require the existence of laws of nature to underpin causal claims, it does require relations of some generality and invariance across some range of interventions [Woodward 2003: 239-314]. The possibilities of intervention or manipulation require relations of some generality. Hence if singular causal claims are accounted for using interventionism, their understanding presupposes some general claims, thus undermining a distinction of kind.

In summary, the idea in this section was the following. It might be possible to spell out a notion of idiographic judgement by looking at one version of the related distinction within the Methodenstreit between understanding and explanation. According to Hoerl’s interpretation of Jaspers, understanding concerns singular causation in the psychological domain. Such causation is, on one model at least, underpinned by the idea of intervention rather than nomological generality. Further, according to Campbell, even in the psychological domain, such singular causation need not trade in rational relations. At this point in the combination of ideas, the analysis offered may no longer be an account of Jasperian understanding but seems, partly for that very reason, to be a promising match for Windelband’s emphasis on particularity within and without the mental realm. Sadly, the distinction between singular and general causal relations is a poor match for Windelband’s requirement for a distinction in form of intelligibility rather than subject matter.

Values and the singular aims of idiographic inquiry

So far I have suggested that two broad approaches to filling out Windelband’s account of idiographic understanding have failed. Attempting to articulate a form of judgement that eschews implicit comparison between individuals undermines the content of the putative judgements. Stressing singular rather than general causation produces a distinction of subject matter rather than a distinction in between forms of intelligibility.

In this final section I will sketch a different approach. The clue comes from another passage in Windelband’s rectoral address in which he again stresses the importance of the contrast between the general and specific to his distinction of nomothetic and idiographic.

[T]his distinction connects with the most important and crucial relationship in the human understanding, the relationship which Socrates recognized as the fundamental nexus of all scientific thought: the relationship of the general to the particular. [Windelband 1980: 175]

The commitment to the generic is a bias of Greek thought, perpetuated from the Eleatics to Plato, who found not only real being but also real knowledge only in the general. From Plato this view passed to our day. Schopenhauer makes himself a spokesman for this prejudice when he denies history the value of a genuine science because its exclusive concern is always with grasping the specific, never with comprehending the general... But the more we strive for knowledge of the concept and the law, the more we are obliged to pass over, forget, and abandon the singular fact as such… [ibid: 181]

So far these passages repeat the importance of the singular over the general that has already been discussed. But in explaining why this is important, Windelband introduces a further element:

In opposition to this standpoint, it is necessary to insist upon the following: every interest and judgment, every ascription of human value is based upon the singular and the unique... Our sense of values and all of our axiological sentiments are grounded in the uniqueness and incomparability of their object. [Windelband 1980: 182]

Now in one respect this does not help since it merely stresses the the uniqueness and incomparability of the objects of idiographic judgement and, as the discussion above has suggested, this does not help single out a form of judgement or intelligibility to stand in opposition to the nomothetic. But there is a further idea: that what we as subjects value in judgement and sentiment is tied to uniqueness and incomparability.

This is a contentious claim and it is far from obvious that it is true. The Categorical Imperative implies, to the contrary, that love of the good has an essential generality. More mundanely, one might value a piece of industrial design – a car, bicycle or cutlery – despite or even because of its mass production. But there are some cases where value seems to be tied to uniqueness: feelings of love and friendship directed to particular individuals – by contrast with a generalized love of humanity – being paradigmatic.

This suggests a different way of thinking about the idiographic: not as a novel form of judgement or intelligibility but rather as pertaining to the nature of interest taken in its subject matter. In some cases, one is interested in individuals because they are instances of generalities. In others, the interest is in them as individuals.

Here is a mundane example of the contrast. In 2009, UK members of parliament (MPs) were found to have taken part in widespread abuse of their expenses system to augment their incomes. UK newspapers investigated many such cases and every day printed new instances of the absurd financial claims made. But the focus seemed to be to use each new instance to justify the general claim that MPs as a whole were a corrupt group rather than having an interest in any previously obscure MP. The reputation of politicians as a class of people was the target. By contrast, in 1997 Diana, Princess of Wales, died in a car crash provoking much newspaper coverage. One particular newspaper – the Daily Express – continued, for a decade afterwards (!), to favour for its front cover any story about the late princess. But the claims advanced were not intended to shed light on royalty, or even princesses, in general. Rather the focus was relentlessly on Diana herself. The interest was, in the sense I have suggested, idiographic.

One consequence of moving the conception of idiographic from a form of intelligibility to the nature of the interest taken in individuals is that it places no constraints on the kind of intelligibility in play. Materials from either side of the traditional explanation versus understanding distinction, for example, could be deployed for idiographic purposes. No attempt need be made to frame descriptions that could only fit one individual.

Given this, however, it may seem that the contrast between idiographic and nomothetic as proposed does not amount to very much. What does it matter with what interest or value the subject matter of idiographic inquiry is approached if the actual judgements offered are as they would be in nomothetic inquiry?

In response to this question I will suggest two general consequences. The first is that idiographic inquiry – so understood – can simply escape one of the conceptual challenges of small scale qualitative social science research. This is the question of whether and how the results can be generalised. By contrast with large scale often quantitative research, a narrow but deep qualitative focus may not be based on a statistically significant sample and hence may not reliably generalise to other individuals or populations. But if not, what is the point of the inquiry? Idiographic inquiry, however, can bite on this bullet because it has no interest in other individuals or populations. Like the Daily Express’s interest in Diana, its focus is on the particular for the sake of the particular.

The second is that idiographic inquiry is naturally resistant to a source of error that Jonathan Dancy calls ‘looking away’ [Dancy 1993]. This is a virtue he claims for particularism over generalism in moral philosophy. Generalism claims that moral judgements can be codified in context-independent principles. Particularism opposes this and insists that small differences in a particular situation can reverse their moral valence. Hence Dancy argues from his particularist commitments for the importance of scrutinising particular situations with great care rather than being distracted by a premature comparison of that situation with others.

Particularism claims that generalism is the cause of many bad moral decisions, made in the ill-judged and unnecessary attempt to fit what we are to say here to what we have said on another occasion. We all know the sort of person who refuses to make the decision here that the facts are obviously calling for, because he cannot see how to make that decision consistent with one he made on a quite different occasion. We also know the person (often the same person) who insists on a patently unjust decision here because of having made a similar decision in a different case. It is this sort of looking away that the particularists see as the danger in generalism. Reasons function in new ways on new occasions, and if we don’t recognize this fact and adapt our practice to it, we will make bad decisions. Generalism encourages a tendency not to look hard enough at the details of the case before one. [Dancy 1993: 64]

Although the motivation differs, idiographic inquiry ‘sees’ its subject matter not primarily as interesting because it instances generalities but interesting for being the particular individual it is. And hence, whilst any subject matter will instance generalities – and such is the content of the any judgement made about it – the focus is bottom up: from individual to general characteristics rather than top-down from generalities to instances.

Conclusion

Recent calls for psychiatry to augment criteriological diagnosis with a more individualistic element have glossed this as an idiographic element. But this prompts the question of what the idiographic could amount to. Windelband’s various characterisations do not yield a distinct account of a form of judgement to contrast with nomothetic judgement. Nor is the use of singular causation an appropriate fit for this purpose.

Instead, Windelband’s suggestion that there is a connection between a focus on individuals rather than generalities and what is of value suggests a distinct response. On this suggestion, idiographic inquiry does not have a different form of intelligibility of its subject matter but rather has a particular kind of interest in it. It is an interest in the individual as such. This helps sidestep a worry about how to generalise small scale qualitative research and to avoid an epistemic bias of ‘looking away’: prematurely looking away from the individual to generalities. It is in such differences, rather than the form of judgement taken, that the difference between idiographic and nomothetic lies.

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Thornton, T. (2007) Essential Philosophy of Psychiatry Oxford: Oxford University Press

Thornton, T. (2008a) ‘Does understanding individuals require idiographic judgement?’ European Archives of Psychiatry and Clinical Neuroscience 258 Suppl 5:104–109

Thornton, T. (2008b) ‘Should comprehensive diagnosis include idiographic understanding?’ Medicine, Healthcare and Philosophy 11: 293-302

Thornton, T. (2010) ‘Narrative rather than idiographic approaches as counterpart to the nomothetic approach to assessment’ Psychopathology 16: 284-291

Woodward, J. (2003) Making Things Happen: A Theory of Causal Explanation. Oxford: Oxford University Press

Wednesday, 22 March 2017

Delusion post in Imperfect Cognitions

Lisa Bortolotti's Imperfect Cognitions blog has recently published a short summary that Bill Fulford and I wrote, advertising the view of delusions we took in our chapter in Schramme, T. & Edwards, S. (eds) Handbook of the Philosophy of Medicine.

I try to resist being drawn into substantial theorising but in this case I think a kind of non-theory theory might be called for. It also serves as a reason to connect delusion to tacit knowledge.

We think that there is a clinically recognizable local breakdown in that those relations which is not sufficient to take someone outside the space of reasons (a mere machine) but which resists specific understanding because, as Jaspers emphasised, the reasons cannot be shared. Further, just as rationality as a whole resists codification so breakdowns in the space of reasons do too. Recognising delusion is thus a matter for tacit rather than explicit knowledge.

Wednesday, 15 March 2017

Big or small p philosophy and/of psychiatry?

I gave a talk (briefly described here) at the Northern Ireland division of the Royal College of Psychiatrists the other day and so decided to pitch it at the idea that philosophy is a more or less obligatory part of self-conscious mental healthcare. The contrasting foils I considered were that it was either a debunking account of psychiatry in other terms such as an exercise of social control or, as Jennifer Hansen suggested to the AAPP a few years ago, a desperately needed defense of psychiatry against criticism essentially from outside it. I suggested instead that philosophical reflection grows organically out of internal debates in thoughtful psychiatry.

Afterwards, and after some interesting questions and debate, one person expressed surprise that the talk had been more about the philosophy of psychiatry than he had expected. I think he said that he had expected more philosophy with a small ‘p’. But I think he meant what I would express by saying philosophy with a large ‘P’: general, unapplied philosophy. So I have volunteered to go back and do that, if they wish, in the future. Mainstream philosophy for psychiatrists, as it were.

The irony is that when I was first invited to give philosophy of psychiatry sessions at large international psychiatry conferences by Bill Fulford, he always stressed that psychiatrists would be most interested in the standard philosophical debate about the mind-body problem. At the time, this was fortunate because there wasn’t a wealth of bespoke philosophy of psychiatry (not that I could bring myself to do quite or only that). Now with somewhere between 50-100 books published in the last 20 years by philosophers and by psychiatrists on what we thus call philosophy and psychiatry (and 30 years of PPP) it seems curious if actually Bill’s suggestion for what is really wanted remains true.

Tuesday, 21 February 2017

The Palgrave Handbook of Sociocultural Perspectives on Global Mental Health

I see that the Palgrave Handbook of Sociocultural Perspectives on Global Mental Health edited by Ross White, Sumeet Jain, David Orr and Ursula Read has now been published (see here).

The publishers' blurb runs:

This handbook incisively explores challenges and opportunities that exist in efforts aimed at addressing inequities in mental health provision across the globe. Drawing on various disciplines across the humanities, psychology, and social sciences it charts the emergence of Global Mental Health as a field of study. It critically reflects on efforts and interventions being made to globalize mental health policies, and discusses key themes relevant for understanding and supporting the mental health needs of people living in diverse socio-economical and cultural environments. Over three rich sections, the handbook critically engages with Global Mental Health discourses. To help guide future efforts to support mental health and wellbeing in different parts of the world, the third section of the handbook consists of case studies of innovative mental health policy and practice, which are presented from a variety of different perspectives.

My self-centred interest is that I have chapter in it on 'Cross-cultural psychiatry and validity in DSM-5'

Abstract
The fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual, DSM-5, puts greater emphasis than previous editions on cross-cultural factors affecting mental illness [APA 2013]. Diagnostic criteria have been revised to take account of cross-cultural variation, there is a more specific cultural formulation and a glossary lists nine ‘Cultural Concepts of Distress’. But the DSM does not present a clear view of the universal or local constitution of mental illness. Nor does it give an account of the relation of the cultural concepts to the rest of the taxonomy of disorders nor the extent to which they are put forward as valid diagnoses. The first section of this chapter outlines three possible views of the nature of cultural concepts of distress. On one view, which dates back to the German psychiatrist Karl Birnbaum, an underlying universal ‘pathogenic’ component is overlain by a variable ‘pathoplastic’ cultural shape [Birnbaum 1923]. This combination suggests the possibility of two single factor models: pathogenic-only and pathoplastic-only. But, as the second section argues, establishing the correctness of any one of these is difficult. Two influential approaches to the nature of the concept of disorder – Wakefield’s harmful dysfunction analysis and Fulford’s failure of ordinary doing – can be pressed with only minor adjustment to support any of the a priori models of cultural concepts. The final section examines one of the nine cultural concepts: khyal cap or wind attacks, a syndrome found among Cambodians. On inspection none of the three models helps accommodate its own incompatible aetiological theory with the biomedical view of the rest of the DSM. This suggests that the very idea of cultural concepts of distress fits uneasily with the aspirations to validity of the rest of DSM-5.

Monday, 20 February 2017

Philosophy as a research method in health research

Here is another video of me. Sorry. But it was made a year ago to promote health research methods at UCLan. Such videos persuade me of the real skills of those who make presentation both seamless and natural. I manage neither here.