Transcript mental - Pitzer College

Is there a special,
conceptual problem of
mental disease
(beyond the problem of disease
itself)?
Brian L. Keeley
Philosophy
&
Science, Technology, and Society
Field Groups, Pitzer College
<[email protected]>
Preamble
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This talk is pretty tentative.
The short answer to the titular
question:
Yes
What’s the issue here?
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Is there something more to the
question of defining “mental
disease” (or “mental illness,”
“mental health,” etc.) beyond the
well-known conceptual problems
of defining “disease” (or “illness”
or “health”) simpliciter?
Does the “mental” component add
anything significant to the
problem?
What’s the issue here?
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This is important to me, in
particular, because I am a
philosopher of neuroscience
and a materialist…
…one who takes it as a working
hypothesis that, in some robust
sense, the mind just is the
brain.
Hence, “mental disease” just is,
in some robust sense, “brain
disease” (or, better, “mind/brain
disease”).
What’s the issue here?
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That would seem to lead me to
the conclusion that brain health is
just the same matter as the health
of any other organ system in the
body, hence there’s no special,
conceptual worry here.
But, I think that is too fast.
There are adequate reasons and
resources to conceive of a
special problem of mind/brain
disease without inconsistencies
with a naturalized, materialist,
neurophilosophical view of
things.
But, hold on a moment!
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What about functionalism?
Functionalism is a materialist
philosophy of mind that
nonetheless supports antireductionism wrt mental
phenomena (cf. Putnam, Fodor,
etc.)
One can imagine a fully
materialist, yet functionalist,
account of mental illness whereby
there’s a special (functionallydefined) problem independent of
bodily health.
Not an option for me

The problem: I reject the notion
that functionalist explanation
entails any significant
independence of psychology from
neuroscience.
Cf., Bechtel & Mundale (1999), “Multiple
realization revisited: Linking cognitive and
neural states” Philosophy of Science
 Keeley (2000), “Shocking lessons from
electric fish: The theory & practice of
multiple realization” Philosophy of Science
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So, that avenue is closed to me.
Overview of talk
 The basic, conceptual problem of
health and disease
 The conceptual problem of mental
disease
 An illustrative case:
Williams’ Syndrome
 Conclusion
 The Basic, Conceptual
Problem of Health and
Disease
Defining Health &
Disease
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Broadly speaking, two main
approaches have been taken,
each having its own
problems:
 Normative theory
 Naturalism
Normative Theory
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An essential component of any
definition of health or disease is
human evaluation.
Something only counts as a
disease if it violates some
personal or social norm.
On this account, the concept
“disease” falls into the same
category of concepts as “weed” or
“pest”.
Normative Theory
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Peter Sedgwick:
“The blight that strikes at corn or at
potatoes is a human intervention, for
if man wished to cultivate parasites
(rather than potatoes or corn) there
would be no blight, but simply the
necessary foddering of the parasitecrop… Outside the significances
that man [sic] voluntarily attaches to
certain conditions, there are not
illnesses or diseases in nature.”
Problem cases for
normativism
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The whole field of plastic surgery (which is
medicine, after all): breast/penis size,
ethnic physical features, unwanted
pregnancy, baldness
The fact that I can’t bat like Barry Bonds or
have the manual dexterity of Glenn Gould
or maintain my 20-year-old physique (in
other words, I’m not as good physically as
I’d like to be).
Naturalism
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Against the rampant relativism of the
normative theory, naturalists such as
Christopher Boorse argue that “disease”
can and ought to be defined in biological
terms.
The proper norms here are biological
norms.
Hence, my baldness shouldn’t count as a
disease because it is normal for (males of)
my species.
Naturalism
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Boorse:
“The root idea of this account is
that the normal is the natural. The
state of an organism is theoretically
healthy, i.e., free of disease, insofar
as its mode of functioning
conforms to the natural design of
that kind of organism…. Theoretical
health now turns out to be strictly
analogous to the mechanical
condition of an artifact.”
Defining “normal”
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Not an easy task.
Statistical normality is out… that
tooth decay is the statistically
normal state of adult humans does
not seem to it out as a disease
state.
Boorse invokes normality relative
to a natural design. Tooth decay is
a result of a hostile environment,
not normal development.
Problem cases for
naturalism
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Homosexuality (although, as we
will see, if this gets classed in
the mental/behavioral domain,
the issue is side-stepped) (Ruse).
Aging (dementia, menopause,
hearing loss)… quite natural to
the species, but often seems
paradigmatically disease-like
(Caplan)
Defining Disease in
General
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My purpose here is not to solve
this problem, but rather to
demonstrate what the problem
is, such that we can consider
whether something different is
going on in the case of mental
disease.
 The Conceptual
Problem of Mental
Disease
Even more problematic
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Greetings & salutations!
If the problem of bodily health
& disease is a headache,
mental disease is even more
problematic.
First, because the biological
causes (if any) are occult,
historically social norms have
played a much larger role:
Homosexuality, masturbation,
hysteria, and drapetomania
have all been seriously
considered to be mental
diseases.
The elimination of the
concept of mental
disease
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One response to the additional problems
engendered by the concept of mental
disease is to simply divorce it from
anything but a metaphorical connection
to the disease model of physiological
medicine.
For example, it has been argued that
while normativism has nothing to do
with biological disease, it has everything
to do with psychological “disease” (in
scare-quotes)
Szasz’s dilemma
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Another related response has been put
forth famously by Thomas Szasz (The
myth of mental illness, 1961).
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Proposes a mutually exclusive pair of
categories
What we call mental illness must be
either:
 brain disease
 “problems in living”
Szasz’s dilemma
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“…a disease of the brain, analogous to a
disease of the skin or bone, is a neurological
defect, not a problem in living. For example, a
defect in a person’s visual field may be
explained by correlating it with certain lesions
in the nervous system. On the other hand, a
person’s belief--whether is be in Christianity, in
Communism, or in the idea that his internal
organs are rotting and that his body is already
dead--cannot be explained by defect or disease
of the nervous system. Explanations of this
sort of occurrence--assuming one is interested
in the belief itself and does not regard it simply
as a symptom or expression of something else
that is more interesting--must be sought along
different lines.”
Szasz’s dilemma
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Attempts to eliminate a special
problem of mental disease by either
reducing it to simple brain disease
(and hence, no special problem
beyond disease in general) or reidentifying it as “problems in living”
(which is an issue of choice, lifestyle
and prejudice, not a medical problem
at all)
My thesis
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Even if we give up the notion that
there is a special problem defining
mental disease based on some
special nature of the mental…
…there might still be a source of a
special problem if it were true that
there is something special about the
mind/brain itself
…something importantly different
about the brain as compared to other
organs.
I suspect that this is the case.
The specialness of the brain
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QuickTime™ and a
Animation decompressor
are needed to see this picture.
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In essence, the brain is a
flexible, adaptive behavior
machine.
Much of what it does is
superfluous wrt keeping the
organism as a whole running
well.
As a result, the space of
possible sustainable behavioral
dynamics wrt the brain is huge
when compared to other organ
systems.
The specialness of the brain
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The special problem created by this
large space of possible dynamics is
figuring out which are deleterious
(formerly known as “mental disease”).
Sometimes a brain becomes wired up
in a way that the subject testifies (and
acts consistent with the belief) that
his/her body is dead (aka “Cotard’s
syndrome”).
Other times it becomes wired up in a
way that the subject testifies (and acts
consistent with the belief) that Jesse
Ventura would make a great President.
The difference here?
 An illustrative case:
Williams’ Syndrome
William’s Syndrome
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A good example of what I’m
suggesting.
A genetic disorder first identified in
1961
estimated to occur in 1/20,000
births
Results from moderate to severe
deletion of material on chromosome
#7 including the gene that makes
the protein elastin (a protein which
provides strength and elasticity to
vessel walls.)
William’s Syndrome
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Resulting symptoms:
Distinctive facial features
Heart and blood vessel
problems
Hypercalcemia (elevated blood
calcium levels)
The cardiovascular problems,
if uncorrected are generally
fatal during childhood.
We learned to treat these
problems, which revealed…
William’s Syndrome
Resulting brain symptoms:
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Overly friendly (excessively social)
personality
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Developmental delay & learning
disabilities
 remarkably spared linguistic
abilities despite impaired problemsolving and general cognitive
abilities
 relatively intact face processing,
and
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severe spatial cognitive deficits
similar to those found with right
parietal damage.
But notice
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One and the same genetic disorder
has significant effects on both the
cardiovascular and nervous
system.
But, the effect on the cardio
system just kills you.
The effect on the nervous system
is significant, but it doesn’t kill the
subject.
In other words, because the
cardiovascular system works with
a much smaller window of
sustainable dynamics, even small
variations result in death.
But notice
 The amazing diversity of mental
diseases (as was) testifies to the
flexibility of brain dynamics.
 The special problem of mind/brain
disease is sorting that large space
of possible dynamics.
 Conclusion
Conclusion
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Although it is still admittedly
tentative & sketchy, I think it is
possible to develop an argument for
a special problem of mental disease
based not on special properties of
the mental, but rather on the special
properties of the brain.
I look forward to your questions and
comments.