Introduction and Synopsis

The starting point of this book is the assumption that theories of the mind need to provide an account of order and disorder, which have been traditionally the domain of psychology and psychiatry; and that psychology and psychiatry need to understand the nature of their explanations, which is the province of the philosophy of mind and philosophy of science. Here and in the first chapters of the book we review the philosophical issues and make specific proposals that are in some respects novel. We then show how these ideas can be applied to biological systems in general and to the mind and its functioning both in order and disorder, and in the ground between the two.

In this opening section we set out to orient the reader to the issues in psy-chopathology by reviewing how the questions are posed in relation to the commonest adult mental health problem, depression, illustrating briefly the links between the philosophical, research, and clinical issues. Depressive episodes involve changes of behaviour, mood and thinking about the self, the outside world, the past and the future. They may be understood in two contrasting ways. In the first it is assumed that being depressed is like any other human emotional state and that there is a reason for it, in a loss or threat or other similar adverse external circumstance. In the second view, it is not part of the person's usual set of emotional responses to events, but is a form of illness. We will be concerned in this book to make clear how either interpretation gives rise to questions, to offer some solutions to those questions, and above all to show how important it is to keep alive several lines of thought in the investigation and treatment of psychiatric or psychological disorder.

The difference between the two types of explanation, broadly speaking, lies in whether or not they refer to the meaning of the mood, beliefs, and behaviours. In the first they are thought to be meaningful in relation to the rest of the person's life, their past and present experiences. Why is this problematic? Where the precipitants are clear, such an account may be straightforward, but often they are not. The person appears to have nothing to be depressed about, or can think of no reason to be depressed. The depressed person does not feel or seem to be his/her normal self. The depression is experienced as happening to the person, rather than being part of them. In other words the experience and the observed phenomena have the qualities of an illness that intrudes inexplicably and uncontrollably into the life of the individual. Many psychiatric conditions have this quality, to a greater or lesser extent, of being experienced as intrusive, or inexplicable, and some ways as alien.

A further question arises from the meaningful account, where we are able to identify reasons for the depression. In what sense could a loss such as the death of a loved one be the cause of the depression? We can describe in human terms how that might be: because the two people had shared happy experiences, had supported each other, confided intimate concerns; in short because they meant a lot to each other. Does this mean that the loss caused the depression in the same sense that loss of support causes an apple to fall? Apples fall off trees all over the world in the same way, following the same laws of nature, yet the death of one person has a quite different emotional effect from the death of another. The difference appears to be related to the significance of one and not the other. We must conclude either that our concepts of meaning and significance must be translatable into other terms more like those of physics, or that different ideas of cause and effect are operating. If it is the latter, are cause and effect in the mind different from cause and effect in the rest of the world? In the course of the book we shall argue that states of mind are genuinely causal, that the causal processes are different from those of physics, but not different from those in biology generally. We will also find that even mental states that are experienced as intrusive, inappropriate, and uncontrollable may arise from the experiences and personality of the individual. Then the clinical and research implication is that therapeutic approaches should address those areas.

We will see also that the second kind of explanation of depression, as a form of illness, may be appropriate. We will not however be able to entertain that possibility until we have addressed a further set of questions. If the constellation of emotions, beliefs, or behaviours, seen in depression is not linked to the rest of a person's life or experiences, is there a difference between this and their other mental states which we readily think of as meaningful? For instance if I was happy last year because I got a good new job, and now I am depressed for no apparent reason, was the job really the cause of my happiness, or was my happiness as inexplicable as my depression? If I suppose that my depression arose from an abnormality of my brain function, could I then put last year's happiness down to brain function? This has a certain appeal because it must have involved alterations in brain function, but does that mean that the new job was not really part of the causal chain? As we shall see attempts have been made to argue that those meaningful events that we think of as causing our feelings, thoughts, and behaviours do not really do that, and only brain processes are genuinely causal. But these attempts do not succeed. The alternative is to suppose that different causal processes might have operated in last year's happiness and this year's depression. If this is the case we will need again two forms of causal process. From the research and clinical perspectives, the questions do not stop there. Even if we can elucidate two different kinds of origin of mental events and behaviours, how do we determine when each is operating separately or in combination? Our aim is to provide an approach to this question, first through an analysis of causal processes in the operation of the mind, then through a consideration of these within the context of biology and development, and finally in an enquiry into the origins of some of the major psychiatric disorders.

The problem area with which we are concerned of course has historical roots, and an understanding of these helps to make the issues clearer. The distinction between meaning and causality, and the related distinction between understanding and explaining, arose at the turn of the nineteenth century within the new cultural sciences, the Geisteswissenschaften. The distinctions signified a major problem, the apparent misfit between the phenomena studied by these new sciences—human beings and culture, and specifically the meaning that pervades them—and the assumptions and methods of the natural sciences, developed since the seventeenth century. Meaningful phenomena show a particularity ('uniqueness') uncaptured by general laws. They apparently cannot be subsumed under causal laws of the natural sciences. Further, meaning bears a loose relation to 'hard facts', so that understanding of it tends to appear subjective. It seemed, therefore, that knowledge of meaningful phenomena could not be accommodated by the methodology of the natural sciences, based in assumptions of generality, causality, and objectivity. Hence there arose a dichotomy between the natural sciences and the sciences of meaning, implying the autonomy of the latter. This whole problematic, subsequently endorsed and elaborated in hermeneutic readings of the cultural sciences, and evident currently in various post-modernist critiques, was expressed by the turn-of-the-century distinctions between meaning and causality, and understanding and explaining.1

The problem of meaning in relation to scientific method and explanation as it arose at the turn of the nineteenth century was recognized immediately as relevant to the new psychiatry by Jaspers. His Allgemeine Psychopathologie2 attempted to construct a psychiatry that could embrace both causal explanation in terms of material events and empathic understanding of non-causal meanings. The tension between the two methodologies, however, was covered over rather than resolved. Jaspers' problem was psychiatry's problem. He anticipated what was to become a split within psychiatry between explanation of disorder in terms of brain pathology and 'explanation' in terms of (extraordinary) meanings. The former had no room for meaning; the latter became subject to much philosophical stick, because of its pretensions to be science.

Psychoanalytic theory, as the main and uncompromising proponent of meaningful explanation of disorder, has carried the burden of the problematic status of meaning in relation to scientific method. Problems identified for it included apparent lack of objectivity of data, the non-empirical character of its hypotheses (alleged unfalsifiability), and the questionable assumption that meanings are causes. The pressure, mounting in the 1960s, contributed to the development of the hermeneutic readings of psychoanalytic theory popular in the 1970s, which accepted, with more or less regret, the demarcation between understanding and causal, or more generally, scientific, explanation.3 The hermeneutic readings of psychoanalytic theory, important and presumably inevitable as they were at the time, were relatively short-lived. In part this was because of their implausibility: psychoanalytic theory, like all psychological theories, did seem interested in the aetiology of behaviour, and not just in, as it were, spinning meanings out of the air. But also and in any case, at about this time, the terms of the problem were being transformed. In psychology, behaviourism was in process of being surpassed by a new kind of psychological science, in which mental states played centre stage. This was of course the 'cognitive revolution' in psychology, which began roughly in the 1960s and which continues apace.

The appearance of this cognitive paradigm has powerful implications for the problems embodied in the traditional distinctions between meaning and causality, and between understanding and explaining. The new paradigm establishes mental states and processes as subjects for scientific enquiry, and as having a role in the scientific explanation of behaviour. At the same time, the working assumption is apparently that mental states are causal, or, to put the point more fully, that mental states are invoked in causal explanations of behaviour. Further, though here we encounter many problems and controversies, the prima facie implication is that the meaning which characterizes mind comes within the domain of scientific enquiry, implicated in mental causation.

Inevitably psychiatry has inherited all the philosophical or conceptual problems of psychology, including the problem of meaning and causality, but it faces further specific ones of its own. There are certainly problems with construing meaningful mental states as causes of behaviour already in the normal case, but there is a further reason for doubting the relevance of meaningful explanation in the case of disorder. The reason is simple, on the surface, namely, that the notion of disorder is applied precisely at the point where meaning comes to an end. Roughly, the question of disorder is raised when there is (serious) failure of meaningful connection between mental states and reality, or among mental states, or between mental states and action. In the apparent absence of meaningful connections, we may posit different kinds of mechanism, involving physical causation, mechanisms which have nothing to do with meaning, with beliefs, desires, plans, etc. Given breakdown in meaning, in mental order, it is plausible to suppose that we require explanation in terms of non-meaningful processes, specifically disruption by some form of biological abnormality. This a priori consideration lends weight to the so-called 'medical model' in psychiatry, insofar as it seeks to explain psychological disorder by reference to biological pathology.

The simplicity of this line of thought is overshadowed, however, because the issue of where the limits of the meaningful lie presses hard. Psychological theory may find meaning beyond the point at which common sense runs out. Many controversies within and around psychiatry turn on this point. The various alternatives to and critiques of mainstream, medical psychiatry share in common the charge that it has abandoned the search for meaning prematurely, has over-hastily opted for the lower-level form of explanation in terms of biological causation, because of a poverty-stricken theory of meaning. Freudian theory extended the limits of the meaningful beyond what was envisaged by the common sense, and the psychiatry, of the time. The diverse critiques of the 'medical model' which appeared in the 1960s and which came to be known collectively as the 'anti-psychiatry' movement, likewise charged psychiatry with having a blinkered perception of meaning. Szasz questioned the legitimacy of the very idea of'mental illness' as used in psychiatry, and attacked the associated medicalization of what he described rather as (comprehensible) 'personal problems of living'.4 Laing reframed madness, schizophrenia, as being an understandable, indeed the only sane response to a confused and contradictory family life.5 In examining the historical presuppositions of the relatively recent idea of 'mental illness', Foucault sought to show that it arose as an inevitable consequence of the excessive rationality of the Enlightenment, as the mere negation of reason, meaning and validity, that this essentially negatively defined madness was expelled, as it were, from consciousness, so also geographically, out of the community, into the asylums.6 The general criticism was that there is more meaning in so-called mental illness than meets the eye of psychiatry, and behind that, of the culture in which modern psychiatry has arisen.

Having surveyed from an historical perspective the problem space within which we are working, we can sketch briefly our position. Concerning the central problem of meaning and causality, we argue that explanations which invoke meaning (meaningful mental states) are causal, but they are in critical respects different from causal explanations of the sort found in the physical sciences. In this way we draw a distinction between two varieties of causal explanation, which we call the intentional and the non-intentional. This distinction differs from the distinction between meaning and causality obviously because it is not drawn in terms of what is or is not causal. But also, the distinction we propose appears at a different place in the spectrum of the sciences, not between the 'hard' natural sciences and the 'soft' cultural sciences, but rather between the natural sciences of physics and chemistry, and the (equally natural) biological sciences. In the biological sciences we find concepts of function, design, rules, information, and information-processing, which are the essential ingredients of intentional-causal explanation as understood here. Marking the distinction at this point, between the pre-biological and the biological sciences has the effect of assimilating biology to psychology, and indeed to the cultural sciences. Our point can be put briefly by saying that meaning is akin to, or is on a continuum with, the information that pervades biological systems and functioning. This proposal stands in contrast to those which in one or another way endorse a radical distinction between the meaning of mind, language, and culture, and anything to be found in the natural sciences, biological or otherwise. These alternative positions, which otherwise of course vary greatly among themselves, include materialism and hermeneutics, and the views of such contemporary philosophers as Quine and Davidson.

For psychiatry, which seeks models of aetiology and intervention, the exploration of meaningful processes is of interest only insofar as meanings are causes. Once this claim is defined and established in the first part of the essay, though Chapters 1 to 6, we turn in the second part of the essay, Chapters 7 to 9, to explore breakdown of intentionality, and the nature and limits of intentional explanations of psychological disorder. The notion of breakdown of intentionality is also relevant to the first part of the essay, however. Intentional-causal explanations, our whole way of conceiving the phenomena which they explain, are permeated by concepts involving normative distinctions, such as function, and hence dysfunction, design more or less suited to the environment and task, normal as opposed to abnormal environmental conditions, true/false belief, adaptive as opposed to maladaptive behaviour, and so on. In this sense themes concerning disorder and its explanation run through all of the chapters.

While the philosophy of psychology has a long and familiar history, and is currently flourishing, the philosophy of psychiatry has been relatively neglected. The most thorough and influential analysis of the philosophical foundations of psychiatry was Jaspers', and the distinction between meaningful and causal connections was fundamental to it. Since Jaspers it would be fair to say that philosophical study of general psychiatry has been in limbo. Philosophers have perhaps been wary of tackling the problems of psychiatry because of unfamiliarity. In part this would be modesty appropriate in the philosophy of any science, art, or scholarly discipline, but a further factor here is probably the one identified by Foucault, that in the modern age 'madness' became alienated from culture, delegated then solely to the psychiatric profession. This has been a result detrimental to all concerned. While the philosophical foundations of psychiatry suffered from inevitable neglect, attention focused rather on the two broad areas referred to earlier: the scientific status or otherwise of psychoanalytic theory, and the diverse 'anti-psychiatry' critiques. The former debate did not concern primarily the concept of disorder, nor, a related point, psychiatry in general. The latter debates certainly were about psychiatry and the notion of'mental illness', but their problems were social, political, and historical, not primarily philosophical. Controversy about the scientific status of psychoanalytic theory continued, and mainstream, medical psychiatry defended itself against the radical critiques.7

We do not attempt in this essay to weigh into these well-known though by now dated debates. Our aim is rather as stated above, to examine some philosophical aspects of the problem of meaning and causality, in the light of contemporary theory in philosophy of mind and cognitive psychology, and their bearing on the concepts of mental order and disorder. This examination is relevant to the controversies surrounding psychoanalytic theory, and the notion of mental illness, but these are not the main focus. If the essay can claim allegiance to any 'tradition' in the philosophy of psychiatry it would be to that represented by Jaspers. That said, we have no pretensions to follow Jaspers in the non-philosophical direction of his work, concerned with the details of psychiatric phenomenology and its classification. That emphasis belonged with the idea that meaningful phenomena have no causal role: all that was to be done, in this case, was to describe and classify them. By contrast, insofar as meaningful phenomena are implicated in causal processes, the task is to try to explicate some basic principles of their operation.

Having described some context, colloquial and historical, for the present essay we turn now to a Synopsis of its main themes:-

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