The missing self in scientific psychiatry

Abstract

Various traditions in mental health care, such as phenomenological, and existential and cognitive-behavioral psychotherapy, implicitly or explicitly acknowledge that a disruption of the self, or the person, or the agent (often using these three concepts synonymously) is among the common denominators of different mental disorders. They often emphasize the importance of understanding patients as reasonsresponsive, in their full mental health relevant complexity, if their mental disorder is to be treated successfully. The centrality of the concept of the self is not mirrored in the mainstream scientific approaches in psychiatry however; the self has rarely been considered as the object of scientific research, the empirical investigation of which might yield successful explanations of and interventions in mental disorders. Thus, even though self-related phenomena are clinically relevant in so far as they give important information about a mental disorder to the clinician and help the development of effective interventions, they are not considered among the scientifically relevant properties of mental disorders. Leaving the self-related phenomena out of the scientific research on mental disorders can be attributed to the presupposition that the self is not empirically tractable and its use will hinder psychiatry’s goal to be scientific. In this paper, taking issue with this, I argue the self is empirically tractable, and its use as a target of research will not hinder psychiatry’s scientific commitments.

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Notes

  1. 1.

    Tellingly, albeit after much contentious debate, DSM-5 removed the bereavement exclusion criterion from the depression description. This means if an individual displays the above-mentioned symptoms for a two-week period because she has lost a significant person in her life, she can still be diagnosed with depression (Wakefield 2015; Tekin 2015).

  2. 2.

    There is disagreement on whether and precisely how Hempel’s work affected the DSM. DSM-III Task force chair Robert Spitzer denies such influence, whereas philosophers such as Joseph Parnas and Louis Sass emphasize it. In a review article, Kendler et al. discuss the influence of Hempel’s operationalism on the development of Feighner criteria by psychiatrists at Washington University in St. Louis. Most recently, Parnas and Bovet trace the emergence of operationalism in psychiatry to Hempel. However, Schaffner and Tabb address the complexities of the causal relationship between Hempel and the DSM by pointing out the later work of Hempel moves away from logical positivism and is more sympathetic to a Kuhnian approach. I do not want to overstate Hempel’s influence on the DSM, but insofar as his work represents the shared understanding of science at the time, it is important to engage with it to understand the underlying reasons for psychiatry’s choice to ignore the self in scientific contexts (Parnas and Bovet 2014; Schaffner and Tabb 2014; Fulford and Sartorius 2009).

  3. 3.

    I want to make it clear that I am not trying to develop an understanding of the metaphysics of the self, a debate in philosophy with a long and complex history. I do not commit myself to developing a philosophical account of the self; rather, I argue for its instrumental value in psychiatry.

  4. 4.

    The desire to include the self as a scientific target in psychiatry embraces pluralism in psychiatric research and other models of the self may also be promising. I will not discuss those here.

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Acknowledgements

I thank Owen Flanagan, George Graham, William Bechtel, Adele Abrahamsen, the audiences present at the University of Pittsburgh (2014), the Southern Society for Philosophy of Psychiatry (2016), and the two anonymous reviewers for their feedback.

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Correspondence to Şerife Tekin.

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Tekin, Ş. The missing self in scientific psychiatry. Synthese 196, 2197–2215 (2019). https://doi.org/10.1007/s11229-017-1324-0

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Keywords

  • Self
  • Person
  • Mental disorder
  • Psychiatry
  • Science