In this article I examine some of the issues involved in taking psychiatric disorders as natural kinds. I begin by introducing a permissive model of natural kind-hood that at least prima facie seems to allow psychiatric disorders to be natural kinds. The model, however, hinges on there in principle being some grounding that is shared by all members of a kind, which explain all or most of the additional shared projectible properties. This leads us to the following question: what grounding do psychiatric disorders qua natural kinds have? My principal method for examining the issue is a case study of a particular psychiatric disorder: the so-called “apathetic children.” I argue that there appear to be at least two competing models that both appeal to non-organic a grounding of the disorder. However, for other psychiatric disorders, such as Alzheimer’s disease, the evidence points toward an organic explanation of the disorder. I contend that what unites psychiatric disorders is not a distinctive type of grounding that all psychiatric disorders share, but the distinctive set of determinable properties that is shared by all psychiatric disorders.
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One reason I chose the term “grounding” over “essence” is to distance the explanatory concern I have in this article from various modal/semantic concerns that have taken the front seat in the debates over essentialism and natural kinds. Having said that, I have been informed that the notion of (ontological) grounding has also emerged as a central topic in recent logic and metaphysics (see e.g., Rosen 2010). The term should in the article be understood in the sense of its role in explaining the multiple projectible properties of a kind, leaving possible modal and more fundamental metaphysical concerns to one side.
Elsewhere I have argued (2012) that the historical-relational and the intrinsic account are not mutually exclusive and can in some cases coexist, e.g., in the case of genetic disorders.
Incidentally this means that the relevant contrast class to natural kinds here might be “conventional/nominal” or “functional” categories and not “social” or “human” categories—the latter which according to this model might in many cases, such as in the case of psychiatric disorders, be natural kinds.
After 2006, there was a sharp decline of cases with only a couple of cases encountered in recent years (Godani et al. 2008).
This is not certain for those cases where the child was deported from Sweden, as there was often no follow-up to them.
The concern was closely related to a number of debates concerning the fact that the asylum applications were often denied for families with children with PWS—both prior to and after the child developed the disorder. In several cases the immigration authorities and doctors authorized the deportation of the children with the disorder, even after the children had reached a comatose state (see Tamas 2009).
Though here I will only have space to suggest rather than argue for this model being superior to Hacking’s I&I model (see Godman 2012).
Godani et al. (2008, p. 30) note that 2/3 of the children in their report were “habitually well behaved.”
“(Depressive) devitalization” is Bodegård’s name for PWS. He also subscribes to the idea that there is “a close relationship between what we call depressive devitalization and PRS” (2005, p. 349).
It is possible that there are some underlying neurological correlates for the high-achieving personality that offer a (reductive) alternative explanation for these psychological effects.
At this juncture I suspect that Hacking would protest that the over-representation of PRS cases in Sweden during the past decade has still not been explained as I have offered the very same hypotheses for the grounding of the Swedish cases as I have for the otherwise rare child psychiatric disorder. I accept that the over-representation is to some extent still puzzling if we merely draw on the account of grounding that I have presented; but of course population-level frequencies were not what an account of grounding set out to explain (for further defense see Godman 2012).
So far these plaques and tangles only tend to show up in post-mortem examinations, yet it is agreed that only such an examination counts as a definitive diagnosis of Alzheimer’s disease. One of the hopes is that in the future neuroimaging techniques (PET and SPECT scans) will allow us to visualize and quantify the plaque and tangle load in the brain and so better assist in the diagnosis of the disorder (Agronin 2008).
Some elderly persons may also have plaques and tangles and yet are not considered to have AD. It is therefore possible that the intrinsic grounding is better understood as a particular type of (intrinsic) trajectory, distinctive to people with AD.
“Determinables are not specific properties like red or square, but rather the disjunctions of contrary properties like colored (equals red or blue or green or …) and shaped (equals square or triangular or circular or …)” (Millikan 2000, p. 10).
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Earlier drafts of this paper were presented at a philosophy of psychiatry workshop in Birmingham (June 2010) and at the “Natural Kinds in Philosophy and in the Life Sciences Workshop in Granada” (September 2011). I am grateful to all the participants for the useful discussions and I am especially indebted to Lisa Bortolotti, Rachel Cooper, Thomas Reydon, and Miles MacLeod for invitations to present my work. I wish to thank Bryan Lask for an invaluable discussion about the Swedish case and Pervasive Refusal Syndrome in general. Thanks also to Martin Bellander for a careful and insightful reading into the psychiatric, psychological, and philosophical aspects of the disorder. Finally, I would like to thank Gellert Tamas who first inspired me to probe further into this intriguing yet very sad case of the apathetic children.
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Godman, M. Psychiatric Disorders qua Natural Kinds: The Case of the “Apathetic Children”. Biol Theory 7, 144–152 (2013). https://doi.org/10.1007/s13752-012-0057-z
- Alzheimer’s disease
- Ian Hacking
- Ruth Millikan
- Multiple projectibility
- Natural kinds
- Pervasive refusal syndrome
- Psychiatric disorders