Psychiatric Disorders qua Natural Kinds: The Case of the “Apathetic Children”

Abstract

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.

This is a preview of subscription content, access via your institution.

Notes

  1. 1.

    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.

  2. 2.

    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.

  3. 3.

    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.

  4. 4.

    After 2006, there was a sharp decline of cases with only a couple of cases encountered in recent years (Godani et al. 2008).

  5. 5.

    This is not certain for those cases where the child was deported from Sweden, as there was often no follow-up to them.

  6. 6.

    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).

  7. 7.

    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).

  8. 8.

    Godani et al. (2008, p. 30) note that 2/3 of the children in their report were “habitually well behaved.”

  9. 9.

    “(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).

  10. 10.

    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.

  11. 11.

    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).

  12. 12.

    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).

  13. 13.

    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.

  14. 14.

    “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).

References

  1. Agronin ME (2008) Alzheimer disease and other dementias: a practical guide, 2nd edn. Lippincott Williams & Wilkins, Philadelphia

    Google Scholar 

  2. Ahmadi N (2005) Asylsökande barn med uppgivenhetssymtom: Kunskapsöversigt och kartläggning [Asylum-seeking children with withdrawal symptoms: an overview]. Statens Offentliga Utredningar, Stockholm

    Google Scholar 

  3. Barlow DH (2002) Anxiety and its disorders: the nature and treatment of anxiety and panic, 2nd edn. Guilford Press, New York

    Google Scholar 

  4. Beebee H, Sabbarton-Leary N (2010) Are psychiatric kinds real? Eur J Anal Philos 6:11–27

    Google Scholar 

  5. Bodegård G (2004) Asylsökande flyktingbarn utvecklar livshotande funktionsbortfall [Asylum-seeking refugee children develop life-threatening loss of function]. Läkartidningen 101:1696–1699

    Google Scholar 

  6. Bodegård G (2005) Life-threatening loss of function in refugee children: another expression of pervasive refusal syndrome? Clin Child Psychol Psychiatry 10:337–350

    Article  Google Scholar 

  7. Boyd R (1999) Kinds, complexity and multiple realization: comments on Millikan’s “historical kinds and the special sciences”. Philos Stud 95:67–98

    Article  Google Scholar 

  8. Broad CD (1968) Induction, probability and causation. Reidel, Dordrecht

    Book  Google Scholar 

  9. Cooper R (2005) Classifying madness: a philosophical examination of the diagnostic and statistical manual of mental disorders. Springer, Dordrecht

    Google Scholar 

  10. Dennett DC (1991) Real patterns. J Philos 88:27–51

    Article  Google Scholar 

  11. Devitt M (2008) Resurrecting biological essentialism. Philos Sci 75:344–382

    Article  Google Scholar 

  12. Ellis B (2001) Scientific essentialism. Cambridge University Press, Cambridge

    Google Scholar 

  13. Gillies A (2010) Keeper. Short Books, London

    Google Scholar 

  14. Godani G, Bodegård G, Rydelius P-A (2008). Bördan de kom med. Rapport från Forskningsprojektet: Barn i asylprocessen som utvecklade uppgivenhetssymtom i Sverige. [The burden they came with. Report from Research Project: The children in the asylum process who developed withdrawal symptoms in Sweden]. Rädda Barnen & Karolinska Institutet, Stockholm

  15. Godman M (2012) Human kinds and other natural kinds. PhD thesis, King’s College London (unpublished)

  16. Hacking I (1991) A tradition of natural kinds. Philos Stud 61:109–126

    Article  Google Scholar 

  17. Hacking I (2007) Kinds of people: moving targets. Proc Br Acad 151:285–318

    Google Scholar 

  18. Hacking I (2010) Pathological withdrawal of refugee children seeking asylum in Sweden. Stud Hist Philos Biol Biomed Sci 41:309–317

    Article  Google Scholar 

  19. Häggqvist S (2005) Kinds, projectibility and explanation. Croatian J Philos 5(13):71–87

    Google Scholar 

  20. Haslam N (2002) Kinds of kinds: a conceptual taxonomy of psychiatric categories. Philos Psychiatry Psychol 9:203–217

    Article  Google Scholar 

  21. Jaspers T, Hanssen GMJ, van der Valk JA, Hanekom JH, van Well GTJ, Schieveld JNM (2009) Pervasive refusal syndrome as part of the refusal-withdrawal-regression spectrum: critical review of the literature illustrated by a case report. Eur Child Adolesc Psychiatry 18:645–651

    Article  Google Scholar 

  22. Kihlbom M (2007) SOU som försvar för flyktingpolitik [SOU as a defense of policy towards refugees]. Läkartidningen 104:561–562

    Google Scholar 

  23. Lask B (2004) Pervasive refusal syndrome. Adv Psychiatry Treat 10:153–159

    Article  Google Scholar 

  24. MacLeod M (2012) Limitations of natural kind talk in the life sciences: homology and other cases. Biol Theory 7(2). doi:10.1007/s13752-012-0079-6

  25. Mattson MP (2004) Pathways toward and away from Alzheimer’s disease. Nature 430:631–639

    Article  Google Scholar 

  26. Mill JS (1869) A system of logic. Harper and Brothers, New York

    Google Scholar 

  27. Millikan RG (1999) Historical kinds and the special sciences. Philos Stud 95:45–65

    Article  Google Scholar 

  28. Millikan RG (2000) On clear and confused ideas: an essay about substance concepts. Cambridge University Press, New York

    Book  Google Scholar 

  29. Pickard H (2009) Mental illness is indeed a myth. In: Broome M, Bortolotti L (eds) Psychiatry as cognitive neuroscience: philosophical perspectives. Oxford University Press, Oxford, pp 83–101

    Google Scholar 

  30. Putnam H (1975) Mind, language and reality. Philosophical Papers, vol 2. Cambridge University Press, Cambridge

  31. Rosen G (2010) Metaphysical dependence: grounding and reduction. In: Hale B, Hoffman A (eds) Modality: metaphysics, logic and epistemology. Oxford University Press, Oxford, pp 109–136

    Google Scholar 

  32. Samuels R (2009) Delusion as a natural kind. In: Broome M, Bortolotti L (eds) Psychiatry as cognitive neuroscience: philosophical perspectives. Oxford University Press, Oxford, pp 49–79

    Google Scholar 

  33. Slater M (2012) Cell types as natural kinds. Biol Theory 7(2). doi:10.1007/s13752-012-0084-9

  34. Sulloway FJ (1996) Born to rebel: birth order, family dynamics, and creative lives. Pantheon Books, New York

    Google Scholar 

  35. Tamas G (2009) De apatiska. [The apathetic] Natur och Kultur, Stockholm

  36. Thompson SL, Nunn KP (1997) The pervasive refusal syndrome: the RAHC experience. Clin Child Psychol Psychiatry 2:145–165

    Article  Google Scholar 

  37. von Folsach LL, Montgomery E (2006) Pervasive refusal syndrome among asylum-seeking children. Clin Child Psychol Psychiatry 11:457–473

    Article  Google Scholar 

Download references

Acknowledgments

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.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Marion Godman.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

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

Download citation

Keywords

  • Alzheimer’s disease
  • Grounding
  • Ian Hacking
  • Ruth Millikan
  • Multiple projectibility
  • Natural kinds
  • Pervasive refusal syndrome
  • Psychiatric disorders