Abstract
This chapter critiques common answers to the question ‘what are mental disorders?’ Previous conceptual models are presented, first focusing on those that answer structural questions (i.e., where are mental disorders and how should we think about their causal structure) followed by those that answer normative questions (i.e., on what basis can we label someone’s thinking and behavior as dysfunctional or disordered). It is shown that all perspectives reviewed have different strengths, but that each has clear weaknesses. It is again observed that how we think about mental disorder seems deeply related to how we think about human functioning.
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Notes
- 1.
Biological sex is an arguable case of a discrete kind but is a good illustrative example in that it has no single essence, instead being composed of multiple related components (e.g., xx/xy chromosomes, hormone levels, internal and external physiology) that tend to bifurcate into male and female camps in most cases. This is not to deny the existence or validity of intersex persons in anyway. One could also argue that biological males or females are examples of fuzzy kinds. I am less convinced that there is truly a clear demarcation between fuzzy and discrete kinds, but I include reference here to stay true to Haslam’s taxonomy.
- 2.
‘Realism’ refers to the view that there are ontic things in the world to which the label ‘mental disorder’ could refer, that these things, whatever form they take, are ‘discovered’ and exist independently of our attempts to classify them (i.e., they are not entirely socially constructed or pragmatic). I briefly discuss social constructionism and pragmatism in the following section on normatively oriented concepts. Socially constructed kinds could possibly be discussed in this section as, while they are constructed, they still have an ontic reality in the form of a pattern of behavior (Mallon, 2016); for example see the controversial socio-cognitive model of dissociative identity disorder (Gleaves, 1996). I cover social constructionist models in the normative section due to their association with anti-psychiatry.
- 3.
By discussing two separate ideas/dimensions in proximity I risk conflating them here. The idea of a continuum of homogeneity (simple/essentialist—complex/emergent) and the idea of a ‘continuum’ of etiological domain (biological-social) are in fact separate ideas that are often conflated (although it is interesting to consider if there is actually a possible relationship between these dimensions). Also note that the idea of particular mental disorders existing at one place on a organic-to-social continuum is a strongly criticized idea, mental disorders from schizophrenia to borderline personality are better seen as ‘dappled’ across this spectrum, each with mechanisms at a variety of scales (Kendler, 2012).
- 4.
- 5.
Khalidi (2013) offers a discussion of this issue, arguing for a shift away from mind independence as a criterion for natural kindship and toward consideration of whether a kind is categorized together based on causal relation/similarity versus categorized together as a matter of convention. Many social kinds (war, money, racism) can indeed be natural despite their mind dependence.
- 6.
‘Theory-reductionism’ is the view that the different domains of science can be reduced to the more ‘fundamental’ sciences, i.e., that psychology is applied biology, is applied chemistry, is applied physics, is applied math.
- 7.
- 8.
The difficulty here is ruling out other possibilities such as anxious-depression being something different all together, or depression simply being radically continuous (i.e., a non-kind).
- 9.
Following Boyd (1991), the philosophical terminology is homeostatic property cluster (HPC), but here I use Kendler et al.’s label (MPCs) as this is conventional in the psychopathology literature.
- 10.
This is not to pre-suppose a categorical difference. In fact, the divide seems likely to be continuous.
- 11.
- 12.
Briefly, my key issue with these reason-based-models is that they commit to an understanding of the ‘rational man’ as an ideal from which to contrast disorder. This seems very culturally specific, and it seems there is a risk that this may illegitimately pathologize cultural variance. Megone’s (1998) model in particular is also reliant on unfavorable ideas such as Aristotelian teleology (final causes as a function of essence), and human exceptionalism (the idea of a unique and vital difference between humans and animals).
- 13.
Briefly the issue with these Roschian/Wittgensteinian models is that they are overly flexible, thereby providing very little specificity or guidance. This is a similar weakness to the pragmatic concepts that I will discuss. I will briefly return to Roschian models when discussing the work of de Haan in later chapters.
- 14.
Such views are expressed elsewhere in academia. One notable example from within psychopathology is the Power Threat Meaning Framework (Johnstone et al., 2018) which takes a similar deflationary perspective on mental disorder.
- 15.
Boorse indicates that ethnicity should sometime be considered insofar as the differences in functional design across ethnic groups are relevant (Boorse, 1977).
- 16.
Both Kingma (2007) and Varga (2011) counter Boorse’s claim that the BST is in fact value-free by pointing that the use of sex, age, and ethnicity to define the reference class is not itself based on empirical fact but on intuition, and thereby is likely importing value into the process. For example, one common criticism of the BST is that is seems to define homosexuality as a disease on the basis of its statistical deviance and the resulting lower rates of reproduction. Kingma points out that the addition of sexual orientation to the defining attribute of the reference classes would change this entirely. Those that include sexual orientation in the reference class selection would view homosexuality as entirely normal, and those that do not would view it as a disease. Really the BST is only potentially value-free post the selection of a reference class.
- 17.
Fulford (2001) criticizes the BST, for one arguing that, even if it does produce an internally consistent value-free concept of disease it fails to recognize that the term ‘disease’ is used evaluatively, even by Boorse himself.
- 18.
- 19.
This label is by no means a perfect fit, for example, I am not sure whether Bergner and Ossorio would agree with the use of ‘functionalism’ here. I could label it contextualized behavioral statisticalism or something similar. However, in so far as behaviors one ‘ought’ to be able to do can be referred to as functions the label used seems acceptable. The current label also highlights important similarities across divergent views; just as the BST contrasts the individual’s physiology against a reference class, this view contrasts the individual’s capacities against similar others in similar contexts. Further, my sense is that Bergner would disagree that context can ever really be sufficiently captured by use of a reference class nor any statistical means, and that therefore clinical judgement will always be required in diagnosis. He is probably right, but how do we go beyond the statistics while maintaining clarity, rigor, and a common language? This is another reason why a richer conceptual model/framework is required.
- 20.
This normative gap is of course nothing new—it is simply the domain-local version of Hume’s ‘ought-from-an-is’ problem (Hume, 1978/1738)
- 21.
- 22.
The popularity of such naturalized value-free models may well be a reaction to the arguments of the anti-psychiatry movement who questioned the concept of mental disorder predominantly on the basis of its evaluative (and therefore on their view non-scientific) conceptual nature (Varga, 2011).
- 23.
There is a charge of circularity that can be made against this position. For example, what exactly defines an ‘emotional or psychological impairment’? This seems to be another term for a mental disorder. I take this to be representative of O’Connor’s point—on his view mental disorder is a conceptually thin notion, constructed through the practice of a morally defined institution.
- 24.
Zachar explicitly recognizes this partial nominalism/historicism in his Imperfect Community Model, where mental disorders are seen to be clustered under a single banner partially due to genuine family resemblance, but partially due to pragmatic and historical factors (Zachar, 2014).
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Nielsen, K. (2023). Current Conceptual Models of Mental Disorder. In: Embodied, Embedded, and Enactive Psychopathology. Palgrave Studies in the Theory and History of Psychology. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-031-29164-7_2
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