Richard Gipps

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.3 (2003) 255-259 [Access article in PDF] Illnesses and Likenesses Richard G. T. Gipps IN THIS RESPONSE to Neil Pickering's paper I shall focus only on what he describes as the "strong objection" to the typical use of the likeness argument. The likeness argument, to recap, has it that we can decide whether conditions such as schizophrenia, depression, or alcoholism do or do not deserve the designation of illness depending on whether they possess features which, if they occurred in physical conditions, would enable one to decide for or against the designation. To take an implausible example, if it were decided that it would be enough to describe a physical condition as an illness if it involves pain not caused through injury, then a psychological condition would be appropriately described as an illness just to the extent that it too involved such pain.In arguing against typical deployments of the likeness argument, Pickering finds that it is only on questionable initial descriptions of psychological conditions that such conditions appear to share the features that, in physical conditions, would be taken to be indicative of illness. That is to say, theorists who deploy the likeness argument to urge either the reality or unreality of mental illnesses typically presuppose what both we and they had all along hoped would be demonstrated in their argument. In terms of the above example, we might say that a certain psychological condition can count as an illness if it involves psychic pain. The concept of psychic pain is however (so the argument would have it) contestable; there exist other descriptions that make no reference to pain and in so doing fail to provide what a user of the likeness argument would need to substantiate the claim that a conception of the condition as an illness is more than a façon de parler.By way of arriving at this conclusion the following precondition for the applicability of the likeness argument (Pickering's "assumption" (2)) is insisted on: "That, with respect to the presence or absence of [those features of conditions which features decide whether or not the conditions are illnesses], a condition such as schizophrenia [must be] describable independently of the category it is assigned to." This can seem a quite reasonable restriction, for—it could be said—one can only win an argument if it is first allowed that there is actually something to argue about. That is, it is only if both partisans and detractors of the illness conception first accept a certain description of schizophrenia as spelling out what schizophrenia essentially involves that they can then progress to determining whether or not such a condition so described is or is not an illness.Yet, whereas this seems like a perfectly reasonable requirement, it is I believe uncertain whether it will always capture the form of the intuitions of adherents and detractors of the illness conception—or of the form of philosophical arguments more generally. To be sure, some philosophical discussions can perhaps be reconstructed as debates about the validity of certain inferences [End Page 255] from mutually understood premises (i.e., given X, does Y follow or not?). Yet if this were the case, then genuinely interesting philosophical arguments would probably be few and far between. If we are agreed as to the precise significance of our premises, and are not furthermore just making straightforward mistakes in reasoning, it is hard to see how or why we could all fail to arrive at the same conclusions.In the Philosophical Investigations paragraph 128 Wittgenstein wrote that "If one tried to advance theses in philosophy, it would never be possible to question them, because everyone would agree to them" (Wittgenstein 1953). Now that proposition might seem on rather weak grounds, because all one has to do to actually disprove it is merely disagree with it. But presumably Wittgenstein is rather articulating his intuition that although philosophical arguments often take the form of clashes concerning what conclusions can be drawn from what premises, most of their substance comes from a prior failure to unpack the intrinsic significance...

In lieu of an abstract, here is a brief excerpt of the content:Pathology of the Mind: Disorder Versus DisabilityRichard G. T. Gipps (bio)Keywordsorder, disorder, ability, disability, mental illnessAlfredo Gaete (2008) describes mental disorders as impairments in intentionality, phenomenal consciousness, and intelligence that cause harm to the affected person. I found persuasive Gaete’s claim that the concept of ‘mental disorder’ is best understood as nontheoretical and nontechnical. I also find compelling his argument that a previous contribution of my own—which relied in part on specifying different senses of ‘disorder’ in psychological, physiological, and social cases—was misguided. Further, his suggestion that we ought at least to attempt analysis in terms of necessary and sufficient conditions before we seek out less definitive characterizations (in terms of family resemblances) also persuades me, although I find myself less sanguine than he about the general possibility of achieving such analyses.One of Gaete’s principal claims is that mental disorder is helpfully understood in terms of an absence of a capacity—that is, as a disability. There are two related objections—or two aspects of the same objection—that I would like to offer the author with respect to this claim. These may well not be conclusive, but will I hope at least function as foils against which the author can usefully sharpen his argument. One objection suggests that there is a viable distinction between the concepts of mental disorder and mental disability, as commonly used in clinical contexts, which the account offered seems unable to respect. The second suggests that the account may not be able to theorize what is argued to be the essential contribution of the concepts of order and disorder (as opposed to ability and disability) to the everyday concept of mental disorder. Accordingly, it questions the power of a disability approach such as Gaete’s to capture the essential nature of mental disorder.In his paper, Gaete classifies mental retardation and developmental, or (what in the United Kingdom are known as) learning, disabilities (autism, etc.) as cases of mental disorder. I found this surprising because it is not common linguistic practice in the psychological circles in which I operate. It would also seem to make a nonsense of commonly accepted ideas like: “Mental disorders are more likely to occur in patients with developmental disabilities (e.g., in autism, Asperger, or Down syndrome) than in the general population.” (For an example, see Campbell and Malone [1991]). On Gaete’s classification, it would appear that people with autism eo ipso have a mental disorder, and [End Page 341] hence the commonly accepted idea would need to be interpreted as merely a statement about comorbidities of different disorders of the same general (i.e., mental) type. But that is not, I believe, how the term is commonly used, and Gaete’s suggestion must therefore be treated as revisionary rather than descriptively analytical.One way of reconstructing a rationale underlying the distinction between mental disabilities and mental disorders is as follows. A developmental disability involves a failure of (certain aspects of) the mind to grow and reach an expected level or type of organization. A mental disorder by contrast involves a disturbance or disorganization (not simply an impoverishment) within the mind at whichever level of organization it has reached. As the mind develops, and reaches new levels or types of organization, the forms which mental disorders may take accordingly change.Autism and schizophrenia provide helpful illustrations of this distinction. Autism represents a failure of (among other things) the social mind to develop in childhood. The person with moderate to severe autism may attain at best a very shaky grasp on the realities of other minds and social conventions. That is, the degree of mental structure they obtain—their social competencies or capacities—will likely remain limited. It is this fundamental deficit that marks out the disability, and not the social anxieties or other such disturbances that can beset the autistic person.Schizophrenia, by contrast, tends to occur at late adolescence, when the individual has developed higher levels of—albeit often fragile—mental structure. Yet it is not the fragility of such mental structure, but rather the disruptions that can occur within such structures as have developed, that mark them out...

Cognitive psychologists have recently identified alterations in perception and reasoning that contribute to the formation and maintenance of beliefs that happen to be delusional. Clinically significant delusions, however, are often deeply unusual. An account of their formation and maintenance must explain not merely how someone can come to hold false or uncommon beliefs, but also how someone can arrive at beliefs that seem profoundly improbable and even bizarre. This paper uses the philosophical concepts of the Bedrock and the Background to provide an account of that foundational, nonrepresentational, non–rule-governed, dispositional structure of everyday understanding that underpins both our perception and our reasoning. The central claim is that the formation and maintenance of delusions becomes intelligible once they are seen to reflect disturbances to this foundational dispositional structure. Different dimensions of the Background are described along with the delusions that might follow from distortions to these dimensions. We challenge the assumption of much recent cognitive psychological theorizing that delusions can be understood as explanations of unusual experiences or as the product of hasty reasoning. Finally, the implications of the theory for the therapy of the delusional patient are briefly discussed.

In lieu of an abstract, here is a brief excerpt of the content:The Background Theory of Delusion and Existential PhenomenologyRichard G. T. Gipps (bio) and John Rhodes (bio)KeywordsPhenomenology, psychological explanation, epistemology, schizophreniaSituating and Clarifying the PaperThe commentaries of Nassir Ghaemi and Giovanni Stanghellini help to sketch out the intellectual landscape of philosophical perspectives in psychiatry, and situate our paper within it. A happy convergence between the analytical philosophy perspective from which we were writing, and the existential–phenomenological paradigm described by both authors, is the result. Stanghellini in particular carefully describes three main theories of existential deformations, tracing delusion formation back to either (i) a disturbance of meaning synthesis conceived as a dysfunction of a Husserlian consciousness, (ii) a disturbance of pre-reflective self-consciousness resulting in a kind of paralyzing hyperreflexivity, and (iii) (Stanghellini’s preferred model) a disturbance of embodiment. This final account views delusion as springing from a failure in the subject’s corporeal and praxical being-in-the-world. As the subject’s practical, pre-reflective grip on the world is loosened, so their minds become unconstrained by that understanding and practical rationality immanent within that grip, and thought, now unconstrained, starts to travel through delusional worlds. Stanghellini accordingly views our model as an example of a disembodiment theory, which allows it to overcome the disadvantages of the first two models, which may both, in their own ways, overvalue the rôle of (disturbances of) reflective consciousness in the formation (and delusional deformation) of everyday understanding.Being situated within a preexisting landscape has both its benefits and its disbenefits, the principle example of the latter being the potential assimilation of anything new to what has already been said. Thus, although we are grateful to our commentators for placing us on the larger historical and conceptual map, it may be helpful to briefly rehearse our motivations for drawing on the philosophical ideas of the Bedrock and Background in our theory of delusion. Our paper was primarily motivated by a concern that current, psychologically mainstream, cognitive models of delusion, although helpfully drawing our attention to common reasoning and perceptual deficits in the person with psychosis, fail to adequately account for what is delusional about delusions. It was, in [End Page 321] particular, to account for the certainty with which the deluded person clings to often quite extraordinary beliefs that we drew on the epistemological notion of the background. And although this epistemological notion fits quite neatly with ontological concerns regarding the embodied and praxical character of human existence, it is the particular epistemic rôle that it played in our theory—to do with the extraratiocinative constraint on judgement provided by the Background—that we wish to stress here.We return to this shortly, but first wish to comment briefly on two specific considerations raised by the commentaries. The first concerns Stanghellini’s claim that, for us, “when studying delusions, the focus should be on providing an adequate framework for understanding, rather than providing empirical hypotheses to be tested” (2008, 311–314). It seems to us, however, that both are equally important. What we wished to stress, however, was that empirical hypothesis testing may be led astray if it is not informed by an adequate framework for understanding. For example, most cognitive psychological experiments on delusions concern themselves with the individual’s ability to make appropriate guesses (e.g., regarding the color of beads in a bag), and their tendency to jump to conclusions; they do not concern themselves with the kinds of extraordinary conviction and certainty met with in delusion. The risk run by empirical researchers of cognitive factors in delusion is that a lack of a prior adequate theorization of delusion makes for accounts that are ultimately only of the formation, not of delusion in particular but rather of false or unusual beliefs more generally. An analytical approach, however, can help to explicate the ways in which the psychiatric concept of delusion fails to be adequately characterized by the quite general ‘external criteria’ of delusion (as Jaspers [1963] called them: falsity, stubbornness, uncommon), and aids in the construction of empirical hypotheses this time constrained by an understanding of the true ‘internal criteria’ of psychotic belief. Such an approach helps to spell out the...

In lieu of an abstract, here is a brief excerpt of the content:Mental Disorder and Intentional OrderRichard Gipps (bio)Bengt Brülde and Filip Radovic inform the reader that they will assume "there is such a thing as a general category of disorder, of which mental and somatic disorders can be regarded as subcategories" (2006, 100). With this assumption in place, they take up a fascinating discussion of what warrants our categorizations of certain disorders as mental as opposed to physical. The answers they then canvass include the possibilities that it is the mentality of the internal causes, or of the symptomatic effects, of these disorders which renders them mental, or that there is no single answer, or that there is no valid distinction to be drawn.In what follows I wish to question the initial assumption, and then offer an understanding of the nature of mentality that I hope will lead to a different way of answering the question, what is mental about mental disorder? It worries me that the views I develop here may share too little by way of common framework assumptions with the views developed in Brülde and Radovic's paper. I hope that this does not render dialogue impossible, or make the thoughts that were inspired by their thoughtful paper appear just too off field to be seriously entertained.The Concept of DisorderBrülde and Radovic assume that "mental disorders" and "physical disorders" are subtypes of a general category of disorder. (In what follows I describe this as the assumption.) They also distinguish between two questions: (1) What is mental about mental disorder? (in what follows I describe this as the question) and (2) What does it take for a condition to be a disorder? This latter question is, they acknowledge, certainly important, but is set aside for the time being.Mental disorder, physical disorder, and we might perhaps also add social disorder, are then subcategories of disorder. They are perhaps not natural kinds, but nevertheless they are subcategories within a general category. With their assumption in place it makes good sense to reject accounts of the mentality of mental disorders that seem to simply presuppose the concepts of mind and body when they address the question.There is of course a trivial sense in which everyone must agree that mental disorders and physical disorders are to be considered subcategories of disorder. There is what could be described as a logical sense of category and subcategory, in which any noun is said to designate a category and any adjectival qualification of it to introduce a subcategory. However, we can also distinguish what I call a "semantic" sense, in which talk of categories and subcategories is more restricted. Here we rely on there being a unitary sense to the putative category if we are to talk meaningfully of subcategories of this single category. [End Page 117]The philosophy of the individuation of senses is not within my expertise, but I am relying on an intuitive notion spelled out by the following. First, that a good dictionary would elaborate these senses by providing different definitions of the putative category rather than a single definition followed by examples. Second, that when we do not have to do with categories in the semantic sense, we would find ourselves more in want of true understanding of what was being said, and not so much in want of mere further knowledge, if we are offered a description that included the noun (disorder) without the qualifier (mental). Third, that we are less likely to be dealing with subcategories within a general semantic category if we easily can turn the adjective–noun pair (e.g., mental disorder) around to provide two nouns in a short phrase (e.g., disorder of the mind), or if there are verbal and adjectival forms of the second noun that can also be used in conjunction with the first noun (e.g., disordered mind).An example serves to make things clearer. Consider a chemist who has a reaction in her laboratory. What is referred to may be an emotional reaction (to her sudden scientific breakthrough), or a chemical reaction. In this case, I suggest, we do not have to do with a semantic category of "reaction," which...

In lieu of an abstract, here is a brief excerpt of the content:Autism and Intersubjectivity:Beyond Cognitivism and the Theory of MindRichard Gipps (bio)The papers that make up this special issue of Philosophy, Psychiatry, & Psychology are obviously united by both topic and approach. They all look at autism through a philosophical lens—both at infantile autism (Gallagher 2004a, 2004b; McGeer 2004; Shanker 2004) and at schizophrenic autism (Stanghellini and Ballerini 2004). Moreover, they are all concerned with the foundations of our understanding of people and their minds, both the minds of others (Gallagher 2004a, 2004b; Shanker 2004; Stanghellini and Ballerini 2004) and that of oneself (McGeer 2004). The developmental disorder of infantile autism provides a conspicuous example of a disruption in the ability to develop such an understanding and enter into the social world, whilst schizophrenic autism provides a conspicuous example of what happens when one falls out of it (Stanghellini and Ballerini 2004).Yet what further affords the opportunity of this introduction is the possibility of discerning a strong common theme that runs through the philosophical treatment the papers provide. For they are united in their rejection of the primarily cognitive approach toward our capacity to relate to one another (or to ourselves) as to minded people taken by many in the mainstream of developmental psycho(patho)logy today.1 Such mainstream approaches ascribe to the developing child a 'theory of mind,' tacit knowledge of which supposedly enables them to negotiate the social world. In place of such an intellectualist, disengaged, cognition-focused psychology, we are offered perspectives that stress the primitive foundational character of our pre-reflective (noncognitive) engagement with one another, our emotion, our expression, and our embodiment.The grounds for this stressing of the affective and praxical dimensions of personal life over the cognitive and representational are twofold. First there is the developmental trajectory itself, and the claim is that the autistic child's interpersonal lacunae manifest themselves considerably before they develop the cognitive capacities for social knowledge (Gallagher 2004a; Shanker 2004). The principle ground, however, is philosophical, and the claim here is that what needs to be rejected in the developmental psycho(patho)logy is an alienated ontology and estranged epistemology that has implicitly become inscribed within it, constraining its explanatory project and limiting its vision of possibilities.2 That at least is how I [End Page 195] would put it and, by way of providing an overarching philosophical presentation of the papers of this issue, what follows shall be its elaboration.The ontology in question has it that the mind is an inner domain, that bodily behavior is an outer domain, that belief and thought epitomize the former, that intentionality is a function of the former and only derivatively manifest in the latter, that the form of our embodiment is contingent, that understanding is manifest primarily in thought and not intrinsically in praxis, that the mind is populated by free-standing inner representations, and that perception and the emotions are extrinsic to the understanding (Gallagher 2004a, 2004b; McGeer 2004; Shanker 2004). And such an ontology carries a host of epistemological implications. The self retreats from the interpersonal interactive domain, taking up residence even behind the subject's own mind, which itself becomes an objectified domain. In our own case, we are left in the predicament of needing to inspect (or intro-spect) our own inner states to find out how things are for us; our self-reports (avowals of what we think and feel) thereby become avowals of judgments of what we take ourselves to think and feel (McGeer 2004). And when we confront others the task becomes one of cognitively figuring out, from merely 'outer' clues, how things stand with them on the inside. The encounter with others is then epistemologically fraught, relying on inference and theory to take us from an outer domain of mere movement to a hidden inner world of intentionality (Gallagher 2004a, 2004b; Shanker 2004).Thus, an alienated ontology of the person and their mind bequeaths its own epistemological problematic, and the estranged epistemology gives to developmental psychology the task of filling in the details of the actual cognitive states and mechanisms which instantiate the theories and inferences which it has discerned a priori to be required. And psychopathology...