Bennett Knox

This paper presents the preliminary results of a survey-based study investigating geneticists’ understanding of genetic causation. We are motivated by an underlying assumption that to improve interpretation and implementation of behavioral genetics research, and furthermore for that research to have a positive societal impact, it is important to reveal how geneticists themselves understand their research. Results of sixty-two survey responses from clinical and research geneticists at the University of Utah are discussed and assessed to fulfill these aims and survey the landscape of the field. Analysis of our survey results revealed some variation in responses to questions about genetic causation from geneticists across different research areas.

As part of the expansion of digital mental healthcare and the growing attention towards artificial intelligence in psychiatry, Large Language Models (LLMs) are being explored as devices for the delivery of psychotherapy. In this paper I consider what it would take for LLM-based psychotherapy chatbots to be effective, and argue that this question leads to a deep and difficult problem: the threat of value capture. In short, there is a risk of these systems becoming overly optimized towards improving outcomes on simplified, standardized psychometric scales. This may cause the systems to guide users towards adopting values which have been constructed based on convenience for institutions and developers, rather than fostering the type of self-reflection that would yield values better tailored to an individual. I outline the concept of value capture, explain how it applies to this context, and motivate the idea that it is a problem we should be concerned about. I then give suggestions about how the problematic aspects of value capture in the case of LLM psychotherapy chatbots can be at least partly mitigated.

In this chapter I propose and support a view about the relationship between psychiatric science and activist movements such as the NeurodiversityNeurodiversity Movement, which I call “hermeneutical pluralismPluralism.” Using the moral imaginationMoral imaginations framework from Science and Moral ImaginationMoral imaginations (Brown, Science and Moral Imagination: A New Ideal for Values in Science, University of Pittsburgh Press, Pittsburgh, 2020)Brown, M., I explore a contemporary case study in psychiatric science: the controversy over the Spectrum 10K genetic studySpectrum 10K genetic study on AutismAutism. Through the application of this framework to a case involving significant interplay between psychiatric science and the NeurodiversityNeurodiversity Movement, I draw out some lessons about how these knowledge systems might relate to each other in a productive manner. Ultimately, I argue that this case illustrates the attractiveness of my hermeneutical pluralism view: the NeurodiversityNeurodiversity Movement (and other movements like it) ought to be maintained as knowledge systems that are independent of psychiatric science, even as these movements and psychiatric science ought to foster some form of engagement with one another.

In lieu of an abstract, here is a brief excerpt of the content:The Uselessness of Polygenic Scores for Addressing Campus DrinkingBennett Knox (bio), Hannah Allen (bio), and Stephen M. Downes, PhD (bio)Here we articulate a negative answer to Turkheimer and Greer’s question: “Is it possible to envision a genetically informed program that ethically intervenes on campus drinking?” (Turkheimer & Greer, 2024). However, first, we note that the authors cover an immense amount of ground in their paper. They lend insight into how psychiatric genetics, at its very core, is conducted through their detailed examination of a large body of work in one specific area of this large field. A main result of this is to explain the gulf between results and conclusions, work that provides an invaluable service not just to various areas in philosophy and bioethics, but that are deserving of readership by a very wide audience. This gulf is explained via a careful accounting of the statistical measures used to assess the impact of genes on alcohol-related behavior in the college students sampled and comparisons between the strength of these measures and the strength and scope of conclusions drawn by the Spit for Science (S4S) researchers.A brief mention of the statistical measures in question helps set up our main focus. As Turkheimer and Greer note, before advances in sequencing technology, human behavior geneticists generated heritability coefficients for traits of interest. These coefficients were standardly produced from twin study work, which historically was the best way of getting a sense of the relative contribution of genes to a trait of interest as we cannot, or rather should not, conduct breeding experiments on humans. Current descendants of heritability coefficients come from genome-wide association studies (GWAS), which can be conducted on large groups of unrelated people. One key measure of interest arising from GWAS is a polygenic score (PGS), which “can be thought of as an observed manifestation at the individual level of the abstract variance ratio estimated by a heritability” (Turkheimer & Greer, 2024). Turkheimer and Greer focus on R2 values, which roughly “describe the magnitude of the relationship between the polygenic score and the phenotypes [of interest]” [End Page 437] (Turkheimer & Greer, 2024). They point out that the largest R2 reported in an S4S study is 6.5% (0.065). R2 are taken to be small at 0.01, medium at 0.09, and large at 0.25 in many areas of social science research but there are fields, for example, drug assay work, where only much higher R2 values are considered indication of a large effect. By this assessment, most of the R2 values reported by the S4S researchers, or calculated by Turkheimer and Greer when not reported, are very, very small, sitting well below the level of small effect of 0.01.Given these very low R2 measures, we agree with Turkheimer and Greer that S4S researchers did not uncover genetic information that could be informative, let alone actionable, for administrators concerned with campus drinking. However, it is worth asking what it would have looked like if S4S had produced such information. Suppose that S4S had been wildly successful, producing the Gattaca-like genetic information of “polygenic scores making reliable predictions that individuals had a 35% chance of developing a psychiatric disorder [here, alcoholism]” (Turkheimer & Greer, 2024). If a student was given their PGS, how are they to interpret it and act on it? How would this information be put to use by an administrator to address the problem of campus drinking?For the information to be leveraged at all, it would require consent from a significant number of students to have their PGS calculated and made available to themselves or administrators. Were scores to be calculated without active consent from the student (perhaps by using the sample provided to S4S), this would be a serious ethical violation. But even if a sufficient number of students did consent to having their PGS for alcoholism calculated, it is still not clear how this information could be used in an ethical manner to address the problem of campus drinking.If this student was already aware of a family history of alcoholism, then the PGS might do little more than quantify...

This paper draws on Kukla’s “Institutional Definition of Health” to provide a definition of “psychiatric condition” that delineates the proper bounds of psychiatry. I argue that this definition must include requirements that psychiatrization of a condition benefit the well-being of 1) the society as a collective, and 2) the individual whose condition is in question. I then suggest that psychiatry understand individual well-being in terms of the subjective values of individuals. Finally, I propose that psychiatry’s understanding of collective well-being should be the result of a “socially objective” process, and give certain desiderata for this understanding.

In lieu of an abstract, here is a brief excerpt of the content: Let me begin by expressing my gratitude to AAPP, PPP, and the Jaspers Award Committee—I am deeply honored to receive this award. So too let me thank Anke Bueter (2022) and Awais Aftab (2022) for their thought-provoking commentaries. Many of the concerns they bring up are ones that I share, so I am delighted to have a chance to discuss them in my response. I will bring up three central issues in turn: 1) the role of shared standards versus background assumptions, 2) the limits of inclusion, and 3) pluralism in psychiatry. Shared Standards or Background Assumptions? Both Bueter and Aftab reference Longino's "shared public standards" criterion for social objectivity (1990, p. 77; 2002, p. 130), which I did not explicitly discuss in the original paper (Knox, 2022). This was a choice I made partly because in the case of psychiatry determining what constitutes an appropriate "shared public standard" is often not at all straightforward, which points to a potential problem for Longino's view. Namely, in some cases it is a matter of dispute whether some assumption shared within a scientific field should be counted as a "shared public standard" (which Longino requires that there be) or a "background assumption" (which she requires be subjected to critical scrutiny). And it is sometimes unclear how we could effectively adjudicate this type of disagreement. Take the example Bueter uses of "psychiatrists aiming for biomedical explanations of a particular mental disorder, whereas the critics value research that does not assume the existence of mental disorders" (2022, p. 273). A conflict along these lines often does arise between advocates of the pathology paradigm and the neurodiversity paradigm with regard to Autism, for example. A psychiatrist working within the pathology paradigm may argue that something like "psychiatry must deal only with mental disorders, understood as pathologies" constitutes a shared standard, and so psychiatric research on Autism must understand it as a pathology. An advocate of the neurodiversity paradigm, however, might argue that this same proposition is merely a normative background assumption shared among many psychiatrists, which ought to be questioned and ultimately rejected. How might we adjudicate this meta-disagreement about the status of this standard/assumption? Bueter gives some helpful guidance on this issue by pointing to Carrier's requirement that participants exhibit the "epistemic attitude" (2013). I agree that if all participants commit themselves to this attitude, then "…differences in conceptual resources and standards of assessment need not make shared deliberation impossible, and the standards can be a subject of discussion themselves" (Bueter 2022, p. 273). For instance, since this attitude requires some commitment to empirical adequacy, we might search for some empirical evidence that favors one paradigm over the other. But advocates of both paradigms might actually agree on all the empirical facts, and yet still have a deep disagreement about which paradigm's understanding should be accepted as a shared standard. If participants are committed to some common standards and goals, we may often be able to resolve this sort of problem. But there is still a danger that we may arrive at an impasse, with no clear idea how to proceed. Though in many cases scientific experts must be allowed some power to set the standards in their domain (lest we dilute that expertise in ways that Aftab rightly points out would be problematic), I would also caution against accepting that something is a legitimate shared public standard just because the members of a scientific community say so. In keeping with the spirit of Longino's reliance on Quine, none of our shared standards are in principle immune from revision—save perhaps a minimal commitment to empirical evidence and rational argument. The Limits of Inclusion My impression is that Longino's response to the "Nazi problem" presented by Hicks (2011) might be to bite the bullet: her account does require allowing Nazi scientists to participate, and perhaps even cultivating their participation. But if (as seems likely) the Nazi shows themself to be unable to adhere to the shared standards...

Abstract:This article brings together considerations from philosophical work on standpoint epistemology, feminist philosophy of science, and epistemic injustice to examine a particular problem facing contemporary psychiatry: the conflict between the conceptual resources of psychiatric medicine and alternative conceptualizations like those of the neurodiversity movement and psychiatric abolitionism. I argue that resistance to fully considering such alternative conceptualizations in processes such as the revision of the Diagnostic and Statistical Manual of Mental Disorders emerges in part from a particular form of epistemic injustice (hermeneutical ignorance) leveled against a particular social group (which I call the "psychopathologized"). Further, insofar as the objectivity which psychiatry should aspire to is a kind of "social objectivity" which requires incorporation of various normative perspectives, this particular form of epistemic injustice threatens to undermine its scientific objectivity. Although many questions regarding implementation remain, this implies that psychiatry must grapple substantively with radical reconceptualizations of its domain if it is to achieve legitimate scientific objectivity.