Bennett Knox

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:Standards and Assumptions, the Limits of Inclusion, and Pluralism in PsychiatryBennett Knox*, MA (bio)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.1 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 [End Page 275] 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 InclusionMy 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.