Hane Htut Maung

In an essay entitled “Schopenhauer’s Flute and Descartes’s Lute” (2024), Helen De Cruz asks: “what can musical practice tell us about philosophy?” The present paper offers an answer to this question, with a specific focus on the musical practice of canonic counterpoint in the Renaissance and Baroque periods. I examine two ways in which this musical practice is philosophically significant. First, drawing on work on musical representation through convention and resemblance, I argue that canonic counterpoint as a form can convey philosophical ideas. Second, drawing on contrapuntal treatises and recent work on modal property perception, I argue that canonic counterpoint as a procedure can yield insights into the perceptual and reasoning processes of musicians. This analysis highlights how musical composition can be a medium for engaging with philosophy.

In a recent paper, Harriet Fagerberg argues that the disease debate in the philosophy of medicine makes little sense as conceptual analysis but instead should proceed on the assumption that disease is a real kind. I propose an alternative view. The history and practice of medicine give us reasons to doubt that the category of disease forms a real kind. Instead, drawing on work by Quill R. Kukla, I argue that the disease debate makes good sense on an understanding of disease as an institutional kind. As well as explaining key features of the disease debate, this can facilitate a philosophical understanding of disease that captures the eclectic scope of medicine and the complex reasons why conditions get classified as diseases.

Evolutionary psychiatry suggests that mental disorders can be explained in evolutionary terms (a) as failures of psychological mechanisms to produce the adaptive effects for which they were naturally selected, (b) as mismatches between naturally selected psychological mechanisms and contemporary environmental pressures, or (c) as naturally selected psychological mechanisms whose effects continue to be adaptive. In this paper, I present a philosophical critique of evolutionary psychiatry that draws on Subrena Smith’s matching problem for evolutionary psychology. For evolutionary psychiatry hypotheses to be empirically supported, proponents of evolutionary psychiatry must demonstrate (1) that the contemporary psychological mechanisms involved in mental disorders resemble the psychological mechanisms of our evolutionary ancestors, (2) that the contemporary psychological mechanisms are phylogenetically descended from the ancestral psychological mechanisms, and (3) that the ancestral psychological mechanisms were naturally selected because their effects had adaptive benefits. However, for many mental disorders, evolutionary psychiatry lacks the methodological resources to demonstrate these conditions. Therefore, many evolutionary psychiatry hypotheses are empirically untestable and remain indefinitely underdetermined by data.

In a recent paper, I argued that an externalist understanding of mental disorder from the philosophy of psychiatry presents an ethical challenge to the practice of medical assistance in dying (MAiD) for psychiatric illness, because it highlights the ways in which the suffering associated with psychiatric illness is sustained by features of the external environment wherein the person is embedded, including social barriers and injustices. In a response to my paper, Harry Hudson argues that addressing social inequality lacks relevance to the immediate permissibility of psychiatric MAiD and that the issue of psychiatric MAiD should be informed by ‘pragmatic politics’ rather than by ‘obfuscatory philosophy’. Herein, I contend that Hudson’s response misconstrues my position and ascribes to me views I neither express nor endorse. My paper does not claim that psychiatric MAiD should be denied to people who are presently in intolerable distress. Rather, it suggests that the provision of psychiatric MAiD comes along with social responsibilities of the state to attend to the barriers and injustices that sustain and exacerbate psychiatric illness, as well as ethical responsibilities of clinicians to consider a wider range of presently available psychological and social interventions which may have been neglected under a traditional internalist approach.

Illusionism is the view that conscious experience is some sort of introspective illusion. According to illusionism, there is no conscious experience, but it merely seems like there is conscious experience. This would suggest that much phenomenological enquiry, including work on phenomenological psychopathology, rests on a mistake. Some philosophers have argued that illusionism is obviously false, because seeming is itself an experiential state, and so necessarily presupposes the reality of conscious experience. In response, the illusionist could suggest that the relevant sort of seeming here is not an experiential state, but is a cognitive state, such as a judgement or a belief, which is fully amenable to a physical or functionalist analysis. Herein, I argue that this response is unsuccessful and fails to undermine the reality of conscious experience. Nonetheless, the response does raise the problem of how a judgement or belief about the character of a conscious experience, even if it is true, can be justified if the conscious experience has no causal role in the formation of the judgement or belief. This is not a new problem, but is a reiteration of an old problem that is known in the philosophy of mind literature as the paradox of phenomenal judgement. I consider how the paradox of phenomenal judgement can be resolved and how the judgement or belief about conscious experience can be justified with appeal to the notion of acquaintance.

This is a comprehensively edited reissue of a self-published book, which was partly based on a dissertation I completed in History and Philosophy of Science at the University of Cambridge many years ago. The book was intended as a personal project to make sense of my own philosophical thinking, rather than as something that would be of interest to the wider academic community. Sometimes philosophy can be done just to fulfil a personal need. I doubt it contains anything that would be of interest to anyone, but I have archived it here in case of curiosity.

Gender affirming hormone treatment is an important part of the care of trans adolescents which enables them to develop the secondary sexual characteristics congruent with their identified genders. There is an increasing amount of empirical evidence showing the benefits of gender affirming hormone treatment for psychological health and social well-being in this population. However, in several countries, access to gender affirming hormone treatment for trans adolescents has recently been severely restricted. While much of the opposition to gender affirming hormone treatment for trans adolescents has in part been ideologically motivated, it also reflects a debate about whether there are harms that outweigh the benefits of the treatment. Accordingly, a systematic and comprehensive philosophical analysis of the ethics of gender affirming hormone treatment for trans adolescents is needed. Herein, I offer such an analysis that draws on the four principles of biomedical ethics by Tom Beauchamp and James Childress. Based on the considerations of beneficence, nonmaleficence, autonomy, and justice, I argue that the provision of access to gender affirming hormone treatment for consenting trans adolescents is ethically required and that the current restrictions to such treatment are ethically wrong.

Diagnoses are central to the practice of medicine, where they serve a variety of functions for clinicians, patients, and society. They aid communication, explain symptoms, inform predictions, guide therapeutic interventions, legitimize sickness, and authorize access to resources. Insofar as psychiatry is a discipline whose practice is shaped by medical conventions, its diagnoses are sometimes presented as if they serve the same sorts of function as diagnoses in bodily medicine. However, there are philosophical problems that cast doubt on whether the functions of psychiatric diagnoses can legitimately be considered to be equivalent to those of medical diagnoses. The aim of this chapter is to explicate some of these problems, particularly conceptual and epistemological problems pertaining to the roles of diagnoses as explanations. I begin with an overview of the various functions that medical diagnoses normally serve and suggest that many of these functions receive justificatory support from the explanatory roles of the diagnoses. I then present issues regarding the epistemic functions of psychiatric diagnoses and how these issues have featured in the arguments of prominent critics of psychiatry.

This thesis is a philosophical examination of the explanatory roles of diagnoses in psychiatry. In medicine, diagnoses normally serve as causal explanations of patients’ symptoms. Given that psychiatry is a discipline whose practice is shaped by medical traditions, it is often implied that its diagnoses also serve such explanatory functions. This is evident in clinical texts that portray psychiatric diagnoses as referring to diseases that cause symptoms. However, there are problems which cast doubt on whether such portrayals are justified. I address these problems and examine whether psychiatric diagnoses provide explanations of symptoms. The first problem is conceptual. In diagnostic manuals, psychiatric diagnoses are defined by their symptoms. This suggests that invoking them as explanations of the symptoms amounts to circularity. I argue that this can be resolved with an appropriate conceptual framework that captures the complex semantic values of diagnostic terms and their different uses in clinical discourse. I put forward such a framework based on two-dimensional semantics. The second problem is ontological. Empirical research suggests that diagnostic categories in psychiatry do not correspond to invariant causal types, but are associated with variable combinations of diverse causes that interact across biological, psychological, and social levels. Given this heterogeneity, I argue that psychiatric diagnoses fall short of paradigmatic cases of causal explanation, but that some can still provide other sorts of useful causal explanatory information. The original contribution of this thesis is the illumination of the conceptual relations between diagnoses and symptoms. This philosophical work is important, because it can be brought to valuable application in modifying psychiatric practice.

In the political discourse regarding gender identity, the concept of biological sex has been weaponised by gender critical commentators to oppose gender affirmation for trans people. Recently, these commentators have appealed to an essentialist model of sex based on anisogamy, or relative gamete size, to argue that one’s sex is an immutable characteristic. I argue that the gender critical argument is unsound. The diverse purposes of sex classification and the complex variability of people’s sexual characteristics show that an essentialist model is untenable. I then consider how a more adequate theoretical framework from the philosophy of biology can accommodate this complexity and capture how sex is classified in relevant contexts. Further implications of the framework are explored which concern the vagueness, polysemy, and mutability of sex. These undercut the gender critical argument and show that the appeal to biological sex fails to undermine gender affirmation for trans people.

It is widely assumed that there is value in the biological tie between parent and child. An implication of this is that adoption is often considered a less desirable alternative to procreation. This paper offers a philosophical defence of adoptive parenthood as a valuable and authentic form of parenthood. While previous defences have suggested that society’s valorisation of the biological tie is unjustified, I argue herein that the conception of the biological tie that features in the normative discourse on parenthood is too narrowly genocentric. Against this genocentric conception, recent work in the philosophy of biology has emphasised the roles of joint determination, dynamic construction, and extended inheritance in development, which I suggest can substantiate a more inclusive conception of the biological tie. Accordingly, I propose that adoptive parents form a rich variety of biological ties with their children, some of which are as heritable and formative as genetic relatedness.

The notion that rape is an act of violence rather than sex is a central tenet in rape crisis support and education. A therapeutic benefit of this conceptualisation of rape is that it counters shame and guilt by affirming that the victim was not a complicit partner in an act of sex. However, this conceptualisation has recently been criticised for not capturing what makes rape an especially serious kind of wrong. This raises an apparent dilemma for rape crisis support. Recent work in analytic moral philosophy on the nature of rape offers a way to resolve this dilemma. It is argued that rape is not sex, but is nonetheless sexual. This distinction allows for a charitable reformulation of the central tenet in rape crisis support, which can facilitate the dual therapeutic aims of countering the sense of shame and of recognising the especially serious kind of the harm suffered by the victim.

Diagnoses in medicine are often taken to serve as explanations of patients’ symptoms and signs. This article examines how they do so. I begin by arguing that although some instances of diagnostic explanation can be formulated as covering law arguments, they are explanatory neither in virtue of their argumentative structures nor in virtue of general regularities between diagnoses and clinical presentations. I then consider the theory that medical diagnoses explain symptoms and signs by identifying their actual causes in particular cases. While I take this to be largely correct, I argue that for a diagnosis to function as a satisfactory causal explanation of a patient’s symptoms and signs, it also needs to be supplemented by understanding the mechanisms by which the identified cause produces the symptoms and signs. This mechanistic understanding comes not from the diagnosis itself, but rather from the theoretical framework within which the physician operates.

In the philosophical literature on consciousness and the mind-body problem, the conceivability argument against physicalism is usually taken to support a form of dualism between physicality and phenomenality. Usually, the discussion focuses on the qualitative character of experience, which is what the phenomenal feel of a given experience is like. By contrast, the subjective character of experience, or its individuation to a given first-person subject, tends to be set aside. The aim of this paper is to present a new and more robust version of the conceivability argument for dualism that appeals to the subjective character of experience. Drawing on insights by philosophers in the phenomenological tradition, I conceptualise the first-person subjective character of experience as a transcendental condition of possibility for phenomenality that cannot be reduced to third-person facts about the physical world. Given this, the mind-body problem as it pertains to consciousness does not merely concern the inability of the set of physical facts about a brain state to capture the qualitative character of experience, but concerns the existential issue of why this brain state is accompanied by first-person subjectivity at all. This allows us to reconceive the conceivability argument in a way that presents a stronger case for dualism than the traditional version of the argument.

Medical assistance in dying, which includes voluntary euthanasia and assisted suicide, is legally permissible in a number of jurisdictions, including the Netherlands, Belgium, Switzerland and Canada. Although medical assistance in dying is most commonly provided for suffering associated with terminal somatic illness, some jurisdictions have also offered it for severe and irremediable psychiatric illness. Meanwhile, recent work in the philosophy of psychiatry has led to a renewed understanding of psychiatric illness that emphasises the role of the relation between the person and the external environment in the constitution of mental disorder. In this paper, I argue that this externalist approach to mental disorder highlights an ethical challenge to the practice of medical assistance in dying for psychiatric illness. At the level of the clinical assessment, externalism draws attention to potential social and environmental interventions that might have otherwise been overlooked by the standard approach to mental disorder, which may confound the judgement that there is no further reasonable alternative that could alleviate the person’s suffering. At the level of the wider society, externalism underscores how social prejudices and structural barriers that contribute to psychiatric illness constrain the affordances available to people and result in them seeking medical assistance in dying when they otherwise might not have had under better social conditions.

In The Biopsychosocial Model of Health and Disease, Derek Bolton and Grant Gillett argue that a defensible updated version of the biopsychosocial model requires a metaphysically adequate account of disease causation that can accommodate biological, psychological, and social factors. This present paper offers a philosophical critique of their account of biopsychosocial causation. I argue that their account relies on claims about the normativity and the semantic content of biological information that are metaphysically contentious. Moreover, I suggest that these claims are unnecessary for a defence of biopsychosocial causation, as the roles of multiple and diverse factors in disease causation can be readily accommodated by a more widely accepted and less metaphysically contentious account of causation. I then raise the more general concern that they are misdiagnosing the problem with the traditional version of the biopsychosocial model. The challenge when developing an explanatorily valuable version of the biopsychosocial model, I argue, is not so much providing an adequate account of biopsychosocial causation, but providing an adequate account of causal selection. Finally, I consider how this problem may be solved to arrive at a more explanatorily valuable and clinically useful version of the biopsychosocial model.

This paper contributes to the debate in the philosophy of psychiatry regarding the relation between thought insertion in schizophrenia and the sense of selfhood. Some scholars have suggested that thought insertion presents a case where the sense of selfhood is lacking. Other scholars have disputed this by proposing that a form of minimal selfhood is a necessary feature of consciousness that is still present in thought insertion, albeit in a disturbed manner. Herein, I argue that the notion of minimal selfhood that is used by these scholars is ambiguous between two meanings. The first is an ontological notion concerning the first-person individuation of consciousness. The second is a phenomenological notion concerning how a conscious experience is experienced as being given to the first-person subject. I argue that the former ontological notion is indeed a necessary feature of conscious experience, but the latter phenomenological notion is only a contingent feature. Therefore, even if it is possible that thought insertion presents a case where the feeling of first-person givenness is lacking or disturbed, the first-person individuation of consciousness remains present and undisturbed. As well as further clarifying the connection between consciousness and selfhood, this philosophical analysis reveals the extent to which schizophrenia can and cannot be said to comprise a disorder of selfhood.

This paper offers a philosophical analysis of the connection between mental disorder and suicide risk. In contemporary psychiatry, it is commonly suggested that this connection is a causal connection that has been established through empirical discovery. Herein, I examine the extent to which this claim can be sustained. I argue that the connection between mental disorder and increased suicide risk is not wholly causal but is partly conceptual. This in part relates to the way suicidality is built into the definitions of some psychiatric diagnoses. It also relates to the broader normative assumption that suicidal behavior is by definition mentally disordered behavior. The above has significant epistemological implications, which I explore. I propose that the claim that suicide is connected with mental disorder cannot be justified solely by appealing to empirical evidence but also warrants a justification on conceptual and normative grounds.

In contemporary philosophy of mind, the conceivability argument against physicalism is often used to support a form of dualism, which takes consciousness to be ontologically fundamental and distinct from physical matter. Recently, some proponents of the conceivability argument have also shown interest in panpsychism, which is the view that mentality is ubiquitous in the natural world. This paper examines the extent to which panpsychism can be sustained if the conceivability argument is taken seriously. I argue that panpsychism’s ubiquity claim permits a strong reading or a weak reading. This presents a dilemma. On the one hand, the strong reading, which is typically characterised as a form of monism, is undermined by the conceivability argument. On the other hand, the weak reading, while compatible with the conceivability argument, turns out just to be a special case of dualism. I also show that the related position of panprotopsychism cannot provide a tenable monist position because it too cannot withstand the challenge of the conceivability argument. Therefore, if the conceivability argument is taken seriously, then we are committed to a dualist metaphysics, regardless of whether or not we accept the ubiquity claim.

Is psychopathy born or made? Contemporary psychopathy research shows that there is much wrong with this question. It is increasingly accepted that the development of psychopathy is dependent on multiple causal factors interacting with one another. However, there remains the major theoretical challenge of understanding the relations between these multiple causal factors in the developmental process. In this paper, I argue that the conventional picture of gene-environment interactionism does not offer an adequate account of psychopathy development. Instead, I propose that a theoretical framework from the philosophy of biology, namely developmental systems theory, can facilitate a better understanding of psychopathy development that captures the contingent and dynamic relations between multiple causal factors. Some practical implications of a developmental systems theory approach to psychopathy are also explored.

In somatic medicine, diagnostic terms often refer to the disease processes that are the causes of patients' symptoms. The language used in some clinical textbooks and health information resources suggests that this is also sometimes assumed to be the case with diagnoses in psychiatry. However, this seems to be in tension with the ways in which psychiatric diagnoses are defined in diagnostic manuals, according to which they refer solely to clusters of symptoms. This paper explores how theories of reference in the philosophy of language can help to resolve this tension. After the evaluation of descriptive and causal theories of reference, I put forward a conceptual framework based on two-dimensional semantics that allows the causal analysis of diagnostic terms in psychiatry, while taking seriously their descriptive definitions in diagnostic manuals. While the framework is presented as a solution to a problem regarding the semantics of psychiatric diagnoses, it can also accommodate the analysis of diagnostic terms in other medical disciplines.

This paper examines the complex research landscape of contemporary suicidology from a philosophy of science perspective. I begin by unpacking the methods, concepts, and assumptions of some of the prominent approaches to studying suicide causation, including psychological autopsy studies, epidemiological studies, biological studies, and qualitative studies. I then analyze the different ways these approaches partition the causes of suicide, with particular emphasis on the ways they conceptualize the domain of mental disorder. I argue that these different ways of partitioning the causal space and conceptualizing mental disorder result in incommensurabilities between the approaches. These incommensurabilities restrict the degrees to which the different approaches can be integrated, thus lending support to explanatory pluralism in the study of suicide causation. They also shed light on some of the philosophical underpinnings of the disagreement between mainstream suicidology and the emerging area of critical suicidology.

Claims about whether or not infertility is a disease are sometimes invoked to defend or criticize the provision of state-funded treatment for infertility. In this paper, I suggest that this strategy is problematic. By exploring infertility through key approaches to disease in the philosophy of medicine, I show that there are deep theoretical disagreements regarding what subtypes of infertility qualify as diseases. Given that infertility's disease status remains unclear, one cannot uncontroversially justify or undermine its claim to medical treatment by claiming that it is or is not a disease. Instead of focusing on disease status, a preferable strategy to approach the debate about state-funded treatment is to explicitly address the specific ethical considerations raised by infertility. I show how this alternative strategy can be supported by a recent theoretical framework in the philosophy of medicine, which avoids the problems associated with the concepts of health and disease.

Delusions and hallucinations present a challenge to traditional epistemology by allowing two people’s experiences of the world to be vastly different to each other. Traditional objective realism assumes that there is a mind-independent objective world of which people gain knowledge through experience. However, each person only has direct access to his or her own subjective experience of the world, and so neither can be certain that his or her experience represents an objective world more accurately than the other’s. This essay proposes an intersubjective account of psychosis, which avoids this sceptical attack on objective certainty by considering reality not at the level of an objective mindindependent world, but at the level of peoples’ shared experiences. This intersubjective hypothesis is developed further, with reference to Husserl’s concept of multiple lifeworlds, into a relativistic account. The implication on the social role of psychiatry is also explored.

In clinical medicine, a diagnosis can offer an explanation of a patient's symptoms by specifying the pathology that is causing them. Diagnoses in psychiatry are also sometimes presented in clinical texts as if they pick out pathological processes that cause sets of symptoms. However, current evidence suggests the possibility that many diagnostic categories in psychiatry are highly causally heterogeneous. For example, major depressive disorder may not be associated with a single type of underlying pathological process, but with a range of different causal pathways, each involving complex interactions of various biological, psychological, and social factors. This paper explores the implications of causal heterogeneity for whether psychiatric diagnoses can be said to serve causal explanatory roles in clinical practice. I argue that while they may fall short of picking out a specific cause of the patient's symptoms, they can nonetheless supply different sorts of clinically relevant causal information. In particular, I suggest that some psychiatric diagnoses provide negative information that rules out certain causes, some provide approximate or disjunctive information about the range of possible causal processes, and some provide causal information about the relations between the symptoms themselves.

Assisted reproduction using donor gametes is a procedure that allows those who are unable to produce their own gametes to achieve gestational parenthood. Where conception is achieved using donor sperm, the child lacks a genetic link to the intended father. Where it is achieved using a donor egg, the child lacks a genetic link to the intended mother. To address this lack of genetic kinship, some fertility clinics engage in the practice of matching the ethnicity of the gamete donor to that of the recipient parent. The intended result is for the child to have the phenotypic characteristics of the recipient parents. This paper examines the philosophical and ethical problems raised by the policy of ethnic matching in gamete donation. I consider arguments for the provision of ethnic matching based on maximising physical resemblance and fostering ethnic identity development. I then consider an argument against ethnic matching based on the charge of racialism. I conclude that while the practice of ethnic matching in gamete donation could promote positive ethnic identity development in donor-conceived children from historically subjugated ethnic minorities, it also risks endorsing the problematic societal attitudes and assumptions regarding ethnicity that enabled such subjugation in the first place.