reason is intact but not fully accessible, like someone throwing a blanket over a lamp. The lamp itself functions perfectly beneath the blanket but is unable to light the room at its full capacity. Reason itself functions at full capacity but is unable to guide moral reasoning and action because it is dampened by the symptoms of trauma.
{"title":"Distressed But Not Helpless","authors":"Katie Harster","doi":"10.1353/ppp.2022.0034","DOIUrl":"https://doi.org/10.1353/ppp.2022.0034","url":null,"abstract":"reason is intact but not fully accessible, like someone throwing a blanket over a lamp. The lamp itself functions perfectly beneath the blanket but is unable to light the room at its full capacity. Reason itself functions at full capacity but is unable to guide moral reasoning and action because it is dampened by the symptoms of trauma.","PeriodicalId":45397,"journal":{"name":"Philosophy Psychiatry & Psychology","volume":"41 1","pages":"165 - 168"},"PeriodicalIF":2.3,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82676612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract:Bipolar or related disorders (BoRD) present unique practical and existential problems for people who live with them. All agents experience changes in the things they care about over time. However people living with BoRD face drastic shifts in what seems valuable to them, which upset their longitudinal values (if, indeed, any stable longitudinal values are available in the first place). Navigating these evaluative high seas presents agents living with BoRD with a distinctive existential question, not shared by those on calmer waters. I draw out two contrasting ways in which someone living with BoRD might seek to support their self-determination in these circumstances, by crafting appropriate self care and support regimes. The first strategy involves managing one’s affective episodes so that they do not interrupt one’s plans and long-term agency over time. The second involves a regimen that allows one the greatest degree of freedom in adapting to changes in one’s experiences of value. What distinguishes these sorts of self-determination is the scope at which they are predicated. Although both sorts of self-determination allow an individual to rule themselves, they alter the overall shape of one’s autonomy in quite different ways.
{"title":"Bipolar Disorder and Self-Determination: Predicating Self-Determination at Scope","authors":"E. Porter","doi":"10.1353/ppp.2022.0030","DOIUrl":"https://doi.org/10.1353/ppp.2022.0030","url":null,"abstract":"Abstract:Bipolar or related disorders (BoRD) present unique practical and existential problems for people who live with them. All agents experience changes in the things they care about over time. However people living with BoRD face drastic shifts in what seems valuable to them, which upset their longitudinal values (if, indeed, any stable longitudinal values are available in the first place). Navigating these evaluative high seas presents agents living with BoRD with a distinctive existential question, not shared by those on calmer waters. I draw out two contrasting ways in which someone living with BoRD might seek to support their self-determination in these circumstances, by crafting appropriate self care and support regimes. The first strategy involves managing one’s affective episodes so that they do not interrupt one’s plans and long-term agency over time. The second involves a regimen that allows one the greatest degree of freedom in adapting to changes in one’s experiences of value. What distinguishes these sorts of self-determination is the scope at which they are predicated. Although both sorts of self-determination allow an individual to rule themselves, they alter the overall shape of one’s autonomy in quite different ways.","PeriodicalId":45397,"journal":{"name":"Philosophy Psychiatry & Psychology","volume":"8 1","pages":"133 - 145"},"PeriodicalIF":2.3,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84602911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Professor Katie Harster has considered the phenomenon of psychological trauma, bringing philosophical understandings into play. She provides an informed account of observed “symptoms,” and associated treatments. I comment as a counseling psychologist, although I do not specialize in the evidence-based treatments that she describes. Usually, in my work with clients, we are trying to make sense of what has happened, with a concern for what might happen in the future. I am grateful therefore to colleagues who have the expertise that I lack. I recall a discussion with one of these colleagues, who suggested that, “If a house is on fire, your priority should be to put out the flames and you can worry about how it caught on fire sometime later.” A good point I thought, and this is supported by Harster’s account. I am stretching the analogy, but a traumatized person could be like that annoying faulty smoke alarm. It keeps going off even though there is no actual fire. When a person’s anxiety appears to be unwarranted, it is taken to be a symptom of mental illness. My colleagues measure anxiety, using standard rating scales, and interventions are considered evidence-based when they reduce scores on those measures. However, we know that removing the batteries from an annoying smoke alarm is not an adequate response. I observe below that anxiety can be positive and protective. I also observe that trauma can be so far off the scale of what we usually experience, that it will be difficult to make sense of what has happened, or to adjust to it. Harster describes how a Kantian framework supports pragmatic and stoic responses to trauma. This framework underpins certain areas of psychological theory and practice, in which it is suggested that we cannot trust our emotions, and we must turn instead to reason. I support this to a degree, but I am concerned that reason and symptom reduction will not always be enough. Harster describes how traumatized people can struggle with self-blame. How they lack a sense of self-worth and how they can lapse into extreme risk taking. Within that Kantian framework, it is assumed that there is something wrong with them. However, if we take time with them to explore what happened,
{"title":"Immanuel Kant and the Task of Understanding Another’s Lived-Experience","authors":"S. Wharne","doi":"10.1353/ppp.2022.0033","DOIUrl":"https://doi.org/10.1353/ppp.2022.0033","url":null,"abstract":"Professor Katie Harster has considered the phenomenon of psychological trauma, bringing philosophical understandings into play. She provides an informed account of observed “symptoms,” and associated treatments. I comment as a counseling psychologist, although I do not specialize in the evidence-based treatments that she describes. Usually, in my work with clients, we are trying to make sense of what has happened, with a concern for what might happen in the future. I am grateful therefore to colleagues who have the expertise that I lack. I recall a discussion with one of these colleagues, who suggested that, “If a house is on fire, your priority should be to put out the flames and you can worry about how it caught on fire sometime later.” A good point I thought, and this is supported by Harster’s account. I am stretching the analogy, but a traumatized person could be like that annoying faulty smoke alarm. It keeps going off even though there is no actual fire. When a person’s anxiety appears to be unwarranted, it is taken to be a symptom of mental illness. My colleagues measure anxiety, using standard rating scales, and interventions are considered evidence-based when they reduce scores on those measures. However, we know that removing the batteries from an annoying smoke alarm is not an adequate response. I observe below that anxiety can be positive and protective. I also observe that trauma can be so far off the scale of what we usually experience, that it will be difficult to make sense of what has happened, or to adjust to it. Harster describes how a Kantian framework supports pragmatic and stoic responses to trauma. This framework underpins certain areas of psychological theory and practice, in which it is suggested that we cannot trust our emotions, and we must turn instead to reason. I support this to a degree, but I am concerned that reason and symptom reduction will not always be enough. Harster describes how traumatized people can struggle with self-blame. How they lack a sense of self-worth and how they can lapse into extreme risk taking. Within that Kantian framework, it is assumed that there is something wrong with them. However, if we take time with them to explore what happened,","PeriodicalId":45397,"journal":{"name":"Philosophy Psychiatry & Psychology","volume":"2 1","pages":"161 - 163"},"PeriodicalIF":2.3,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81938422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Is autism a condition internal to the person that causes problems in social interaction? Or should we conceive of autism primarily at the level of interaction, as a “two-way” phenomenon (Krueger & Maiese, 2018) that develops in the relation between the person with autism and her social-material environment? Over the last decade or so, this issue has increasingly gained interest, not only in academia, but also in the field of mental health care and in the wider public domain. Much is at stake here. Framing autism as an internal deficit or rather as an interaction phenomenon has far-reaching implications for scientific research and clinical practice. It steers the focus of autism research by determining the kind of research questions we deem scientifically and clinically relevant. In mental health care, it influences the way in which we conceive of the problems people with autism struggle with and seek help for. Are the social difficulties that people with autism experience to be framed in terms of their lack of “theory of mind” (e.g., Baron Cohen, 2000)? Or should we rather start our clinical inquiry with the acknowledgment of a “double empathy problem” (Milton, 2012) that shapes the social interaction between the autistic individual and non-autistic people, health care professionals included? More generally, are the problems experienced by people with autism to be explained with reference to internal mental dysfunction? Or should rather we take as our primary diagnostic unit of analysis the structural mismatch in needs, interests, experienced salience and perceived possibilities between the person with autism and the wider social world? These background assumptions regarding the nature of autism shape diagnostic case formulations, guide treatment interventions and determine the tone of the therapeutic relationship. Beyond scientific and clinical interests, the issue also has wider societal implications. Framing autism as a difference rather than a disorder, voices in the recovery and (neuro) diversity movement have suggested that the problems experienced by people with autism are first and foremost social—or rather societal—problems originating from a failure of society to make room for autistic forms of life (cf. Silberman, 2015).
{"title":"Matters of the Autistic Mind: What Is the Role of Material Objects in Social Interaction?","authors":"D. Strijbos","doi":"10.1353/ppp.2022.0027","DOIUrl":"https://doi.org/10.1353/ppp.2022.0027","url":null,"abstract":"Is autism a condition internal to the person that causes problems in social interaction? Or should we conceive of autism primarily at the level of interaction, as a “two-way” phenomenon (Krueger & Maiese, 2018) that develops in the relation between the person with autism and her social-material environment? Over the last decade or so, this issue has increasingly gained interest, not only in academia, but also in the field of mental health care and in the wider public domain. Much is at stake here. Framing autism as an internal deficit or rather as an interaction phenomenon has far-reaching implications for scientific research and clinical practice. It steers the focus of autism research by determining the kind of research questions we deem scientifically and clinically relevant. In mental health care, it influences the way in which we conceive of the problems people with autism struggle with and seek help for. Are the social difficulties that people with autism experience to be framed in terms of their lack of “theory of mind” (e.g., Baron Cohen, 2000)? Or should we rather start our clinical inquiry with the acknowledgment of a “double empathy problem” (Milton, 2012) that shapes the social interaction between the autistic individual and non-autistic people, health care professionals included? More generally, are the problems experienced by people with autism to be explained with reference to internal mental dysfunction? Or should rather we take as our primary diagnostic unit of analysis the structural mismatch in needs, interests, experienced salience and perceived possibilities between the person with autism and the wider social world? These background assumptions regarding the nature of autism shape diagnostic case formulations, guide treatment interventions and determine the tone of the therapeutic relationship. Beyond scientific and clinical interests, the issue also has wider societal implications. Framing autism as a difference rather than a disorder, voices in the recovery and (neuro) diversity movement have suggested that the problems experienced by people with autism are first and foremost social—or rather societal—problems originating from a failure of society to make room for autistic forms of life (cf. Silberman, 2015).","PeriodicalId":45397,"journal":{"name":"Philosophy Psychiatry & Psychology","volume":"1 1","pages":"213 - 216"},"PeriodicalIF":2.3,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89592484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
I thank the commenters for their insightful remarks, from which I have learned much. In my article, I sought to explain psychiatric vagueness, which arises in borderline cases where there is no fact of the matter as to whether a diagnosis rightly can be said to apply.1 I argued “if psychiatric vagueness exists, then some of it is at least partially semantic” (Tilmes, 2022). A semantic account holds that vague utterances express different propositions since small gaps in how linguistic communities apply terms modify their referents, making their precise extension indeterminate.2 On my view, this best accommodates intuitions about the nature of conditions and explains historical changes in the application of psychiatric terms. A semantic account implies that we can sometimes settle diagnostic questions by attending to linguistic data and that some vagueness will remain so long as differences in language use do. I also argued that solely epistemic and ontic accounts—which attribute vagueness to ignorance and the world—come to implausible conclusions about psychiatric vagueness and fail to help us navigate it, respectively. It is worth clarifying my position here. First, I do not claim that all psychiatric vagueness is semantic, but only that some cases of it at least partially are. “This leaves open the possibility of vagueness having multiple sources” (Tilmes, 2022) and does not require abandoning all nonlinguistic considerations. Indeed, thinking that the borders of psychiatric conditions are affected by language need not entail rejecting concepts of etiology or kinds altogether, just as thinking that it is indeterminate when red turns to orange does not entail rejecting the notion that color is shaped by wavelengths of light. Second, I do not argue that diagnostic manuals or theories of psychiatric kinds necessarily reflect assumptions about vagueness, but that each account of vagueness lends itself more to certain approaches. For instance, if understanding psychiatric vagueness as a problem of language commits one to anti-realism, adopting a primarily semantic approach may give one reason to reject realist theories of psychiatry. Dan Stein contends that we should “side-step the Sorites paradox, and its notion that our language categories are in any way related to precise formulation in terms such as n and n + 1” (Stein, 2022). For instance, he notes that while the Diagnostic and Statistical Manual of Mental Disorders (DSM) requires symptoms of generalized anxiety disorder to last 6 months, the International Classification of Diseases, 11th edition, only stipulates that they last for several months. However, this does not solve the problem of vagueness so much
{"title":"Examining Assumptions about Vagueness","authors":"Nicholas Tilmes","doi":"10.1353/ppp.2022.0038","DOIUrl":"https://doi.org/10.1353/ppp.2022.0038","url":null,"abstract":"I thank the commenters for their insightful remarks, from which I have learned much. In my article, I sought to explain psychiatric vagueness, which arises in borderline cases where there is no fact of the matter as to whether a diagnosis rightly can be said to apply.1 I argued “if psychiatric vagueness exists, then some of it is at least partially semantic” (Tilmes, 2022). A semantic account holds that vague utterances express different propositions since small gaps in how linguistic communities apply terms modify their referents, making their precise extension indeterminate.2 On my view, this best accommodates intuitions about the nature of conditions and explains historical changes in the application of psychiatric terms. A semantic account implies that we can sometimes settle diagnostic questions by attending to linguistic data and that some vagueness will remain so long as differences in language use do. I also argued that solely epistemic and ontic accounts—which attribute vagueness to ignorance and the world—come to implausible conclusions about psychiatric vagueness and fail to help us navigate it, respectively. It is worth clarifying my position here. First, I do not claim that all psychiatric vagueness is semantic, but only that some cases of it at least partially are. “This leaves open the possibility of vagueness having multiple sources” (Tilmes, 2022) and does not require abandoning all nonlinguistic considerations. Indeed, thinking that the borders of psychiatric conditions are affected by language need not entail rejecting concepts of etiology or kinds altogether, just as thinking that it is indeterminate when red turns to orange does not entail rejecting the notion that color is shaped by wavelengths of light. Second, I do not argue that diagnostic manuals or theories of psychiatric kinds necessarily reflect assumptions about vagueness, but that each account of vagueness lends itself more to certain approaches. For instance, if understanding psychiatric vagueness as a problem of language commits one to anti-realism, adopting a primarily semantic approach may give one reason to reject realist theories of psychiatry. Dan Stein contends that we should “side-step the Sorites paradox, and its notion that our language categories are in any way related to precise formulation in terms such as n and n + 1” (Stein, 2022). For instance, he notes that while the Diagnostic and Statistical Manual of Mental Disorders (DSM) requires symptoms of generalized anxiety disorder to last 6 months, the International Classification of Diseases, 11th edition, only stipulates that they last for several months. However, this does not solve the problem of vagueness so much","PeriodicalId":45397,"journal":{"name":"Philosophy Psychiatry & Psychology","volume":"15 1","pages":"187 - 189"},"PeriodicalIF":2.3,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78371442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Research on autistic spectrum disorder (ASD) commonly describes autistic individuals as displaying: i) a preoccupation with the world of objects and ii) a withdrawal or detachment from the world of subjects. In her insightful and persuasive article, Sofie Boldsen argues that we should not fall into the trap of viewing the world of objects and the world of subjects in isolation from one another. Drawing from her qualitative and phenomenological study on social interaction in ASD, Boldsen urges us to recognize how interacting with material objects can scaffold, facilitate, and regulate different forms of social connectedness in ASD. In doing so, the distinction between the “social” and “non-social” dimensions of ASD is problematized, and a robustly situated and embedded understanding of ASD is presented. Excerpts from both observational and interview-based data are used to illustrate ways in which social interaction in ASD is mediated via interaction with the material world. Line and Helene engage with one another through their mutual attention to a guitar; Ina and Viola dance together, guided by a virtual dance partner; Hanna and Mads connect while playing a board game. Boldsen argues that through engagement with material aspects of the environment various social possibilities are opened; social possibilities that are importantly experienced as less uncertain and overwhelming. Boldsen suggests two ways in which material mediation regulates and grounds social interaction. First, through their sensible nature, objects can scaffold social co-ordination and attunement. The rhythmic structure of music, for example, is socially supportive; it entrains our bodily movements both in time with the music and, in turn, with others also dancing. As such, the music provides a shared structure in which bodily movement and attunement unfolds, guiding and delineating when and how to act. Second, Boldsen highlights how objects can make normative rules and expectations explicit. As such, they not only provide a structure which shapes the spatio-
{"title":"Mediated Encounters in Autistic Spectrum Disorder: From the Material to the Digital","authors":"Lucy Osler","doi":"10.1353/ppp.2022.0026","DOIUrl":"https://doi.org/10.1353/ppp.2022.0026","url":null,"abstract":"Research on autistic spectrum disorder (ASD) commonly describes autistic individuals as displaying: i) a preoccupation with the world of objects and ii) a withdrawal or detachment from the world of subjects. In her insightful and persuasive article, Sofie Boldsen argues that we should not fall into the trap of viewing the world of objects and the world of subjects in isolation from one another. Drawing from her qualitative and phenomenological study on social interaction in ASD, Boldsen urges us to recognize how interacting with material objects can scaffold, facilitate, and regulate different forms of social connectedness in ASD. In doing so, the distinction between the “social” and “non-social” dimensions of ASD is problematized, and a robustly situated and embedded understanding of ASD is presented. Excerpts from both observational and interview-based data are used to illustrate ways in which social interaction in ASD is mediated via interaction with the material world. Line and Helene engage with one another through their mutual attention to a guitar; Ina and Viola dance together, guided by a virtual dance partner; Hanna and Mads connect while playing a board game. Boldsen argues that through engagement with material aspects of the environment various social possibilities are opened; social possibilities that are importantly experienced as less uncertain and overwhelming. Boldsen suggests two ways in which material mediation regulates and grounds social interaction. First, through their sensible nature, objects can scaffold social co-ordination and attunement. The rhythmic structure of music, for example, is socially supportive; it entrains our bodily movements both in time with the music and, in turn, with others also dancing. As such, the music provides a shared structure in which bodily movement and attunement unfolds, guiding and delineating when and how to act. Second, Boldsen highlights how objects can make normative rules and expectations explicit. As such, they not only provide a structure which shapes the spatio-","PeriodicalId":45397,"journal":{"name":"Philosophy Psychiatry & Psychology","volume":"75 1","pages":"209 - 211"},"PeriodicalIF":2.3,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85557771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Autism is a highly heterogeneous phenomenon. Not only is it difficult to understand the various and diverse aspects of autism, their relation to each other is also complex and still poorly understood. In my article, “Material encounters. A phenomenological account of social interaction in autism,” I have addressed this heterogeneity by presenting an understanding of how social features of autism (e.g., difficulties with social interaction) relate to behavioral features (e.g., preoccupation with objects). Straddling this divide between the social and the non-social that still pervades much thinking in philosophy, psychiatry, and psychology is crucial for understanding the diverse experiences of autistic persons and how social connectedness may emerge out of practices commonly regarded as asocial (Williams, Costall, & Reddy, 2018). Thus, my approach to autism has been one of questioning deep-rooted distinctions within the field. However, in their generous and perceptive commentaries, Lucy Osler and Derek Strijbos both draw attention to the importance of making certain distinctions, such as between the different forms of social engagement that different objects afford and between the differential contributions of the various dimensions of such objects.
{"title":"On the Actuality and Virtuality of Autistic Encounters: Respecting the Autistic Voice and Reimagining the Social","authors":"Sofie Boldsen","doi":"10.1353/ppp.2022.0028","DOIUrl":"https://doi.org/10.1353/ppp.2022.0028","url":null,"abstract":"Autism is a highly heterogeneous phenomenon. Not only is it difficult to understand the various and diverse aspects of autism, their relation to each other is also complex and still poorly understood. In my article, “Material encounters. A phenomenological account of social interaction in autism,” I have addressed this heterogeneity by presenting an understanding of how social features of autism (e.g., difficulties with social interaction) relate to behavioral features (e.g., preoccupation with objects). Straddling this divide between the social and the non-social that still pervades much thinking in philosophy, psychiatry, and psychology is crucial for understanding the diverse experiences of autistic persons and how social connectedness may emerge out of practices commonly regarded as asocial (Williams, Costall, & Reddy, 2018). Thus, my approach to autism has been one of questioning deep-rooted distinctions within the field. However, in their generous and perceptive commentaries, Lucy Osler and Derek Strijbos both draw attention to the importance of making certain distinctions, such as between the different forms of social engagement that different objects afford and between the differential contributions of the various dimensions of such objects.","PeriodicalId":45397,"journal":{"name":"Philosophy Psychiatry & Psychology","volume":"27 1","pages":"217 - 220"},"PeriodicalIF":2.3,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84737641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract:Many discussions in the philosophy of psychiatry hinge on, among other things, the concepts of disorders, the role of underlying mechanisms, and the merits of various diagnostic models. Yet, some such disputes rest on assumptions about vagueness in the sense of susceptibility to the Sorites paradox as opposed to mere uncertainty in clinical practice. Studying borderline cases of psychiatric conditions—those where it is indeterminate whether applying a diagnosis is appropriate—may shed light on broader debates about the nature and boundaries of these conditions. In this article, I will argue that if psychiatric vagueness exists, then some instances of it stem at least partially from how we describe the world instead of the state of the world or what we know about it. In other words, vagueness in psychiatric terms and concepts is at least in part semantic and neither solely epistemic nor solely ontic. On this view, slight differences in how various linguistic communities apply diagnostic terms modify their referents, making their precise extension indeterminate. This implies that we can sometimes answer questions about diagnosis by settling disagreements about language, which may provide traction in debates about the philosophy of nosology and help inform psychiatric practice.
{"title":"Semantic Vagueness in Psychiatric Nosology","authors":"Nicholas Tilmes","doi":"10.1353/ppp.2022.0035","DOIUrl":"https://doi.org/10.1353/ppp.2022.0035","url":null,"abstract":"Abstract:Many discussions in the philosophy of psychiatry hinge on, among other things, the concepts of disorders, the role of underlying mechanisms, and the merits of various diagnostic models. Yet, some such disputes rest on assumptions about vagueness in the sense of susceptibility to the Sorites paradox as opposed to mere uncertainty in clinical practice. Studying borderline cases of psychiatric conditions—those where it is indeterminate whether applying a diagnosis is appropriate—may shed light on broader debates about the nature and boundaries of these conditions. In this article, I will argue that if psychiatric vagueness exists, then some instances of it stem at least partially from how we describe the world instead of the state of the world or what we know about it. In other words, vagueness in psychiatric terms and concepts is at least in part semantic and neither solely epistemic nor solely ontic. On this view, slight differences in how various linguistic communities apply diagnostic terms modify their referents, making their precise extension indeterminate. This implies that we can sometimes answer questions about diagnosis by settling disagreements about language, which may provide traction in debates about the philosophy of nosology and help inform psychiatric practice.","PeriodicalId":45397,"journal":{"name":"Philosophy Psychiatry & Psychology","volume":"20 1","pages":"169 - 178"},"PeriodicalIF":2.3,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83289555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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