Brian L. Keeley Philosophy & Science, Technology, and Society Field Groups, Pitzer College

1. Is there a special, conceptual problem of mental disease(beyond the problem of disease itself)? Brian L. Keeley Philosophy & Science, Technology, and Society Field Groups, Pitzer College <brian_keeley@pitzer.edu>

2. Preamble • This talk is pretty tentative. • The short answer to the titular question: Yes

3. What’s the issue here? • Is there something more to the question of defining “mental disease” (or “mental illness,” “mental health,” etc.) beyond the well-known conceptual problems of defining “disease” (or “illness” or “health”) simpliciter? • Does the “mental” component add anything significant to the problem?

4. What’s the issue here? • This is important to me, in particular, because I am a philosopher of neuroscience and a materialist… • …one who takes it as a working hypothesis that, in some robust sense, the mind just is the brain. • Hence, “mental disease” just is, in some robust sense, “brain disease” (or, better, “mind/brain disease”).

5. What’s the issue here? • That would seem to lead me to the conclusion that brain health is just the same matter as the health of any other organ system in the body, hence there’s no special, conceptual worry here. • But, I think that is too fast. • There are adequate reasons and resources to conceive of a special problem of mind/brain disease without inconsistencies with a naturalized, materialist, neurophilosophical view of things.

6. But, hold on a moment! • What about functionalism? • Functionalism is a materialist philosophy of mind that nonetheless supports anti-reductionism wrt mental phenomena (cf. Putnam, Fodor, etc.) • One can imagine a fully materialist, yet functionalist, account of mental illness whereby there’s a special (functionally-defined) problem independent of bodily health.

7. Not an option for me • The problem: I reject the notion that functionalist explanation entails any significant independence of psychology from neuroscience. • Cf., Bechtel & Mundale (1999), “Multiple realization revisited: Linking cognitive and neural states” Philosophy of Science • Keeley (2000), “Shocking lessons from electric fish: The theory & practice of multiple realization” Philosophy of Science • So, that avenue is closed to me.

8. Overview of talk The basic, conceptual problem of health and disease The conceptual problem of mental disease An illustrative case: Williams’ Syndrome Conclusion

9. The Basic, Conceptual Problem of Health and Disease

10. Defining Health & Disease • Broadly speaking, two main approaches have been taken, each having its own problems:  Normative theory  Naturalism

11. Normative Theory • An essential component of any definition of health or disease is human evaluation. • Something only counts as a disease if it violates some personal or social norm. • On this account, the concept “disease” falls into the same category of concepts as “weed” or “pest”.

12. Normative Theory • Peter Sedgwick: • “The blight that strikes at corn or at potatoes is a human intervention, for if man wished to cultivate parasites (rather than potatoes or corn) there would be no blight, but simply the necessary foddering of the parasite-crop… Outside the significances that man [sic] voluntarily attaches to certain conditions, there are not illnesses or diseases in nature.”

13. Problem cases for normativism • The whole field of plastic surgery (which is medicine, after all): breast/penis size, ethnic physical features, unwanted pregnancy, baldness • The fact that I can’t bat like Barry Bonds or have the manual dexterity of Glenn Gould or maintain my 20-year-old physique (in other words, I’m not as good physically as I’d like to be).

14. Naturalism • Against the rampant relativism of the normative theory, naturalists such as Christopher Boorse argue that “disease” can and ought to be defined in biological terms. • The proper norms here are biological norms. • Hence, my baldness shouldn’t count as a disease because it is normal for (males of) my species.

15. Naturalism • Boorse: • “The root idea of this account is that the normal is the natural. The state of an organism is theoretically healthy, i.e., free of disease, insofar as its mode of functioning conforms to the natural design of that kind of organism…. Theoretical health now turns out to be strictly analogous to the mechanical condition of an artifact.”

16. Defining “normal” • Not an easy task. • Statistical normality is out… that tooth decay is the statistically normal state of adult humans does not seem to it out as a disease state. • Boorse invokes normality relative to a natural design. Tooth decay is a result of a hostile environment, not normal development.

17. Problem cases for naturalism • Homosexuality (although, as we will see, if this gets classed in the mental/behavioral domain, the issue is side-stepped) (Ruse). • Aging (dementia, menopause, hearing loss)… quite natural to the species, but often seems paradigmatically disease-like (Caplan)

18. Defining Disease in General • My purpose here is not to solve this problem, but rather to demonstrate what the problem is, such that we can consider whether something different is going on in the case of mental disease.

19.  The Conceptual Problem of Mental Disease

20. Even more problematic • If the problem of bodily health & disease is a headache, mental disease is even more problematic. • First, because the biological causes (if any) are occult, historically social norms have played a much larger role: • Homosexuality, masturbation, hysteria, and drapetomania have all been seriously considered to be mental diseases. Greetings & salutations!

21. The elimination of the concept of mental disease • One response to the additional problems engendered by the concept of mental disease is to simply divorce it from anything but a metaphorical connection to the disease model of physiological medicine. • For example, it has been argued that while normativism has nothing to do with biological disease, it has everything to do with psychological “disease” (in scare-quotes)

22. Szasz’s dilemma • Another related response has been put forth famously by Thomas Szasz (The myth of mental illness, 1961). • Proposes a mutually exclusive pair of categories • What we call mental illness must be either: brain disease “problems in living”

23. Szasz’s dilemma • “…a disease of the brain, analogous to a disease of the skin or bone, is a neurological defect, not a problem in living. For example, a defect in a person’s visual field may be explained by correlating it with certain lesions in the nervous system. On the other hand, a person’s belief--whether is be in Christianity, in Communism, or in the idea that his internal organs are rotting and that his body is already dead--cannot be explained by defect or disease of the nervous system. Explanations of this sort of occurrence--assuming one is interested in the belief itself and does not regard it simply as a symptom or expression of something else that is more interesting--must be sought along different lines.”

24. Szasz’s dilemma • Attempts to eliminate a special problem of mental disease by either reducing it to simple brain disease (and hence, no special problem beyond disease in general) or re-identifying it as “problems in living” (which is an issue of choice, lifestyle and prejudice, not a medical problem at all)

25. My thesis • Even if we give up the notion that there is a special problem defining mental disease based on some special nature of the mental… • …there might still be a source of a special problem if it were true that there is something special about the mind/brain itself • …something importantly different about the brain as compared to other organs. • I suspect that this is the case.

26. The specialness of the brain • In essence, the brain is a flexible, adaptive behavior machine. • Much of what it does is superfluous wrt keeping the organism as a whole running well. • As a result, the space of possible sustainable behavioral dynamics wrt the brain is huge when compared to other organ systems.

27. The specialness of the brain • The special problem created by this large space of possible dynamics is figuring out which are deleterious (formerly known as “mental disease”). • Sometimes a brain becomes wired up in a way that the subject testifies (and acts consistent with the belief) that his/her body is dead (aka “Cotard’s syndrome”). • Other times it becomes wired up in a way that the subject testifies (and acts consistent with the belief) that Jesse Ventura would make a great President. • The difference here?

28. An illustrative case: Williams’ Syndrome

29. William’s Syndrome • A good example of what I’m suggesting. • A genetic disorder first identified in 1961 • estimated to occur in 1/20,000 births • Results from moderate to severe deletion of material on chromosome #7 including the gene that makes the protein elastin (a protein which provides strength and elasticity to vessel walls.)

30. William’s Syndrome • Resulting symptoms: • Distinctive facial features • Heart and blood vessel problems • Hypercalcemia (elevated blood calcium levels) • The cardiovascular problems, if uncorrected are generally fatal during childhood. • We learned to treat these problems, which revealed…

31. William’s Syndrome • Resulting brain symptoms: • Overly friendly (excessively social) personality • Developmental delay & learning disabilities remarkably spared linguistic abilities despite impaired problem-solving and general cognitive abilities  relatively intact face processing, and severe spatial cognitive deficits similar to those found with right parietal damage.

32. But notice • One and the same genetic disorder has significant effects on both the cardiovascular and nervous system. • But, the effect on the cardio system just kills you. • The effect on the nervous system is significant, but it doesn’t kill the subject. • In other words, because the cardiovascular system works with a much smaller window of sustainable dynamics, even small variations result in death.

33. But notice • The amazing diversity of mental diseases (as was) testifies to the flexibility of brain dynamics. • The special problem of mind/brain disease is sorting that large space of possible dynamics.

34. Conclusion

35. Conclusion • Although it is still admittedly tentative & sketchy, I think it is possible to develop an argument for a special problem of mental disease based not on special properties of the mental, but rather on the special properties of the brain. • I look forward to your questions and comments.