‘Philosophy and Mental Health’ took place at Accrington and Rossendale College on 18 April 2018. The Royal Institute of Philosophy sponsored the event, which was organised by Angela Woods from the college. Sessions were targeted at students studying mental health related courses, but were also open to the public. Rachel Cooper and Sam Fellowes, both from PPR, Lancaster, gave talks.
Rachel Cooper: ‘Mental disorder outside the head’
My aim in this talk was to draw links between contemporary accounts of what it takes to have a mind and accounts of mental disorder. In particular, I aimed to introduce the audience to the idea that our minds can extend beyond our bodies. The ‘extended mind’ thesis was first set out by Andy Clark and David Chalmers in their well-known 1998 paper. I aimed to persuade the audience that normal minds can indeed be extended, and that this implies that some mental disorders might also be located outside of patients’ heads.
I started the talk by considering the Identity Theory of mind; a view that was developed in the 1950s (notably by Smart and Place) but that remains popular today. The identity theory claims that the mind just is the brain, and that any particular type of mental state (pain say) is identical with some particular type of brain state (maybe, C-fibres being simulated). The identity theorists take the claim that the mind is the brain to be a claim of the same type as the claim that water is identical to H20. ‘Mind’ and ‘brain’ are taken to be two labels for the same thing, in the same sort of way that water and H2O is the same stuff. The identity theory seems especially plausible when one considers the images that are nowadays produced by various types of brain scanning study. It’s very plausible to suppose that the images show the mind/brain engaged in different types of thinking.
There is, however, one big problem for the identity theory: The identity theory claims that what it is to have a mind is to have a brain, and that what it is to have any particular type of mental state is to have some particular type of brain state. An implication of such claims is that only beings very like typical humans can possibly have mental states. And to many this seems an implausible claim. The worry is that we can’t rule out the possibility that there might be minded-beings that don’t have brains like us. Maybe somewhere out there in the galaxy there are intelligent aliens, with heads full of green gunk. Or, at some point in the future, maybe we will develop a computer that can really think. If one supposes that it is possible that there might be a minded, but non-brained, being then one has to reject the identity theory – it can’t be true that having a mind is just having a brain of the right type.
Functionalism is an account of mind that was developed to allow for the possibility that creatures that don’t have brains like ours might think. The functionalist allows that there might be minded-beings that are made of electronics, or green gunk, or whatever. On the functionalist account, mental states should be characterised in terms of their characteristic functional roles. In the same sort of way that what it is for something to be a mousetrap is that it’s a device for catching mice, what it is for a state to be a pain is that it plays the right sort of causal role. Pains have characteristic causes – such as tissue damage. They lead to characteristic types of behavior – like screaming, and they connect in characteristic ways with other mental states, for example, pains typically trigger desires for pain killers. On the functionalist account, anything that fulfils the appropriate role counts as a pain, it doesn’t matter whether it’s brain activity, or electronics, or green alien gunk that does the work.
Of course, mental health professionals have enough trouble dealing with human patients, and there may seem to be little point in them concerning themselves with accounts of mind that are designed to accommodate aliens and robots. However, it’s quite plausible that even if one restricts one’s attention to human beings, an identity account, which claims that any particular type of mental state is identical with some particular type of brain state, may be overly restrictive. Many of us have unusual brains – we may have recovered from a stroke, or have been dropped as children. It seems plausible that even amongst human beings there can be variation in the types of brain activity that are associated with particular types of thought (indeed Blasi et al 2002 demonstrates as much). As such, even those who are solely interested in humans should accept functionalism over the identity theory.
If one adopts functionalism about the mind then this has implications for how we should think about certain types of mental disorder. David Papineau (1994) has argued that functionalism about the mind implies that some types of mental disorder will not be reducible to brain disorders. Papineau’s paper is highly recommended, but in the talk I didn’t have time to talk much about the implications of functionalism for psychiatry. I wanted to press on to talk about the implications of the idea that the mind can be extended.
The functionalist claims that it doesn’t matter what physical stuff a mind is made of. If one adds to this the claim that it also doesn’t matter where the physical stuff is located (inside or outside of heads) then one ends up with the claim that minds can extend outside of bodies. In their seminal paper, Clark and Chalmers (1998) discuss a character called Otto. Otto has suffered brain damage and his organic memory has been destroyed. But Otto has found a new way to remember – he writes notes in a book that he carries everywhere. Clark and Chalmers claim that Otto’s notebook fulfils the functions that are more typically fulfilled by an organic brain-based memory. They thus conclude that Otto’s notebook is his memory – and of course his notebook is outside of his head.
If one accepts that Otto’s notebook is his memory then the conclusion that mental disorders can be located outside of patients’ heads quickly follows. If Otto’s notebook is his memory, then burning his notebook can destroy his memory. Here we have a memory-disorder that is located outside of Otto’s head. Or, as another example, consider the case of a child who carries a teddy everywhere and strokes the teddy to calm themselves down. If the teddy is lost, their ability to regulate their emotions may be destroyed. In such a case the emotion-regulation disorder is located outside of their head. If minds extend beyond heads, then mental disorders do too.
Sam Fellowes: ‘Lessons for today from the history of autism’
The first half of my presentation was largely a re-cap of my previous criticism of Neurotribes (https://www.sciencedirect.com/science/article/pii/S1369848616300954). In this book Silberman (2015) argues Leo Kanner’s original description of autism (1943) was of a disorder that was “vanishingly rare” and “monolithic by definition”. Silberman argues that Kanner’s ‘autism’ was quite unlike the condition described as autism today. He claims that modern notions of autism have a significantly better scientific foundation and are much more suitable for neurodiversity than Kanner’s approach was.
However, in this paper I argued that when properly understood Kanner’s autism is much more like the autism that is described today than Silberman acknowledges. I argue that it is crucial to appreciate that Kanner considered autism to be a subtype of childhood schizophrenia (Kanner 1969). I argue Kanner thought it was only vanishingly rare in the sense of it being a rare subtype of the fairly common childhood schizophrenia. I accept that Kanner’s autism did have quite restrictive symptoms (even if it was not monolithic) but I situated it as being a subtype of a much less monolithic childhood schizophrenia which shared many symptoms of Kanner’s autism but did not require the stringent diagnostic criteria. Silberman claims that adherence to Kanner’s views prevented the full autistic spectrum being recognised for many decades but, if you consider Kanner’s views on childhood schizophrenia, it looks like Kanner endorses a position quite like a spectrum.
In the second half of my presentation I discuss some of my more recent research. I outlined Lauretta Bender’s (1956) approach to childhood schizophrenia and considered how elements of her approach fit modern psychiatric evidence surprisingly well. Additionally, they could be used to formulate alternative approaches to neurodiversity, one based around meaningful subtypes with nuanced inter-relationships between them, rather than an account of neurodiversity based around the DSM-5 spectrum which lacks subtypes.
As far as I was aware, none of the audience were professional historians or philosophers. I found it positive to deliver my work to a wider audience, getting the findings of my research out to a wider audience. Some of that audience were mental health professionals or training to become mental health professionals, thus some are or would be interacting with autistic people regularly in their line of work. As a historian and philosopher my work often can be a bit removed from actual practise, thus it was good to be speaking to and opening dialogue with individuals who have much practical hands on experience of working with autistic individuals. The audience were engaged and asked interesting questions. These included questions about alternative ways of thinking about diagnosis, what the value of diagnosis was, how to keep in focus the aspects of the individual not covered by the diagnosis and even if diagnoses were needed at all. I think these are all important questions and it was good to see questions about them. Overall, I feel that academics often do not engage sufficiently with the world outside academia. It was very encouraging to attend a talk which was so well attended by an audience who asked engaging questions so I feel the whole process was very much a worthwhile experience.
References:
Bender, Lauretta. 1956. Childhood Schizophrenia Symposium. American Journal of Orthopsychiatry, 26 (3), pp.449-506.
Blasi, V., Young, A.C., Tansy, A.P., Petersen, S.E., Snyder, A.Z. and Corbetta, M., 2002. Word retrieval learning modulates right frontal cortex in patients with left frontal damage. Neuron, 36(1), pp.159-170.
Clark, A. and Chalmers, D., 1998. The extended mind. Analysis, 58(1), pp.7-19.
Kanner, L. 1943. Autistic Disturbance of Affective Contact. Nervous Child 2, pp.217-250.
Kanner, L. 1969. The Children Haven’t Read Those Books, reflection on differential diagnosis. Acta Paedopsychiatrica 36, p.2-11.
Papineau, D., 1994. Mental disorder, illness and biological disfunction. Royal Institute of Philosophy Supplements, 37, pp.73-82.
Place, U. T. (1956). Is consciousness a brain process? British Journal of Psychology 47:44-50.
Silberman, Steve. (2015) Neurotribes. (London: Atlantic Books).
Smart, J. J. C. (1959). Sensations and brain processes. Philosophical Review 68:141-56.