Lecture 3 Fundamental Philosophical Issues Lecture Outline I. Introduction II. Mind-Body relationship III.Determinism vs indeterminism IV. Value-free science V. Mental health and morality VI. Autonomy vs conformity VII.Conclusions ------------------------------------------- I. Introduction: Adherents to the different theoretical orientations take sides on numerous philosophical issues concerning the nature of humanity. These issues lie at the heart of some theoretical controversies and the conflicts between professionals. These controversies and conflicts reflect implicit, unexamined, gut-felt metaphysical beliefs, in addition to scientific knowledge. To understand the various theoretical paradigms and why there are different paradigms, we must understand these beliefs. As we progress in this course, these issues will arise again and again in our discussions. By way of introduction, we will make them explicit now. (This discussion is based in part on Weckowicz, 1984) II. Mind - Body Relationship A. Overview: Philosophy of Mind Numerous positions have historically been held and perhaps just as many positions are currently held, regarding the relationship of the mind to the body. These include dualism, materialism, identity theory, and others (Churchland, 1984). 1. Dualism (eg: Descartes): The mental and the physical are two distinct realities, composed of fundamentally different "stuffs" - irreducibility. The real you is not your physical/material body, but a nonspatial, ghostly, perhaps spiritual thinking substance: "mind stuff" (Churchland, 1984). (Descartes: "I think, therefore I am"). This does not necessarily mean that the physical world and the mental world do not interact. But it does commit you to the position that the mental can not be explained or understood by reference to the physical. This position is certainly consistent with various religious beliefs regarding the existence of a soul. There is no way to understand the soul by looking at nerve cells and the organs of the body. Cells and organs are something utterly different from a soul - as such, they certainly can't explain how the soul works or even what a soul is. 2. Materialism (eg: Paul and Pat Churchland): In contrast to dualism, this approach states that there is only one reality: the physical. No matter how much we believe there is a soul or an otherwise nonphysical-something-about-us, there is not. This position sees the only reality as that of the nerve cell, the organ, and other physical (ie: "material") things. There are variations on this idea (eg: Classical (Skinnerian) behaviorism, where all that is actually real is the observable/physical behaviors of an organism); but they all argue that there is no purely mental, mystical or spiritual reality existing alongside the physical world. Thus, psychological theories that talk about mental-type things (like beliefs, desires, love, unconscious conflicts, etc) are wrong - these things (beliefs, desires, etc) do not actually exist! Some of the evidence for this position comes from the fact that theories that attempt to explain human behavior using these mental concepts often do a really poor job of predicting, let alone explaining, that behavior. Materialists argue that this poor showing is because these theories are using concepts that have nothing to do with the real world. 3. Identity Theory (eg: J.J.C. Smart): Each and every type of mental state is identical with some type of physical/ neurochemical state. Eg: Just like "light" is identical to electromagnetic waves, "pain" (a mental state) is identical to stimulation of nociceptive fibers of the hippocampus (physical state). NB: This is claiming more than mere correlation of states; there is an identity. The identity theory is similar to eliminative materialism in its emphasis on the physical side of things, but here there is no need to throw out all our mental terms and theories that refer to them. These theories and concepts can still be scientifically very useful. In other words, mental terms can be "translated" into physical phenomena ("love" is actually the firing of these neurons). B. Abnormal Psychology 1. Basic Question: Is the cause of mental illness in the mind or in the body? 2. The Body: Medical Models of psychopathology. a) disease models - an altered state of the organism, a break with its natural state caused by some etiological agent. b) constitutional models - inherited disorder, an inborn characteristic. c) diathesis-stress models - a constitutional/inborn vulnerability plus environmental factors (ie: general or specific stress) (Meehl, 1962). d) combination - some combination of (a), (b) and (c). Sum: Psychopathology is caused by physiological and biochemical activities of the body and especially the brain. Mental phenomena are a) symptoms, and b) epiphenomenal (for the most part). 3. The Mind: The causal factors are in the mind: desires, conflicts, motives, attributions, delusions, dreams, plans, implicit theories; whether conscious or unconscious. Thus, psychological phenomena are meaningful (causal) in their own right. These inner experiences are necessary to explain psychopathology. There are various theoretical orientations that see the mind as important: eg - psychodynamic theories (Freud and others), where it is argued that unconscious psychological conflicts and the various psychological processes we engage in to deal with these conflicts accounts for who we are and what we do. Note: There are also theories that focus on neither the mindnor the body: 4. The Environment: Behavioral models. The cause of psychopathology is unique sequences of environmental events: contingencies and conditioning. 5. The Social: Interpersonal approaches. The roots of this orientation are with the school of Symbolic Interactionism (eg: G.H. Mead, Cooley). The emphasis was on reflected appraisals and the "looking glass self" - we come to see ourselves as others see us. Thus, the Interpersonal approaches today perceive the cause of psychopathology to be in our interpersonal communications. III. Determinism vs Indeterminism A. Basic Question: Do humans have free will? Is there such thing as free will, or is it a myth? B. Determinism: Medical models, Behavioral approaches. Events have causes, and by altering the things that caused the events you can influence the course of future events. Behavior is predictable and controllable. Typically, this position is expressed thusly: A combination of heredity and environment causes human behavior. (ie: Nature and nurture make us do what we do). Therapy is therefore directed at discovering the underlying causes and changing them: through drugs, surgery, or behavioral engineering. C. Indeterminism: Humanistic and Existential approaches. Human beings possess the capacity for free will and they are responsible for their acts - this is the essence of our humanness and dignity. (Sartre: "I am my choices". Weckowicz (1984): "We are the architects of our own lives"). This emphasis on freedom and choice means people are unpredictable, and therefore uncontrollable. Indeed, to control someone is to deny them what is essential to their humanness - their free will. D. Intermediate positions: Psychodynamic, Cognitive, Interpersonal. Behavior is caused by various events, but also their is to some extent a degree of indeterminism. eg: Freud: On the one hand, there is determinism: psychological determinism (unconscious drives, motives, conflicts). We experience this when we feel compelled by our compulsions and fears - our free will feels restricted. On the other hand, psychoanalysis allows more conscious control and the ability to make free(er) choices. The patient moves from being a slave to his/her passions to being a rational free individual. However, Freud does admit that we are rarely completely free of the unconscious forces. IV. Value-Free Science Abnormal psychology is a branch of Scientific psychology. A science strives to be value-free so as to provide veridical accounts and explanations of reality. However, it is increasingly recognized that values do influence the scientific process (Howard, 1985; Kuhn, 19 ; Weckowicz, 1984). Different values are espoused by the various theories of psychopathology, either explicitly or implicitly. This is especially important when the science is an applied one, such as Abnormal Psychology (Weckowicz, 1984). The role of values in the science of psychology George Howard, in American Psychologist, 1985: A. Making value judgments is an essential part of the work of science. The question is not whether but how values are embedded in and shape science, and what that means in fields like Psychology where the subject matter is human beings. Current beliefs, assumptions and values influence what you choose to study, the findings you expect, the results you actually obtain, and how you interpret the results. For example: Shields (1975) reviewed sex difference research of the past century and found that instead of correcting society's misperceptions, the research findings reflected the dominant values of the period. Howard is not arguing that science is actually just values in disguise. But he is arguing that values play a part in the scientific process, even though scientist rightly control them as much as possible. B. Traditionally, the scientist is supposed to just observe nature. Nature is not supposed to react to being observed. However, as quantum physics has taught us, it isn't always so: the nature of what the physicist observes depends on being observed and how it is observed - depending on the physicist's assumptions and methods of observation, he/she will either see a particle atomic phenomenon or a wave atomic phenomenon. Or let's look at an example of this in the field of psychology: Why do psychologists like to observe people through one-way mirrors? Obviously it's because if the person being observed is aware of the observer, his/her behavior is likely to be altered. [Of course, it's not so certain that the presence of the mirror and the person's knowledge that someone is behind it watching them doesn't also effect the person's behavior!]. So, when the "things" being observed are people, it is very possible that the mere act of observing them will influence them. The role of values becomes particularly salient given the unique nature of psychology's subject matter - human beings. Humans, argues Howard, are active agents in the world; as we watch them, they are watching, deciding and acting based on their own models, scripts, and implicit theories which they construct. Given this unique nature of the human being (the watcher/actor/theory- maker), an interesting thing may be happening in our science: There is a reciprocal relationship or interaction between the scientist-observer and the individual-object. Analogous to the observations the physicist made of atomic phenomena, the observations psychologists make of humans and the theories psychologists construct will affect humans. For example, humans may come to believe the results, the models and the theories and act accordingly. If I'm observing you, and you are aware of that, and if you also know that I believe you are mentally ill or that I think being emotionally expressive is the best way to be, then after awhile you may come to act accordingly, especially if you believe me to be an Expert a scientist, psychologist, etc). My beliefs and values can influence you. C. The issue is this: If human nature is influenced by how science views it, not only should we consider whether values can be removed from psychological research (which is unlikely), but we must also consider if they should be removed. There are many who argue that "yes, we must remove values from any science". However, to do away with values (what's good/bad, the shoulds/oughts, ideals) we may run the risk, argues Howard, of constructing an impoverished, overly rigid vision of humanity, ignoring what humanity could become. D. Howard's solution: Because values and thus theoretical orientations inevitably influence our findings, psychological research findings should be looked at not as demonstrating what necessarily occurs in the world (some objective reality), but what is possible if human beings are considered from a particular perspective. Each perspective has something to offer; no one is the correct perspective. E. The theoretical controversies we will confront in this course arise largely because each perspective is claiming itself to be the model of objective reality. The controversies and debates are seen in a different light, perhaps less hot, when viewed from Howard's position. V. Mental Health and Morality A. The terms "mental health" and "mental illness" are entangled in moral and legal issues. Can mental illness/abnormality be distinguished from sin, crime, and immorality? "Mad or Bad?" Here is the dark side of the humanist's coin: if people have free will and are responsible agents, then are they not accountable for all their actions? B. The Insanity Defense: Freedom of choice/free will is constrained and distorted by mental illness - the person acts under duress and is therefore not responsible. With most crimes, conviction requires proof of the particular act (actus reus) plus proof of a particular mental state (mens rea = culpable mind) (Ennis, 1982). In other words, in addition to showing that the person did the crime, it must also be shown that the person had a conscious objective to commit the act. This is the heart of the Insanity Defense used with people like John Hinckley, Jr. (Hinckley tried to assassinate President Reagan on March 30, 1981 - he succeeded in wounding both Reagan and an aide. He was tried and found not guilty by reason of insanity. He was confined to a mental hospital). The controversy is concerned with how you tell whether an adult has free will? It is a highly subjective judgement - there is no clear criterion. Expert witnesses contradict each other. "One person's delusion may be another's religion" (Cohen, 1982); or in the words of Lily Tomlin: "If you speak to God, it's a prayer, if God speaks to you it's schizophrenia". The question is: does mental illness impair free will? This is an unresolved, inherently philosophical question. VI. Autonomy vs Conformity A. The basic question: What is the basis of mental health? Autonomy of the individual or conformity to society? B. Conformity: A model of humankind and society which argues that the best world is one in which there are few disruptions, where conflict is rare or even nonexistent. The best way to achieve this is for people to conform to particular ideals or ways of acting, etc. The goal is for smooth, undisrupted functioning. C. Autonomy: An "open system model", with a goal of growth, development and change. (eg: humanistic psychology's emphasis on self-actualization; conformity leads to mental illness). D. A Combination: Some people claim (C) is the "best" - especially in the U.S. where so much value is placed on individualism. But imagine what life would be like if there was no conformity? Imagine what your life would be like if you never attempted to conform. Most theories of mental health (explicitly) take the position that a combination of conformity and autonomy is important for mental health. However in practice (ie: implicitly) there is still much debate whether the various theoretical orientations are taking a combination approach (Rappaport, 1977). This leads us to the issue of the rights of individuals (especially mental patients) vs the rights of society. Sometimes these may be incompatible. What choice the clinician makes is crucial for defining his/her role as clinician. VII. Conclusions We have discussed 5 philosophical issues that are fundamentally intertwined in the topic of Abnormal Psychology: The relationship between the mind and body, determinism vs indeterminism, the place of values in psychology, mental health and morality, and autonomy vs conformity. These issues will arise repeatedly throughout this course and it will be important to explore them as they do. Such explorations may help us clarify some of the confusion across the different theoretical orientations.