A Philosophy of Nursing Forum
Thursday, November 16, 2006
Kitcher Said: "Read 'Madness and Civilization,'" So I Did

There are few projects in recent philosophy that I admire more than Phillip Kitcher's defense of a correspondence role for the concept of truth (although I admire Fred Sommers' treatment of the same subject as well), and I think his "Science, Truth and Democracy" is a VERY important book that everyone involved with health care policy and analysis needs to read and reflect on. So, when he said I should read Foucault's "Madness and Civilization," I did.

The book makes a LOT of claims (I'm assuming the English translation I have is accurate - I can't read French). Here are my thoughts on ONE of the claims I think Foucault is making.

Claim - We should view mental illness as "culturally constructed," and therefore individuals who lived in different cultural contexts than we do today just COULD NOT HAVE the same mental illnesses that we do today.

The first thing to say about this claim is that it is an egregious case of either a) begging the question, or b) hasty generalization, or both. IF he means that some behaviors that were thought to be "mad" 400 years ago would not be thought "mad" today (and vice versa), he is clearly correct, but then he has just provided us with another of P.F. Strawson's "non sequitur(s) of mind-numbing grossness."

To take a simple example, 300 years ago you could announce, in Salem, MA, USA, that you had been bewitched, and the town would burn some poor old lady alive. Make that pronouncement today in the same location and YOU will be thrown in the looney bin and be started on Zyprexa, or at least be prevented from handling sharp objects, puppies (remember what happened last time, Lenny!), or your own money. The list of beliefs that counted as delusionary in 1656, and a list of beliefs that count as delusionary in 2006, is not EXACTLY the same list. Wow! Will they really award tenure in France for noticing something like that?

Point being, it still might be the case that some (perhaps many) beliefs would be on BOTH lists. In which case, we have a hasty generalization, and have established, well, nothing.

But, perhaps Foucault means something else. Maybe he means that, for example, while two people might have had Folie a Deaux (otherwise known as shared psychotic disorder) in 1985, people just COULD NOT HAVE HAD Folie a Deaux in 1685, because the cultural contexts are different. But this, surely, begs the question - it isn't an argument. Moreover, it seems wildly implausible.

Whether it is something exotic like Folie a Deaux, or something pretty mundane, like depression, we often come across descriptions of patients from the past that are sign and symptom identical to contemporary patients with these conditions. But are we supposed to believe that something different was wrong with great great great great grandpa than was wrong with cousin Elmer last month, in spite of the fact that they both wet the carpet, howled at a full moon and ended up blowing their own brains out, because they are embedded in different "cultural contexts?" Sorry, I am unpersuaded.

In fact, I am not just unpersuaded that Foucault is right; I am persuaded that he is just wrong as regards at least some (perhaps most) of the conditions we identify today as "mental illness." Comparisons with other forms of illness might be instructive.

I presume that Foucault would NOT deny that we can examine the historical record and determine that, 400 years ago, lots of people died of an acute, diarrheal illness. I would also presume that he would not be concerned to deny that today, people die of cholera, that "cholera" is an acute, diarrheal illness caused by infection of the intestine with the bacterium Vibrio cholerae, and that people presenting with cholera exhibit the identical symptoms of those unfortunates we read about in the historical record. So, did they have "cholera" 400 years ago, that is, an acute, diarrheal illness caused by infection of the intestine with the bacterium Vibrio cholerae, or is acute, intractable diarrhea "culturally constructed," and cannot have the same cause this year as it did 400 years ago?

Let's return to great great great great grandpa (hereinafter GGGGGp) and cousin Elmer. Suppose we do a bit of historical detective work, and consult the family bible (the ultimate repository of family lore in rural North Carolina). Therein we learn that GGGGGp wet the floor, howled at the moon and blew his brains out after a year of drinking a quart of moonshine every day. We learn from Elmer's wife, Becky Lynn, that Elmer wet the floor, howled at the moon and blew HIS brains out after a year of drinking a quart of moonshine every day. We learn from the medical examiner down yonder in Chapel Hill, where all those intellectuals and scientific types are, that Elmer had brain damage from drinking all that moonshine, and that any number of Tar Heels over the years who had wet the floor, howled at the moon and blown THEIR brains out after a year of drinking a quart of moonshine every day had damaged brains too.

All of this information reveals a pattern; perhaps their are Kripkesque, "de re necessities" built into the very nature of brains and their interactions with moonshine. Perhaps, while the activity of making and drinking moonshine is in some sense dependent on, or a product of, cultural context, the EFFECTS on the human brain of drinking a quart of the stuff every day for a year are not.

Perhaps some (many?) instances of "madness" and/or "mental illness" are like "Tar Heel moonshine/brainbecomesmush" syndrome. That is to say, perhaps the behaviors some madman is exhibiting today are a consequence of something being wrong with his brain - lesions on the prefrontal cortex, perhaps, or whacky neurotransmitter imbalances. And, if those same things were wrong with someone's brain 400 years ago, that person would exhibit "mad" behavior too. But, if that is so, then at least sometimes, today's mental illness just metaphysically IS yesterday's "madness," and Foucault is wrong.

Sunday, November 05, 2006
Nursing's Love Affair with Phenomenology: The Intellectual Version of
“What Does She See In Him?"

Whenever a cousin or family friend would bring a new beau by to meet our family, my mother would be the gracious southern lady. Juleps or sherry were served, along with country ham biscuits (sort of tastes like British bacon, but with lots of hickory smoke, sugar, pepper and salt), cantaloupe, and other delectables. Polite probing concerning educational achievement, social status, and net worth would be conducted that had to be, for the victim, about as pleasant as "waterboarding." No sooner were the poor souls out the door than she would turn to my father and ask: "What does she see in him?" He never had a satisfactory answer of course, but he wasn't expected to in any event. The American South is, after all, a matriarchy. There is some information, the nuclear secrets of the human experience, that southern men a not permitted access to, and such questions are asked only to remind us that we don't have an answer, and are, in a way Marx never imagined, "everywhere in chains."

I am in the same predicament when it comes to Phenomenology, at least as Husserl propounded it. One reason might be my "philosophical upbringing;" my philosophical mentors have been, broadly and variously, logicians, pragmatists, process philosophers, Humeans, and neo-Kantians. None of them were particularly "phenomenology friendly." However, I deny that my cluelessness about the virtues of phenomenology is only blind prejudice, acquired in the philosophical cradle, or through Skinnerian conditioning. I think I have good reasons for believing that a phenomenological approach is of only (very) limited value to the intellectual life of nursing today. Moreover, I feel exactly the same way about that line of thought, beginning with Kierkegaard, running through Nietzsche and ending (blessedly) with Sartre, which is labeled as "existentialism" for the sake of convenience. Let's leave existentialism for another post. And, this blog isn't a good vehicle for detailing all of the reasons why I don't think phenomenology is particularly valuable to nurses, or anyone else for that matter (except, perhaps, MA candidates in Sociology who want to justify getting a degree based on a thesis that really amounts to a mediocre autobiography). Instead, I'll just provide a sketch of one such reason, and wait for the fallout.

What, exactly, is phenomenology supposed to do for us? What makes it big news? Supposedly, if I am recalling Husserl correctly through the mists of time, it is supposed to 1) tell us how the mind works, and 2) provide a way to reach apodictic conclusions (conclusions which are indubitable in some way or another). Leaving aside the discussion of #1 for now, how does a phenomenological approach, per Husserl, accomplish feat #2? A follows: by setting aside any assumptions about the existence of an external world and studying only the way things seem, we reach conclusions about which we cannot be mistaken. Or so the story goes. We're all transcendental idealists now!

It isn't hard to see a particular reading of Kant (of which Kant himself might not approve) at the heart of this, admixed with a regrettable dose of Descartes and his attempt to beat the skeptical demon from the first person point of view (the wrong tactic, as far as I am concerned). Phenomenology, as thus described, is a sort of transcendental idealism, making its philosophical living on the supposed distinction between phenomena and noumena. The phenomenal, "lived" world; that world we can "know" about no matter what tricks Descartes' Demon, or mad alien scientists who have "envatted" us, are trying to pull. However, the noumenal, "external" world, the world of the "thing in itself," the world as it is from no particular point of view, is either 1) forever "out of bounds," something that it makes no sense (but only SEEMS to make sense) to even talk about, even though we are compelled in some way to do so, or 2) something which we somehow posit, or infer, on the basis of what we KNOW in virtue of the study of phenomena, or 3) something our minds construct (via mechanisms to be explained at some future, conveniently unspecified, date). On any of these interpretations, the possibility of error is supposedly excluded.

The initial plausibility of the first step in such a project is easy enough to sympathize with. It certainly seems that, as I type this, I am experiencing a seeming of "Stonewall the old black and tan coon dog snoozing on a mat in the corner," and that this is, indeed, apodictic. But, as I recollect, even Husserl would agree that this bit of information is neither particularly interesting nor useful. But there are lots of potentially useful and interesting things I DO want to know; things like: who will read this post, and what will they think of it? Will the Democrats regain control of Congress next week? Do I have any Wild Turkey left in the decanter?

These concepts of IPONS subscribers, fellow citizens, and Wild Turkey, in other words, are concepts of an objective reality; I do not conceive of them as appearances in my mind, but as features and fellows in a world I am happy I share with them. In the case of IPONS list subscribers, for example, my concepts are concepts of a real John Paley, John Drummond, Janet Holt, Catherine O'Neill, Geralyn Hayes, Helen Kohlen, Drerek, Sarah, et. al. My concepts of IPONS members are concepts of persons with bodies existing in an objective reality, extended in time and space, having minds and separate identities, offering handshakes and hugs, and existing outside of my (maybe envatted) brain and in no way dependent on it (fortunately for them - who in their right mind would want to be dependent on my mind for their existence? Or does the question beg the question?)

If the aforementioned memory serves, Husserl wasn't oblivious to this. To grossly oversimplify here, I read Husserl as attempting to demonstrate that we naturally, based on apodictic experience (or perhaps even prior to it), posit, or theorize, or just naturally assume the existence of, other "I's," who also experience a world of seemings, and this in turn gives rise to the conception of an objective world. For these reasons, it is open to Husserl to argue that the fact that my concepts are concepts of objectivity is just what I should expect. The difficulty here is that, the minute we start talking about naturally tending to posit other "I's," the certainty that was the desiderata of this project has disappeared. Why is it not possible that this "natural tendency" is systematically mistaken and misleading? How is it a better guide to the really real than "clear and distinct ideas," and, therefore, how are we any better off with Husserl than we were with Descartes?

Turning to the question of insights into the mind, here too phenomenology may not be really offering us what we need. We want to know not only how the mental seems to us, but also how minds (yours, mine, Stonewall's, George Bush's, our patients, etc) work in terms of interacting with this objective world Husserl claims to have shown that we cannot help but conceptualize. I recall nothing helpful in Husserl when THAT question is posed. Actually, it is less than clear that Husserl would even acknowledge that our minds DO interact with an external, objective reality; rather, I recall him saying at some point that the mind "conditions the possibility of the world," whatever that is supposed to mean.

Notice how most of these problems just go away when we stop goofing around in the philosophical first person, and start our inquiry from the third person point of view. Rather than solipsistically musing about my own seemings, I can begin inquiry when I behold Stonewall on the trail of that ancestral enemy of his blood, the raccoon, and undertake a study of this remarkable creature's truly wonderful capacities to know and act upon his world. Tom Nagel and his misdirected musings about bats notwithstanding, I can learn many things about what it is like to be Stonewall, and others of his brave and noble kind, and come to know how he is able to accomplish the truly amazing feats of which he is capable. There seems to be no conceptual barrier to doing the same thing with others of MY kind, as well, and no good reason to believe that what is true in their case is not also true in mine, and vice versa.

But, if the first person is the wrong place to begin, then phenomenology generally is the wrong tool to use. So, asks my Mom, "what does she see in him?"

This Blog is devoted to philosophical inquiry into nursing. If you would like to POST a paper, contact: philprofbob@care2.com. To comment on a post, 1) go to the bottom of the posting you wish to comment on and click on the word "comments;" 2) type in, or paste in, your comments; 3) beneath the words "choose an identity," at the bottom of the field, select "other" (NOT "Blogger!"); 4) type in your name, perform the "word verification" if required, and preview and publish your comments.

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