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.

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Hi Bob,

Sadly, I don't have the time to go read it and will defer on trying to read and figure out how your full argument relates to something I have not read. But, never at a loss of willingness to walk over the edge of a cliff on my way to the abyss...

Would not 'madness' have been socially constructed in yesteryear's metaphysical discourse? Why madman rather than prophet, seer, healer?

Is not, the treatment of cholera or smallpox a 'regime of power?'

After all, one might argue, there is no shortage of pestilence in the world and various 'regimes of power' choose which populations to allow to enjoy the fruits of pestilence while the same or other 'regimes of power' also decide which populations to deprive of the fruits of pestilence with 'treatment.'

Hard for me to see how 'disease' is not the end result of a social construction and treatment of it mediated by social construction of whether or not it ought to be allowed to run its course.

It is getting clearer and clearer to me that when a "treatment" is invented or discovered, a "disease" has to be identified in order to sell the treatment (for example, RLS!)
Well done Robert - very entertaining blog.

Trouble is that anyone with half a brain can see that Foucault and most other pseudo-academic tosh is not worth the paper it is written on.

In one way all the devotion to Foucault and the other philosophical phoneys ironically support his case that we create cultures of power or some such - because otherwise surely no literate person outside these
cultures could take these guys seriously for more than five minutes.
Thanks for the kind words.

I think you make an interesting point, actually, about the cottage industries which grow up around intellectual grifters like Foucault and Derrida. I am beginning to believe that relativism about truth, and radical skepticism, have some sort of strange power over the human mind. These notions seem to show back up, again and again in the history of ideas, just slightly repackaged. An "eternal return," of sorts. I guess they are what Dennett and Dawkins would call "pernicious memes."
Hi Bob

That is an interesting point too. I think the phenomenon is religious and also a powerful psychological defence mechanism. It is religious because relativism consigns us to a place where we can never know the truth - all we can do is have some faith that something we can never know is holding whatever we take to be real together. It is a defence because people find something comfortable and homely in being able to think that WE make reality. So it allows these guys to assume at the same time that we are ultimately powerless but also that it doesn't matter because we can live in the worlds we (somehow - not at all clear how!) choose to live in. Weird, and more than a little sad.
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