Abstract

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 11.4 (2004) 357-359 [Access article in PDF] A Madness for the Philosophy of Psychiatry John Z. Sadler His enthusiasm brimming over with the rich set of ideas and problems he has discovered, Louis Charland's essay on identity, ethics, and the Internet should be grist for the philosophy of psychiatry mill for years. Indeed, a brief commentary cannot answer the many questions raised by his paper. In response, I would like to focus on two general issues for this essay. Labels, Diagnoses, Reference, Experiences Many psychiatrists will take issue with Charland's use of the term label in reference to mental disorder concepts in this paper. I did not, but his relatively uncritical use of the labels and labeling terms in his essay prompts me to unpack some concepts that lurk behind the many other conceptual issues raised here. Psychiatric "labels" and "labeling" have a derogatory sense for many psychiatrists, because they are associated with a virulent antipsychiatry temperament dating back to the 1960s, at least in the United States (Sadler 2003). For many clinicians (as well as others) labeling implies that there is nothing more to psychiatric diagnosis and "mental illness" than the names given to various sorts of human diversity. This sort of psychiatric nominalism, the viewpoint goes, serves to pigeonhole people for the purposes, primarily, of political control or power. Charland's own viewpoint is more subtle than this, illustrated by his discussion of Hacking's "looping effects" and the related idea that social factors are influential in the manifestations, even causation, of mental disorders, but are not exhaustive in explaining mental disorders. However, because the whole matter of social construction of clinical phenomena is at the heart of Charland's discussion, further consideration of this metaphysical territory is warranted.The notion of a mental disorder concept as "label" betrays little about what, substantively, mental disorders are. A label on a can of peas tells us little, ultimately, about the nature of the contents; indeed, it is only a clue. When we shift labeling from a can of peas to a person—a self—then such a shallow clue to the "contents" of a person is an offensive simplification of a person's identity and selfhood. Hence the railing against psychiatric labeling in the 1960s through today.The general goals for psychiatric diagnosis and classification in systems like DSM-IV is are multiple, but at minimum, such denotations of clinical conditions are intended to advance the generation of knowledge about the conditions as well as provide a "shorthand" for clinicians in communicating about and understanding patients' conditions. How successful these diagnostic classification systems are for these and other purposes is a discussion for another time, but the [End Page 357] point here is that some sort of method of characterizing people's distresses is a precondition for understanding and explaining such distresses. The scientific processes of validation of psychiatric categories, at core, are to ensure that, as Gorenstein notes (1992), our clinical concepts are not empty, self-fulfilling prophecies, but rather refer to other, hopefully predictable, features of the patient's distress. Such validation of clinical "constructs" is the basis for developing and testing specific treatments, as well as understanding more richly and deeply the clinical phenomenon. To have a label, then, under this view, is to have an empty nominalization, which is offensive and scientifically vapid. To have a diagnostic construct—a disorder—is to have a concept which empirically refers to, as Paul Meehl put it, a "nomological network" of predictable, lawlike, implications (Sadler 2004a).However, as Charland, Hacking, and others have noted, the reflexivity of the human self and our ultimately crude ways of characterizing selves leads to a serious problem, even for the most rigorously validated psychological categories. That problem is the changeability of the self, the capacity of people to remake themselves according to their own ideas along with the sociocultural ether of ideas that surrounds us all. This means that our understanding of mental disorders, both as aggregates of features, and well as individual patients over time, are "moving targets," the...