Abstract

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.3 (2003) 267-271 [Access article in PDF] Likening Strikes Twice:Psychiatry, Osteopathy, and the Likeness Argument Stephen Tyreman PRIMA FACIE PSYCHIATRY and osteopathy do not appear to share much common ground; however, in at least one important respect they pursue similar goals. By seeking to consolidate their independent identities, each is challenging the dominance of the medical model. This involves justifying what they do and why they should exist as independent professions. With osteopathy the situations are different in the United Kingdom and the United States, but in both countries the same challenge exists (Howell 1999; Tyreman 1998). Broadly, it boils down to how osteopathy is positioned in relation to conventional (orthodox or allopathic) medicine and, particularly, to how its practice and theory is validated by scientific methodology. Howell, an allopathic practitioner, sums up the situation as he sees it in the United States by concluding in his New England Journal of Medicine editorial, "many people—even osteopaths—question what it is that osteopathy has to offer that is distinctive.... The paradox is this: if osteopathy has become the functional equivalent of allopathy, what is the justification for its continued existence? And if there is value in therapy that is uniquely osteopathic—that is, based on osteopathic manipulation or other techniques—why should its use be limited to osteopaths?" (1999, 1468). In the United Kingdom, with the passing of the Osteopaths Act in 1993 and the establishment of statutory self-regulation, the profession has been trying to define itself by identifying its raison d'être and the extent to which it aligns itself with medical assumptions.Fueling this dilemma, which in different ways affects psychiatry and osteopathy (and other professions supplementary to, allied with, or complementary to medicine), is the same question: does the paradigm of physical illness, explained and validated by the biological sciences, provide the basic model for understanding and treating all forms of illness—physical, mental, and functional? How are the concepts of illness and disease to be defined and how do such definitions relate to the justification for treatment and other health interventions?Neil Pickering has produced an interesting contribution to the mental illness side of this debate by analyzing the likeness argument, wherein mental illness is said to be a real illness and therefore a legitimate reason for providing treatment, because, in significant respects, it has the same features as other forms of illness acknowledged as being real illnesses. In criticizing the argument he identifies two key assumptions: "that there are features of human conditions... that decide what category or kind, these conditions are a member of" and "that, with respect to the [End Page 267] presence or absence of these features, a condition... is describable independent of the category it is assigned to" (2003, p. 245). He rightly points out that these assumptions do not stand up to analysis and therefore, if indeed they are fundamental assumptions for the argument, the likeness argument must fail. His reason for requiring the argument to fail is that it is not possible to describe (illness) features independently of the category to which they are assigned, which undermines both key assumptions. Therefore all such attempts must fail. He is not clear about what replaces it other than implying that it entails value judgments and human selection.My comments are not so much criticisms of Pickering's conclusion, which I think is correct, but of his reasons for coming to that conclusion, which I think are based on false assumptions; with a different emphasis his argument could be made much stronger.Pickering's argument appears to rest on (at least) three assumptions: he explicitly states that (for the purposes of his argument) illness and disease can be used interchangeably; second, that physical illness is a natural kind; third, that for conventional/allopathic medicine, illness is best understood and explained in physical terms. In addition, and partly as a consequence of the above, there is an implicit assumption that physical illness is the standard against which all other claims to be illnesses should be tested; that is, that...