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alexandra_k
October 19th, 2006, 11:42 PM
Objectivists maintain that whether someone is mentally disordered is determined by facts about the individual.

Subjectivists maintain that whether someone is mentally disordered is determined by facts about whether their behaviour is judged to be inappropriate / unwanted etc.

Wakefield attempts to carve a middle way between the objectivists (realists) on the one hand, and the subjectivists (social constructionists) on the other. He maintains that there are two individually necessary and jointly sufficient conditions for mental disorder.

1) Malfunctioning mental mechanism/s within the individual (objective condition)
2) The effects of the malfunction/s are judged to be harmful (subjective condition)

He attempts to cash out the notion of 'malfunction' and the related notion of 'function' in such a way that it is objective (is not dependent on normative / subjective judgement). In doing so he appeals to work by Neander and Millikan on naturalising biological function.

A is followed by B (at least some of the time)
B is beneficial to the organism
Due to the process of evolution by natural selection...
The presence of A can be explained by the beneficial effects of B
And hence B is the biological / natural / proper function of A.
(Or A has the proper function of producing B)

E.g.,

The heart has a variety of effects.
It makes thumpity thump noises and it pumps blood, for example.
(A is followed by B and A is followed by C)
If hearts made thumpity thump noises but didn't pump blood then the organism wouldn't be around very long, however. If hearts pumped blood but didn't make thumpity thump noises then the organisms would be okay. Because of this we can say that while the heart has a variety of effects the proper / natural / biological function of the heart is to pump blood. The notion is that that is what hearts have been designed to do by the blind forces of evolution by natural selection.

Evolutionary psychologists typically assume that the mind is composed of different mental mechanisms and these mental mechanisms have evolutionary functions. Wakefield thus thinks that evolutionary psychology is the right science to tell us whether there is mental disorder or not.

What do people think about this?

E.g.,

Wakefield, J. 1992 'The Concept of Mental Disorder'. American Psychologist 47: 373-388

Wakefield, J. 1992 'Disorder as Harmful Dysfunction: A Conceptual Critique of DSM III-R's Definition of Mental Disorder' Psychological Review: 232-47

Wakefield, J. 1996 'Dysfunction As A Value Free Concept' Philosophy, Psychology, and Psychiatry 2: 233-246

Wakefield, J. 2000 'Spandrels, Vestigal Organs and Such: A Reply to Murphy and Woolfolk's "The Harmful Dysfunction Analysis of Mental Disorder' Philosophy, Psychology, and Psychiatry 7 (4): 253-269

James Brody
October 20th, 2006, 05:57 PM
"Wakefield thus thinks that evolutionary psychology is the right science to tell us whether there is mental disorder or not."

Hello Alexandra....

1) All males have something to sell, Wakefield has something to sell: be cautious. EP sometimes has problems justifying its own sanity. A friend too long out of contact, Dylan Evans, was really into this topic about 10 years ago. Check also Stevens & Price. And tell Dylan that I said "Hi."

2) Peers (starting with mothers, then wives, the guys on the team or at work) pull us into synchrony with them.

3) Synchrony lapses have varied consequences.

There is probably no dependable relationship between what a person does and what is called crazy.

Gordon Paul (about 1963) discussed sync lapses but didn't use that term. People are institutionalized if:

1) They are poor
2) They are bizaare
3) They have no supportive family
4) They are deficient in self care.

All four are required, have one of them intact and you will likely remain free.

Todd, Fred, Cary...behave!

JB

alexandra_k
October 23rd, 2006, 02:01 AM
Hey. Thanks for your response.

I did find something in the archives about this topic...
:-)

> There is probably no dependable relationship between what a person does and what is called crazy.

Wakefield maintains that the DSM criteria is over inclusive. The DSM allows that dysfunction can be purely behavioural whereas Wakefield maintains that harmful behaviour must be caused by malfunctioning inner mechanisms. One example of this would be if there were two people who similarly met criteria for a reading disorder. If one person met behavioural criteria because they had malfunctioning inner mechanisms that prevented their being able to read then they would (intuitively) have a mental disorder. Of one person met behavioural criteris because they had never had sufficient instruction in how to read, then they would not (intuitively) have a mental disorder. Wakefield maintains that person-environment mismatches that aren't caused by malfunctioning inner mechanisms may well constitute 'problems in living' that can benefit from treatment. He also maintains that those individuals aren't mentally disordered, however.

My intuitions go with him on that... But battles of the intuitions can be tricky...

> People are institutionalized if:

1) They are poor
2) They are bizaare
3) They have no supportive family
4) They are deficient in self care.

All four are required, have one of them intact and you will likely remain free.

There have been many abuses of psychiatry... Wakefield would maintain that while we might well instututionalise a person if they are poor, if their behaviour is bizarre, if they have no supportive family, if htey are deficient in self care whether or not they actually are mentally disordered is determined by whether they have malfunctioning inner mechanisms.

I guess there are a variety of things we want a psychiatric nosology (taxonomy) to do:

1) Provide natural kind categories that are useful for scientific research
2) Provide some indication of which treatments are likely to benefit (related to but seperate from the first condition)
3) Provide some indication of who we should treat and / or who is / is not responsible for their conduct (related to but seperate from the second condition)

I'm interested in the prospects for developing a science of psychiatry / psychopathology (the first project).

A few things that I find interesting about Wakefield's account:

- How do we specify the relevant (bio-medical) function of mental mechanisms?

One problem here would be when mechanisms are selected by evolution for one function but when those mechanisms are maintained in the population for another function. E.g., the mechanisms that subserve language.

If the appendix doesn't have a function then it seems that the appendix can't malfunction in Wakefield's sense (which seems counter-intuitive). Problems of spandrels and vestigal organs - if their are mental spandrels / vestigal organs then these can't malfunction... Wakefield maintains that while the appendix can't malfunction at the organ level it can malfunction at the tissue level. What level of analysis (biological, psychological etc) is relevant for function / malfunction?

Wakefield is trying to capture our realist intuitions about mental disorder. Realist intuitions being the idea that there is such a thing as mental illness and whether a person is mentally ill or not is determined by facts about that person.

If realist intutions are wrong then whether someone is mentally disordered or not would be determined on the basis of the judgements we make about the inappropriateness or undesirability of their behaviour. The anti-psychiatry movement seems to think that this is what actually happens and when they say 'there is no such thing as mental illness' they seem to be denying that there are facts about the person that determine whether they are mentally ill or not.

Margaret McGhee
October 24th, 2006, 11:05 AM
I saw this and thought it might be relevant to your topic.

http://scienceblogs.com/corpuscallosum/2006/10/is_it_disease_or_delusion_us_t.php#more

Margaret

alexandra_k
October 28th, 2006, 05:37 AM
Hey James,

> Wakefield has something to sell: be cautious.

Do you know something I don't? My understanding is that he is a Social Worker... He has written close to 20 papers on his 'harmful dysfunction' (HD) analysis of the concept of mental disorder, though. His stuff has been fairly influential but I'm finding it hard to make sense of his view... I just liked the way he appealed to evolutionary psychology as the science that was relevant to fixing mental (and physical) functions.

> EP sometimes has problems justifying its own sanity.

Yeah. Adaptationist assumptions are hard too... There is some stuff on mental disorders being adaptations but then they couldn't be due to malfunction... One notion is that the genes relevant for certain kinds of mental disorder might be like the genes relevant for sickle cell anemea. I can't remember what it is called... But basically if you have a dominant and a recessive gene then you are resistent to sicke cell anemia (which is good) when you have both recessive then you are succeptible (which is bad) if you have both dominant then you have sickle cell anemia (which is bad). Because it is good to have one of the genes the genes are still around in the population. Sorry I probably messed up the example (something to do with sickle cell anemia and / or maleria though) and there is a name for it... Heterozygote advantage? My knowledge of biology is fairly minimal... This is controversial anyway.

> A friend too long out of contact, Dylan Evans, was really into this topic about 10 years ago. Check also Stevens & Price. And tell Dylan that I said "Hi."

I found a post in the archives (early archives on this site) where you were responding to someones thoughts on the topic. I thought you might still be interested, that is why I posted about it. My thesis has evolved from emotions to psychopathology more generally (and psychiatry in particular).

> There is probably no dependable relationship between what a person does and what is called crazy.

Yeah. Though... You could say there is a dependable relationship between what a person does and what is *justifyably* called crazy. Or you could say that there is a relationship between what a person does together with the best theory that we have of their behaviour (that they have a malfunctioning mental mechanism) that together determine whether the person is crazy or not. That is the way Wakefield goes.

The DSM allows the malfunction to be purely behavioural. Wakefield maintains that this has the result that the DSM is over-inclusive. Wakefield maintains that if we think a little harder... Take a person who meets DSM criteria for a reading disorder. If they meet the criteria due to inner malfunction then they are appropriately considered to be mentally disordered. If they meet criteria due to their never having been taught to read, however, then Wakefield maintains that intuitively they do not have a mental disorder though we may consider them to have a problem in living that is worthy of treatment.

Another example would be if we take a smoke detector. Smoke detectors are designed to have a certain number of false positives. It is better for them to go off when they don't have to than to not go off when they should. If we put a smoke detector near the stove then it will go off all the time, however. Wakefield considers that the smoke detector isn't malfunctioning, however, as it is in an alien environment that is outside the range of the environments it was designed for. (Analogy for neurotic fear responses in modern environments).

alexandra_k
October 28th, 2006, 05:38 AM
Hey, thanks for that. I've never really looked at Blogs before... I had a look at that one and from that one there were links to other ones... So I had a look at those too... And spend a good half day reading various blogs on science and psychiatry and medicine! Thanks :-)

Margaret McGhee
October 28th, 2006, 05:24 PM
Be careful. It can be habit forming. Enough so that some are considered to have a mental disorder of being unable to leave their computer / online world for very long. :rolleyes:

Cheers, Margaret

alexandra_k
October 28th, 2006, 10:20 PM
Lol. Yeah, internet addiction, I've read a thing or two about that ;-)

It is a controversial notion that was originally introduced as a joke but it is taken fairly seriously now. Substance addictions are controversial... Addictions to things like sex and gambelling even more so... Addiction to the internet even more so... It does seem plausible that people can develop some kind of obsession / compulsion for just about anything, however.

I was reading this study about a person in Germany who developed DID (formerly multiple personality disorder) after spending a little too much time playing role playing games on the internet. The person reported her personalities being developled around themes in the game... Controversial though.

I do spend more time on the internet than it good for me... I like to post at mental health sites and talk to consumers too... I studied delusions a while back and found it interesting to talk to people who sounded delusional. Otherwise there is a danger that I study those kinds of things in a way that is far removed from the actual phenomena that is of interest. And that... I lose my empathy etc.

But yeah, there is a time to post, a time to check out the blogs, and a time to do some work. Speaking of work...

;-)

Margaret McGhee
October 29th, 2006, 01:27 PM
Alex, please don't bother to respond to my posts as I know you are busy with important things. In that light, here are some additonal thoughts on this topic for your amusement when you have a few moments.

The phenomena of addiction (obsessive behavior of various types) I think illuminates something important about the mind. If one accepts my premise that the mind is an emotional computer that produces behavior choice - then, one can say that evolution has created a mechanism in our CNS that uses emotional forces to generally cause behavior choices that ultimately result in propogation of our DNA into future generations. i.e. our minds evolved in a way that they automatically organize themselves to generally produce and respond to emotional forces in such a way as to produce beneficial behavior choices in terms of our survival and propogation.

In that regard, the principle is that we are only capable of making choices that we "emotionally believe" will result in the best outcome in terms of our future emotional well-being. (That's my premise as to how this mechanism operates.)

In that regard, this "emotional level of belief" is the one that counts - what we "think" about our behavior choices is secondary. Further, that when our intellectual beliefs are not congruent with our emotional beliefs - we will change the former (rationalization).

It is possible for persons with a strong committment to reason - to allow their reasonable conclusions on some matter to alter their previously established emotional beliefs. But, I suspect that we are much less proficient at that than most would accept.

We will be free to use our reason when we encounter a situation where we have no strong emotional beliefs. These are areas where usually there is no important survival effect - like which offramp to take to a store we've never been to before.

Also, it is important to see that in those cases where we do alter our emotional beliefs using reason, even thenbehavior choice is still the result of (now altered) emotional beliefs - which, as I have asserted, will always be the case.

Addiction is a prime example of this process. My partner has suffered for the last year from an addiction to Freecell, an internet solitaire game that is available on-line as well as in resident form in one's hard drive. The online version allows the player to immediately compare their cumulative score after each game with others (all over the world) who are currently playing. She developed the ability to score fairly high and apparently is addicted to those competitive aspects of the game.

As time went by - she got better and better at the game and it became a sure and reliable source of fast positive emotions when she was bored or struggling with a difficult task. She was starting to feel terribly guilty about the siginificant amount of time she was wasting online playing this game - and how little work she was accomplishing. She became periodically depressed about this.

Since she has no strong desire to play it alone - she asked me to do something to her computer so that she could not access the game online. This was after trying several other remedies. First, she asked me to hide her wireless modem card - but she needs to be online for her work. (She works part-time as an editor for a national philosophical magazine. She screens manuscript submissions for them and does all her work by transferring files over the internet. Just as background, she has a PhD in political science (Corrected 11/2, her PhD is in Political Theory) and is retired as a researcher for the US Dept. of Education.)

I tried asking her several times a day (in a friendly way) if she was working or playing Freecell. That eventually resulted in her relating to me as her nemesis. Bad for the relationship - so I stopped that. :)

Finally, I went into her laptop one day when she was out and inserted a couple of lines into her system admin area that now re-directs any browser requests for a list of URL's that I specified - to a dead-end. This was a month ago. She is now a much happier person and thanks me every few days for having done that.

As is the case with most addictions - the addictee knowns full well (intellectually) that the behavior is destructive and ultimately will decrease their well-being. Still, the emotional strength of their need to choose the compulsive behavior is far stronger than their ability to resist it. In my view, their intellectual conclusion does not have sufficient emotional strength to overcome their desire - to play the game in this case, and derive the sure emotional payoff.

My analysis - intellectual "knowing" is not emotional "knowing". Only the latter can affect our behavior choices. Saying that, "I know that smoking is bad for me", as many smokers will readily admit, is not really "knowing". It is simply saying some words that I suspect they hope will possibly result in less condemnation for their behavior.

Only when intellectual "knowing" in the form of words and concepts - transforms into emotional "knowing" (of sufficiant strength) can it actually alter our behavior choice decisions. For typical smokers, only when the fear of a terrible death from lung cancer becomes emotionally "real" enough - will that "emotional belief" be able to take part in their decisions.

(A prediction of this theory is that addicted smokers will be more likely to stop smoking after they witness a friend or relative die a painful death from similar behavior choices.)

The example of addiction only makes this more obvious. I assert that all our behavior choices are determined by that purely emotional behavior choice mechanism that evolution has provided for us. A basic problem with modern psychology is in assuming that what we think about things determines our behavior and that our emotions are just interesting side-effects - when the opposite is actually the case. (The whole field of Cognitive Psychology is chasing down the wrong alley IMHO.)

The underlying question regarding mental disfunction becomes a question of how our minds adjust to provide different weights (amplifiers, attenuators plus positive and negative feedback) for various emotional inputs - something we are designed by evolution to do. Certainly, in some cases there is pathology, a diseased tissue in our CNS that does not respond as it should. But the human mind especially - is designed by evolution to provide many different ways to reorganize itself according to changes in its environment.

Addiction, while ultimately destructive to the organism, could be the price we pay for having a mind that is capable of such creative re-organization in response to strong emotional inputs. While some humans may die of their addictions, others' minds may reorganize in ways that create cures for pathological diseases - and even remedies for emotional addictions - in response to similarly strong emotional inputs.

Simply being aware of the destructive power of such addictions is probably the best way to minimize the damage they cause to individuals and to society. Of course, by being aware - I don't simply mean being intellectually aware - I mean being emotionally aware, and therefore having real emotional fear of the damage they can do to us.

Cheers, Margaret

Margaret McGhee
October 29th, 2006, 02:00 PM
After reading that last post back I see the need for an additonal level of explanation:

While what I said above is accurate IMO - an additonal part of that explanation is the human phenomena of "time discount of value". This has been tested in numerous studies. Basically this means, for example, that a small child when asked to choose between a piece of candy right now, and two pieces of candy at this time tomorrow - will invariably choose the single piece now.

We are hardwired to not value the prospect of things in the future as much as we value them at the present time. That is an emotional calculation that we make. In a free market (where persons are free to follow their emotional decision calculator) - things like banking systems emerge where interest is payed on deposits and is charged as a fee for loans, for example.

A smoker values their immediate gratification from nicotine now - more than they value the likelihood that 20 years from now they will not be dieing of lung cancer. They believe emotionally that they will benefit more - their well-being will benefit more - from having a smoke right now - than their well-being will benefit from being lung cancer free twenty years from now. Logically, it makes little sense to a non-smoker - but emotionally it makes complete (emotional) sense to a smoker - at the time.

Likewise, my partner valued the immediate prospect of good feelings from winning a few games of Freecell - more than the prospect that a week from then - she would be feeling good about the additional work she had accomplished in the interim.

But, in all cases these were emotional calculations (albeit discounted for future value) that resulted in behavior choice.

Margaret

James Brody
November 3rd, 2006, 06:20 PM
My apologies: my computer went to sleep ten days ago but now lives again. Apologies for the delay!

In regard to evolution and diagnoses...

1) You can imagine the mind as an emergent network of adaptations, each of which is one of a family of parallel developmental cascades weakly linked to the others (See Rudy Raff, Structure of Life, 1996). You might expect an 80:20 arrangement: 20% of the units take in 80% of the resources. And relative prominence day-to-day predicts degree of impairment if one of them breaks. eg: sex can be a bigger problem than eating. Also, basic stuff for survival is unnoticed unless damaged: sleep, eating, appetite, social dominance, getting laid. (Barabasi calls these things "strategic attacks"

2) Pretend that a domain-general psychopathology exists. Such reflects common language and maybe instinctive good sense.

How could this be if we are modular? Simply pretend that modules are particles and can be described as if a gas or liquid. Conclude that "YOU are crazy" rather than "your mating program needs adjustment."

3) A signal detection model fits either case.

SDM revolutionized much of psychophysics (Swets, Tanner, & Birdsall, about 1963, Psych Review). They distinguished "detection" from "decision-to-report." (Typical Fechner arrangement: graduate students had high thresholds because Fechner enraged if they reported "present" when signal absent. The opposite error, "absent" when present was punished far less. And punishment was far more relevant for Fechner's grad students than for the average camper looking for meteors!

Import: There are two outcomes.

1) There are, for all practical purposes, no absolute thresholds for vision or hearing. Tiny signals get lost in spontaneous or elicited "noise" but observers still do better than chance even when dealing with 1-3 photons or with vibrations the diameter of a hydrogen atom.

In a similar manner, we can find zanyness in anyone!

2) The probability of a "decision to report" depends on consequences for "true" and "false" positives and negatives. Given lots of health insurance, hospitals keep clients longer and treat smaller symptoms. Cut money and also cut durations while raising chances taken with medication or outpatient care. (This arrangement leads to an arms race between malpractice lawyers and health insurance companies.)

There are cultural variations and each culture views itself as doing the "correct" thing. For example, I caught some indignation when suggesting that WD Hamilton had bipolar moments. The preferred outlook of one writer is that science leads to mood swings. Suggesting a diagnosis might extend a life but it also may upset its recipient or a family.

Another example: ADHD is traditionally reserved in the UK for kids who exhibit conduct disorder. Ordinary day dreaming or impulsiveness is managed by paddling as it once was in the USA. American practice is to prefer the stimulant to punishments. The UK is moving to American practices. I think driven by competitions that mothers have for the success of their sons. (Lines up with cross-species research.)

Long term solution: snippets of hair or drops of spit may eventually reveal not only which medications might help or poison you but also the conditions in which you will benefit from them. And we will probably find that derivatives from vasopressin or oxytocin will be very useful for separation anxiety, borderline personality, and the sweet purple dysphoria that follows being dumped.

You should find six papers in the above drivel...

I apologize for my telegraphic style: my DELL went to sleep while I watched. I saw what was happening and backed up my current work with no more than two minutes to spare. My Compaq, however, is not only old but also has no firewall or virus protection. And it's amazing how many important things I had to tell once I had only limited means to tell them! Now the DELL is back and I will again take forever to put stuff up because of my sense of having forever to do it.

Eaagh!

With love and squalor...

JimB

Copyright, 2006, James Brody, all rights reserved.