Saturday, October 5, 2013

The Ontology of Psychology (ter)

To begin, explicit talk of structural units:

The unit of social intercourse is called a transaction.
-- Eric Berne, Games People Play (1964)

Whence the label for the analytic/therapeutic movement he launched, “Transactional Analysis”.

Birdwhistell calls each of these movements a kine, or the smallest recordable movement.
-- Julius Fast, Body Language (1970)

… the collective unconscious  and the functional units of which it is composed -- the archetypes.
-- Anthony Stevens, Jung: A Very Short Introduction (1994), p. 47


The notion of a culture unit, the most basic element of all, has been around for over thirty years, and has been dubbed by different authors  variously as mnemotype, idea, idene, meme, sociogene, concept, culturgen, and culture type.  The one label that has caught on the most, and for which I now vote to be winner, is meme.
Edward O. Wilson, Consilience (1998), p. 136

Actually, in anthropological and folkloristic structuralism, the notion of such units has been around rather longer than that -- Wilson cites an example himself, George Murdoch’s “classic 1945 compendium”. --   Anyhow, Wilson believes that, by working with such postulated units (how like an atom; how like a gene) we may pursue “the central program of consilience, in this instance the causal connections between semiotics and biology."
Causal, note;  strong stuff.  Even physics has in many areas backed off from this terminology of the one-way street.  (What caused the pion to decay at that precise instant, rather than another?  Um…)


Psychiatry, like any branch of medicine, seeks to heal.   And though  a priori  ills need not come packaged in discrete categories, it is so much more convenient if they are.

Character disorders  do not form a nosological unit.
 -- Otto Fenichel,  The Psychoanalytic Theory of Neurosis (1945), p. 539

The old pathological approach, which persists in general psychiatry to this day, describes mental illnesses  as distinct ‘entia’, each presenting a specific clinical picture.
-- Anthony Stevens, Jung: A Very Short Introduction (1994), p. 123

The taxonomy of physical nosology was aided by the discovery of pathogens,  freeing the clinician from the ambiguities of symptomatology.   Where these are absent or multiple, the disease is often ill-defined -- cf. the complexus of the various cancers.  

A historical example:
As to the nosological status of paranoia, Freud agreed with Kraepelin that it should be grouped together with the various forms of dementia praecox, rather than being a distinct entity.
-- Ernest Jones, Freud: Years of Maturity (1955), p. 271

Psychiatry gets even less guidance from microbiology or histology, leaving its taxonomic task problematic.   The attempt is made, nonetheless, every several years, to formalize this down to the last detail, in the much-discussion DSM -- the Diagnostic and Statistical Manual of mental disorders.   Aetiologically problematic to begin with, their stabs at classification have by now been largely divorced from genuine science, the DSM serving mainly simply as a tool for getting reimbursed by insurance companies, rather than any actual assistance to the diagnostician.   The whole enterprise descends to the level of a reductio, as various prickly pressure-groups veto the identification of the misbehaviors that typify them.  These, then, are meekly deleted.  (The labels vanish; the behaviors persist.) Yet the protestors have won but a Pyrrhic victory, as they still need treatment, and want to be covered by insurance;  hence the medical profession must invent euphemistic new categories to cover the old territory.

“There are no schizophrenics;
there are People with Schizophrenia.”
-- Elyn Saks,  2013;  professor of law, and herself a schizophrenic

That slogan, although posing as the denial of the existence of a certain class of entities, while affirming that of another (oddly, coextensive with the one that supposedly does not exist),  has actually nothing to do with ontology, but is simply a familiar move  in the game of rhetorical manipulation by interest groups.   Whether schizophrenia does or does not form a “nosological unit”, is a very open question;  but this “People With …” ploy  is a mere quibble.

A sort of upside-down version of that rhetorical move, from general medicine rather than psychiatry:

Even the hard-headed authors of current medical textbooks  sometimses find it necessary to inform their readers that [quoting from a 1953 text] ‘there is no disease, only the diseased … disease has no real existence.’
-- Jonathan Cohen, The Diversity of Meaning (1963), p.

While we’re (sort of) on the subject -- savor this tragic disorder which The World of Doctor Justice was the first in the world to identify:  Oligophrenia mathematica.   I shall be lobbying for its inclusion in the next edition of the DSM, and expect gigantic retroactive payouts from my insurance company.

[Update 1 Aug 2013]  The current issue of the London Review of Books  has an article by Ian Hacking on the new DSM-V.  He acutely quotes Darwin saying: “All true classification  is geneological”.  For nosological taxonomy, whether physical or psychiatric, that translates to aetiological.  And, remarkably, the NIMH has suddenly taken this philosophico-methodological precept to heart, having announced, just a week before the DSM-V was released (and thus rather spoiling the launch), “that it was going to abandon the DSM because it dealt only with symptoms.”

For an ususual sort of psychological thriller,
try this
Murphy Calls In a Specialist
 [Kindle] [Nook]

[Psycho-sociological appendix]

The more intensively we analyze the “self system”, the the more apparent it becomes  that the true unit in the social process  is not the biological entity comprised of man the organism:  rather, each unit is a person-to-person context.
-- Harold Lasswell, Psychopathology and Politics (1930; 2nd edn. 1960; re-issued 1977), p. 287

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