Still Defining Mental Disorder in Terms of Our Goals for Demarcating Mental Disorder

I thank Eric Matthews and Julian Savulescu for their thought-provoking comments. Unfortunately, I am not here able to discuss all the important points they raise, but must settle for briefly addressing their main criticisms of my view.

Reply to Matthews

I believe that some arguments are rationally irresolvable, but do not think that about all philosophical arguments. In terms of moral philosophical argumentation, though not only that, I share the rather common belief that we should proceed by seeking reflective equilibrium between requirements of logic, the best factual knowledge about ourselves and our environment, and our strongly held evaluative intuitions. (This is not to say that there would always be a clear distinction between facts and values.) By such intuitions I refer, for example, to the intuition that it is morally wrong to torture babies for fun. If we are considering whether it is morally permissible to act in a particular way and realize that acting in that way is in the morally relevant respects similar to torturing babies for fun, we conclude that it is not morally permissible to act in that way. That question is solved for persons who accept the moral intuition that it is wrong to torture babies for fun and wish to take facts and logic into account. This method is useful in the context of defining mental disorder, too.

Although we have some strongly held intuitions as to what mental disorder is about, such as that person A is a paradigm case of a mentally disordered person, referring to them has not sufficed to solve the controversy concerning the demarcation of mental disorder. Therefore, I want to consider the possibility that referring also to the goals we have for demarcating mental disorder could help us in solving it. At this stage of enquiry at least, I thus believe that the controversy is solvable, but only among persons who share certain points of departure. Accordingly, the "our" in expressions like 'our goals for demarcating mental disorder,' whose reference Matthews enquires about, refer to those who share the intuition that A is a paradigm example of a mentally disordered person, consider the demarcation goals significant, want to take facts into account, and wish to make logically valid inferences.

If one cares about the other things but does not want to consider A's case, one can focus on some other case of a person whose psychological capacity for autonomy is diminished. (Unless, of course, one thinks that no such persons exist and all whom we believe to lack psychological capacity for autonomy are really playacting, malingering, etc.) I, however, now continue with A's case. We have, ex hypothesi, sufficient reason to believe that A lacks not merely relevant information, but also the psychological capacity that understanding it and making use of it in assessing her beliefs and desires presupposes. If someone who knows this about A still insists that A is in perfect mental health and wants, say, to treat her as an object of entertainment in a human zoo, my argument is unlikely to reach him. But who is he to say that we should not care about A's loss of capacity for autonomy and the misfortunes it involves?

And of course, also rationally establishing that a person who lacks such capacity is mentally healthy or that the controversy on the nature of mental disorder is not rationally resolvable presupposes that the discussants share some points of departure, including evaluative intuitions. Instead of the intuitions that to be ill is essentially to suffer harm, that behavior governed by one's feelings is always autonomous, and so on, that Matthews refers to, proponents of such views are, however, well advised to resort to less obscure and less controversial intuitions. What, for example, is meant by 'harm'? Is a person who is so overwhelmed by emotions that she is unable to think clearly always autonomous with respect to the actions she performs while in that state? If one takes that all intuitions are useless...