Philosophy of Psychopharmacology

PHILOSOPHY OF PSYCHOPHAPvMACOLOGY DAN J. STFJN* Introduction Psychotropic substances and medications presumably have been used since the evolution ofman, and they are an integral aspect of many cultures [I]. Modern psychopharmacology, however, has had only a short history, starting in earnest during the middle of this century [2]. The subsequent growth of this field has been tremendous, with the development of new classes of agents and more selectively active medications, and with the demonstration of increasing indications for the use of psychotropics. As in other areas of the intersection between medicine and philosophy, a growing body of medical knowledge might be expected not only to present several new philosophical problems, but perhaps also to contribute to the discussion of a number of long-standing philosophical issues. Nevertheless, the intersection between philosophy and psychopharmacology has received little attention. I will consider this intersection it terms of three headings: (1) the definition of mental disorder; (2) the mind-body problem; and (3) the question of personhood. The Definition of Mental Disorder I have previously found it useful to contrast three philosophical stances on mental disorder [3] . This contrast is a schematic and heuristic classification and is not intended to encompass the work of any particular philosopher of psychiatry. The three philosophical stances are those of positivism, hermeneutics, and a synthetic position. A positivist view of mental disorder emphasizes the objective nature of the phenomena that comprise psychiatric disorder. Psychiatrists can observe the data of psychiatric disorder and can determine the laws which *Department of Psychiatry, University of Stellenbosch, P.O. Box 19063, Tygerberg 7505, South Africa.© 1998 by The University of Chicago. All rights reserved. 0031-5982/98/4102-1047$01.00 200 Dan J. Stein ¦ Philosophy ofPsychopharmacology account for these phenomena. There are no distinctions between medical and psychiatric disorders: both are value-free constructs. This view is in keeping with a positivist view of science and language which emphasizes the objective nature of science and the verification functions of language. The hermeneutic view of mental disorder, on the other hand, emphasizes the subjective nature of the phenomena that have been labelled as psychiatric disorder. Observation of the data of so-called psychiatric illness is theory-dependent, and psychiatrists have adopted one language (many others are possible) to communicate about such phenomena. Whereas some hermeneutic philosophers might see physical disorder as an objective phenomenon , all would agree that mental disorder is a relative concept and that its boundaries vary from time to time and place and place. This view is in keeping with a hermeneutic view of science and language which emphasizes the subjective nature of science and the narrative functions of language . A synthetic view ofmental disorder attempts to integrate the previous positions . Psychiatric (and somatic) disorders have both a transitive and an intransitive aspect. The phenomena that comprise disorders, and their underlying generative structures and mechanisms, exist as real objects, but psychiatrists (and other physicians) can only communicate about such entities using historically specific social forms. Although the diagnosis of mental (and somatic) disorder is value-bound insofar as it entails a value judgment , such value judgements can be rationally debated (for example, masturbation is quite rightly no longer considered a mental disorder) . Typical valuejudgments used in determining whether or not a particular entity is a disorder include such considerations as suffering, harm, and lethality, and typically do not include such considerations as moral reprehensibility. This position is in keeping with a synthetic view of science and language which emphasizes that although we have knowledge of real structures and mechanisms in the world, our ways of communicating about such knowledge are socially constructed. It is not the goal of this paper to provide philosophical arguments for or against these positions. I have previously suggested, however, that a synthetic view of mental disorder is better able to account for good clinical theory and practice than are the positivist and hermeneutic views (despite the fact that many nosologists have described their approach in positivist terms) [3]. Similarly, it may be suggested that a synthetic view is best able to account for good psychopharmacology theory and practice (again, even if many psychopharmacologists were to describe their assumptions in a positivist way) . For...