Contingency, Arbitrariness, and Failure

PICKERING AIMS TO affect the form of the debate about the reality of mental illness. He notices that many influential arguments both for and against the existence of mental illnesses are in an important sense circular. It is observed that a given condition is relevantly similar to conditions we all agree are genuine illnesses and on the basis of this observation it is concluded that it too can be classified as a type of illness—from which it can be inferred that mental illnesses do indeed exist. But Pickering contends that the initial observation can only be made if we already construe the condition in question as a type of illness. Otherwise we may interpret the data differently.

So unless we help ourselves to the categorization whose legitimacy it is supposed to establish, the likeness argument cannot get going. He illustrates his point effectively. Most of his examples are taken from authors defending the existence of mental illness and it would have been interesting to see a more detailed account of the argument working in the other direction. Even so, his references to Szasz (Pickering 2003) are sufficient to convince readers familiar with Szasz's work that a version of the likeness argument (the paradigm approach) is as much at work in his refutation of the existence of mental illnesses as is it in Boorse's proof of their reality.

This is an incisive analysis, which should be taken very seriously indeed by contributors to the debate. Its most immediate implication is a negative one. We should not rely upon any version of the likeness argument to establish the existence (or nonexistence) of mental illnesses: "the likeness argument must fail" (Pickering 2003, p. 253). One important question left unanswered by the paper concerns what form the debate should take, if its criticisms are accepted. Assuming we agree that the likeness argument is methodologically flawed, what should the methodology be for debating the substantive issues at stake? Put another way, how can we break the circle? How is it possible to construct arguments that do not presuppose their main conclusions, and so to make real intellectual progress in addressing this issue? Is this in fact possible? What would a valid argument in this area look like, and what sort of observational premises (if any) would be acceptable as evidence?

On the most skeptical reading of his thesis, Pickering's arguments render the ideal of intellectual progress toward a resolution of this debate strictly unattainable. The circle cannot be broken, because the theory dependence of our categorizations makes the truth about the reality of mental illness either unknowable or irredeemably relative to one's intellectual starting point. Having argued that the likeness argument fails in the case of alcoholism, Pickering states one possible response to this failure on the part of psychiatry as the concession that the classification of alcoholism as an illness is "very much a matter of opinion (2003, p. 250). Because he then argues that the argument fails for logically analogous reasons in the case of schizophrenia, we may feel invited to draw the same conclusion about that condition. He later admits there is "some truth in the charge" that "the rejection of the likeness argument seems to introduce an unacceptable element of contingency into the way important questions about the categorization of schizophrenia and alcoholism are answered" (p. 253). His response to this is that it is not his arguments that lead to this element of contingency, and he reiterates that the likeness argument cannot get beyond such contingencies (p. 253).

Certainly he seems committed to the view that no observational premises can "decide, or help decide, the issue" because the "detectable and observable features" of a purported mental illness "do not determine what description should be given of them" (p. 250). Even the fact that a particular description seems intuitively irresistible or "natural" cannot decide this. His argument on this point concerns the fact that what appears natural or intuitively obvious to us is...