Disordered Minds: A Response to the Commentaries

Two points above all in Deborah Spitz’s helpful comments seem to call for a response, as she seems to have misunderstood what I was seeking to say. It is good to have this chance to try to express myself more clearly.

First, Spitz rightly sees that it is central to my purpose to distinguish among different types of disorder. But she is wrong to think that the distinction I am after is one between the “biological” and the “psychological,” if by that she means a distinction between types of causation. I make it clear in my paper that I reject Cartesian dualism, and therefore any view which implies that the “psychological” cannot have neurological events among its causal factors. (Causation is always complex, and I think it would be simplistic to say baldly that thoughts, emotions, and so on, are “caused by” neurological changes—but that is another matter.)

The distinction that I wish to propose is not one between the ways in which disorders may be caused but between the different senses in which a condition may be termed “disordered.” Someone’s condition may be “disordered” in the sense that he or she has suffered some biological harm—his life has been shortened, she is suffering physical pain or disability, and so forth. Or one’s condition may be “disordered” in the sense that, as a result of the disorder, his or her life falls short of being a satisfactory one in some nonbiological way: perhaps she cannot cope with the ordinary demands of social life, or he feels a lack of will to get up in the morning, or she is tormented by feelings of guilt. To repeat, this distinction is neutral with regard to causation: I do not hesitate to accept that biological changes can be involved in the causation of many psychiatric conditions of the second type. Nor do I think, as I tried to make clear in my paper, that all mental disorders are of the second type

Dr. Spitz’s second misunderstanding concerns my use of the word moral. I recognize that this was a dangerous word to choose, in view of its modern, post-Kantian usage. But an essential part of my aim was to suggest that there were other possible ways of using this term that might be helpful in thinking about what I have just called the “second type” of disorder. In particular, ancient philosophical usage suggests that we might think in terms of pursuit of the “good life for human beings” rather than acting out of reverence for duty. That ancient way of thinking seems to imply that a life may be “morally disordered”; i.e., fall short of being a good or satisfactory life, even if the person in question does not choose—in our ordinary modern sense of the word—to live that way. My insistence that patients with mental disorders require compassion rather than blame surely ought to have made clear that I do not, as Spitz claims, want to suggest that, for example, people with depression or compulsive patterns of behavior choose to be depressed or to behave compulsively. Similarly, moral education in my sense does not mean being preached at; but rather, being helped to find a more satisfactory pattern of life.

Piers Benn’s commentary is very sympathetic to my project and so requires less in the way of response. His main criticism is that I have perhaps exaggerated the differences between Kantian and Aristotelian ethics. I can accept that I may have done so here, but I think such an exaggeration is justified in order to bring out the more substantive elements of my thesis clearly.

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