- Getting the Personal Perspective into View
the personal perspective, first-person authority, intentional action, empirical generalizations, functionalism, Nisbett, Nagel, Williams
There is a Long-Standing concern that psychiatrists have the task of fitting a square peg into a round hole: the empirical generalizations upon which diagnoses are made have seemed too many to overlook something essential about the individual person who is the subject of the diagnosis. This concern prompted a World Psychiatric Association (WPA) workgroup to suggest that a personalized component should be added to patients’ diagnostic assessment (IDGA Workgroup 2003). One might have the following worry about the WPA workgroup’s suggestion: if this personalized component is merely tagged on to the existing diagnostic framework, and diagnoses still rest primarily on empirical generalizations, which are left untouched by this added personalized component, then it is far from clear that anything has really been gained by the addition of the personalized component.
Now the hope of integrating a personalized component into diagnostic practice in a meaningful way presumes that we have a reasonably clear understanding of what such a component would amount to in substantive terms. However, the notion of personalization is vague as it stands. In what follows, I suggest a way of conceiving of the personalized component and offer one reason for believing that it is indispensable to psychiatric diagnoses.
To begin with, I take it that the integration that is sought after is the integration between the personal and the scientific perspectives 1 There have been at least two motivations for wanting include the personal perspective within the specific context of psychiatric assessments. In what remains, my focus is on the first motivation.
1. The metaphysical motivation: Human actions are a distinct kind of event, they are performed for a reason, and agents explain what they do by justifying their actions. This contrasts with brutely causal explanations of events, which involves subsuming properties under true empirical generalizations.
2. The ethical motivation: There is a strand of thought in recent history of philosophy, most famously associated with the philosopher Levinas, that argues we should resist the tendency to understand persons in terms of generalizations (especially stereotypes).
Thinkers inspired by the metaphysical motivation hold that explanations of human behavior that appeal to empirical generalizations and those that consist in justifying an action by appeal to reasons are of entirely different logical orders. It is conceptually incoherent to try to reduce explanations of the latter sort to explanations of the former sort; and conversely.
If you accept this idea, and you think that understanding a person involves having his actions (rather than mere behavior) in view, then you will think that the personal perspective is ineliminable to an adequate understanding of the person being [End Page 127] diagnosed. For example, although a generalization may register, of an individual person, that she went without sleep for 72 hours because she was experiencing a manic episode, if this is all we had in view, our view (of the person) would be incomplete if this person also offered a justification for staying up for 72 hours, namely that she was experiencing a bout of creativity and that she wanted to make the most of it by completing an essay she had to submit next week (in the language of belief–desire psychology, she had the desire to submit a good essay next week, and believed that by writing the essay now, while feeling creative, she would produce a good essay).
How does the existing DSM multi-axial diagnostic assessment deal with the subject’s own justification for her disrupted sleep behavior? Does it bring her personal perspective into view? In favor of the claim that the DSM framework already does this, one might argue that the generalizations that DSM-based assessments depend upon (e.g., psychobiological, psychological, psychosocial, and sociological laws) are not reducible to so-called natural laws (the laws found in basic physics and perhaps basic chemistry). However, although it may be true that psychological laws are not reducible to natural laws, it does not follow from this alone that explanations that appeal to psychological laws are explanations that consist in justification. It may simply be...