- Philosophy's TerritorialismScientists Can Talk About Values Too
Depression, fact–value distinction, is/ought distinction, Kuhn, psychiatric classification
Tamara Browne proposes a provocative idea: She argues that philosophers, sociologists, and bioethicists should act as an independent editorial panel for future editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Her paper depends on some well-versed claims in philosophy of psychiatry: She argues that psychiatric classifications are inherently value laden and philosophers, sociologists, and ethicists are best placed to discern (i) the values are that embedded within scientific descriptions of mental disorders, and (ii) to speculate on the effects of any such classifications on individuals and the populace at large as a result of these classifications.
I agree with Browne that the DSM (and indeed, medicine in general) requires outsiders—among them philosophers (including medical ethicists) and sociologists—to help influence diagnostic systems. My criticism is that Browne delimits the role of outsiders in medicine to the above academics, whom she sees as some category of elite experts in values. In what follows, I argue that the motivation for her proposal rests on a problematic interpretation of the fact–value distinction (one, I argue, that is prevalent in philosophy of psychiatry and does not see facts and values as fully entwined). Building on these comments, I conclude that although an ethics review panel composed of philosophers and sociologists might have (a few) teeth it would have a lot more bite if it also comprised a composite of academics drawn from the rest of the human sciences (including social psychology, evolutionary psychology, cognitive science, and anthropology).
Browne (2017, p. 187) claims that, "there are certain questions that science cannot answer authoritatively where there may be clashes between different scientific groups and decisions made for non-scientific reasons." Following an established tradition of philosophical commentary on the value ladenness of psychiatry she argues that, "there are value judgements inherent in psychiatric classification which are unavoidable and cannot be answered by evaluating scientific evidence alone." In respect of this Browne echoes Sadler (2005) and Radden (1994), the latter of whom argues that "the question of where to draw the boundary between mental health and mental disorder will rest on decisions, not mere discoveries" (p. 198).
First, some preliminary observations impel me to recommend that Browne be explicit about her own views in regard to the following matter: Does [End Page 231] she consider that values are a product of subjective preferences (taste, or whim)? Rejecting the fact–value dichotomy need not oblige us to side with social constructionism and the idea an objective reality (out there in the world, so to speak) is naive; by extension it ought not to compel us to construe reality as wholly socially constructed and socially determined. Is there evidence that Browne supports this extreme value-drenched perspective? Although I would emphasize that Browne does not explicitly attach her views to this framework her paper is consistent with it—and this is troubling. Browne (2017, p. 189) uncritically cites Foucault in support of the claim that "value judgments are inherent in psychiatric classification," and she endorses the view that sociologists (as well as philosophers) are uniquely equipped to discern the values that are embedded in science. Which brand of sociologist does she have in mind? Social constructionists? And, if this is not her stance, why only committee roles for sociologists among human scientists? To embrace a postmodernist agenda (or to fail to distinguish one's position from it) is a mistake.
Certainly, we can agree with the standard wisdom in the philosophy of psychiatry that the fact–value dichotomy is a dogma and one to be rejected; indeed, key developments in post-positivist philosophy of science have taught us that values are deeply entwined with facts (cf. Kuhn, 1962; Polyani, 1962). Cutting to the chase, however, the epistemological problem with social constructionism is that it creates a theoretical void: as Barkow rhetorically asks, "Where do social constructions come from, what are they made of, how do we know them?" (2001, p. 129). Rejecting the fact–value distinction cannot amount to the claim that science is not, thereby, objective...