Values Constitute the Boundaries in Between the Rules of Nature and Social Recognition

The boundary problem on defining the conceptual scope and limits of a mental disorder may be tackled at either side of the boundary. On one side, philosophers and philosophically minded clinicians tried clarifying the concept of mental disorder and its related concepts of mental illness and dysfunction in their use and definition. On the other side, Mohammed Rashed's article (2021) gives a substantive and refreshing account of this neglected side in terms of social recognition. Thereby the boundary is clarified from the outside through the limits set by the epistemic status of identity claims and the diachronic and synchronic unity of the self-conceptions that make up a person's identity.

Stimulated by and building on Rashed's approach, I highlight some of the strengths and the crucial growth-points by which some of the limitations to Rashed's approach will be apparent and may be tackled conceptually. Among the various strengths including the aesthetic clarity, originality, coherence and rigor of his argument, a salient strength of Rashed's approach is that it makes explicit and espouses some of the values that illuminate the boundary. Values are thus not quashed or denied as in the naturalists' attempts to define mental disorder (or diseases more generally) in value-free terms – unsuccessful as these attempts have been (see, for example, the article by Fulford [1990] in which he shows that Boorse does not succeed in averting value terms in clarifying the concept of disease despite Boorse attempting to do so).

The first growth-point concerns the logical qualifiers in a key premise in Rashed's article. The premise is: If X is in the scope of social recognition, X is not a mental disorder. Rashed provides inductively examples of mental disorders for which this premise would be true. This premise is true, however, only if all mental disorders are outside the scope of social recognition, or the weaker version, in so far as mental disorders are outside the scope of social recognition. Rashed's article is neither clear on, nor providing support for which of these qualifiers pertain, but this may be addressed in further conceptual and empirical research.

This issue prompts a second growth-point. If all mental disorders are not outside the scope of social recognition, Rashed's article clarifies only that area of the boundary where there is no conceptual overlap between mental disorder and social recognition. That some overlap may indeed pertain is suggested by a quality of both social recognition and mental disorders – that is, both are matters of extent (or degree) rather than "all-or-nothing" phenomena.

Rashed argues that the theory of recognition presupposes a range of capacities: the capacity to determine the nature of the relation between one's subjective conviction and the social category with which one identifies; the capacity for diachronic unity of self-conception; and the capacity for synchronic unity of self-conception. These capacities are sometimes partially rather than completely affected by mental disorder. That one may be affected in these capacities partially rather than in an "all-or-nothing" way, is for example taken as a given in therapeutic pursuits by which agency is gradually recovered during a therapeutic process – see for example the March 2021 issue of Philosophy Psychiatry and Psychology on personal recognition. From the theory of recognition side, further clarification is also required on the extent to which these capacities must be intact for social recognition, which does not feature in Rashed's article and is at best implied in the mentioned PPP issue.

A third growth point, inviting supposedly even more substantive work than the preceding ones, concerns another hidden qualifier to the key premise of Rashed's article. The values that Rashed identifies as operating on the one side of the boundary and on which his account of social recognition hinges, are Kantian deontological values, Aristotelian virtues and the duty and virtue "to care," His account is cogent: these values are relevant and important. Notwithstanding, the values crucial on either side of the boundary are not limited to these values and need...