Tuesday 26 July 2022

Dual Processes, Dual Virtues

This post is by Jakob Ohlhorst (University of Cologne) on his recent paper "Dual processes, dual virtues" (2021, Philosophical Studies).

Daniel Kahneman’s Thinking, Fast and Slow has been unabatedly popular in the last decade. It illustratively presents one of the dominant psychological theories of cognition, how we process information: dual process theory. The theory distinguishes two types of cognition: 

Type 1 processes happen automatically, they requires little effort, they are specific to domains, and they use reliable heuristics. This roughly corresponds to the common notion of intuition. A nice example for it is the great amount of information that we gain from simply looking at faces: we can read a person’s mood, recognise the person, estimate their age, and so on. 

Type 2 cognition on the other hand is executed with voluntary control, it requires cognitive effort, it can be applied to any topic, and it operates by explicit inference. For example, solving a high school math problem with pen and paper is a typical Type 2 process. 

Meanwhile, there is a similar distinction in virtue epistemology: reliabilist and responsibilist theories disagree on the exact nature of epistemic virtue. Virtue epistemology in general looks to the agent’s epistemic capacities and abilities rather than her single beliefs and inferences. 

Epistemic successes like knowledge and discovery are explained by the agent’s capacities rather than their evidence and inferences. Marie Curie’s discoveries are not explained as a result of what she had as evidence and so on but as a result of her specific epistemic competences to reason, that is her virtues. 

Virtue epistemologists have disagreed on the exact nature of these virtues: Virtue reliabilists argue that a capacity’s being a virtue is a question of its reliably producing true beliefs. If you recognise people most of the time by simply looking at their faces then your face recognition capacity is a reliabilist virtue. 

Virtue responsibilists, meanwhile, look to Aristotelian virtue ethics to explain epistemic virtue: just as behavioural dispositions like courage are moral virtues, epistemic habits like patience and conscientiousness are epistemic virtues that in turn explain epistemic success. 

You need to exhibit the responsibilist virtues of carefulness and patience, if you want to successfully solve a math problem. Responsibilist and reliabilist virtue theories are usually taken to be incompatible and in competition because they explain entirely different notions of epistemic success and virtues. 

The way that I used my examples shows already, that I propose a different avenue: the two virtue theories are not competitors; instead, they describe the virtue of the different types of cognition. Namely, reliabilist virtue means the disposition of Type 1 capacities to function reliably, and responsibilist virtue means the disposition of Type 2 cognition to function excellently. 

Reliabilist Type 1 virtues need to be reliably true because that is the epistemic good that Type 1 capacities deliver best, meanwhile responsibilist Type 2 virtues deliver a broader range of epistemic goods like understanding, explanation, or justification. Marie Curie was able to make her Nobel Prize worthy discoveries because she possessed both the necessary Type 1 and Type 2 virtues.

This shows us that reliabilism and responsibilism are both right; they simply explain the virtue of different types of cognition. These types of cognition complement each other and, consequently, also Type 1 and Type 2 virtues are complementary: each is able to achieve epistemic goals that the other cannot. 

Tuesday 19 July 2022

Are Mental Disorders Brain Disorders?

In today's post, Anneli Jefferson discusses her new book, Are Mental Disorders Brain Disorders? (Routledge 2022)She is a lecturer at Cardiff University who works in the philosophy of psychology, moral philosophy, and at the intersection of the two. 

In the last 20 years or so, neuroscience and psychiatry have increasingly been researching what brain differences can be found in people suffering from mental distress, and how these might help to explain and treat mental disorders. There is a long-standing belief that mental disorders must be brain disorders, because whatever psychological dysfunction we find must have some basis in the brain. However, many psychiatrists, clinical psychologists and philosophers strongly resist this idea, and debates about this issue can get quite heated. In my book I set out to get to the bottom of what makes this debate so intractable and provide a way forward in the debate.

I argue that resistance to calling mental disorders brain disorders stems primarily from a very narrow and specific view of what is entailed when we call a condition a brain disorder. This narrow view looks to paradigmatic brain disorders such as brain cancer as a model for what makes a condition a brain disorder. It concludes that a condition can only be a brain disorder if the following conditions are met: dysfunction in the brain is specifiable independently of the psychological level, it causally precedes mental symptoms, and treatment of the disorder targets the brain directly, for example through medication or surgery. (This specification that the brain is targeted directly is important because psychological treatment through talking therapy targets the brain as well, but does so indirectly.)

Anneli Jefferson

The narrow view is unsatisfactory because both the etiology of brain disorders and the treatment involve a plurality of factors (Kendler 2012). Furthermore, somatic dysfunction, too, is not specifiable independently of the adverse effects a structural or functional anomaly in the body has for an organism. It’s therefore unclear why we should demand a higher standard for brain dysfunction. 

Instead, we should say that differences in brain structure or function that we find in mental health conditions are dysfunctional precisely because they realize mental dysfunction. This gives us a more modest notion of brain dysfunction and disorder, which only requires that we find differences in the brain that are sufficient for realising psychological dysfunction. This means that for many psychiatric disorders, brain dysfunction will only be specifiable as such because it realises psychological dysfunction.

The second half of the book considers objections and implications, I address the objection that brain disorder labels are committed to a problematic reductionism and that mental disorders are relational (externalist) in a way that a focus on dysfunction in the brain cannot allow for.

Finally, I discuss worries about how brain disorders affect responsible agency and how the ‘brain disorder’ label might influence people’s self-perception and the way others see them. I argue that while brain disorders do often have an impact on responsible agency, we can and should only assess responsibility by looking at an agent’s psychological profile. Knowledge of brain dysfunction can inform such psychological assessments, but it cannot replace them. 

I then consider the worry that rightly or wrongly, hearing that a person is suffering from a condition that involves dysfunction in the brain will make people see them as unable to do anything to recover from or manage their condition and make them think that person is not responsible for their actions. I discuss two possible explanations for such effects: one is that we draw unwarranted conclusions by drawing analogies to certain paradigm brain disorders such as brain cancer, the other is the hypothesis that we are intuitive dualists, who think of brain and mind as separate. I end by proposing ways to mitigate these undesirable associations.

Tuesday 12 July 2022

Protecting the Mind

Today's post is by Pablo López-Silva who is an Adjunct Professor at the School of Psychology and Research Professor at the Institute of Philosophy, Universidad de Valparaíso, Chile. He is Young Research Fellow at the Millenium Institute for Research in Depression and Personality (Chile). 

Pablo's areas of research are Philosophy of Mind, Philosophy of Psychology, Psychopathology, and Neuroethics and he's director of the Project FONDECYT 1221058 'The architecture of psychotic delusions'. Here, he discusses his new book, Protecting the Mind: Challenges in Law, Neuroprotection, and Neurorights (Springer 2022, edited by Pablo López-Silva & Luca Valera).

In John Milton’s Comus, the British poet writes “Thou canst not touch the freedom of my mind”. With this, the author depicts the human mind as the last bastion of privacy, freedom, and agency. For a long time, this idea remained unchallenged. However, the rapid progress of neurotechnologies with direct access to our neural data has jeopardized the limits of our mind’s privacy and freedom. Large research initiatives around the world (Adams et al. 2020) are mapping with unprecedented degrees of accuracy the neural paths that the brain builds over time to create our experience of reality, and specific mental states such as motor actions, beliefs, memories, and thoughts. 

Importantly, the very possibility of recording with such a precision the neural activity that produce specific mental states might offer scientists and governments the possibility of not only reading, but also controlling the production of mental states in the minds of regular citizens, process that has been called “brain-hacking” (Yuste 2019, 2020a, b). This – almost science fictional - scenario has not only motivated discussions about the ways in which the access and control over our own neural data (mental privacy) could be protected, but also, debates about our very notions of the human mind and the most fundamental anthropological model of ourselves. 

Pablo Lopez-Silva

Protecting the Mind: Challenges in Law, Neuroprotection, and Neurorights is a multidisciplinary effort to think critically about philosophical, ethical, and empirical issues that emerge from the potential misuses of neurotechnologies in medical and non-medical contexts. The contributions contained in the collection cover a wide range of topics, but, altogether, they are able to inform current discussion that local governments are having in light of the many threats posited for the unregulated use of neurotechnologies with access to neural data around the world. 

One of the main concerns that guide this collection has to do with the lack of clear and specific legal frameworks that could protect the mind from external intromission allowed by such neurotechnologies. We believe that important philosophical discussion about how to conceptualize our mind arise from this threat. But, at the same time, we believe that conceptual discussions must be accompanied by specific actions focused on protecting the life of citizens. In this collection, we have tried to maintain an equilibrium between these complementary levels of analysis in order to invite the academic community to keep discussing these matters. Given the ongoing nature of these debates, we hope this collection of essays motivates further discussion to develop comprehensive concepts and to inform contextualized legal frameworks. 

In the last chapter of our collection, we leave open some questions: 

  • Must we protect our mind and persons? 
  • Is this protection only motivated by the fear of the unknown—e.g., the possible consequences that neurotechnologies may have on our society—and by the current lack of knowledge? 

In any case, what is clear, here, is the twofold role of neurotechnologies: “Neuro-technology is developing powerful ways to treat serious diseases, to improve lifestyles and even, potentially, to enhance the human body. However, this progress is also associated with new self-understandings, existential challenges and problems never seen before” (Echarte 2016, 137). The bet we have to make concerns, then, both what we can gain and what we can lose: we could achieve qualitatively better lives but forgetting our vulnerability and losing our “image;” we could be better off, but we would lose the possibility of experiencing authentically. We need to evaluate if such a gamble is convenient and, above all, if it is authentically human.

Tuesday 5 July 2022

The Misclassification of Body Dysmorphic Disorder

Amy MacKinnon is a graduate student at Western University studying philosophy of psychiatry, mind-brain sciences, and disability. Muhammad Ali Khalidi is Presidential Professor of Philosophy at CUNY Graduate Center. His book, Cognitive Ontology: Taxonomic Practices in the Mind-Brain Sciences, will be published by Cambridge University Press in 2022. 

Amy MacKinnon

Understanding the nature of psychiatric disorders is something that philosophers of psychiatry, as well as practicing psychiatrists and psychotherapists, are concerned about. Every so many years, after a long revision process, a new Diagnostic and Statistical Manual of Mental Disorders (DSM) is produced by the American Psychiatric Association. In the most recent edition (DSM-5), as in all previous editions, some disorders were removed, some re-named, and some new ones added. With each revision, the hope is that we are gaining validity and reliability. 

As philosophers, we’re interested in the underlying basis of these classifications, so we decided to examine one particular psychiatric disorder, Body Dysmorphic Disorder (BDD), to better understand the grounds for psychiatric classification. In the DSM-5, BDD is classified under the category of Obsessive-Compulsive Related Disorders (OCRDs). The main feature of BDD is that it involves persistent and intrusive thoughts about a perceived bodily flaw that is not observable or appears slight to others. 

At some point during the course of the disorder, an individual with BDD will have performed repetitive behaviors (e.g. mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (e.g. comparing his or her appearance with that of others) in response to concerns about their own appearance. The preoccupation causes clinically significant distress or impairment in social, occupational or other areas of functioning. Moreover, the preoccupation with appearance is not better explained by concerns with body fat or weight, and symptoms do not otherwise meet diagnostic criteria for an eating disorder.

Muhammad Ali Khalidi

On the surface, it might seem as though BDD is aptly classified as an OCRD in so far as it shares some similar features with the four other disorders in the OCRD category (namely, obsessive-compulsive disorder, hoarding disorder, trichotillomania, and excoriation). But we think that even though BDD does have obsessive and compulsive components, the similarities are superficial. Though BDD and OCD patients both engage in repetitive behaviors that they have difficulty controlling, the underlying causes seem quite different.

Various philosophers of science, from John Stuart Mill to Ruth Millikan, have proposed that the basis of scientific classification ought to be causal and that valid categories in science should track causal relationships. Building on this basic insight, we argue that by focusing on the etiology of the disorder, it becomes apparent that the differences between BDD and OCD are such that they should not both be subsumed under the category of OCRD. We propose a tentative causal model of BDD that sets it apart as a psychiatric disorder and corroborates the claim that it has been misclassified in the DSM-5. Reclassification of BDD on the basis of its causal profile should have implications for the diagnosis and treatment of patients.

We think that there are three causal factors implicated in BDD that do not appear to be present in the disorders that it has been classified with. BDD involves a perceptual deficit that is not apparent in OCD. People with BDD tend to focus on details at the expense of the whole picture or “configural” features. Neuropsychological studies suggest that those with BDD tend to over-focus on minor details when drawing complex figures from memory, compared to those without BDD. This is congruent with other research suggesting that people with BDD are more likely to examine details in visual tasks and less likely to take in the holistic picture. This phenomenon seems to be supported by studies in which people with BDD and controls perform matching tasks (e.g. matching images of inverted faces).

In addition to a perceptual deficit, people with BDD also have distinctive cognitive deficits. Compared to people with OCD, people with BDD show a theory of mind deficit and they engage in referential thinking especially when it comes to social situations. People with BDD tend to have difficulty in understanding others’ intentions and attitudes in social settings. When asked to observe video sequences of a dinner party and report on those people’s attitudes and intentions, people with BDD tend to perform poorly relative to controls. When it comes to referential thinking, people with BDD tend to perceive neutral or even positive stimuli as being negative. A smile from a stranger on the sidewalk is more likely to be perceived as a mocking gesture rather than a friendly greeting.

People with BDD also seem to differ from those with OCD when it comes to level of insight into their own condition. Whereas people with OCD usually have a fair level of insight, those with BDD tend to show poor insight. People with OCD will often report knowing that their behaviour – such as checking the stove 20 times to make sure it is off -- is senseless. They might know that checking once is enough, but they still carry out the ritual of checking repeatedly. By contrast, people with BDD really believe that their body is mis-shaped, and they think that they are justified in mirror-checking as often as they do. In other words, they have different attitudes towards their own behaviours. Moreover, BDD patients also report feeling worse after engaging in repetitive behaviors and experience no reduction in anxiety, as compared with OCD patients, whose rituals seem to relieve their anxiety, albeit temporarily.

Additionally, people with BDD are resistant to others’ attempts at reassurance and reject evidence that contradicts their beliefs. No matter how often someone says, “your nose looks fine,” or provides evidence that their facial features are not asymmetrical, people with BDD do not accept this information. This suggests that they might have a strong version of a confirmation bias, which has also been found in other psychiatric patients with entrenched delusions, such as those with schizophrenia. Meanwhile, OCD patients do not seem to have such entrenched delusions. This cognitive bias may be a third causal factor that is distinctive of BDD and contributes to the occurrence of the disorder.

These contrasts with OCD have led us to posit a causal model of the emergence and persistence of BDD in certain people. We conjecture that their perceptual abnormality may lead them to focus excessively on specific body parts, which may result in dissatisfaction with their appearance. Moreover, their theory of mind deficit may lead them to think that others disapprove of their appearance, further confirming their own dissatisfaction. These negative attitudes may be reinforced by an exaggerated form of confirmation bias, which helps give rise to a full-blown delusion about their appearance that is difficult to dislodge and bring about a lack of insight into their own condition. We conjecture that these three causal factors, when found together in a single individual, result in this distinctive psychiatric condition and set it apart from the disorders that it has been lumped with in the DSM-5. 

This perceptual-cognitive causal account of BDD may serve as a model for other psychiatric disorders, some of which may also emerge as a result of atypical perceptual and cognitive traits. By examining the underlying causes, as well as focusing on the patients’ own perspectives and attitudes, rather than just looking at outward symptoms, it becomes apparent that BDD is sufficiently different from OCD that they should not be classified in the same category. We believe that this is important when it comes to understanding the validity of the classification, and we think this could have important implications for understanding effective treatments in the form of causal interventions.