Understanding, The Manifest Image, and 'Postmodernism' in Philosophy of Psychiatry

Understanding, The Manifest Image, and 'Postmodernism' in Philosophy of Psychiatry The author reports no conflicts of interest. Despite how he begins, suggesting that it is somehow a problem for me that I think "there is such a thing as philosophy, which could then be useful for psychopathology," (Ghaemi, 2024 p. 17, emphasis added), ultimately it is clear that the possibility of philosophy is not the issue for Ghaemi. Rather, his issue is with academic philosophy of psychiatry, as he sees it, and with my failure to ask what underlying assumptions typically operate in it. I do not dispute that someone like Jaspers would want to ask such a question, nor do I dispute that it is, in general, a perfectly good question. But Ghaemi thinks that my paper is missing out on something by not posing it. The reason he thinks this is because he thinks my paper is an instance of a pattern in the discipline against which he evidently has an axe to grind. In particular, he thinks philosophy in general should be more attendant to the ways in which Diagnostic and Statistical Manual of Mental Disorders (DSM) categories are (problematically) socially constructed. The fact that philosophers have failed to critically point this out allegedly shows philosophy of psychiatry's— and my—unexamined sympathy with the postmodern tendencies—understood as tendencies toward "relativism about truth" and "skepticism about science"—of psychiatry itself. This is odd for a number of reasons, especially in the present context. Firstly, I am not presently in a position to exhaustively defend all of philosophy of psychiatry on the charge of 'postmodernism,' or on the charge of failure to critically engage with the DSM, but it is worth simply stating that I find these to be rather patently unsubstantiated charges. Prominent works that falsify the latter and easily come to mind are by Tsou (2011), Cooper (2004, 2007), Horwitz and Wakefield (2007), Murphy (2006), Poland and von Eckhardt (2013), and Lalumera (2016). Of these, only Lalumera is interested in defending a DSM-style descriptivism (which perhaps Ghaemi would call a kind of "social constructionism"), but even she limits her defense of DSM categories to their role as reference-fixing representations. It is also true that Tsou's paper is an argument that the practical End Page 21 considerations which go into shaping the DSM categories sometimes represent values that permissibly operate in psychiatry. Perhaps this could be construed as a kind of social constructionism as well, and presumably Ghaemi would disagree with it, but no one here is guilty of a failure to engage critically with the DSM and its history. Further, whichever position is taken by these theorists on whether the DSM does, or even one day could, cut nature at its joints, or whether some of the values that shape its construction do so permissibly or impermissibly, one's acceptance or rejection of relativism about truth is an entirely logically independent matter. I am certainly not committed to relativism about truth by anything that I say in the paper. Ghaemi is motivated to target these general criticisms at me largely because he sees me invoking the DSM conception of clinical depression. It is worth pointing out that what I say about clinical depression is somewhat secondary to the paper's main argument, about which Ghaemi has nothing to say. But more puzzling still, the terms to which he seems to be reacting, namely, 'major depressive disorder' and 'MDD,' do not actually appear in my paper, so even the connection between my work and the (unsubstantiated) general trends he wishes to indict is obscure. (Those terms do appear in other work of mine, some of which I cite, so perhaps he is somehow reacting to what I have written there, but he does not say this.) In the present context, I use 'depression' and 'clinical depression,' terms that were chosen for their theoretical neutrality and independence from the DSM. The point in that section is simply that whatever purely descriptive conception of clinical depression one is working with, a fair number of problematic ideas will need to be invoked to get to the conclusion that there is anything disordered or dysfunctional about...