‘Is there such a thing as nursing knowledge?’ for Chambers, M. (ed) Psychiatric & Mental Health Nursing: the craft of caring
Is there such a thing as ‘nursing knowledge’? What do and should we mean by that phrase? And does it help define nursing itself? It may seem that denying that there is such a thing, or unified kind, as nursing knowledge risks undermining the profession of nursing and runs counter to its new graduate status in the UK. But I will argue that on one understanding of the question, at least, it is correct to answer ‘no’ but that this is no threat to a picture of nursing as richly knowledge-based.
To do this, I will consider three important distinctions of kind which divide up forms of knowledge and argue that, in each case, nursing knowledge is distributed across both sides. This suggests that it is implausible to think that nursing knowledge is unified. At the same time, however, I will suggest that in each case there is reason to think that what is involved is, indeed, a form of knowledge. Finally, I will suggest that there is a key form of knowledgeable judgement at the heart of nursing but that this takes the form of an art rather than a science.
‘Naturalism and dysfunction’ for an MIT collection on Harmful Dysfunction edited by Denis Forest (Philosophie, Histoire et Sociologie de la Médecine Mentale (PHS2M) programme University of Paris Descartes)
The harmful dysfunction account of disorder separates an explicitly normative or evaluative notion of harm from the idea of dysfunction which is subject to a reductionist naturalistic account. Dysfunction is analysed as a failure of function which is itself reduced via evolutionary biology. In this paper, I question this latter aspect of the account. Light can be shed on the prospect of reducing the apparently normative notion of dysfunction by comparing it with two distinct reductionist projects in the philosophy of content which stand to each other as do the contrasting options in the euthyphro dilemma. A more modest project takes for granted the structure of normative relations between concepts and attempts to solve an engineering problem of how human thought can fit that structure. A more ambitious project aims to explain that structure itself in naturalistic terms. The ambitious project, however, is undermined by an argument from Wittgenstein. I argue that the harmful dysfunction analysis of disorder has to be interpreted as isomorphous with the latter project and is thus subject to the same objection.
‘The normativity of meaning and the constitutive ideal of rationality’ for Verheggen, C. (ed) Wittgenstein and Davidson on Thought, Language, and Action CUP
The normativity of meaning and the constitutive ideal of rationality. One legacy of the later Wittgenstein is the view that both meaning and mental content is normative. This is suggested by two distinct threads in the Philosophical Investigations. There is the idea that word use can be compared to rule governed games. And there is the idea that propositional attitudes prescribe satisfaction conditions likened to a ‘despotic demand’. But both elements have come under recent fire by philosophers who grant that meaning may be governed by constitutive rules but that these need not be thought of as having any prescriptive force and, further, there are no plausible articulations of any relevant prescriptive norms. Light can be shed on what has become a rather sterile debate, however, by comparing parallel views of the role of normativity arising from Davidson’s constitutive ideal of rationality which has been criticised as descriptively inadequate in the face of widespread empirical irrationality. But it also suggests a way in which the norms of meaning can be both constitutive and prescriptive.
‘Psychiatric classification, vagueness and tacit knowledge’ for Keil, G., Kutschenko, L., Hauswald, R. (eds) Gradualist Approaches to Mental Health and Disease
DSM III aimed to improve the reliability of psychiatric diagnosis via an operationalist emphasis on ‘observable’ signs and symptoms and the initial downplaying of aetiological theory. Signs and symptoms are first elicited and then syndromes derived through diagnostic algorithms. Whilst this has prompted the charge that reliability has improved only at the cost of validity, there has also been a criticism, from European psychiatrists, that the signs and symptoms articulated within DSM III and IV are vague by contrast with the specification provided by explicitly phenomenological psychiatry. Rather than providing a reliable foundation, the connection between individual symptoms and conditions in the DSM lacks specificity. By contrast, phenomenological psychiatry can chart a correlation between schizophrenia, for example, and particular kinds of catatonia or delusional structure. Correlations are not between schizophrenia and delusions in general but delusions with a specific schizophrenic colouring.
In this chapter, I attempt to shed light on these claims without presupposing the phenomenological tradition but instead by forging a connection between diagnosis and tacit knowledge. In The Tacit Dimension, Michael Polanyi introduces the idea of such knowledge with the phrase ‘we can know more than we can tell’ but that leaves the nature of the knowledge underdetermined. I suggest, first, that it is a context-dependent but conceptually structured practical skill and, second, that the top-down approach to psychiatric symptoms compensates for the vagueness of DSM descriptions of symptoms through an exercise of recognitional tacit knowledge. This connection is not, however, unique to psychiatry. Although linguistic classification is the first step to making knowledge explicit it is itself an exercise of tacit skill, referred to by Polanyi as the ‘art of denotation’.
Bootstrapping conceptual normativity?
Both anti-reductionist and reductionist accounts of linguistic meaning and mental content face challenges accounting for learning a first language. Anti-reductionists cannot account for a transition from the pre-conceptual to conceptual without threatening to reduce the latter to the former. Reductionists of a representationalist variety face the challenge of Fodor’s argument that language learning is impossible.
This paper examines whether Ginsborg’s account of primitive normativity might provide some resources for addressing these issues. Rejecting her ‘no conception’ account of normativity in favour of a demonstrative, local conception provides one response to Fodor’s argument which is available to an anti-reductionist and at least a further hint as to how context-independent linguistic concepts can be developed from context-dependent local conceptions of how to go on.
‘Phenomenological implication as transcendental argument’ for Pickering, N. and van Staden, W. (eds) Wittgenstein and mental health for submission to the OUP International Perspectives in Philosophy and Psychiatry (IPPP) series
In their paper ‘Explaining schizophrenia: the relevance of phenomenology’, Sass and Parnas argue that phenomenological psychopathology can be explanatory rather than merely descriptive because it articulates the way in which mental symptoms are understandably connected by relations of ‘phenomenological implication’. They illustrate this claim through an account of schizophrenia as a disorder of a sense of ipseity from which two aspects seem to follow as a matter of phenomenological implication: the characteristic hyper-reflexivity of subjects with schizophrenia and what Sass and Parnas call ‘diminished self-affection’ which is a diminished sense of existing as a subject of awareness or agent of action. Both would follow if schizophrenia were at root a problem with ipseity. They further argue that these connections cannot be captured using the conceptual resources of Anglo-American philosophy.
In this chapter, I argue that the last claim is not true. Light can be shed on phenomenological implication by examining the nature of the synchronic and diachronic relations Sass and Parnas describe. I argue that their apparent intelligibility stems from their resemblance to expressive reactions, to rational action explanation and to the kind of transcendental argument one finds in the Kantian-Wittgensteinian tradition exemplified by analytic philosophers such as David Pears and Peter Strawson. In the last case, Sass and Parnas’ connections can be seen as mirroring such attempts within broadly Wittgenstein-influenced analytic philosophy to articulate the conditions of possibility of experience such as the connection between embodiment and judgement suggested by interpretations of Wittgenstein’s ‘private language argument’. But, I argue, there is a key disanalogy between such analytic investigations of the conditions of possibility of normal experience and a phenomenological investigation of psychopathology. In the former case, the connections are articulated from within a familiar and shared form of mindedness. Aspects of that are abstracted from the whole. By contrast, Sass and Parnas chart – partial, at least – failures of the conditions of possibility of normal mindedness. Given this contrast, it is less clear that phenomenological implication can successfully shed light on psychopathology.
‘Transcultural psychiatry’ for White, R. (ed) The Palgrave Handbook of Global Mental Health: Sociocultural Perspectives
‘Non-rational understanding? Feelings and the Beltane Fire Festival’