‘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
Abstract…
‘Non-rational understanding? Feelings and the Beltane Fire
Festival’
Abstract…
