A Critical Analysis of Murphy\'s Concept of Mental Disorder

CRITICAL ANALYSIS OF MURPHY'S CONCEPT OF MENTAL DISORDER 12




A Critical Analysis of Dominic Murphy's Concept of Mental Disorder





Jaipreet Mattu
PHIL 500
April 11th, 2016




















Introduction
This paper is a critical analysis of the concept of mental disorder proposed by Dominic Murphy. Murphy offers a hybrid account called the two-stage picture of mental disorder that distinguishes between (1) when organs in the body work improperly, and (2) assessing how these findings bear on our evaluation of lives that are affected by breakdowns. According to Murphy, the two-stage picture is more suitable than Jerome Wakefield's Harmful Dysfunction (HD) analysis, another hybrid account. However, a detailed look at Murphy's concept of mental disorder reveals that it is lacking clarity and succumbs to the very challenges he poses to Wakefield.
The paper is outlined as follows: In the first section, I illustrate Murphy's contribution to the philosophical discussion of mental disorder, along with his criticism against the Diagnostic and Statistical Manual of Mental Disorders (DSM). The second section proceeds in two parts. In the first part, I outline Murphy's arguments against the HD analysis and in the second, the two-stage picture is explained. In the third section, I address the shortcomings of Murphy's concept of mental disorder. Finally, in the fourth section, I defend an alternative hybrid account. In conclusion, I argue that the account I put forward can direct psychiatry to a more sophisticated psychiatric nosology, thereby leading to effective intervention.
1. The Philosophical Discussion on Mental Disorder & the DSM
Murphy is an objectivist about disease, meaning, he believes that there are facts about the human body on which the notion of disease is founded. On this view, Murphy argues for reformulating the objectivist's platform for thinking about mental illness. He argues that rather than giving authority to science, former theories yield too much authority to common sense. Murphy's principle argument in the debate regarding the concept of mental disorder is that it needs to shift towards dealing with inquiries in a scientifically informed way, rather than remaining at the level of conceptual analysis.
In particular, Murphy distinguishes himself as a revisionist objectivist against those who are conservative objectivists. Conservative objectivists take a perspective of disease that "incarnates what philosophers call 'folk psychology', a set of everyday unscientific theories about the mind". Folk concepts use the method of conceptual analysis to answer questions about mental disorders and as Murphy puts it, this is "inquiring from our armchair about what other people think". Thus, conservative objectivist who endorse folk psychology as a means of explaining mental illness, favour everyday intuitions over facts of science.,
Murphy argues that the DSM is provincial because it adopts folk concepts of mental disorders, rather than taking into account information from diversity of sciences. For instance, the definition of mental disorder adopted by the DSM—as a 'result of dysfunction'— fails to specify the appropriate etiology of mental disorders. This leads to a failure in distinguishing genuine mental disorders from 'problems in living'. For example, some individuals are diagnosed with major depressive disorder (MDD), when in actuality their behaviour is a normal response to a perturbing life event, such as the loss of a loved one., Furthermore, Murphy argues that the DSM's symptom-based diagnostic criteria also leads to misdiagnosis because many of the same symptoms are associated with different disorder. For example, insomnia, hallucination, and suicidal thoughts are associated with MDD and schizophrenia, so an individual with these symptoms can be misdiagnosed as having one disorder over the other.
Murphy's revisionism rejects the authority of common sense over science and holds that "while our current concept of health and disease are a necessary starting point they should not constrain the inquiry". We may come to realize that our folk concepts are incorrect when they are assessed against facts or fail to meet the standards of science in another way. Murphy notes that like physical illnesses, mental disorders are inquiries of empirical study, discoverable by biomedical investigation, insofar as they concern psychological function and malfunction. Thus, Murphy advocates for a merger between psychiatry and cognitive neurosciences because it will in effect, lay down the foundations for the causal explanations of mental disorders.
2. The Harmful Dysfunction Analysis & The Two-Stage Picture of Mental Disorder
Murphy's Critique on the Harmful Dysfunction Analysis
Wakefield's HD analysis involves two individually necessary and jointly sufficient components. The naturalist component states that disorder is based on the dysfunction of internal mechanisms of evolved systems that make up a species design. The normative component states that harm of such dysfunctions is assessed by sociocultural standard.
Murphy makes three arguments against Wakefield. First, evolutionary malfunction is not a necessary condition for disorder. To refute this, Murphy contends that "functional analysis does not require an evolutionary explanation, it requires only that the role played by the structures in the overall functioning of the living organism can be identified". Thus, the HD analysis is constructed too narrowly since it only involves failures of evolved functions. Second, mental disorders are not the result of dysfunction alone. To defend this, Murphy relies on literature that explains the psychopathology of behavioral problems as "a combination of excessive or misdirected physiological drives, operant conditioning, and bad social learning". The HD analysis disregards the distinction between mental disorders and behavioral disorders, thus, Wakefield upholds an incoherent view of mental illness. Third, Murphy argues that the HD analysis leads to counterexamples. In stating that a mental illness results from the failure of internal mechanisms to do its evolved job, Wakefield would have to grant blindness as a mental disorder since it is a failure of the perceptual system. Although Wakefield regards blindness as a physical disorder, it meets the conditions of the HD analysis since an internal mechanism has failed to perform its evolved function (sight), and the state is deemed harmful because it is undesirable.
Murphy's Two-Stage Picture of Mental Disorder
Murphy's two-stage picture:
"Distinguishes sharply between (i) working out when organs in the body work improperly, and (ii) assessing how these findings bear on our evaluation of lives that are affected by breakdowns" (Murphy, 2006, p. 19).
The first component is understood as objective and amenable to scientific inquiry and the second component is understood as normative. Four claims are essential to advancing the two-stage picture. First, the two-stage picture is only applicable if psychiatry is divested from folk psychology and synthesizes with cognitive neurosciences. Second, Murphy asserts that "there is no coherent conception of the 'mental' in psychiatry that one is bound to respect". Since the concept is undistinguished, Murphy adopts a broad scope of the mental, one that regards cortical blindness and diabetic comas as mental illnesses. Third, since the mind consists of many capacities (e.g. perception and thought), there is a diverse set of ways the mind can break down. Fourth, given the heterogeneity of the scope of mental disorders, there cannot be a single concept of mental disorder that scientific and non-scientific projects can use.
On the first claim, Murphy states that psychiatry should be seen as clinical cognitive neuroscience concerned with the breakdown of the mind/brain. Therefore, cognitive neuroscience research will provide more information as to how the mind/brain works. As a result, we will be able to distinguish genuine mental disorders from non-disorders and subsequently identify the proper etiology of mental disorders. This in turn, will lead to a more sophisticated psychiatric nosology. On the second claim, Murphy states that the concept of mental disorder should be expanded "across the domain of psychopathology that goes beyond common sense and that of contemporary psychiatry". Scientific inquiry based on mental processes provides us with conditions relevantly similar to say, schizophrenia, and thus, can aid in explaining it. By accepting these conditions, "the revisionist bullet that lumps perceptual deficits in with depression and schizophrenia should indeed be bitten, not as a piece of conceptual analysis but as a methodological heuristic, since psychological models will include models of the visual system and its role in thought and action".
The third claim arises from Murphy view that psychiatry is a science that "possess whatever unity it has because it answers to a set of human concerns. Its subject matter is whatever we need to give science its point, which is the theoretical understanding of disruptions to normal psychology". On this view, Murphy adopts a soft naturalist approach because it preserves some role for folk thought insofar as it grants that folk concepts can have constraints on our scientific projects. For that reason, "the softer line is more appealing when it comes to mental illness".
With these conditions in place Murphy states that his two-stage model will lead to an objective answer about whether or not someone is dysfunctional, and subsequently, infer how to regard the dysfunction based on normative assessments. On this view:
"Mental disorder is a concept like "pest", "weed", or "vermin" … Whether something counts as a weed or vermin depends on human interests in a way that allows the class to grow over time, or vary across projects… Concepts that are sensitive to human interests in this way are open-ended—things may fall into them (or drop out of them) as human interests change over time" (Murphy, 2006, p. 98-99).

On this view, Murphy states his fourth claim. Even though science provides us with the resources for understanding mental disorders, "our developing thought about psychopathology [is] shaped by the goals of medicine, therapy, and the law—and the wider practical and moral interests those goals answer to". Since non-scientific requirements establish what counts as a mental disorder through their various projects (e.g. insurance companies and policymakers), this heterogeneity renders that there cannot be just one unequivocal concept of mental illness.
3. The Shortcomings of Murphy's Account
Murphy claims to have completed two tasks: He analyzed the concept of mental disorder through a scientific lens and provided us with a concept of mental disorder that can be carried out in scientific and non-scientific contexts of psychiatry. The scientific rationale that Murphy advocates is compelling, however, if we were to adopt his view, we are left with a number of ambiguities and incoherent concepts about mental disorders. I will address five inadequacies in Murphy's concept of mental disorder.
The first two shortcomings concern the objective component of the two-stage picture, which distinguishes when organs in the body work improperly. First, Murphy's description disregards the various levels at which medical sciences operate thus, this component is constructed too narrowly. In merely appealing to an improperly working organ, Murphy's account doesn't take into account lower-level mechanisms in the body (i.e. miscrophysiological). Second, although Murphy emphasizes the difficulties in adopting folk concepts, his soft naturalist approach preserves some role for folk thought. Yet, Murphy does not specify to what extent folk thought can explain mental disorders and thus it remains unclear what role folk psychology plays in this first component, in particular.
Third, Murphy claims that the two-stage picture demarcates scientific theories of the mental disorders from normative assessments about what human beings ought to be like. However, the two-stage picture leaves us questioning whether or not certain disorder are mental illnesses or not. Consider the case of gourmand syndrome. Murphy uses this against Wakefield in some of his works, by arguing that the HD analysis doesn't tell us if in fact gourmand syndrome is an undesirable or harmful dysfunction for someone to have. Yet Murphy's two-stage picture leaves us asking the same question: is gourmand syndrome a mental illness or not?
Fourth, Murphy's concept leaves us with a set of mental disorders that psychiatry, as a branch of medicine, does not exclusively entail (let alone intervene with). While Murphy expanded his conception of mental illness to include, for example, cortical blindness, he fails to separate such disorders from clinical psychiatry. It is generally understood that blindness is dealt with by a branch of medicine called ophthalmology, but Murphy does not establish this demarcation. As a result, he leaves us with an uncertainty of what psychiatry should be concerned with and even a bigger mess of classifying mental disorders.
The fifth shortcoming is that Murphy's scope of the mental leads to counterexamples. If cortical blindness is a mental illness as much as schizophrenia, then Murphy would have to concede that both color blindness and deafness are mental illnesses. Color blindness is a perceptual disorder and given that one of the symptoms of schizophrenia is auditory hallucinations (hearing voices), then a complete loss of auditory sensory function (deafness) must also denote a mental illness. These two counterexamples can be placed in Murphy's concept of mental disorder since the optic nerve of the eye and auditory nerve of the ear, communicate directly with the mind/brain. However, this offends widely held beliefs, since it is generally recognized, especially by those who are themselves colorblind and or deaf, that they are not mentally ill.
4. An Alternative Hybrid Account
In this section, I argue that Jacob Stegenga's 'hybrid account of effectiveness' is more suitable than the two-stage picture. Stegenga's account holds both a causal basis of disease and a normative basis of disease as necessary and jointly sufficient conditions for a state to be considered a disorder. The causal component holds two conditions; it regards disease as a failure of certain mechanisms to operate their particular functions at typical efficiency and, the causal basis refers to the causal constitution of a disease (as opposed to causal etiology). In addition to this, the normative component states that the disease must cause harm. Specifically, Stegenga's account is more applicable as a concept of mental disorder for two reasons.
First, it avoids the criticisms faced by the HD analysis and the two-stage picture. Based on the two requirements of the causal basis component, it does not restrict itself to dysfunction of evolutionary function or improperly working organs. Furthermore, Stegenga's hybridism avoids counterintuitive examples and can attribute genuine mental disorders that pertain to psychiatry as a branch of medicine. For instance, the constitutive causal basis component would consider cortical blindness as an impairment of the occipital lobe. We can determine that there is no harmful effect on the mental, emotional, or behavioral state of an individual and thus, cortical blindness is not a mental illness. On this view, the hybrid account of effectiveness permits a more viable way to classify and causally explain mental disorders. For example, it can distinguish MDD individuals from individuals who are suffering from problems in living, based on irregular biological or cognitive functions.
Second, this account provides the conditions required for a medical intervention to be effective. Stegenga notes that the effectiveness of an intervention is characterized by its capacity to intervene on either the constitutive causal basis of the disease or the normative basis of the disease (the harm produced by the dysfunction). This account emphasizes that "for a medical intervention to be deemed effective, it must target a genuine disorder". An intervention at the constitutive causal basis of a disease should effect, for example, the microphysiological level at which the disease arises, and thus increase the functional efficiency of the mechanism of interest. Also, an intervention satisfies the normative basis of disease by mitigating the symptoms of a given disorder. Stegenga further notes that effectiveness is denoted by the interventions ability to manifest beyond the controlled clinical setting, and work for a general population.
Conclusion
Murphy's two-stage picture of mental disorder is overall, unconvincing. Both the objective and normative component succumb to the same criticisms as the HD analysis. Moreover, the conception of mental disorder, put forward by Murphy, leads to counterintuitive examples. Lastly, Murphy's argument, that what counts as a mental disorder, may fluctuate over time, leads to an unpromising future towards establishing a sophisticated psychiatric nosology. Ultimately, this concept of mental disorder fails to provide an adequate account of mental disorder that can be used in the clinical and research context, in order to effectively intervene on mental illnesses.
The alternative hybrid account that I present is more applicable to the concept of mental disorder. Specifically, it offers theoretical groundwork for the causal-explanation of mental disorders and more importantly, for effective medical interventions. The necessary and jointly sufficient conditions of a causal and normative basis of disease, necessitates that a given state meet these requirements in order to be deemed a genuine disorder. By adopting this account, one can distinguish disorders from non-disorders. Furthermore, this account holds that it is a necessary condition for an effective medical intervention to target either the causal basis or normative basis of the disease. In the end, the hybrid account of effectiveness "provides a conceptual standard with which one can evaluate problematic practices regarding disease" such as overdiagnosis and unwarranted medicalization. Ultimately, the hybrid account of effectiveness appeals to the true definition of psychiatry as a branch of medicine, that is, as the treatment and prevention of mental, emotional and behavioral disorders.
References
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American Psychiatric Association. (2016). DSM. Retrieved from http://www.psychiatry.org/psychiatrists/practice/dsm
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Godfrey-Smith, P. (2003). An introduction to the philosophy of science: Theory and reality. Chicago, IL: The University of Chicago Press.
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Murphy, D., & Woolfolk, L.R. (2000). The harmful dysfunction analysis of mental disorder. Philosophy, psychiatry & psychology, 7(4), 241-251.
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Murphy, D. (2006). Psychiatry in the scientific image. Cambridge, MA: MIT Press.
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Retrieved from http://plato.stanford.edu/entries/health-disease/
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Running Head: CRITICAL ANALYSIS OF MURPHY'S CONCEPT OF MENTAL DISORDER



Murphy, 2006
A majority of information regarding Murphy's concept of mental disorder is taken from chapter 2 and 3 of Psychiatry in the Scientific Light called, The Concept of Mental Disorder and Psychiatry and Folk Psychology, respectively. However, many other of his works that are relevant to Chapter 3 are also referenced.
Nosology is a branch of medicine that deals with classification of diseases.
Murphy, 2006. It is important to acknowledge that hybrid accounts of disease incorporate both naturalism and normativism. The naturalist component upholds that philosophy should be continuous with science (although, naturalists do not agree on what this continuity is) (Godfrey-Smith, 2003). And the normative component is based on social assessment.
Murphy, 2006
Murphy, 2005, p.117. An example of a folk concept of mental illness is that, mental illnesses, can be traced back to unresolved conflicts experienced at the early stages of childhood. For instance, homosexuality was considered to be a failure to identify with the parent of the same sex (Thornton, n.d.).
Murphy, 2005, p.50
Murphy, 2008
Ibid.
Ibid.
The DSM-IV defines mental disorder as follows: "Each mental disorder is conceptualized as a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and is associated with present distress... Whatever its original cause, it must currently be considered a manifestation of a behavioral, psychological or biological dysfunction in the individual" (as cited in Murphy, 2006, p. 30).
Horwitz & Wakefield, 2007; Murphy, 2006
Horwitz & Wakefield, 2007
Murphy, 2006; Tsou, 2011
Murphy, 2006
Murphy, 2005, p. 117
Murphy, 2006
Ibid.
Ibid.
Wakefield, 2007
Wakefield, 1992
Ibid.
Murphy, 2006
Murphy, 2006, p. 79. Murphy makes reference to a number of philosophers who have contributed to modern literature regarding function in philosophy of science, biology and medicine. See page 79-80 for a detailed account.
Ibid.
Murphy, 2006, p.72
Murphy, 2006
Ibid.
Ibid.
Murphy, 2006
Murphy, 2006, p.54
Murphy, 2006
Ibid.
For the purposes of this paper, mind and brain will be denoted as mind/brain in the remainder of the paper.
Murphy, 2006, p. 93
Murphy, 2006, p. 94
Murphy, 2006, 96
Ibid. The soft naturalist line is opposed to the hard naturalist line, which claims that our folk view of the world should be discarded (Murphy, 2006)
Murphy, 2006, 96
Murphy, 2006, p. 102
Murphy, 2006
Gourmand syndrome occurs when there is a lesion in the brain as a result of previous injury or disease, resulting in individuals to become obsessed with gourmet food and fine dining (Murphy, 2006).
Murphy, 2008
Ereshefsky, 2009
Stegenga, 2015
Ibid. As an example of what it meant by constitutive causal basis, Stegenga states that, "the constitutive causal basis of type 1 diabetes is the physiological state characterized by the inability to produce insulin as a result of damage to the pancreas; our knowledge of this constitutive causal basis has been developed in sophisticated detail" (Stegenga, 2015, p. 35) On the other hand, the causal etiology of a disease explains an effect by its causes. An example of this would be that type 1 diabetes is caused by genetic heritability or the result of a previous disease or illness.
Ibid.
Aldrich et al., 1987
Nevertheless, there can be a case in which an individual with functioning vision becomes depressed after an accident causes them to go blind. However, an analysis on the constitutive causal basis of this depression can reveal the origin of the depression as either a response to the individual's distressing life event or an abnormal cognitive or biological function.
Stegenga, 2015
Stegenga, 2015, p. 54. As noted by Stegenga (2015), various levels of effect concern, for example, clinical interventions that mitigate symptoms and or population-relevant effects that modify the average longevity of a population.
Intervention at the constitutive causal basis of the disease can also target and effect the normative basis. This is because most symptoms are caused by dysfunction at the microphysiological level. In other cases, the causal basis of the disease cannot be intervened on, thus, only the normative basis (symptoms) are mitigated (Stegenga, 2015).
Stegenga, 2015
Stegenga, 2015, p. 59