Reading between Philosophy and Clinical Social Work

 (I wrote one long post on Kukla and broke it into two. This is the second part.) II. “What Counts as a Disease, and Why Does It Matter?” (2022)   Eight years later, Kukla published “What Counts as a Disease, and Why Does it Matter?” in The Journal of Philosophy of Disability ( https://doi.org/10.5840/jpd20226613 ). I downloaded a pre-print of this article at the time and have not tracked down a copy with the proper pagination, so I will treat page 1 as the first page of the article.   Kukla is a bit clearer about methodology this time. They disavow the method of conceptual analysis, which is what Boorse and Wakefield were doing. Instead, they contend that the role of the philosopher is “clarifying the pragmatic and normative conditions under which ‘disease’ is a useful concept that can be mobilized appropriately” (p. 6). This is more or less exactly what I would expect a certain kind of pragmatist to say. It seems quite close to the kind of thing Foucault tried t...

 This post marks my fifth on the concept of health. Here I will look at two texts by Quill Kukla on the topic. These are not the only texts I could have selected; Kukla is dazzlingly prolific across a wide range of topics from gender to sexual violence to bioethics to philosophy of language. I have taken these two pieces as exemplary of a certain tendency in Kukla’s thinking, but my choice perhaps comes at the expense of looking at their more “applied” work.   As the title suggests, Kukla is a pragmatist. I mean two things by this. First, Kukla draws on the philosophical tradition of American pragmatism, classically associated with Peirce, William James, and Dewey, and more recently revived by Rorty, Brandom, and others. It’s a complex inheritance, to be sure, but, to simplify a great deal for my purposes here, I think this is the main point. Pragmatists about the meaning of concepts say that what a concept means has to do fundamentally with how we use it. If we want to ex...

This is now my fourth post in a series on health and disease. I spent the last two posts discussing Boorse’s naturalism, which attempts a purely value-free definition of health and disease.  In this post, I will discuss Jerome Wakefield’s “harmful dysfunction” theory of mental disorder, which is sometimes considered a “hybrid” of naturalism and normativism. My focus here will be on a single article, “The concept of mental disorder. On the boundary between biological facts and social values” ( 1992 ), although Wakefield follows this up with several later elaborations. Wakefield  has doctoral degrees in social work and philosophy and has extensive clinical experience, in addition to holding a professorship in the NYU school of social work . Aside from his classic articles about mental disorder, he is also known for a book co-authored with Allan Horwitz, The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Disorder (2007). Wakefield has a public reach un...

  This is the third post in a series on philosophical debates about the nature of disease and health. I am especially interested in the ramifications of this debate for how we think about the notion of mental health. In the last post, I examined what I saw as the broader sociopolitical stakes of the debate for the chief representative of the “naturalist” or “objectivist” school of thought, Christopher Boorse. This post will summarize Boorse’s account of health, which he calls the biostatistical theory (BST). I will focus principally on “Health as a Theoretical Concept” (1977) and will not discuss his later replies to critics here.   The broad position Boorse is defending is follows: Attributions of health are value-neutral and empirical. Whether someone is healthy or not is an objective matter, independent of personal or social values or judgments.   This broad position is characteristic of naturalism about health. It is worth spending a bit of time unpacking it. ...

  “Health is not unconditionally worth promoting, nor is what is worth promoting necessarily health.” (Boorse, “On the Distinction between Disease and Illness,” p. 60)   “The trouble with calling physical or mental or moral excellence health is that it tends to unite under one term a value-neutral notion, freedom from disease, with the most controversial of all prescriptions—the recipe for an ideal human being.” (Boorse, “Health as a Theoretical Concept,” p. 572)   In this series of posts, I am exploring philosophical accounts of disease, health, and disorder. My previous post introduced the topic. In this post and the next one, I will examine Christopher Boorse’s highly-influential attempt at a naturalistic, value-free theory of health and disease. According to Boorse’s 1 997 restatement  of his views , he developed his theory in a single manuscript that covered physical health, mental health, and the concept of biological functions (Boorse 1997, pp. 101-102...

I recently read Stein et al (2024), “Philosophy of psychiatry: Theoretical advances and clinical implications ." This review article has the double merit of including some of the most prominent names in philosophy of psychiatry among its co-authors and of appearing in a psychiatry journal, World Psychiatry , thus promoting the relevance of philosophy to mental health professionals and researchers. As with any review article, breadth comes at the expense of depth, and, as with any review article, I find myself tempted to criticize it for its omissions rather than its inclusions. Yet despite its attempt to serve as a non-technical introduction to the subject, the paper deliberately advances several core positions in the debates it covers.   The authors select three thematic areas : 1) the nature of disorder; 2) pluralism in psychiatry (ontological, explanatory, axiological); and 3) enactivism or the “4E” framework as an integrative approach. I am going to focus here on the f...