Mental disorder as a puzzle for constitutivism

Abstract

In the Nicomachean Ethics, Aristotle argues that the performance called for by being human is rational flourishing and a life that falls short of flourishing will fail to constitute a life lived in accordance with the norms governing human kind in virtue of its function. Against this constitutivist story, a puzzle arises: On Aristotle's criteria, it looks impossible for a person with a mental disorder to flourish. I consider whether this puzzle can be satisfactorily addressed without abandoning Aristotelian constitutivism. I regard this as a puzzle worthy of serious engagement because there is a tension between the adoption of Aristotelian virtue ethics as a normative backbone for applied ethics and the possibility that the theory would consign many, many people to being incapable of virtue or flourishing. I first set out the basic commitments of a constitutivist Aristotelian account and show how it generates the hypothesis that a person with mental disorder could never flourish. I then present two contemporary concepts of mental disorder-one from the fifth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders and one from philosopher George Graham's The Disordered Mind. I show that Graham's treatment of mental disorder supplies the basis for a compelling response to the puzzle for constitutivism. That response is rooted in his conceptualization of disorder as involving truncated rather than absent rationality. I suggest that Aristotle's discussion of death can be construed as supporting a second response. Finally, I discuss possible clinical implications under the auspices of caring constitutivism, which treats Aristotle's account of the human function as a basis from which ideals of rationality and recovery can be empathetically developed.

Solving for stigma in mental health care

“…This is also consistent with one major stream of sociological research on mental health, which focuses on well‐being over the life course 60 . Understanding that the effects of mental illness on one's well‐being is not fixed is crucial for conceiving of recovery as possible 58 …”

Students’ approach to learning: evidence regarding the importance of the interest-to-effort ratio

“…We assessed network stability using bootstrapping procedures to estimate the stability of the centrality indices and to estimate the accuracy of the edge values (Heney, 2018). Regarding edge accuracy estimation, we used the bootnet R package (Epskamp et al, 2018b) to compute the 95% confidence interval for each edge.…”

Treating real people: Science and humanity

“…We are delighted to report that, in the year following these comments, we have received a vast amount of correspondence and submissions from some of the most insightful and influential commentators in health research and practice, taking this “great debate” forward in just the way we had hoped. This thematic edition of the Journal of Evaluation in Clinical Practice (the largest single edition of the JECP in its 24‐year history) includes over 50 papers, reviews, and reports of conferences that reflect the attention being given across the board—by practitioners, guideline developers, systematic reviewers, and philosophers—to the relationship between evidence, science, context, bias, truth, value, and methodology, with the quintessentially pragmatic goal to develop accounts of these concepts to assist decision‐making in practice. It includes specific sections consisting of papers delivered to major conferences on diagnostic categories (focussing on both their limitations and their overuse), clinical guidelines, and mechanisms in medicine .…”

“…This section raises issues such as the ontology of disease/disorder—discrete biological entities vs dimensional network entities, or meta‐biological, nonfixed, person‐dependent states; the interplay of history of medicine, history of psychiatry, and cultural history in making up the identity of mental disorder; fictitious clinical categories, futile diagnoses, the utility of diagnostic categories; popular culture stereotypes of certain mental disorders and the role these as well as communal attitudes play in the life of the mentally ill; stigma; capability‐focused vs deficit‐centred care; and the possibility of living well within illness …”

“…The last two papers in this section are also concerned with this communal inclusion and the healing potential it possesses, as well as the capacities of people challenged by mental illness to live a good life. Diana Heney submits that, either as a clinician or a member of the community, one could usefully adopt the revised, nonperfectionist version of Aristotelian constitutivism that she advances, which claims that the imperfect rationality of the mentally disordered does not preclude their possibility to flourish as human beings. Using George Graham's account of mental disorder, she argues that “truncated rationality” keeps open for these people the possibility to live “a life high in well‐being”, all the while admitting with Aristotle that rationality is the constitutive norm of human nature, and required, though not in perfect degree, for human flourishing.…”