engleski

Mental disorders, harm and internal reasons

It seems to be a commonplace that the notion of mental disorder is at least partly value- laden. According to this line of thought, a condition that a person has is not a disorder if it is not harmful to that person. The relevant notion of harm can be spelled out in many ways. It usually refers to something that negatively affects a person’s well-being. However, philosophy of psychiatry lacks a consensus on what constitutes a person’s well-being and when it is sufficiently reduced by a condition to merit the label of mental disorder. In addition, it is not clear what kind of considerations can legitimately qualify a harmful condition as a mental disorder. I will approach this issue using the model of internal reasons as developed by Bernard Williams and others after him. The investigation will be twofold. First, I investigate how much the model can illuminate the normative aspect that harm imports to the notion of a disorder. In general, we can say that judging that some condition is harmful involves the judgment that it is undesirable. On Williams’ view, this claim is explicated in terms of rational routes ; I have a reason not to desire to be in some condition only if I would reach that desire by rational deliberative route from my initial desires. This notion of a practical reason captures some aspects of the role the notion of harm plays in psychiatry. For instance, one of the major reasons why homosexuality was removed from the second edition of the Diagnostic statistical manual of mental disorders (in 1973) is because it normally does not cause subjective distress to a person. Second, applying the internal reasons model to mental disorders exposes some of the often-noticed weak points of this model of reasons. For instance, it might have problems capturing the undesirability of disorders that involve profound lack of insight. Accordingly, no amount of rational deliberation, without making the conditional fallacy, could lead to the judgment that the condition is undesirable. In that case, however, I argue that the notion of a rational route could benefit from incorporating an objective notion of function that explains when capacities underlying rationality are malfunctioning. From this perspective, we can say that the condition is harmful because it is either judged by a person as undesirable or because it impairs capacities for rational thinking that are necessary for being an agent.

Harm ; mental disorder ; internal reasons

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