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Safeguarding Against the Medical Treatment of Homosexuality Taryn Knox

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Safeguarding Against the Medical Treatment of Homosexuality Taryn Knox Safeguarding against the medical treatment of homosexuality Taryn Knox A thesis submitted for the degree of Doctor of Philosophy at the University of Otago, Dunedin, New Zealand Date: 30 April 2018 i Abstract In the past, homosexuality, masturbation, being a runaway slave and being a political dissident have all been considered to be mental disorders and medically treated on this basis. The medical treatment of these conditions seems to be an example in which psychiatry has been used as a guise for social control. If the medical treatment of these conditions can be safeguarded against, then future misuses of psychiatric treatment might also be safeguarded against. This thesis considers whether the misuse of medical treatment of these and other conditions can be safeguarded against by showing that the following two criteria are fulfilled: 1. Only mental disorders may be medically treated on the basis of being mental disorders, and 2. These conditions are not mental disorders in any society. The thesis shows that there is a pragmatic (c.f. prescriptive) link between the way the concept mental disorder is ordinarily used and medical treatment, and so the first criterion is fulfilled. For the second criterion to be true, it needs to be shown that the extension of mental disorder is: 2.1 Static between societies, and 2.2 Excludes homosexuality, masturbation, being a runaway slave and being a political dissident. Three potential ways of achieving both 2.1 and 2.2 are considered – basing the extension of mental disorder on ordinary language, natural kinds or evaluations. Firstly, the way mental disorder is ordinarily used by health professionals and informed lay-people in the developed world does exclude homosexuality and the other conditions mentioned earlier. However, ordinary language does not make the extension of mental disorder static between societies, and so does not fulfil criterion 2.1. Secondly, the ordinary use of mental disorder does not pick out a natural kind, so the extension of mental disorder cannot be fixed in this sense. If dysfunction (being a component of mental disorder) picks out a natural kind, then the extension of mental ii disorder might be partly static i.e. criterion 2.1 might be fulfilled. However, it is shown (using revisionist and conservative naturalism) that if criterion 2.1 is met, then criterion 2.2 cannot be met and vice versa. This applies whether dysfunction picks out a family resemblance natural kind or an essentialist natural kind. Thirdly, as disvalue is a necessary component of the ordinary sense of mental disorder (as used by health professionals and informed lay-people), there might be Rawlsian primary goods concerning the extension of mental disorder. While Graham’s (2013) basic psychological capacities might be primary goods, their expansiveness means that they are highly unlikely to fix the extension of mental disorder i.e. meet criterion 2.1. As none of these approaches fulfil both components of the second criterion, the thesis has not shown that the medical treatment of homosexuality, masturbation, being a runaway slave and being a political dissident can be safeguarded against by showing, for once and for all, that they are not mental disorders. iii Acknowledgements With the benefit of hindsight, I recognise that when I started this thesis, my thinking was very philosophically naïve. It is with the help of my friends and colleagues at the Bioethics Centre, especially my supervisors Dr. Neil Pickering and Prof. John McMillan, that my philosophy has become (hopefully) less naïve. Thank you for giving me the time and guidance to help to carve out a more sophisticated philosophical stance. Thanks must also go to my proof readers (Brigid, Emma, Claire, Georgia, Kathryn, Ian, Steven) and those friends and family members who tolerated my unrelenting and escalating grouchiness during the final months of writing. Writing this thesis has not only given me the chance to develop academically, but also in my personal life. For this reason, I dedicate this thesis to those who had hope in me, when I had none. iv Contents Abstract .................................................................................................................................................... i Acknowledgements ................................................................................................................................ iii Chapter One - Introduction ..................................................................................................................... 1 1. Mental disorder and medical treatment .................................................................................... 1 2. Thesis Argument ......................................................................................................................... 8 3. Three notes on terminology ....................................................................................................... 9 3.1 Concepts, terms and things in themselves ............................................................................... 9 3.2 Disorder, disease or illness? .................................................................................................... 10 3.3 True extension v. Static Extension .......................................................................................... 11 4. Thesis Structure ........................................................................................................................ 12 Part One ........................................................................................................................................ 13 Chapter Two: Four Historical Case Studies ................................................................................... 13 Chapter Three: Ways of showing that a condition should not or may not be medically treated 14 Chapter Four: The link between mental disorder and medical treatment ................................... 14 Part Two ........................................................................................................................................ 14 Chapter Five: Conceptual Analysis and Ordinary Language Philosophy ....................................... 14 Chapter Six: Do mental disorder or dysfunction pick out natural kinds? ...................................... 15 Chapter Seven: Natural Kinds continued – Conservative and Revisionist Naturalism ................. 15 Chapter Eight: Are the values concerning mental disorders fixed? .............................................. 16 Chapter Nine: Conclusion ............................................................................................................. 16 PART ONE – THE LINK BETWEEN MENTAL DISORDERS AND MEDICAL TREATMENT ........................... 18 Chapter Two – Historical Case Studies.................................................................................................. 18 1. Introduction ............................................................................................................................. 18 2. The meaning of mental disorder ............................................................................................. 20 3. Historical case studies ................................................................................................................. 22 3.1 Homosexuality ....................................................................................................................... 22 3.2 Drapetomania (and dysaesthesia Aethiopica) .................................................................... 29 3.3 Masturbation ......................................................................................................................... 33 3.4 Sluggish schizophrenia ......................................................................................................... 37 4. Conclusion and analysis of the four case studies .................................................................. 41 Chapter Three – Ways of showing that a condition should not or may not be medically treated ...... 47 1. Introduction ............................................................................................................................. 47 2. Disorders and non-disorders should be medically treated according to the standard bioethical criteria/Values-Based Medicine ................................................................................... 49 3. Only disorders may be medically treated .............................................................................. 52 v 4. Only mental disorders may be medically treated on the basis of being mental disorders 53 5. Conclusion: Advantages and disadvantages of each approach ............................................ 55 Chapter Four – Link between disorder and medical treatment ........................................................... 59 1. Introduction ............................................................................................................................. 59 2. What is medical treatment? .................................................................................................... 60 2.1 Medical treatment and the four historical case studies ..................................................... 63 3. There is no exclusive prescriptive link between mental disorder and medical treatment 65 4. There is a pragmatic link between disorder and medical treatment .................................. 67 5. Conclusion ...............................................................................................................................
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