Sam Fellowes, BSc, MA Does autism merit belief? Developing an account of scientific realism for psychiatry Ph.D. Philosophy March 2016 1 Abstract Sam Fellowes, BSc, MA Does autism merit belief? Developing an account of scientific realism for psychiatry Ph.D. Philosophy March 2016 The PhD outlines criteria under which a psychiatric classification merits belief and, as a case study, establishes that autism merits belief. Three chapters respond to anti- realist arguments, three chapters establish conditions under which psychiatric classifications merit belief. Chapter one addresses the pessimistic meta-induction. I historically analyse autism to show there has been sufficient historical continuity to avoid the pessimistic meta induction. Chapter two considers arguments from underdetermination. I consider the strongest candidate for an alternative to autism, classificatory changes which occurred between 1980 and 1985. I argue this does not constitute underdetermination because those changes were methodologically and evidentially flawed. Chapter three considers theory-ladenness. I consider the two strongest candidates for background theories which might have a negative epistemic effect (cognitive psychology and psychoanalysis). I show these have little influence on what symptoms are formulated or how symptoms are grouped together. Chapter four argues against psychiatric classifications as natural kinds and against notions that inductive knowledge of psychiatric classifications requires robust causes. I outline psychiatric classifications as scientific laws. They are high level idealised models which guide construction of lower level, more specific, models. This opens alternative routes to belief for psychiatric classification lacking robust causes. Chapter five shows that psychiatric classifications can set relevant populations for deriving statistically significant symptoms. The same behaviour can count as statistically significant for one psychiatric classification but not another. I argue this process strengthens psychiatric classifications inductively, thus contributing to belief. Chapter six bases belief on theoretical virtues. Unifications and causation are 2 the two main theoretical virtues. Autism strongly exhibits unifications, stringently covering a wide range of otherwise unrelated symptoms. Additionally, emphasising causation may reduce unifications and thus reduce belief. Attributing unifications is reliable because autism is accessible without employing extremely complicated experimental processes and relies upon secure background theories. 3 Contents Publications Acronyms 0.0 Introduction 0.1 The Problem 0.2 Importance of the Problem 0.3 Major aims of thesis 0.4 Initial hunch and initial development 0.5 Identifying Arguments 0.5.1 The arguments against belief 0.5.2 The inapplicability of arguments for belief in psychiatric classifications 0.5.3 Suitability of autism as an example 0.6 Alternative starting point and argument 0.7 Chapter summaries 1.0 Chapter 1 – Historical continuities of autism 1.1 Introduction 1.2 Discontinuity and Pessimistic Meta Induction 1.2.1 Discontinuity and history of autism 1.2.2 Pessimistic Meta Induction 1.3 1925 to 1943 1.3.1 Leo Kanner 1.3.2 Kanner’s autism and discontinuity 1.3.3 The addition of autism to the diagnostic field 1.3.4 Kanner and Bleuler 1.4 1943 to 1978 1.4.1 Kanner's changing notion of autism 1.4.2 Autism as social impairment 1.4.3 Autism and low intellect 4 1.4.4 Kanner on other classifications - 1.4.4.1 Childhood Schizophrenia - 1.4.4.2 Acute childhood schizophrenia - 1.4.4.3 Circumscribed interests -1.4.4.4 Symbiotic psychosis 1.4.5 Autism as a spectrum 1.5 Pessimistic Meta Induction 1.6 Hacking and the Pessimistic Meta Induction 1.7 Conclusion 2.0 Chapter 2 – The challenge of underdetermination 2.1 Introduction 2.2 Underdetermination 2.3 The demise of childhood schizophrenia 2.4 Kolvin's separation of autism and childhood schizophrenia 2.4.1 Kolvin's study 2.4.2 Relationship between Kolvin and prior decades of childhood schizophrenia research 2.4.3 Unrepresentativeness 2.4.4 Additional Problems 2.5 Reactions to Kolvin 2.5.1 Scientific Reactions to Kolvin 2.5.2 DSM and Kolvin 2.5.3 Schizoid and schizotypal personality disorder 2.6 Lorna Wing, Asperger's syndrome and an autistic spectrum 2.7 Underdetermination and DSM-III autism 2.7.1 Pessimistic Meta Induction 2.8 Conclusion 3.0 Chapter 3 – The Theoretical Robustness of Autism 3.1 Introduction 3.2 Theory Laden Nature of Evidence 5 3.3 Psychoanalysis, cognitive psychology and autism 3.3.1 Modern Symptoms 3.3.2 Modern Classifications 3.4 Cognitive Psychology 3.5 Psychoanalysis 3.5.1 Psychoanalytical explanations of autism 3.5.2 Bettelheim - 3.5.2.1 Symptoms - 3.5.2.2 Classification 3.5.3 Tustin - 3.5.3.1 Symptoms - 3.5.3.2 Classification 3.5.4 Rhode and Klauber 3.6 Similarities and Differences 3.6.1 The alternative symptoms of psychoanalysis 3.6.2 Symptoms not associated with modern autism 3.6.3 Symptoms observed but discounted 3.6.4 Alternative interpretations of symptoms 3.6.5 Classification 3.6 Conclusion 4.0 Chapter 4 – A scientific law approach to psychiatric classifications 4.1 Introduction 4.2 Psychiatry, natural kinds and the causal structure of the world 4.2.1 Biological species approach to psychiatric classifications - 4.2.1.1 Cooper's Position - 4.2.1.2 Problems with Cooper 4.2.2 Rejecting biological species and the search for causes - 4.2.2.1 Murphy's Position - 4.2.2.2 Problems with Murphy 4.3 Psychiatry, causal disunity and laws 6 4.3.1 Physical Systems and phenomena 4.3.2 Symptoms as phenomena 4.4 What are classifications? 4.4.1 Causes 4.4.2 Mechanism 4.4.3 Explanations 4.4.4 Laws - 4.4.4.1 Autism as a law - 4.4.4.2 Autism as an entity 4.5 Mind-independence, causes and regularities 4.6 Conclusion 5.0 The interaction between symptoms and classifications 5.1 Introduction 5.2 Classifications and symptoms 5.2.1 Classifications 5.2.2 Symptoms 5.3 Systematicity 5.3.1 Constructing symptoms 5.3.2 Employing classifications to systematise symptoms 5.4 Systematicity helping with other background theories and ethics 5.4.1 Theories 5.4.2 Ethics 5.5 Historical evolution and interaction of symptoms and classifications 5.6 Consequences 5.6.1 DSM 5.6.2 RDoC 5.6.3 Symptom-based approaches to psychiatry 5.7 Classification, systematisation and belief 5.7.1 Enhancing Inductiveness 5.7.2 Systematisation and theory-laden 7 5.8 Conclusion 6.0 Chapter six – Scientific Realism and Autism 6.1 Introduction 6.2 Scientific realism 6.3 Existing approach in philosophy of psychiatry 6.3.1 Neo-Humeanism vs Neo-Aristoleanism 6.3.2 Murphy, Cooper and neo-Aristoleanism 6.4 Alternative approaches to scientific realism 6.4.1 Inference to the best explanation - 6.4.1.1 Ethics 6.4.2 Justifying IBE 6.4.3 Epistemic Risk 6.4.4 Validity 6.5 Arguments for belief 6.5.1 Autism and Inference to the best explanations - 6.5.1.1 Unification and laws - 6.5.1.2 Causes - 6.5.1.3 Ethics - 6.5.1.4 Other inference to the best explanation arguments - 6.5.1.5 Balancing IBEs 6.5.2 Justifying inference to the best explanation attributions - 6.5.2.1 Reliability - 6.5.2.2 Phenomena - 6.5.2.3 Entities - 6.5.2.4 Pessimistic Meta Induction - 6.5.2.5 Theory Laden Evidence 6.6 Epistemic Risk 6.7 Conclusion 7.0 Conclusion 7.1 Aim and novel contribution 8 7.2 Reality 7.3 What are psychiatric classifications 7.4 Belief 7.4.1 Anti-realist arguments 7.4.2 Inference to the best explanation. 7.4.3 Justifying IBEs 7.5 Scientific Realism 9 Publications and Submission Statement I declare that this thesis is my own work, and has not been submitted in substantially the same form for the award of a higher degree elsewhere. Significant elements of sections of this thesis will be published in a forthcoming article: Fellowes, Sam. (2016). A reappraisal of Kendell and Jablensky's account of validity, Journal of Evaluation in Clinical Practise. These sections are 4.3.1 Physical Systems and phenomena, 6.5.1.5 Balancing IBEs, 6.4.4 Validity. Significant elements of sections of this thesis formed the essay, RDoC should not always see symptoms as independent of psychiatric categories, which was one of two winners of the 2016 Jaspers Award from the Association for the Advancement of Philosophy and Psychiatry. These sections are 5.2 Classifications and symptoms, 5.2.1 Classifications, 5.2.2 Symptoms, 5.3 Systematicity, 5.3.1 Constructing symptoms, 5.3.2 Employing classifications to systematise symptoms. 10 Acronyms IBE: Inference to the best explanation, inferring one explanation as better than another. PMI: Pessimistic meta induction, scientists historically believed in theories in the past yet the theories turned out false, suggesting belief over existing theories is undeserved. NMA: No miracles argument, the only explanation of the success of science is miracles or the truth, since miracles are not allowed in philosophy then truth is the only explanation. RDoC: Research Domain Criteria, a project started in 2009 by the National Institute for Mental Health. This is part of the National Institute of Health, an agency of the United States Department of Health and Human Services. Rather than link classifications to causes as typically occurs in DSM based casual research RDoC researchers intend to base causal investigation on directly linking causes to symptoms. The hope is that causal investigation will no longer be held back by the potential falsity of currently employed psychiatric classifications. 11 0.0 Introduction 0.1 The Problem “Under what circumstances should we chuck the whole thing out and start over?” (Kendler 2012a, p.xiv).