Preface to A Metaphysics of Psychopathology   日本語訳はこちらから

With great caution, I commence this preface to the Japanese translation of A Metaphysics of Psychopathology.  In an interdisciplinary field such as the philosophy of psychiatry, an important goal is for one’s work to be relevant to both philosophers and psychiatrists/psychologists. It takes extensive reading and re-reading, and writing and re-writing to cross disciplinary barriers. I have had some success in that respect, but whether what I have written in this book can successfully cross a linguistic and cultural barrier is something I am unprepared to anticipate with any clarity.

For the past twenty-five years, I have advocated for a pragmatist perspective on psychiatric classification. Pragmatism is a theory about the meaning of words such as ‘truth.’ The pragmatist perspective on truth emphasizes its basis in our attempt actively engage the world, to adapt to the world and to change it.  With respect to classification, pragmatism emphasizes how our purposes and goals for classifying are important factors in evaluating the degree to which a classification is successful.

Pragmatism is normally associated with American philosophy, but in my case it is American and British philosophy.  It is less evident in this book, but I look back to the English empiricist John Locke as nearly as much as I do to the American pragmatist William James.

The philosophy of pragmatism was introduced in the late 19th century by a small group mostly American intellectuals with empiricist inclinations. Empiricism is associated with the British philosophers John Locke, David Hume, and John Stuart Mill. Empiricists are suspicious of abstract philosophical concepts such as ‘essence’ and ‘substrate’ because they readily become empty words about mostly other words.  Empiricists prefer to connect abstractions to the data of experience.  The thinkers who introduced pragmatism accepted Darwin’s theory of evolution by means of natural selection soon after it was published in 1879.  Pragmatism is what these thinkers’ empiricism evolved into in the wake of Darwin’s theories.  For pragmatists, abstract concepts should be evaluated with respect to the contribution that they make to our attempts to engage with the world.

There has been considerable westernization across the planet in the past seventy years, but I doubt that a three hundred year old philosophy (empiricism/pragmatism) can reach as deep as what is laid down by thousands of years of tradition. In short, I am pleased and humbled that this translation has been produced, but am curious to learn what readers of this translation will make of it. I hope that they will charitably tolerate its limits.

I will mention one feature of the book that might help it survive the transition across the linguistic and cultural barrier, and that is what the book attempts to be about.  To explain what the book is about, in part, let me contrast what I call the imperfect community model with Jerome Wakefield’s harmful dysfunction model.

According to Wakefield, a mental disorder involves a breakdown in our normal, naturally selected psychological functioning. This breakdown has the additional feature of being harmful to its bearer. Wakefield’s model is as good as any model at articulating what most people mean or even should mean by the concept of mental disorder. But Wakefield’s model was also constructed as a response to a particular problem – how to demarcate real mental disorders from (sometimes) harmful psychological conditions that are not mental disorders.  Wakefield took his conceptual solution to the demarcation problem and generalized it into a theory of mental disorder as a whole.

I approach the nature of mental disorders differently. Rather than assuming that behind the appearances the world comes preferentially organized into categories such as physical disorder and mental disorder, disease and health, and normality and abnormality, I start with the experience of ‘what is there.’ What we find ‘there’ is that that the distinction between health and disease and normal abnormal are mostly clear when we consider the extremes, but distinctions made on the basis of the extremes are inadequate for many purposes.

In later work, I have compared this situation to the paradox of the heap in philosophy.  Let me explain. There is a clear distinction between sand scatted on the floor and a heap of sand. But if we begin with sand scattered on the floor and add one grain of sand at a time, there is no point at which adding one more grain of sand will transform the scattered sand into a heap.  There are borderline regions where the distinction between scattered sand and a heap cannot be precisely made. In some cases, this is also true for the distinction between normal and abnormal in psychiatry.  The distinction cannot be perfectly made.

Many of us desire answers that transcend the complications of experience and allow us to decide with clarity whether things like hysteria, narcissistic personality, and bereavement-related depression are really disorders or not. However, we would either be fooling ourselves or fooling others if we forced quasi-precise distinctions on to what is inherently imprecise.  Just as what we consider to be an adult can vary depending on our purposes for classifying (e.g., to allow drinking alcohol versus voting versus leaving school), what we consider to be a psychiatric disorder can vary – but such variation does not mean that disorders are just made up or that we can decide things any way we want.

Another thing we see ‘there’ is that the domain of psychiatric disorders is a motley collection of different conditions that are alike in some ways and different in other ways, but there is no way in which they are all alike.   It is an imperfect collection that came together not because of the discovery of an inner nature shared by all psychiatric disorders, but because the variety of conditions included in the psychiatric domain were appropriate to the skill set of psychiatrists and psychologists.

I do not argue that these complications mean that mental health professionals should no longer group symptoms clusters into coherent kinds. Abstract kind concepts can be very practical things, but we should understand that it is in the nature of abstract concepts to be inadequate when confronted with the many particulars of clinical reality.

If this notion of ‘what is there’ is reasonably valid, I have some hope that a part of what I have written can survive the transition across the linguistic and cultural barrier.

Peter Zachar
May 20, 2018



『精神病理の形而上学』日本語版への序文 原文はこちらから