VMST 2022: VALUES IN MEDICINE, SCIENCE, AND TECHNOLOGY CONFERENCE 2022
PROGRAM FOR THURSDAY, MAY 19TH
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10:00-12:00 Session 2: Panel Session
Location: JO 4.614
10:00
Beyond the Ivory Tower: Practical Consequences of Philosophical Debates about Psychiatry

ABSTRACT. Given psychiatry’s dual nature as a medical science and a system of social values, debates over the place of values in science have an especially important role to play in this domain. Our panel explores some philosophical and ethical debates pertinent to contemporary psychiatry and shows how the outcomes of these debates can have powerful downstream impacts on the lives of people for whom psychiatry attempts to care. We recognize that there is a contentious debate surrounding how to refer to this community, though for reasons of practicality we will largely put those debates aside, and use the terms like “mental illness,” “mental disorders,” and “psychiatric diagnosis” rather loosely.

Our first panelist will explore how certain philosophical debates about agency, responsibility, and rationality in cases of psychopathology can have powerful, and chiefly negative, impacts on the lives of individuals with psychiatric diagnoses. She suggests that theorists take on special responsibilities when making claims about these individuals, and thus, must take better care in labeling practices. Our second panelist will attempt to defend a particular metaethical orientation for psychiatry, arguing that psychiatry must ground its diagnostic and conceptual practices in the personally held values of those for whom it purports to care. Finally, our third panelist will argue for the pragmatic validity of an objectivist normative framework in psychiatry, by showing how it allows clinicians to overcome the key problem of paternalism.

We propose a panel that will take 2 hours in total, with the following format. Each speaker will be given 20 minutes to give their respective presentation, followed by 10 minutes of Q&A directed towards that speaker. The final 30 minutes of the session will be a broader Q&A and discussion bringing all of the panelists together, to allow for reflection on the interaction among the individual presentations, as well as more general discussion of the panel theme.

Our hope is that connecting more abstract philosophical considerations to concrete effects on people’s lives will highlight what is at stake in theorizing about psychiatry. These debates are not merely an academic exercise, but rather have real consequences for how psychiatric science is conducted, and for how those who fall under psychiatric care are treated. We aim to demonstrate that greater care must be taken in philosophical debates—as characterizations of individuals with mental disorders have significant impact in clinical, legal, and social settings.

Please note that all presenters for this proposed panel are graduate students at significantly varying stages of their progression through the University of Utah's graduate program in philosophy. In addition to sharing philosophical themes and pragmatic aims, we hope that the shared institutional context of these presenters will contribute to the cohesiveness and value of their presenting as a panel rather than as individual speakers. Dr. Natalia Washington, keynote speaker for ViMST, is available to chair the session, should it be accepted; unless the session should immediately proceed or follow her keynote, in which case Dr. Joyce C. Havstad is available to take the chair's role instead.

13:30-14:30 Session 3: Values in Psychiatry and Psychology
Location: JO 4.614
13:30
A Non-Individualistic Psychiatric Ethics: What It Might Mean for Those Living with Schizophrenia

ABSTRACT. Since its origins, disability studies challenged the medical model for defining disability and advocated for a shift of focus on the social and natural barriers faced by people with disabilities, arguing that when one casts those who live with long-term disabilities as persons impaired or lacking, one artificially isolates them from their social environment and places the locus of responsibility for their condition on the individual. Does this approach go far enough, however, in identifying the values required for the treatment of severe mental illness, and of schizophrenia in particular?

What may be required in the context of mental health care could in fact be a non-individualistic ethics. The idea to counter holistic and biocentric forms of ethical theorizing is becoming further and further developed within the field of environmental ethics. Ethical challenges resulting from the technological mediation of nature have demonstrated the need to challenge the individualistic framework of traditional ethical theories as well. Psychiatry, however, despite being human-focused in so far that its care is directed at human beings, is also a form of technological mediation, itself reliant not only on the pharmaceutical manipulation of biological factors but also on ethical applications of its various technologies of the self.

What would a psychiatric ethics that does not rely on individualistic concepts look like, however? In his thought-provoking book Crazy Like Us: The Globalization of the American Psyche Ethan Watters investigates the finding that people with schizophrenia in developing countries experience better long-term outcomes than those who live in industrialized nations (137). Watters cites a wide array of sources from the fields of ethnographic and cross-cultural psychiatry to attribute this difference to cultural factors which do not easily give themselves to measurement by the medical sciences: concepts such as the emotional temperature of families caring for relatives or a patient’s sense of agency as construed within the biomedical vs. the psychosocial models.

Whereas the cross-cultural differences identified by ethnographies of psychiatric practices worldwide would confound the data-focused research methodologies of Western medicine, a value-based normative philosophical approach brings them out with extraordinary clarity. Most intriguing among the insights possible through a value-based approach is the interplay between the scientific beliefs through which one’s understanding of mental illness is framed and one’s understanding of their place within the world at large. The latter of these is closely connected to the degree of agency one deems appropriate for themselves (e.g. whether one believes oneself to be a master of one’s fate or whether one defines one’s lot in life in terms of social support and arbitrary events). One’s subjective sense of treatment outcomes in this way may in fact be a function of the individualism displayed in one’s social and cultural environment. In my paper, I discuss these cross-cultural psychiatric findings as opportunities for developing a new kind of psychiatric ethics, one which upholds an ethical commitment to a non-individualistic worldview but which nevertheless remains thoroughly humanistic in its vision.

13:50
Is Moral Truth “Admissible” in Scientific Moral Psychology?

ABSTRACT. Are appeals to (objective) moral truth scientifically adequate? In other words, is moral truth “admissible” in science? In particular, is moral error (simpliciter)—that is, deviating from or contravening the moral truth—an adequate classification or kind within scientific moral psychology? The motivating context here regards cognitive biases, which are systematic reasoning errors (e.g., confirmation bias). Cognitive debiasing techniques are techniques for reducing cognitive biases. Given that research on cognitive debiasing has yielded empirically based techniques that deliver rational improvement, perhaps analogous research on moral debiasing can yield empirically based techniques that deliver moral improvement. However, moral debiasing presupposes moral biases—that is, systematic moral errors—and there is an important asymmetry between cognitive and moral errors. Cognitive erroneousness is attributed to outputs based upon their deviating from ideal rationality (e.g., violating Bayes’ theorem). In this respect, the standard, ideal rationality, grounds cognitive errors. Often enough, this standard, and the grounding it supplies, is (comparatively) unassailable. In contrast, grounding moral errors is trickier, especially within a scientific context. For instance, prima facie, the default grounding for moral errors would be the true moral theory. However, not only is it unclear which moral theory is true, it is not obvious that any moral theory is true. This deficit in knowledge regarding the true moral theory (de dicto) is a resilient problem. Firstly, since moral theories are not subject to empirical falsification, they are not entitled to the accommodating standards of scientific adequacy afforded to theoretical posits and working hypotheses. In other words, the issue here is not whether a particular judgment occurs, or whether it instantiates an empirically falsifiable property; instead, the issue is whether a given judgment constitutes a moral error—that is, whether moral correctness supervenes upon that judgment—which is an empirically unfalsifiable proposition. Secondly, since a true moral theory is not a necessary presupposition of science, it is not eligible for the sort of waiver granted to science’s axioms and foundational commitments. Similarly, the necessary admission of epistemic values into science does not justify the unnecessary admission of moral values. Thirdly, even when moral evaluation is needed—such as when using categories that depend upon morally thick concepts, such as bullying, domestic abuse, and war atrocities—such evaluations do not require (objective) moral truth since explicitly relativized moral evaluations provide an unproblematic, adequate alternative (e.g., moral error-according-to-utilitarianism, wherein utilitarianism is not a moral theory of the right but merely a moral “standard of interest”). Especially given the proceeding, to incorporate a moral theory—for instance, utilitarianism or Kantian ethics—as the true moral theory within science, that truth needs to be well-established. Currently, no moral theory is such that its truth is well-established—certainly, nowhere near the extent to which, say, Bayes’ theorem is established. Furthermore, given the strong case for metaethical skepticism, moral truth itself is not well-established. As such, appeals to moral truth within scientific moral psychology are scientifically inadequate—in other words, such claims are “inadmissible” in science.

15:00-16:30 Session 4: Keynote Lecture
Location: JO 4.614
15:00
Critiquing Values: Psychiatry and Well-being