Harriet Fagerberg: The Sowerby Project Heads to The Annual Meeting of the Philosophy of Science Association
The Annual Meeting of the American Philosophy of Science Association (PSA) took place in Pittsburgh, Pennsylvania this November 10th – 13th. It was followed by the third meeting of the Philosophy in Biology and Medicine (PhilInBioMed) Network, which works to promote interdisciplinary links between philosophy and medicine and biology. The Sowerby Project was represented at both of these events by myself, Harriet Fagerberg, Postdoctoral Researcher at CUNY and Sowerby affiliate, and Arjun Devanesan, medical doctor, King’s College PhD student, and Sowerby project member.
Having recently relocated to the US from London for a fellowship, I was glad to have the opportunity to attend the Philosophy of Science Association Annual meeting, and excited to see lots of familiar names on the programme. Among them, our very own Arjun was giving a talk entitled “A mereological analysis of pregnancy – According to the immune system” as part of the main conference, as well as a talk considering “Pregnancy, a test case for the discontinuity theory of immunology” at the later adjoining PhiInBioMed meeting.
Philosophy of medicine was well-represented at the PSA meeting. There were sessions on “Psychiatric Practice and Philosophy of Psychiatry”, “Philosophical Perspectives on Cancer Biology and Medicine”, “Scientific Medicine”, as well as a number of sessions on related topics in philosophy of biology. I arrived fashionably late, but Arjun was there from the very beginning and so managed to also catch the International Philosophy of Medicine Roundtable Session on “Treatment evaluation: new perspectives from the bench to bedside and beyond” on the morning of the first day.
Arjun’s talk at the PSA was part of a session entitled “Health and Pandemic Policy”. In it, he considered Sowerby Professor Elselijn Kingma’s immunological argument for a parthood-view of the mereological relation between the gestator and the foetus in pregnancy. Arjun argued that, instead, considerations based on the human immune system supports the view that the foetus and the pregnant organism overlap. There appears, according to Arjun, to be an organism (the foetus) that includes, immunologically speaking, parts of the gestator and there seems to be an organism (the gestator) that includes part of the foetus. Thus, we should conclude that the two organisms overlap.
As the PSA drew to a close – with a lovely dinner of famous Pittsburgh pierogi – the PhilInBioMed meeting was gearing up. This conference offered an exciting programme of talks for anyone with broad interests in the philosophy of science, medicine, biology and psychiatry, and in particular the intersections between philosophies of science and their corresponding scientific fields. Thomas Predeu and Maël Lemoine of the University of Bordeaux kicked off the conference by introducing us to the concept of ‘philosophy in medicine’ as distinct from ‘philosophy of medicine’. Where philosophy of medicine includes any philosophy which concerns itself with or is informed by topics in medicine, philosophy in the biological and medical sciences occurs where knowledge is co-produced by direct interactions or close dialogue between philosophers, scientists and medical doctors.
Given my interests in the philosophy of psychology and psychiatry, I was particularly excited about the keynote by Jerome Wakefield, professor of social work in the Silver School and of the conceptual foundations of psychiatry in the School of Medicine at New York University. Wakefield is most well-known for his influential ‘harmful dysfunction analysis’ of mental disorder, according to which the concept of mental disorder is jointly composed of evaluative harm and failure of natural function.
Lemoine introduced Wakefield’s research and career as a paradigm example of philosophy in medicine. Almost from the beginning, Wakefield’s philosophical work was entwined with and responsive to parallel debates in mental health and psychiatry. This influence ran both ways. Over the years, the definition of mental disorder contained within the Diagnostic and Statistical Manual of Mental Disorders (DSM) has morphed into something decidedly Wakefieldian – a syndrome, reflecting a mental dysfunction, usually associated with distress or disability. Moreover, according to Wakefield himself, developers and champions of the Research Domain Criteria (RDoC) Project – sometimes billed as a challenger to the DSM paradigm – take a similar view of their object of study. The goal, as outlined in Bruce Cuthbert’s standard PowerPoint slide, is to “understand mental disorders in terms of deviations from normal functioning of psychological and neurobiological mechanisms. Cf. Wakefield, ‘harmful dysfunction’” (Cuthbert, 2015; in Wakefield, 2021, p 37).
Wakefield’s contribution in bringing philosophical methods to bear on psychiatric debates powerfully illustrates the applicability of philosophical research when conducted in close dialogue with the sciences. He began by drawing attention to the upcoming 50-year anniversary of the removal of homosexuality from the DSM. Wakefield made the case that this move by the developers of the DSM was motivated, in part, by conceptual arguments regarding the legitimate bounds of the ‘concept of mental disorder’ put forward by psychiatrist Robert Spitzer. As such, this move could be seen to represent one of philosophy in medicine’s greatest and most significant impacts.
Wakefield went on to discuss his own work on the epidemiology of depression. An enduring question in the study of depression is whether the ‘epidemic’ of depressive symptoms visible in epidemiological surveys evidences large-scale and growing pathology, or whether the criteria are now too liberal and therefore encompass a number of non-pathological instances of normal intense sadness and distress. How might we draw a distinction between dysfunctional depression, on the one hand, and normal functional sadness in response to life stressors (such as bereavement or unrequited love)?
Wakefield explains that clinical depression usually carries an increased risk of suicide or an increased risk of recurrence of depressive episodes. In fact, the recurrence of depression has traditionally been taken to be a crucial distinguishing feature of disorder as opposed to normal sadness. Wakefield then shows us an example of his empirical data analyses, drawn from large psychiatric epidemiological data sets, which he pursued over a decade of empirical work on depression. On the basis of conceptual arguments, he predicted that a sub-set of the instances of depression identified by the DSM-criteria as major depressive disorder are likely not in fact disorders. His results confirmed that, on follow-up, the predicted group in fact does not differ from non-depression in risk of suicidality or recurrence, indicating that this form of ‘depression’ is something else altogether.
Arjun’s talk at PhilInBioMed considered the paradox of pregnancy in immunology. He provided a qualified defence of the self-nonself theory of immunology, according to which the function of the immune system is to differentiate the organism’s own tissues (the self) from any foreign invaders (nonself). Prima facie, pregnancy, wherein the pregnant organism’s immune system tolerates the foetus for several months, represents a challenge to the self-nonself view of immune function. Arjun argues that the self-nonself view can accommodate pregnancy: we can accept that the function of the immune system is to preserve the integrity of the ‘self’, but dispute that this function is executed by always rejecting the nonself. Arjun then went on to mount a challenge to Thomas Pradeu’s continuity theory of immunology, arguing that the immune system’s tolerance of the foetus cannot be sufficiently accounted for by a criterion of continuity. As Arjun writes:
“While Pradeu acknowledges that immune function is context sensitive, unless he is able to explain how this arises and how it affects immune behaviours, it can only be seen as an ad hoc addition to the theory. It would be like saying that the immune system is triggered to reject discontinuities, except when it is not.” (Devanesan, unpublished manuscript)
Arjun’s talk prompted an interesting and informative exchange with Pradeu himself, who of course was in the audience – an excellent illustration of the benefit of bringing researchers in this field together to share ideas.
You can find more information about the Philosophy of Science Association here, and about the Philosophy in Biology and Medicine Network here. You can watch Arjun give a talk on philosophy and pregnancy here.
References
Jerome Wakefield, 2021. "From Ribot and Dupré to Spitzer and RDoC: Does the Harmful Dysfunction Analysis Possess Historical Explanatory Power? Reply to Steeves Demazeux", Defining Mental Disorder: Jerome Wakefield and His Critics.
