Şerife Tekin is an assistant professor of philosophy at Daemen College in Buffalo, NY. She is also an Associate Fellow of the Center for Philosophy of Science at the University of Pittsburgh. She completed her PhD at York University in Canada, and held postdoctoral fellowships at Dalhousie University and the University of Pittsburgh. Her work is at the cusp of feminist approaches to philosophy of mind, philosophy of science, and medical ethics. Her co-edited book, Extraordinary Science and Psychiatry: Responding to the Current Crisis in Mental Health Research, has recently been published by MIT University Press. Her work has appeared in journals such as Synthese; Philosophy, Psychiatry and Psychology; Public Affairs Quarterly; Journal of Medical Ethics; Philosophical Psychology; The American Journal of Bioethics, and in books such as Classifying Psychopathology: Mental Kinds and Natural Kinds (MIT Press); The Psychiatric Babel: Assessing the DSM-5 (Springer’s Press); Philosophical Issues in Pharmaceutics (Springer’s Press). She is the Executive Coordinator of the Association for the Advancement of Philosophy and Psychiatry. A native of Denizli, Turkey, she spent her childhood and adolescence on the Aegean coast, wandering around the ruins of Ancient Greek civilization, contemplating the meaning of life. The Olympic torch she has been carrying around since her early childhood days have helped her happily make home in North America.
The Missing Self in Scientific Psychiatry
Thank you, Meena, for giving me the opportunity to say a few things about my research. Before I do, let me say how much I enjoy your blog – it has been a joy getting acquainted with the work of philosophers working in such a wide range of areas. I am honored to be included in such an impressive group. I am taking this opportunity to talk about the main arguments in my article “The Missing Self in Scientific Psychiatry,” which is recently published in Syhthese: An International Journal for Epistemology, Methodology and Philosophy of Science.
Most mental disorders are expressed as anomalies in such self-related capacities and attitudes as self-control, self-conceptualization, self-respect, and self-esteem, and, as such, they cause an individual’s relationship with herself and others to deteriorate. In this regard, most mental disorders directly affect the self – the dynamic, complex, relational, multi-aspectual, and multitudinous configuration of capacities, processes, states, and traits that support agency (Tekin 2017b, 2014b; Bechtel 2008; Jopling 2000; Neisser 1988).
Starting with Socrates’ admonition to know oneself and his claim that the unexamined life is not worth living, the self has occupied a central place in philosophical and scientific inquiry. Debates about the self include metaphysical questions on the nature and reality of selfhood, empirical questions about the developmental and historical trajectory of the human selves, and ethical questions about agency, responsibility, and autonomy. The answers to these metaphysical, empirical, and ethical questions are intertwined, as the nature of selfhood both constrains and enables the range of moral and political actions of an individual in a social world.
In psychiatry, the concept of the self has a complex history. While it was a popular clinical and scientific notion in the early days of psychoanalytic approaches to mental disorders, starting in the 1980s, scientific psychiatry began to sidestep the concept, even though it remains central to clinical contexts (for further discussion see Tekin 2015, 2014a; Tekin and Mosko 2015). In fact, as I argue in the article, there is a misalignment between the scientific research and clinical work on mental disorders with respect to the concept of the self.
Various traditions in mental health care, such as humanistic, psychoanalytic, phenomenological, existential and cognitive-behavioral psychotherapy, implicitly or explicitly acknowledge that a disruption of the self, or the person, or the agent (often using these three concepts synonymously) is a common denominator of different mental disorders. They emphasize the importance of understanding patients as reasons-responsive, in their full mental health relevant complexity, if their mental disorder is to be treated successfully. Self-related phenomena, such as personal identity (e.g., age, gender, race, socio-economic status, employment status, interpersonal relationships) and self-regarding attitudes and capacities, such as self-conceptualization, self-esteem, self-respect and self-control, are important constituents of mental health. In these clinical traditions, the concept of self is used to do the explanatory work of mental disorders, e.g., when the clinician explains the condition to the patient and the family members, and it reappears in subsequently prescribed therapies. For instance, the betterment of the self, e.g., increasing self-esteem, improving self-concepts, enriching self-control capacities, and enhancing self-respect, is set as the goal of the therapeutic encounter and achieved by engaging with various properties of the self, such as reason-responsiveness, self-interpretation and self-assessment.
The centrality of the concept of the self is not mirrored in the mainstream scientific approaches in psychiatry, however. In fact, the self has rarely been the object of scientific research, the empirical investigation of which might yield successful explanations of and interventions in mental disorders. Thus, even though self-related phenomena are clinically relevant insofar as they give important information about a mental disorder to the clinician and help the development of effective interventions, they are not considered among the scientifically relevant properties of mental disorders.
To cite only one example, the tradition of psychiatric research driven by the Diagnostic and Statistical Manual of Mental Disorders (DSM), a classification manual of mental disorders created by the American Psychiatric Association (APA) to guide research, clinical, and policy related inquiries, does not take the concept of the self as an explicit object of scientific inquiry (APA 1994, 2013). Instead, it opts for a mental disorder construct, e.g., major depression, individuated through observable behaviors such as signs and symptoms, not the plethora of self-related phenomena that are compromised in the presence of a mental disorder.
In other words, the properties of mental disorders targeted by clinicians and those targeted by researchers are misaligned. Among the former group, self-related phenomena are considered relevant properties of mental disorders, while among the latter, they are neglected.
The fact that self-related phenomena are missing from scientific research on mental disorders can arguably be attributed to the presupposition that the self is not empirically tractable and its use will hinder psychiatry’s goal to be scientific. Researchers might want to exclude the self from scientific psychiatry because, as a folk concept, it does not sit well with the kind of concepts studied in sciences with the promise of unpacking the etiology of mental disorders, such as neuroscience or genetics. In the near future, the concept of the self might be fractured into different components, some related to memory (auto-biographical memory), others to high-level action control, and so on.
In the paper, I take issue with these connected challenges. I argue the self is empirically tractable, and its use as a target of research will not hinder psychiatry’s scientific commitments. The concept of the self offers rich scientific resources to investigate and intervene in mental disorders; available resources include not only neuroscientific and genetic research but also those areas of study considering the role of interpersonal relationships, environment, culture and epidemiological factors in the development of illness. Though I do not focus on the topic in the paper, the concept of the self can be a rich resource for contemplating the nature of agency, free will, and responsibility, especially in the context of mental illness, thus explicitly connecting psychiatry to other fields in the humanities such as anthropology, law, and politics – if we are to fathom the complexity of mental disorders in the lives of individuals, communities, and the cultures, we must use the resources offered in these fields of study.
In the paper, I raise and respond to two challenges inherent in the presupposition that the self is not empirically tractable and its use will hinder psychiatry’s goal to be scientific.
The first is the question of how psychiatry can meet its aspirations to be a scientific discipline. I respond by proposing that psychiatry, very much like other special sciences, such as economics or biology, should be considered a model-building science. Different objects of inquiry, including the self, the mental disorder construct, or the brain, can be represented and studied using scientific models, thus making complex real-world phenomena empirically tractable. These models can be used to accomplish scientific goals, such as explanations of and interventions in mental disorders.
The second challenge is whether the self is fit for empirical investigation. In response, I offer an empirically tractable model of the self, i.e., the multitudinous self, and explain how it can provide insight into and contribute to our understanding of mental disorders. While a fractured engagement with different parts of the self, e.g., auto-biographical memory, is fruitful, there is virtue in researching the self as a whole, because what happens in one component affects another component – and the entire self-system. In other words, an integrated understanding of the different parts of the self is necessary to fathom the complexity of mental disorders. To illustrate this, I focus on addiction (for a detailed account of my approach to addiction see Tekin 2017a; Tekin, Flanagan, Graham 2017).
The overall goal of my research is to illustrate that we cannot theorize psychopathology by sidestepping the self that is the subject of mental disorders, and a philosophical account of the self is incomplete without including psychopathology. I call for methodological alterations in psychiatric research on and treatment of mental disorders; there is much to be learned from the multidisciplinary sciences of the mind, feminist philosophy, and the memoirs of psychopathology. My hope is that my research program will influence philosophers, bioethicists, psychiatrists, psychologists and neuroscientists, facilitating the development of valuable inquiry into mental disorders.
Bechtel, W. 2008. Mental mechanisms: Philosophical perspectives on cognitive neuroscience. London: Routledge.
Jopling, D. 2000. Self-knowledge and the self. New York: Routledge University Press.
Neisser, U. 1988. Five kinds of self-knowledge. Philosophical Psychology, 1, 35–59.
Tekin, Ş. 2017a (In press). Brain Mechanisms and the Disease Model of Addiction: Is it Really the Whole Story of the Addicted Self? A philosophical-skeptical perspective. In The Routledge Handbook of the Philosophy and Science of Addiction, Pickard, H. and Ahmed, S. eds. Routledge University Press.
Tekin, Ş. 2017b. The Missing Self in Scientific Psychiatry. Synthese. DOI.10.1007/s11229-017- 1324-0.
Tekin, Ş., and Mosko, M. 2015. Hyponarrativity and Context-Specific Limitations of the DSM-5. Public Affairs Quarterly, Volume 29, No: 1, 111-136.
Tekin, Ş. 2015. Against Hyponarrating Grief: Incompatible Research and Treatment Interests in the DSM-5. The DSM-5 in Perspective: Philosophical Reflections on the Psychiatric Babel, P. Singy and S. Demazeux, eds., History, Philosophy and the Theory of the Life Sciences Series, Volume 10, Springer Press, 179-197.
Tekin, Ş. 2014b. The Missing Self in Hacking’s Looping Effects. Classifying Psychopathology: Mental Kinds and Natural Kinds, H. Kincaid and J. A. Sullivan, eds., MIT Press, 227–256.
Tekin, Ş. 2014a. Self-insight in the Time of Mood Disorders: After the Diagnosis, Beyond the Treatment. Philosophy, Psychiatry, and Psychology, 21 (2), 139-155.
Tekin, Ş., Flanagan, O.J., Graham, G. 2017. Against the Drug Cure Model: Addiction, Identity, Pharmaceuticals. In Anthology on Pharmaceuticals, Ho, D., ed., Springer Press.