I decided to click through to Mind Hacks, a blog Madrigal considers "exemplary." It looks good, all right, and something in the most recent post caught my eye. The blogger (actually one of the co-bloggers, I guess), Vaughan Bell, links to his own article at the Observer on developments in the diagnosis of mental illness: "some of the best evidence against the idea that psychiatric diagnoses like ‘schizophrenia’ describe discrete ‘diseases’ comes not from the critics of psychiatry, but from medical genetics. I found this a fascinating outcome because it puts both sides of the polarised 'psychiatry divide' in quite an uncomfortable position."
The “mental illness is a genetic brain disease” folks find that their evidence of choice – molecular genetics – has undermined the validity of individual diagnoses, while the “mental illness is socially constructed” folks find that the best evidence for their claims comes from neurobiology studies.I wonder about this, because I've learned to be suspicious when people from within the sciences start throwing around the term "social construction." Generally they have no idea what social construction means (though in fairness nobody really does), and I'm afraid Bell seems to fit the generalization. In the first place, I think he's confusing social constructionists with the anti-psychiatry movement of the 1950s and 1960s. No doubt there's some overlap there, and it may be that some social constructionists are indeed "uncomfortable" when they "find that the best evidence for their claims come from neurobiology studies." But while I've found plenty to criticize in much social-constructionist work, it is generally misread and/or misrepresented by outsiders.
I'll own to being a social constructionist, though I'm not terribly invested in the label. I'm not an academic, though, and I'm not representative of anybody. But I'm not at all uncomfortable about citing evidence from the sciences against scientists who take positions I dislike. It's not the only way to debate them, but I don't see how being a social constructionist excludes the use of science, as Bell seems to believe. (There's also a popular tendency to assume that any scientist who criticizes biological-determinist dogma -- Stephen Jay Gould, Anne Fausto-Sterling, Richard Lewontin, et al. -- must necessarily be a social constructionist.)
In the case of race, for example, there's no significant doubt that skin color and certain other traits associated with people of sub-Saharan African descent are determined by the genes. (Which genes, we don't know.) But those are the traits out of which race is socially constructed. The constructions can be very different, so that a person who is classified as "black" in the United States would be classified as "white" in Haiti or other countries. In the US, racial classifications have polarized in the past century: we used to have "white," "black," and "colored," with a number of discrete gradations in between. "Mulatto" used to be a category in the US census, but it's gone now: you're either black or you're white, and though mixed-race people challenge this, the US officially operates on an uncomfortable racial binary. Other races fit into the picture rather uneasily, because "race" (like "civil rights') has come to mean black/white first of all. At the same time, while many people insist with liberal goodwill that skin color is just skin-deep, most people seem to think that language, customs, styles of dress, art forms, and other cultural traits are in some way tied to race, or at least ethnicity -- whatever, they're innate, tied obscurely to skin color and hair texture.
As I've argued before, the current (though older than most people realize) scientific construction of homosexuality is of the invert, the soul of a woman trapped in the body of a man and vice versa. The science is confused, to put it gently. This leads to confusion as to whether a man who puts his penis into another man's body is a homosexual, because the theory would dictate otherwise: only the partner who plays the "woman's role" is the real homosexual. Yet scientists are unclear about this problem, partly because most of them seem not to have thought about it. As with race, it comes down to a matter of definition, not science.
So as far as I can tell, science is perfectly compatible with social constructionism where mental illness is concerned. This also ties to homosexuality, since science used to tell us authoritatively that homosexuality was a mental illness -- until suddenly it wasn't anymore. That the categories and diagnoses of mental illness keep changing needn't be an embarrassment to science. It only means that scientists and clinicians need to adopt a becoming modesty about their categories: they aren't final, they aren't set in stone, and they may change -- they almost certainly will, in fact. But in order to maintain their authority, scientists are "attracted by the durability of stone", as Sartre put it.
Oddly (or maybe not), I've had the same trouble getting scientists to grasp this as I've had getting religionists to grasp it about their own magisterium: it makes them very uncomfortable to recognize or admit just how much doctrine has changed over the centuries, and that their own firmly-held beliefs are historically situated and shaped. That's one of the paradoxes of being a thinking human being. As the psychologist Sheldon Kopp wrote in his "Eschatological Laundry List":
We must live within the ambiguity of partial freedom, partial power, and partial knowledge.Some people find it very hard to live with this, not because they don't act or decide, but because they hate to acknowledge that their acts and decisions are constrained by incomplete information. One way to evade acknowledging it is to deploy false binaries and straw men, as Bell did in his post and his article: the only alternative to Science is blank-slate "social constructionism," a total rejection of science and rationality. Which means ignoring the fact that their critics often are scientists. When this becomes impossible to ignore, you just affect bemusement that your science-hating critics are using science to argue against you: how embarrassing for them! But it's not embarrassing for them, not at all.
All important decisions must be made on the basis of insufficient data.
Yet we are responsible for everything we do.
