The Helsinki Network for Philosophy of Psychiatry organized the symposium ”Culture, Extended and Embodied Cognition and Mental Disorders” on June 30-July 1, 2016, in Helsinki. The symposium was dedicated to cultural issues related to diagnostics, definitions and classifications of mental disorders, as well as phenomenological questions of experience, affectivity and embodiment. The symposium took place in Lapinlahti Hospital that was one of the first modern psychiatric hospitals in Northern Europe when it first opened its doors 175 years ago (on 1st of July 1841) - and now is a cultural venue.
Culture-Bound Syndromes and Mechanisms
Several talks focused on the ways culture affects disorders and their classification. In his introduction, Tuomas Vesterinen argued that definitions of mental disorders are inalienably value-laden, and that socio-cultural forces should be taken into account in explanations and classifications in order not to spread the diagnostic categories inadvertently from culture to culture through looping effects.
In his talk, Dominic Murphy showed how culture-bound syndromes (CBS) can be the linchpin for understanding how to combine cultural and neurobiological explanations. Basically there are three options: (i) CBS’s are not disorders at all; (ii) CBS’s can be incorporated into universal categories (even though there are different manifestations of illnesses, the underlying disorders are the same); or (iii) all mental disorders are to be considered as culture-bound. Murphy argued that both universalism (ii) and particularism (iii) are consistent with the idea that when a particular “culture plugs into psychology”, it creates specific outputs, making proximal mental representations the crucial explanatory system.
According to Murphy, although culture may affect everything in human psychology, it is not always relevant in explaining CBS: “Both social and psychological processes need to be entangled in our general understanding of psychopathology – and not just cross-culturally – it may be that we can imagine a spectrum.” In some cases cultural forces may be the source of explanation. On the other hand, models of cultural epidemiology may neither be suited for explaining how culture influences the non-typical mind nor do they provide relevant information in cases of severe neuropsychological collapse (e.g. advanced psychosis or dementia). This point was echoed by Marion Godman who argued that cultural explanations are needed to understand local coping with disorders but may not enhance our understanding of the disorders themselves.
Speakers were divided on whether underlying mechanisms are needed for classifying mental disorders. According to Harold Kincaid, we should direct our efforts on picking out “objective predictive kinds” instead of relying on robust definitions of natural kinds or underlying mechanisms. Kincaid, and Caterina Marchionni in her talk, maintained that disorder kinds or categories can be identified objectively by consistent shared traits without knowing why they are shared. Furthermore, Kincaid argued that ideally the categories should fit into a predictive causal network, and in order to decide which categories are predictive, we need detailed empirical studies. On the contrary, top-down approaches to mental disorders based on evolution or typical brain functioning play no real role in DSM or in other accounts of disorders. The upshot of both Kincaid’s and Marchionni’s talks was the need for pluralistic approaches to classification.
At the other extreme were Samuli Pöyhönen and Petri Ylikoski, who argued for an all-encompassing view of addiction by integrating different approaches under a matrix of mechanisms. According to their “addiction-as-a-kind” hypothesis, different forms of addiction can be united under a single kind upheld by a matrix of mechanisms that are responsible for the disorders’ typical properties (symptoms, etiology, response to treatment etc.). Moreover, different combinations of the matrix underlying different addictions provide a means for objective classification.