Ahmed Helmy –
In Status and Constitution in Psychiatric Classification, Roberts and Wilkinson (2025) aim to intervene in one of the most intractable debates within the philosophy of psychiatry, the relation between values and facts. They do this by introducing their own conceptual distinction that aims to reframe, rather than resolve, the current conflict between objectivism and normativism.
Before delving into the contents of what is an excellently structured and well-argued paper, we must first understand the background of the debate between Objectivism and Normativism. This debate primarily centres around whether mental disorder is a natural fact, or a value-laden judgement.
Objectivism (e.g. Boorse 1975) is the belief that mental disorder is purely a biological disfunction, it is seen as a deviation from species-typical functionality. For the objectivist, moral evaluation is not a factor of disorder, it is purely biological malfunction and should be treated as such. Normativism (e.g. Fulford 1989) on the other hand, is the belief that mental disorders inherently cannot be value-free, as they involve human-led judgements of harm, suffering, and social undesirability. It requires human value judgements to discern whether a schizophrenic is a harm to society, unlike medicine – where an illness like cancer is objectively harmful.
Roberts and Wilkinson intervene with their central distinction, they propose that these separate philosophical positions address different questions: the status of disorder (what makes a condition, a condition) versus its constitution (what empirical structures realise it). They argue that confusion between these two levels sustains the apparent conflict between the two positions. They proceed their argument by distinguishing mind-independent status (e.g. ‘quartz’), value-free mind independent status (e.g. ‘banknote’) and evaluative mind-dependent status (e.g. ‘weed’). They argue that psychiatric classifications should belong to the latter: socially constructed yet evaluatively grounded, and not reducible to mere convention.
Within this view, psychiatry is normative in its status, but empirical constitution. Which aligns with the obvious differences between it and the natural sciences. Biological findings explain how these disorders operate, and what symptoms they cause, but society is what determines which conditions now count as disorders. Their framework strongly and effectively rejects hybrid accounts like Wakefield’s harmful disfunction analysis (1992) which aimed to reconcile the two strands by defining disorder as simultaneously both a condition that causes harm and involves biological dysfunction, but Roberts and Wilkinson argue that this conflation obscures the conceptual distinction between a disorder’s empirical constitution, and its evaluative status (Wakefield, 1992).
Furthermore, against the accusations of relativism, the authors clearly maintain that moral error (drapetomania and other fraudulent conceptions) is distinct from scientific error. Within this – psychiatry remains distinct from morality or law by virtue of its institutional role: addressing problems appropriate for medical treatment. Thus, psychiatry’s value-ladeness does not need to undermine its scientific authority at all.
Far and away, the papers greatest strength is its conceptual clarity. The status/constitution distinguish elegantly dissolves a pseudo debate that has taken place for decades, leading me to wonder how this distinction wasn’t discussed before. The authors taxonomy of statuses serves to offer a middle path between the two strands, and grounding psychiatry within evaluative life without reducing it to a mere, scientifically illegitimate social whim. It is philosophy doing what philosophy does best: clarifying the conditions of intelligibility.
However, I’d argue that the paper’s meta-philosophical significance could be even greater than its contribution to psychiatry. Within exposing a grammatical confusion, Roberts and Wilkinson perform a Wittgenstenian-esque conceptual therapy, they effectively remind the reader that true philosophical progress often occurs not by resolving disputes and defeating opponents, but through reclassifying the very questions that generate them. The result is an excellently demonstrated account of psychiatry as a practice embedded within human forms of life, oriented toward care, and empathy, not detached scientific description.
Yet within this – their framework may risk underplaying the autonomy of phenomenology. I’d be concerned that if psychiatric status depends wholly on evaluative attitudes, it may obscure the lived experience of madness, experiences whose pathological force seemingly exceed social interpretation. Moreover, the separation of status and constitution might be too neat in real practice: our evaluative attitudes often shift because of new biological insights such as homosexuality, once deemed dysfunction, disproven by research showing there was no biological abnormalities in homosexual patients. (Bayer, R. 1981).
Regardless, Roberts and Wilkinson wrote an excellently crated paper, without compromise, with excellent clarification. Their work serves to exemplify philosophy’s unique power to refine the grammar of inquiry itself – to show that what we call “mental illness”, need not belong to nature or culture, but to the evaluative fabric of human life.
Bibliography:
Bayer, R., 1981. Homosexuality and American Psychiatry: The Politics of Diagnosis. New York: Basic Books.
Boorse, C., 1975. ‘On the distinction between disease and illness.’ Philosophy & Public Affairs, 5(1), pp.49–68.
Fulford, K.W.M., 1989. Moral Theory and Medical Practice. Cambridge: Cambridge University Press.
Roberts, T. and Wilkinson, S., 2025. ‘Status and Constitution in Psychiatric Classification.’ Synthese, 203(1), pp.1–23.
Wakefield, J.C., 1992. ‘The concept of mental disorder: On the boundary between biological facts and social values.’ American Psychologist, 47(3), pp.373–388.