Charles Kissane and Imogen Pethick –
For our first Phil on Tap of the year, we were treated to a talk by Dr Sam Wilkinson on how ‘diagnosis’ can be understood through the model of verdict. Sam introduced this talk, which is based on his work with Dr Tom Roberts, with reference to an increasingly popularised idea: that we are over-diagnosing mental health conditions.
By positing questions investigating how this could be, Sam highlighted potential ties between conversations on mental health and issues of governmental funding. But, key to his investigation of the claim, Sam is more concerned with the very nature of diagnosis and whether it is performed correctly or not. If looking at diagnosis as subject to truth or accuracy conditions, we must accept the notion of standard practice and generalised understanding. That is to say, a diagnosis is correct if and only if you actually have the condition, and it is generally agreed you have the condition. Sam elucidated this mainstream understanding through the more neutral example of having long hair, where the diagnosis of long hair is either factually true or it is not.
Unsurprisingly, the debate surrounding diagnosing mental disorders then becomes ontological, questioning whether diagnosis is objective and whether it has some kind of value judgement. However, Sam wanted to question the nature of diagnosis itself rather than assessing the objectivity of a potential diagnostic assertion. This is where he called upon the speech act theory of J.L. Austin (1975). Austin’s theory proposes the idea that when you are using language you are doing an action and that what you’re doing with the language, rather than the language itself, is where meaning is found. Sam utilised an example of running to catch the tube to explain: if you squeeze on and the person next to you says “you’re treading on my foot”, on the surface they are asserting a fact that is either true or false, but the illocutionary force (or intention of the speech act) would be to communicate “get off my foot”. Austin, rather helpfully, provides a taxonomy of performative utterances, which classifies the speech acts whereby saying it makes it so. One such classification is labelled a “verdictive” which provides a verdict. Sam argues that this taxonomy may be used to better understand the nature of diagnoses by suggesting that diagnosis is a verdictive.
Sam first explained the nature of verdictives. Verdictives are performative speech acts that bring a fact into being, such as how a judge finding someone guilty institutionally brings their guilt into being. However, verdictives require institutional authority to be deemed felicitous as speech acts. In other words, they need a degree of consensus (in Sam’s example, we cede to the authority of a judge). If someone without institutional authority performs a verdictive speech act, it is infelicitous.
Verdictives require three conditions:
- Institutional authority
- Institutional consensus
- Consequences
Verdictives are subject to misfires or abuses. A misfire immediately fails to meet the conditions as a verdictive—such as someone on the side of the pitch declaring ‘out’ instead of an umpire. Abuses occur when the speech act is successful but is in some way flawed, such as being insincere, defective, misleading, or mistaken. Sam’s key proposal is that diagnoses are subject to these same conditions and pitfalls and can be thought of as verdicts.
Sam went on to suggest that the model of diagnosis as a verdictive might be beneficial, as in discussion surrounding self-diagnosis. Online activity has seemingly enabled an increase in self-diagnosis, with many people finding commonality with different conditions and experiences. Sam argues there are two different kinds of self-diagnosis: firstly, one can use existing diagnostic categories and diagnose themselves based on how they correspond with their experiences; secondly, there is the rapidly growing type which uses entirely new diagnostic categories which are constructed in online spaces through shared experiences. The latter kind of self-diagnosis can then be seen as a misfire, as those that are diagnosing themselves are not in positions of institutional authority to do so. However, the following is brought into question: what if you reapportion authority? These people have a degree of authority of what they are experiencing in their lives and so the position of authority becomes unclear. It is this line of questioning which may allow for a different perspective on self-diagnosis and its criticisms.
Sam then skilfully returned to the initial point of debate: the over-diagnosis of mental health conditions. By modelling diagnosis as verdict, you might now argue that a complaint about over-diagnosis is a complaint about abuse of a diagnostic speech act. This abuse might be that someone with institutional authority is diagnosing people who they might not think objectively have a condition, but they believe might benefit from the treatment. However, achieving consensus in the case of verdictives is not about having direct grasp on objective facts, it is about a consensus on a course of action that needs to happen, in this case someone receiving treatment. Sam suggests that this is the same for diagnosis. You can end up with a felicitous diagnosis based on consensus (on necessary treatment), provided by an authority, that has the necessary consequences, removing the difficulty of assertion and objectivity within diagnosis.
Thank you for reading our first summary of the year. It was great to see so many of you there!
Bibliography:
Austin, J.L. (1975) How To Do Things With Words: The William James Lectures delivered at Harvard University in 1955. 2nd edn. Oxford University Press.