A brief investigation of the departure from lawful explanation in mental health

The idea of scientific explanation as demonstrating apparently disparate phenomena to be essentially or lawfully similar has been around for a long time (Salmon, 1998), long before the initial proposition from Hempel (1948 as cited in Salmon, 1998) with which the contemporary philosophical discussion of the nature of scientific explanation began. Certain courses in the historical progression of our understanding of mental health however, have led the discussion of scientific law in mental health, and consequently in music therapy to be postponed. Indeed, nowadays we see nothing on the notion of lawfulness or universal principles of mental health neither in the academic curriculums nor in the literature of music therapy or psychology. But the fields’ repulsion for the notion has not always been the case. As early as 1894, William James, who is often referred to as the father of American psychology, proclaimed that “mental therapeutics should not be stamped out, but studied, and its laws ascertained” (Caplan, 1998, p.

63). Likewise, as early as 1940’s Ira Altschuler, a pioneer of music therapy and its usage in psychiatric settings, emphasizes the importance of pursuing every possible therapeutic property

“inherent in music” (Altschuler, 2001, p. 72).

This aim put forth by Altschuler, appears to be in direct contrast with the goals of modern music therapy; both in the constructivist paradigms where the idea of music being “one thing” with certain essential i.e. inherent properties is challenged with the idea that there are instead many

“musics” shaped by particular anthropological perspectives (Stige, 1998), as well as the positivist paradigm which is mainly interested in the probabilistic demonstrations of known or assumed utilities of music, and the pragmatism of the independent variable rather than the necessary properties and principles of its concepts. The latter approach is in concordance with the general principles of the positivist paradigm of science; according to which, because the objective principles of a concept lay outside of the observable (i.e. the empirical domain), they have to be excluded from the interest of “objective” science, whether they pertain to natural or social sciences. In other words, only that which lies in our sensory experience is believed to comprise the subject of scientific pursuit, and the rest ought to be considered as equal in quality with the pre-enlightenment metaphysics.

Consequently, because that which can be experienced can only be relative to the experiencing subject and never absolute, absolute relations in the world or necessary properties of concepts are strictly outside of “scientific interest as defined by positivism”, due to these universal properties themselves being unavailable to direct sensory experience as universals. Thus within this paradigm, scientists are concerned exclusively with that which sensory experience is able to afford; accumulating inductive generalizations rather than objective inherent orders, and with local probabilistic accounts rather than provable universal relations.

However, prior to the rise of the positivist paradigm in science, it has already been known that observation and experience is unable to provide us with the knowledge of the objective world.

While the positivist paradigm insists that science must be directed by experience, Hume, as a thorough exponent of naturalist philosophy himself and a renowned interrupter of dogmatic slumbers (Stanford University, 2019), showed that only psychological representations can be derived from knowledge whose source is experience, and the connection between the representations has no more significance than being subjective associations, or even recitations (Yardımlı, 2012, p. 7). Indeed, experience is not knowledge but what is to be known;

experiences, observations and phenomena are themselves determined by the hitherto comprehended properties of their concepts; accordingly, when conceptual formations develop

and change, this changes the very experience, phenomenon and observation, which were previously assumed to provide absolute objective knowledge (Yardımlı, 2016).

Consequently, scientific aims initially put forth by William James and Ira Altshuler regarding the discovery of inherent principles appear as fundamental; because, just as our current experience and observation of the phenomenon of mental health is directly shaped by the knowledge (or lack of it) of relevant concepts, the further discovery of such principles regarding the properties of these concepts is the only means to truer and richer experience, observations and predictions.

In contrast, the idea that our sense-perception provides objective knowledge of reality, enables us to affirm our categorical descriptions as all encompassing actualities. This assured conviction regarding perceived notions being all encompassing realities leaves no need or possibility to pursue and develop more in depth conceptions, and scientific efforts are instead directed as investigating utilities enabled by available categories.

In accordance with this, up until 1967, the widespread approach among professionals of mental health was based on the indispensability of an aetiological account (Fulford & Sartorius, 2009).

Although struggles had been noted regarding the operationalization of the concepts of psychodynamic theory as the prevalent mental health theory of the time, the need for an etiological basis of mental health and disorder, just as the need for a basis for the reasons of biological health and illness, was common sense.

The presumed dispensability of the knowledge for the reasons of mental health and disorder begins with the shift from utilization of etiological (theoretical) to descriptive (symptom based) accounts of disorder in ICD 8, the first published work with a firmly descriptive classification of mental disorders as its content. It is important to investigate this content in a historical perspective, so as to recognize it as one of the variety of solutions offered in the historical development of our knowledge pertaining to mental health. Then it would be possible to think critically in terms of the reasons as to why the professionals might have suggested them, whether or not they are appropriate solutions for issues they were aiming to solve, as well as the grounds for their approval or disapproval by professionals and institutions. Without this historical context, it is easy to regard the current mental health content shared by the ICD, the DSM as well as academic textbooks, as immediate and unquestionable biological and ontological realities,

rather than as suggestions within the then-zeitgeist with their particular utilities and impediments.

According to Fulford and Sartorius (2009), the reported history of the descriptive turn starts with the World Health Organisation commissioning of a research group led by Erwin Stengel who collaborated with Carl Hempel in order to find out the reason as to why the mental disorders section within the available edition of ICD was not adopted worldwide. One might think that this shift from a theoretical to atheoretical ground could not have occurred without the explicit approval given by Stengel, Hempel or other prominent professionals of the committee as a result of a clear decision after long investigations and pondering of its implications. In other words, it is reasonable to expect that responsible people must have been convinced that a shift towards a system of classification is indeed the better alternative, in order for such a shift to happen.

Surprisingly, the history shows otherwise (Fulford & Sartorius, 2009). The WHO seems to receive nothing in terms of a recommendation for a shift towards the descriptive classifications from neither the committee, Stengel or Hempel. It was instead the suggestion of another member of the committee Aubrey Lewis, to avoid categories based on theoretical concepts and restrict the classifications to the descriptive type, to establish uniformity in comparisons of findings from different countries. This suggestion, although dismissed by the committee, found interest in the Chair of the WHO. Consequently Lewis played a key role in a programme launched by the WHO in 1965, in which the currently used classifications were designed.

Reportedly, worldwide professionals who had been struggling to assess the conditions of their patients up until then, had acquired a tool that provided them with convenience to such a degree in categorizing their patients, diagnostic categories reportedly took a life of their own, gradually leading to being acknowledged as actualities of patients' lives . The convenience and success of diagnostic categories, led them to overstep their purpose and overtime unintentionally provided professionals with the impression that diagnostic categories are biological realities (Pickard, 2009), and with the belief that a sound theoretical basis i.e. causal knowledge for handling issues with mental health is not a strict requisite. Despite the opposition from neurological research (Hyman, 2002; Andreasen, 2007, as cited in Fulford & Sartorius, 2009), along with the consistent resentment from patients for being subjected to what they feel as imposed and artificial labels (Fulford & Sartorius, 2009), as well as ever growing amount of research to

indicate various aspects of their problematic nature, general public and the majority of professionals strongly believing the categories to be sufficient representatives of mental health even today, show how enormously successful the diagnostic categories have been.

Regardless of their popularity, problems with reliability (Williams et al., 1992; McGorry et al., 1995, as cited in Pickard, 2009), co-morbidity (Robins et al., 1991, as cited in Pickard, 2009), and the lack of clear distinction between categories as shown by discriminant function analysis (Kendell and Gourlay, 1970; Brockington et al., 1991, as cited in Pickard, 2009) remain present.

The unifying aspect of scientific law continues to promise actual solutions to these problems of fragmentation which are at the heart of mental health practices, research and education. But an appropriate exploration of this possibility, first and foremost requires an in-depth investigation regarding the limitations of such categories which are causally linked with the issues they arise.

As will be discussed promptly, such limitations do not begin or end with the diagnostic categories of disorder; instead they even pertain to approaches which are proposed as alternatives to such diagnostic structures.

4.3. The unifying aspect of law as an unacknowledged demand of mental