you've been framed

A central claim of much social-scientific critique of psychiatric nosology is that psychiatry too often naively adopts a (let's-call-it) realist perspective on psychiatric illness categories, whereas in truth we'd do better to see a diagnostic category like 'depression' as one, optional, sometimes useful, sometimes not, way of framing human distress / problems in living. It's the second part of this claim that I'd like to focus on here. What do we mean when we talk of framing? Regarding that talk, what's its value; what are its limitations?

The first useful thing to point out about frames (conceptualisations, constructions) is that they aren't themselves in the truth-speaking game. They have to do with what's prior to this: with ways of seeing/thinking/talking/conceptualising. (This is part of the complaint against the realist: the realist is oblivious to these prior questions, and their only critical apparatus is geared up to answering questions about the truth or falsity of judgments.) Now, once you have a frame in place, then you can ask whether some or other (frame-deploying) judgement is true. But the frame is not itself a judgement; it is not itself truth-assayable. Our social-scientific critic has it then that we can't then meaningfully ask, at least in any straightforward way, 'does mental illness as such actually exist?' For talk of 'mental illness' is, they'll say, a window through which one looks, rather than something which may or may not be being accurately seen through such a window. Even so, there are, they note, different, non-existence-related, kinds of critical question we can ask about framings. For example, we might ask whether a particular way of framing matters is or isn't really useful for us, or whether it hasn't perhaps become unhelpfully hegemonic. Or, noticing that frames give us the basic categories in terms of which judgements are made, we might ask whose interests are served by the widespread deployment of such and such a way of talking, seeing or thinking.

What's not often talked about by those who focus on framings is the limit, scope, remit, of the frame metaphor. It's this that I want to focus on here. To pre-empt: my thought is that whilst ignoring frames is naïve, so is taking "frame" to be a master concept for the interrogation of psychiatric judgement.

To start us along our path, consider first what might look like a rather different, metaphysical, matter. This has to do with what's wrong with that kind of transcendental idealism which has it that the mind always supplies the form of our judgement when it brings its concepts to bear on experience, whilst extra-mental reality supplies, through reality's impingements on us, our judgement's content. Take this all the way to a natural conclusion and we arrive at a peculiar view of the unconceptualised world as an intrinsically formless 'noumenal dough' which only has any order within it because we've been applying our cookie-cutter concepts to it. ... The problem now is that if the unconceptualised world really is such an intrinsically amorphous dough, why should there ever be any reason to apply one concept to one experience, another to another? Without structural constraints coming from, rather than imposed on, the experiences, how is discriminating judgement even possible? ... But note that talk of this or that 'structural constraint' shall itself be empty if it doesn't itself deploy more particular concepts. The point generalises: whenever a pundit of the idea of unconceptualised experience talks about our bringing our concepts to bear on any particular experience, which experience do they have in mind? If they can't individuate it without deploying a concept, then what are they even talking about? But how could they pick it out without a concept? (Wittgenstein, Philosophical Investigations, §261: "So in the end when one is doing philosophy one gets to the point where one would like just to emit an inarticulate sound. -- But such a sound is an expression only as it occurs in a particular language-game, which should now be described.")

One way past this problem is to draw a distinction between conceptualisation and framing. Sure, all experience must be conceptualised, but this doesn't mean it all requires framing. Psychiatry's social-scientific critics, for example, typically suggest we should apprehend their object using concepts such as "suffering", "problems in living", "experience", "belief". Thus before we have 'symptoms' we already have (say) 'hallucinations'; before we have 'psychosis' or 'delusions' we already have 'beliefs' and 'experiences'; before we have 'neuroses' we already have 'anxiety', etc. These, then, are the pre-framed but even so always-already conceptualised experiences which are only elevated to the status of illness and illness symptoms when they're viewed through an optional psychiatric lens which frames them a certain way. The idea of non-conceptualised experience may indeed take us down impossibly dark philosophical alleyways, but the idea of non-framed experience needn't.

That, perhaps, is all well and good. But how shall we distinguish between such concepts as are frames and such as are more basic and are required by anyone before we can so much as talk about those experiences which are psychiatry's concern? One way to do this - and I can't think of any other! - is to say that if that over which the psychiatric frame precisely ranges can be picked out without using the frame concept, then it, the frame concept, can happily be seen as an optional extra. Thus we might ask, of the 'suffering' concept itself: is there a way to pick out bona fide experiences of suffering other than through that very concept ('suffering')? If not then we shall count 'suffering' as basic: as a concept which is not itself a frame.

The validity then of talk of framings, when it comes to psychiatry, rests, I suggest, in the viability of reductive analyses of psychiatry's diagnostic concepts. Is it really possible to decompose depression, or obsessive compulsive disorder, or the schizophrenias, or specific phobias, into constituent behaviours and experiences the appreciation of which need involve no awareness of them as 'symptoms of mental illness'? Is the kind of suffering met with in the mental illnesses in principle no different than the kinds of suffering met with elsewhere? Do general concepts like 'problems in living' and 'suffering' really get us into anywhere near-enough specific a terrain as we encounter with 'mental illness'? Do we really not need to tacitly borrow a specifically psychiatric vision in order to hone in on just those problems in living, just those instances of suffering, as are met with in the mental illnesses? Social scientists (including psychologists) sometimes talk as if all of this is just obviously the case. And those who take too conceptually seriously the ICD's or the DSM's putative operationalisations do something similar. My own thought is that all of that is rather naive. Mental illness concepts, as I see them, involve us in the apprehension of a nexus of formally inter-penetrating (hence irreducible to any raw ingredients) ongoing suffering, irrationality, and automatic-yet-motivated state-maintaining avoidance of suffering. 

Whether I'm right in that analysis of mental illness is of course a topic for another day. What I hope to have shown here, though, is something far more modest: that the idea of mental illness talk as offering an optional framing is not something which can be respectably engaged in unless one's prepared to admit certain constraints on what shall count as frames and to spell out how they differ from such concepts as are not optional organisations of experience. What certainly won't do is simply saying something like 'but in this other culture they don't use mental illness concepts when discussing their travails.' Why won't it do? Because it doesn't by itself help us see whether they are simply blind to the character of certain of their own experiences, or whether instead they have adopted one set of metaphors or idioms or conceptualisations or what-have-yous over another. (After all, perhaps a psychiatric sensibility allows us to see that which is otherwise invisible?) ... That the presumption of a radical cultural relativism goes along with the presumption of the validity of 'framing' talk should surprise nobody. What the former can hardly do, however, is vouchsafe for us the latter.