I hate it when a side comment or example completely takes over the main point of a blog post. In my post on ADHD I made what seemed to be a very straight-forward analogy to feminism:

Some feminists insist, against the evidence, that there are no significant differences between the sexes.

My point was only this – that it is a mistake to base a moral position on scientific facts, for then either you must insist that the facts conform to your moral desires, or your moral position is vulnerable to falsification. I specifically referenced Steven Pinker who made this point in The Blank Slate. Pinker also, by the way, gives numerous examples of feminists committing this fallacy in his book – so this is a secondary reference, but sufficient for the minor side point I was making.

A few, however, have completely missed my point, despite my later clarifications in the comments. I will pick on M. Davies since he wrote such a long comment. He writes, regarding my claims that some feminists hold this position:

Do you have some citations for this, some evidence that a distinct philosophy within feminist theory adheres to this claim?

First I must point out that whether or not any feminists actually hold this position is not relevant to my point – it was an analogy. To the extent that anyone takes the position that there are no significant difference between the sexes, they are committing the fallacy I am discussing. But I do hold that this is a distinct philosophy within feminism, and as I said I gave Pinker as one source.

But here are more – Christina Hoff Sommers in her book Who Stole Feminism? published in 1992 coined the terms Equity Feminism and Gender Feminism to describe distinct philosophies within feminism. The former emphasizes equality in law and opportunity (while acknowledging that the sexes are different), while the latter emphasizes the notion that our society is patriarchical and oppressive and that attempts to document differences between men and women are just a mechanism of oppression.

Further, there is a very real debate going on over the question of whether or not there are meaningful cognitive sex differences. Here is, in fact, a debate between Steven Pinker and Elizabeth Spelke on this issue. And to get back to my point – this debate should not be about feminism, but about objective science. We can maintain, as equity feminists do, that the sexes should be equal even if science tells us they are not equivalent.

I thought I was clear on this point, and yet M. Davies felt the need to write:

But of course the question remains whether those ‘clear and persistent differences’ manifest themselves in a way which is socially meaningful and whether those differences justify unequal social arrangements (they don’t; only a misplaced naturalism would assert this). And you probably agree; this is an established and uncontroversial position.

What I do not understand is why Davies felt the need to raise this point as a response to what I wrote and why the statement that I only “probably agree.” There is no probably about it – the second part of the statement was the actual point of bringing it up – that differences do not justify unequal social arrangements. The first part – whether or not such differences are socially meaningful – is a scientific question and can and should be separate from the moral question of equality.

Perhaps M. Davies was just agreeing with me, and I could not tell from his comment. If so, then forgive my using your comment as an example.

But eventually Davies does get to the actual content of my blog post – the nature of mental disorders.

a disorder is an alteration or deficiency of a typical feature or function that results in demonstrable harm

Ok, fair enough. But what about homosexuality? This is ‘an alteration or deficiency of a typical feature or function’ (first criterion) and ‘that results in demonstrable harm’ (second criteria). But of course homosexuality is not a mental illness.

I do not think that homosexuality meets either criteria, but there is definitely ambiguity here. It also does highlight that with cognitive criteria it is challenging to come up with culturally neutral objectivity, but that does not mean that thoughtful and useful criteria do not exist.

First, homosexuality seems to be a ubiquitous trait in the animal kingdom – present in all species in a sizable minority. Also, sexual preference is a spectrum, not a dichotomy. It is therefore probably more accurate to say that animals display a variety of sexual orientations as a function of natural variability. There is even some evidence that having a certain percentage of homosexuals in the population may have a selective advantage.

Further, and perhaps more importantly, sexual preference is not a “deficiency” as defined by the criteria for disorder. It is not a lack or deficiency of a trait or ability normally possessed.

This does bring up an interesting concept – in biology in general we tend to be biased toward the notion that there is one correct configuration of anatomy, physiology, biochemistry, etc. and that any deviation from that is less than normal. But as we have gained a more sophisticated understanding of biology we have realized that variation is the norm, and for almost every feature we can point to there are “normal” variants. I often point out to my residents that the neuroanatomy they will see in textbooks is simply an average or dominant representation, but that there is tremendous normal variability among individuals.

This leads to what might be called a demarcation problem – where do we draw the line between normal variants and an abnormality or deficiency? There is no sharp line, but that does not mean we cannot apply rules that will work most of the time.

The second criteria – demonstrable harm – is much more important for the notion of “disorder”. I think to be meaningful demonstrable harm must refer to harm that results fairly directly from the trait or deficiency itself – due to a lack of function. This specifically rules out  indirect harm that comes from cultural stigma or a similar source. Being left handed is not a disorder simply because culture favors the right handed. It may be an inconvenience, but it’s not a disorder.

Davies continues to another point:

That is a major theme of my critique of mental illness denial – if you apply their arguments consistently, then you end up denying all of medicine.

Well, I am not sure where the fallacy lies. I don’t deny all of medicine either, but if ‘their arguments’ can be applied consistently, then the conclusions must stand, mustn’t they, even if we don’t like them? Or rather, not liking the conclusion does not mean that the argumentation is unsound.

My point is a legitimate use of the argument ad absurdum – if you apply their logic consistently, then their criticisms of psychiatry apply to all of medicine, which is an absurd conclusion that they themselves are not taking. And to clarify – Szasz and his followers claim that psychiatry is not medicine because of x, y, and z – my point is that x, y, and z are features generic to medicine, not unique to psychiatry as they claim.

For example, they claim that mental diagnoses are not legitimate because they are based entirely on symptoms and not biological markers. I pointed out that many diagnoses in medicine, like migraine, are based upon symptoms and not biological markers. So then they slide over to a separate point – that some symptoms, like pain, count while others, like behavior, do not count. But this is simply circular reasoning – they take as a premise that mental symptoms do not count, therefore there are no mental disorders.

And again, it is easy to get caught up in the semantic game of how to define disorder, when the real issue is when is it reasonable to give an intervention to address an identified problem or issue, and what are the risks and benefits of any specific intervention.

What Szasz and his followers are saying is that we should not treat people who display the suite of symptoms we currently conceptualize as ADHD, but they use semantic tricks and poor logic to make their case.