I listened to This America Life--on the radio, instead of on the internet or my ipod, for a change--this afternoon. Judging by Ira's post-postscript, which included events from several years ago, it was a repeat of a pretty old episode. The whole thing was devoted to the story of how the American Psychological Association changed the entry on homosexuality in the Diagnostic and Statistical Manual of Mental Disorders. The story had a moral, of a sort. Two, actually. First, the process by which the DSM was anything but linear; it required the confluence of a wide array of chains of events. Second, the change of the DSM--which bills itself as a statement of the consensus of the psychiatric community--was fundamentally unscientific in character. Or, more accurately, the questions itself--whether homosexuality (or anything else) is a disease--is not a scientific question. Instead, it is a moral question. The piece very effectively illustrates that the central figure in the psychology of homosexuality at the time, and who vigorously supported its classification as pathological, quite simply viewed homosexuality as unnatural and wrong. Alix Spiegel, the reporter, even gets him on tape claiming, in effect, to "know the homosexual" far better than his opponents. As an aside, it is partly TAL's learnedness--that it can subtly address serious theoretical questions, like the form of simple historical narrative, or the politics of scientific epistemology, with due colorings of Said and who knows who else--that makes it so enjoyable.
That said, I am not entirely comfortable with Speigel's conclusion--that the inclusion or not of a certain form of behavior in a list of psychiatric diseases is moral and hence not scientific. It is a conclusion that does not cut as deep as it could. This might not have been Spiegel's intention, but her piece ends with the impression that there was this moral error at the boundaries of a particular scientific discipline. What results is a sort of dualistic view of science, not unlike the distinction between the selection of paradigms and their "normal" internal elaboration. This sort of bifurcated account might seem powerful for the natural sciences, for it theorizes the messiness of scientific disputes while still maintaining a place for disinterested empirical inquiry. But it is hardly without problems. The most pressing is that it goes perhaps too far in presenting paradigms as arbitrary. Paradigm shifts might not happen entirely according to scientific principles of confirmation, but they do nonetheless involve the consideration and investigation of reality. In emphasizing the super- or sub-scientific character of paradigm shifts, a bifurcated account tends to downplay the grounding of paradigmatic disputes in reality; a paradigm enters a crisis when, after all, its link with reality somehow becomes too tenuous. But if a paradigm's relationship with reality, in itself, is not a matter of scientific description, then what is it? This relationship matters, for it is only by appeal to it that paradigms can be said to be more or less truthful. Otherwise, paradigms run the risk of representing a form of epistemological relativism--by autonomously setting the rules of what is confirmed scientific truth within them.
Likewise, the moral questions at the boundaries of psychiatry cannot be neatly kept away from the discipline's scientific core. Psychiatry purports to study human beings' cognitive and emotional interactions with each other and the world, but the territory it seeks to enter is not vacant. It is a major function of human language in general to describe those very interactions. Our own "pre-scientific" descriptions are not disinterested and morally neutral. Perhaps psychiatry (and psychology and sociology as well) thinks its role is to supplement our morally interested language with one that is scientifically distanced. Thus, the account would be that our language is weighed down by traditional moral baggage. But that is an error. The problem is not with the particulars of our language but with what it attempts to describe. Our perception of the world and the significance we give to our interactions are the very stuff of morality. Any science that seeks to contend in the crowded discursive field of the description of human activity and psychology must recognize that by necessity it thereby becomes a moral science. Science always attempts to describe the world we live in, but a moral science strikes closer to home by describing the human world. Just think of the example of punishment. What is a transgression of social norms? Is it a sin? A psychological disorder? Social deviance? (Indeed, even the question cannot be phrased in neutral terms, and I reveal my sociological tendencies with its wording.) Those three possibilities all matter deeply for how we react to a given abnormal behavior. A sin deserves moralizing exhortation or punitive sanction. A disorder requires treatment, perhaps through analysis or drugs. Social deviance, on the other hand, is a social fact; it demands social reforms that adjust the social context and environment.
Whether or not homosexuality is a psychological disease is most certainly a moral question, in that it deeply implicates decisions about how we feel the human world is or ought to be organized. But the perpetuation of psychiatry as a discourse is no less a moral matter. Its presence or relative dominance impacts how we orient ourselves to each other . . . the very essence of morality.
