The Vegetative State as an Interactive Kind

Note: This is the introduction to the draft of my dissertation prospectus.

Doctors diagnosing the vegetative state have always found themselves embroiled in scientific and ethical controversy. Over the last several decades, the diagnosis of the vegetative state has stirred the public imagination and the writings of bioethicists in a way that few other diagnoses has. Take the example of Terri Schiavo, who suffered from a heart attack in 1990 and subsequently lapsed into a coma from lack of oxygen to her brain. After months of no recovery she was formally diagnosed with the vegetative state, a condition doctors describe as a state of “wakeful unawareness”. In this state Schiavo opened her eyes and appeared to be awake but showed no clear-cut intelligent, contingent behavior in response to any stimulation or human interaction. Contingent behaviors are behaviors that occur as appropriate responses to the behavior of other people or objects e.g. if someone sticks out their hand, the appropriate behavior (in some contexts) is to shake it. However, though Schiavo didn’t show any contingent behavior she would show reflexive behaviors such as laughing or crying or randomly moving her eyes or limbs. After years of no recovery from VS her husband Michael asked the state for permission to remove her artificial feeding and hydration.

However, when videos of Terri’s wakeful behaviors were released to the public widespread outrage was provoked in response to what many people considered to be the immoral murder of a living human being. Towards the end of her life during the 2000s, the Schiavo family was convinced that she was in fact in a state called the “minimally conscious state” (MCS) because they thought she showed intermittent signs of conscious awareness, such as laughing appropriately when a joke was told or responding to a family member with an appropriate emotional display. Because the operational standards of diagnosing MCS allow for the possibility of only showing signs of conscious awareness intermittently there is a genuine epistemic question of whether Schiavo was diagnosed properly with most experts retrospectively believing she could not have been in a MCS based on her autopsy reports, which revealed extensive cortical lesioning. But the public imagination was rarely if ever aware of these nuances distinguishing VS and MCS but instead took her wakeful behavior and physical health to be a clear sign that it would be wrong to kill Schiavo by removing her artificial life support.

The Schiavo case rests at the intersection of epistemology, medical diagnosis, ethics, the law, and the norms of society at large. These issues are intertwined. The goal of this dissertation will be to systematically argue that in diagnosing the vegetative state and other disorders of consciousness (DOC) these normative issues are essentially intertwined. In other words, the epistemic certainty attached to any diagnosis of the vegetative state cannot occur outside the broader context of ethics, law, and society. I call this the Thesis of Diagnostic Interaction. The thesis says that diagnosing disorders of consciousness is not a purely objective affair in the same way it is for physicists to determine the number of protons in a gold atom. In other words, a diagnostic label such as “the vegetative state” is not a natural kind because it does not cut nature at its joints in the way the kind GOLD does. The upshot of my thesis is that the question of whether Schiavo was truly in a vegetative state cannot be answered by merely examining her brain or behavior in isolation from the cultural time and place she was diagnosed. We must look at the broader culture of diagnostic practice which itself is essentially shaped by complex ethical and legal norms and steeped in the social milieu of the day.

Interactive Kinds

Instead of VS being understood as a natural kind like GOLD, INFLUENZA, or H2O, the vegetative state can be better understood as what Ian Hacking calls an interactive kind. An interactive kind is a concept that applies to classificatory schemes, ones that influence the thing being classified in what Hacking calls “looping effects”. Hacking’s examples of interactive kinds includes childhood, “transient” mental illnesses such as 19th-century hysteria, child abuse, feeblemindedness, anorexia, criminality, and homosexuality. Interactive classifications change how the people classified behave because they are either directly aware of the classification or the classification functions in a broader socio-cultural matrix whereby individuals and institutions use the classification to influence the individuals being classified. For Hacking, interactive kinds are

“Especially concerned with classifications that, when known by people or by those around them, and put to work in institutions, change the ways in which individuals experiences themselves–and may even lead people to evolve their feelings and behavior in part because they are so classified.” (Social Construction of What, p. 104).

Hacking’s proposal that some kinds of people are interactive kinds boils down to two features. First, scientific classifications of people can literally bring into being a new kind of person that did not exist before. Call this the “new people” effect. Second, such classifications are prone to “looping effects” because the classification interacts with people when they know about the classification or when the classification functions in a larger institutional settings which then influence the individual being classified. For example, consider the diagnosis of “dissociative identity disorder” (DID) otherwise known as “multiple personality disorder”. According Hacking, DID did not come into fruition until scientists and psychiatrists began to look for it i.e. until it became an accepted diagnostic category by a group of therapists and institutions. Moreover, once the classification of DID was popularized in novels and movies, the rates of diagnosis increased dramatically suggesting that the disease had a social-cultural origin not a purely biological origin like the Ebola virus, which is an example of what Hacking calls an “indifferent kind” because the virus does not know about human classification schemes. DID is an example of a looping kind because the spreading awareness of the diagnostic classification led people to conform to the diagnostic criteria.

Making Up Diagnostic Labels

I contend that the vegetative state can also be considered an interactive kind in a similar way that Hacking claims mental illness is. There are several, interrelated reasons why this is the case.

1. Clinical diagnosis of DOC is essentially a process or an activity carried out by finite human beings. Diagnosis does not happen at discrete time points but is an unfolding activity of humans making fallible judgments that have an ineliminable human element of subjectivity.
2. The classification of DOC is under continual revision and varies from time and place, doctor to doctor, institution to institution. A diagnosis about the vegetative state made in 2014 simply would not have made sense in 1990 because the classificatory schemes were different, giving rise to new kinds of patients with DOC. Some doctors are more skilled at making a diagnosis than others and different institutions utilize different classificatory procedures that are mutually exclusive yet equally justified given the pragmatic constraints of neurological diagnosis.
3. The diagnosis of DOC is prone to “looping effects” due to the emergence of new technologies which affect diagnostic practice which in turn shape the development of newer technologies. Decisions to utilize different technology will affect the diagnostic outcomes of whether someone is in a vegetative state or not. For example, whether you use behavioral bedside methods, resting-state PET, or active probe fMRI methods will give different diagnostic outcomes.
4. The diagnosis of DOC is prone to the “new people” effect because new diagnostic categories literally create new kinds of people that did not exist prior to the creation of the diagnostic category. And since the process of diagnosis is an on-going activity, clinical neurology is continually in the process of making up new kinds of people that did not exist before. Moreover, the individuals classified are susceptible to looping effects because once classified they are changed by the classification.
5. The creation of diagnostic categories of DOC cannot be disentangled from broader issues in ethics, the law, and society. Consciousness plays a central role in many moral theories because of its central role in defining the interests of animals and people. We do not consider entities without the capacity for consciousness to have any interests, and therefore they do not deserve our moral consideration. Thus, facts about consciousness determine our ethical obligations in the clinic. A person diagnosed with the vegetative state by definition lacks consciousness. But the criteria for this diagnosis are continually changing in ways that do not reflect pure advances in scientific understanding.

 

Latest Draft of Mental Time Travel Paper

CLICK HERE to read the latest draft of “Measuring Mental Time Travel in Animals”.

I’ve been working on this paper over the semester, responding to comments and generally cleaning it up. I’ve also added a new sub-section that explores an analogy with–believe it or not–whether Pluto is a planet. I also cut down on some repetitiveness towards the end. I will be turning it in as a Qualifying Paper very soon, so any last minute comments/suggestions/corrections would be greatly appreciated.

Beginning to Work on Something Long

Now that I am almost done with coursework — nearly three years later — I am finally beginning to think about something long – a dissertation. To write a dissertation I need a topic, and I think might I have one: measuring consciousness in persistent vegetative state or minimally conscious patients. I got interested in this topic last Fall when I read Nachev and Hacker’s paper “Covert cognition in the persistent vegetative state” for Carl Craver’s class Current Controversies in Cognitive Science. The paper is excellent and raises many fascinating questions. Some questions that I would like to answer in the dissertation include:

• What does it mean to be a PVS or minimally conscious patient? What’s their respective neurology?
• What exactly are we trying to detect in these patients? How is “consciousness” defined?
• What measurement methods are we using and why? How is “consciousness” operationalized? Can it even be measured?
• How can we arbitrate between rival operational measures of consciousness? How can we verify we are detecting what we think we are detecting?
• Is the thing we are trying to detect worth detecting? What should we be looking for?
• How do we determine an acceptable false positive/false negative rate?

This topic is at the intersection of many of my interests: consciousness, philosophy of science, operationalism, behaviorism, and ethics. This semester I am doing directed research with Carl Craver to dive head-first into the topic. I have a long reading list that I will be working my way through and hopefully I’ll be able to share some of my findings as the semester progresses. Stay tuned!

New paper: Minimal Models Make for Minimal Explanations

Williams – Minimal Models Make for Minimal Explanations

Abstract:

The ontic view of scientific explanation is that explanations are objectively in the world. Critics of the ontic view argue it fails to capture the importance of idealization as a critical component of scientific practice. Specifically, Robert Batterman argues that highly idealized mathematical models in physics are counter-examples to the ontic view or at least show why the ontic view is incomplete as an account of scientific explanation. My aim in this paper is to defend the ontic view of scientific explanation against Batterman’s objections.

Feedback welcome! This may or may not be turned in as my second qualifying paper at Wash U.

Quote for the Day – Einstein’s Louse and the Limits of Scientific Understanding

Nature is showing us only the tail of the lion, but I have no doubt that the lion belongs to it even though, because of its large size, it cannot totally reveal itself all at once. We can see it only the way a louse that is sitting on it would.

 ~Albert Einstein to Heinrich Zangger, quoted in Clifford Pickover, Archimedes to Hawking

Abstract of paper I’m working on this semester: Minimal Models Make Minimal Explanations

Abstract: Defenders of the ontic view of scientific explanation argue that explanations for scientific phenomena are in the world regardless of whether we discover them e.g. what explains the hole in the ground is the actual meteor that hit the Earth, not our description of the meteor hitting the Earth. However, critics of the ontic view argue that it fails to capture the importance of idealized models as a critical component of scientific practice. Specifically, Robert Batterman argues that highly idealized minimal models of physical phenomenon are counter-examples to the ontic view insofar as minimal models purport to leverage explanatory power by leaving out all the ontic details. In this paper, I argue that existence of minimal modeling as a scientific practice is consistent with the ontic view of explanation.

This paper topic stems from a recent Philosophy of Science workshop I attended. At the workshop, many talks centered around a contrast between two views of scientific explanation: an “ontic view” and a “non-ontic” view (for lack of better terms). On the ontic view, scientific explanations are out there in the world and models are idealized descriptions of these explanations. On the ontic view, the extent to which a model or description explains a phenomena is proportional to the extent to which that description makes reference to the underlying ontic explanation. In contrast, the non-ontic view states that idealizations are not just “incomplete” or “partial” explanations to be filled in with more ontic details later. Rather, the explanatory work is being done by the details left out of the model.

The paper is an attempt to analyze these views and determine whether they are inconsistent. I argue that the existence of idealizations in scientific practice does not undermine the ontic view of explanation, despite Batterman and others claims to the contrary. At best, they are orthogonal. Batterman’s point is that idealizations are better explanations than ones referring to micro-levels because they help us understand the aspects of the phenomena that we are most interested in: the macro-level regularities. However, the very fact that Batterman is focused on what’s interesting is irrelevant to the ontic view because they are ontic explanations of both interesting and non-interesting phenomena. Thus, the point of what’s interesting to humans is a non-starter as an objection to the ontic view.

Rather than diagnosing this as a mere terminological dispute over the correct usage of the English word “explanation”, I appeal to Richard Feynman’s remarks on mathematics and physics to highlight an under-appreciated feature of theoretical physics that makes it distinct from mathematical physics: the notion that conjectures in physics must have a “physical meaning” to be true whereas mathematical conjectures do not.

Quote for the Day – The Fractal Nature of Scientific Knowledge

I believe that scientific knowledge has fractal properties; that no matter how much we learn; whatever is left, however small it may seem, is just as infinitely complex as the whole was to start with. That, I think, is the secret of the Universe.

~Isaac Asimov, I, Asimov: A Memoir

A Quick and Dirty Argument for Behaviorism

1. All the evidence we have as scientific psychologists is publically observable behavioral evidence.

2. The safest epistemic strategy is to limit as much as possible going “beyond” the evidence, an inevitably risky gambit.

3. “Subjectivity”, “mental states”, “cognition”, “representations”, “feelings”, “consciousness”, “awareness”, “experience”, etc. are not publically observable i.e. if you open up someone else’s skull you will not see cognitions or mental states, you will see a pulsating hunk of flesh.

3. If we value epistemic safety above all, we should never leap beyond behavioral evidence to talk about unobservable mental states, unless such talk is self-consciously understood to be an abbreviated paraphrase of a long conjunction of behavior reports. Therefore,

4. The safest epistemological stance in psychology is behaviorism.

But wait! Don’t scientists in other fields go “beyond” raw data by talking about “unobservable” theoretical entities like atoms and black holes? If it’s epistemically warranted for physicists to appeal to “unobservable” theoretical entities like atoms in order to explain the experimental data, then it should also be okay for psychologists to appeal to “unobservable” theoretical entities like “episodic memory” or “engrams” in order to explain the behavioral data.

Two things can be said in defense of behaviorism.

First, it’s an open question in the philosophy of science whether physicists are in fact epistemically warranted to go “beyond” the data. According to physicist-philosopher-of-science Duhem, theories are only supposed to be tidy and convenient summaries or compressed descriptions of experimental findings, not statements literally describing an unobserved metaphysical reality. On this view, we do not use theoretical entities and equations to explain the data but rather use equations and theories to help us cope with the large and unwieldy collection of facts gathered by experimenters. Duhem argues that if humans didn’t have such finite memories, scientists would not find it necessary to tidily represent messy experimental findings in terms of neat equations and law-like statements.

Consider this: If a theory about domain X is true, then all possible experimental findings relevant to domain X deductively follow from the theory and thus have the same truth-value as a long conjunction of descriptive reports of real scientific experiments. But once you have all the experimental findings on your head, what’s the need for the theory? The need is purely practical, a result of human finitude and our desire for convenience, simplicity, and genuine understanding.

Second, even if we grant physical scientists an epistemic license to go “beyond” the data and talk about theoretical entities, this practice only works well when there are widespread conventions in place for operationalizing theoretical terms (i.e. translating theory into real experimental operations) as well as standards for conducting and verifying results of experimental procedures (measurement verification procedures). It’s not clear to me that cognitive science has reached any widespread consensus on any of these issues.

Compared to “mature” sciences like thermometry with widespread industry standards, there seems to be little if any widespread consensus in the “mind sciences” about theoretical terminology let alone operational criteria for testing theoretical claims or even nailing down what exactly it is we are supposed to be studying in the first place.

Thus, the true problem with psychology is not that it talks about “unobservable” entities or employs theoretical jargon but rather there is no widespread consensus on how to define our concepts and operationalize our methods for getting access to the unobservable phenomena.

The problem facing psychology is two-fold: (1) a lack of consensus on how to pick out the phenomena due to a lack of theoretical consensus in understanding the ostensive definition of a psychological concept and, (2) a lack of consensus on how to interpret the evidence once we have collected it.

 Case in point: recent developments in the “science” of consciousness. First, there is there little to no consensus on where to even look for consciousness to begin the process of measuring it and studying it as a natural phenomena. Can any theorist answer this simple question: should we look for consciousness in insects?

Some theorists think if we looked for it in insects, we will find it because on their definition “consciousness” is not that fancy of a phenomena (e.g. enactivists and neo-panpsychists would both predict a consciousness-meter would register a small amount of consciousness in insects). According to other theorists, if you looked for consciousness in insects you will not find it because on their preferred definition “consciousness” is fancy and thus probably found only in “higher” animals like mammals. Who is right? No appeal to empirical facts will help in this debate because the problem is fundamentally about how to interpret the evidence given all we can go on as psychologists is behavior, which is of course neutral between rival theories of consciousness.

Some might object that I have picked an easy target and that the science of consciousness is a bad example of how psychology in general is done because it is the newest and most immature of the psychological sciences. But in my humble opinion, the science of consciousness is on no worse footing than most other subfields and niches of psychology, which are continually making progress “towards” various grand theories. However, insofar as another subfield of psychology is on firmer ground than consciousness studies, it will be because they have imitated the physical sciences by operationalizing their theoretical concepts in terms that can be directly measured by physical instruments. That is, a subfield of psychology is on firmer epistemic ground insofar as it sticks closer to physical, behavioral evidence, which is all any psychologist has to go on in the end. This is close enough to behaviorism for me.

I have much more to say on this topic, but I promised to be quick and dirty. Remaining questions include: how should we define the observable vs unobservable distinction?

Quote for the Day – C.S. Peirce on How Philosophy Should Imitate the Sciences

Philosophy out to imitate the successful sciences in its methods, so far as to proceed only from tangible premisses which can be subjected to careful scrutiny, and to trust rather to the multitude and variety of its arguments than to the conclusiveness of any one. Its reasoning should not form a chain which is no stronger than its weakest link, but a cable whose fibres maybe ever so slender, provided they are sufficiently numerous and intimately connected.

~C.S. Peirce, “Some Consequences of Our Incapacities”, quoted in The Pragmatic Maxim, by Christopher Hookway

Quote for the Day – We Live In a Dappled World

This book supposes that, as appearances suggest, we live in a dappled world, a world rich in different things, with different natures, behaving in different ways. The laws that describe this world are a patchwork, not a pyramid. They do not take after the simple, elegant and abstract structure of a system of axioms and theorems.  Rather they look like—and steadfastly stick to looking like—science as we know it: apportioned into disciplines, apparently arbitrarily grown up; governing different sets of properties at different levels of abstraction; pockets of great precision; large parcels of qualitative maxims resisting precise formulation; erratic overlaps; here and there, once in awhile, corners that line up, but mostly ragged edges; and always the cover of law just loosely attached to the jumbled world of material things.

~Nancy Cartwright, The Dappled World, p. 1