A few posts ago a commenter questioned why the perpetual furor over psychiatric diagnosis is so strident and acrimonious. I think the matter, dealing as it does with questions of human nature, identity, and responsibility, hits close to home, and often in a visceral way. Psychiatry presumes to comment upon the selves that we are and the selves we ought to be--as such it is as ambitious and as rightly contentious as politics or religion.
This came to mind yesterday when I read Stanley Fish's typically fine primer on pragmatism as a philosophy of life. Pragmatism is the difficult third option once despotic absolutism and cynical nihilism have been spurned. His piece demands to be read in full, but I particularly liked this:
It is a story, says Margolis (following Kuhn) driven from behind and not by a teleological end awaiting us in the form either of a union with a deity or an ascent to the realm of pure Reason. It is, Margolis tells us, "an extraordinary form of bootstrapping."
Pragmatism, when done well, achieves rigor and clarity without oversimplification and preserves freedom and ambiguity without slack complacency. It is the inherently messy, political, and incremental process by which humanity--comparing and trying out alternatives--somehow muddles through, although often not without appalling errors. I particularly like the idea of the universe as propelled by contingency and not drawn forward by the will-o'-the-wisp of a static perfection.
Psychiatry will never be perfected any more than politics will be perfected. However, we readily recognize some politics as preferable to others--it is not a matter of "anything goes"--and so with psychiatry. There is, in theory, no end to the possible number of DSM editions any more than there could be an absolute end to interpreting the constitution. After all, human nature and culture are moving targets.