It is an honour to be in a position to give this talk today, and a great indulgence to be invited to talk for half an hour on anything I want. Before I start I want to thank my family and my colleagues for their support over many years. I also want to thank Professor Lord Kamlesh Patel for making all this possible. It is a great privilege to have a Chair in the Institute for Philosophy Diversity and Mental Health, part of the Centre for Ethnicity and Health. The challenge for me in writing this lecture was to tie philosophy, diversity and mental health together? Could I get them all into a lecture of half an hour; half a day, perhaps. Then I remembered my first meeting with Kamlesh over a year ago. His leg was in plaster after a cricket injury. Later I discovered that at least two of my new colleagues, Kwame McKenzie and Ajit Shah were both keen cricketers. It seemed that there was a tacit sporting focus in the Institute. Was this a clue? Could I use games to make a point about philosophy, diversity and mental health? So I began to think about two different sorts of games. First there are our national games; cricket and football. The second variety I shall return to shortly. But first, a little thought experiment.
I want you to imagine the following situation. Across the globe, Football Associations, egos and wallets bloated by huge injections of cash from Sky, decide to take over minor sports like lacrosse, hurling and cricket. Supported by a consortium of Russian and American venture capitalists, FIFA makes a successful bid for cricket’s international governing body. The future of cricket is now in the hands of the football authorities. FIFA sets up a new committee to consider how cricket can be deregulated.
The committee notices that there are broad similarities between football and cricket. Both involve teams of eleven players; both are played on fields of roughly similar dimensions. Both involve individual skills in controlling a ball. But the interests of profit and economy demand that attempts must be made to ‘harmonise’ the laws of the two games. Of course football is by far the most powerful game financially, so the decision is made to make minor changes to bring the rules of cricket into line with those of football.
Close scrutiny of the rules of cricket reveals unlike football, there is no word or concept that corresponds to handball. So a new rule is introduced to cricket based on FIFA’s rule 12, which determines fouls and misconduct. There are two parts to this rule, which in future must apply to cricket. First, a direct free kick is awarded if a batsperson deliberately handles the ball. Second, umpires, who in future must carry whistles, yellow and red cards, will caution players who persistently infringe the rules. A player will be cautioned by showing him (or her) a yellow card. Any player who receives a second caution will automatically be shown a red card, and dismissed from the field of play. All the other rules of the game remain unchanged. Fielders are still allowed to pick the ball up to return it to the wicket keeper or other fielders when the ball is in play. Finally, they add a new law that any piece of wood held by a batsman is an extension of the batsman’s hand.
But the new rule has unexpected consequences. At the first cricket match to be played under them the batswoman takes her guard at the crease. (You will notice that the new rule is tried out first in women’s cricket.) She asks for middle and leg. The bowler sends down the first delivery and the batswoman plays a perfectly correct forward defensive stroke. The umpire blows her whistle, approaches the batswoman and tells her that she has just handled the ball and that if she breaches the rules again, she will be shown a yellow card. “But I didn’t handle the ball,” claims the batswoman, “I just hit it with my bat.” “The new rule defines the bat as a part of your hand,” says the umpire. “You must either kick the ball or head it.” The bowler sends down the next delivery, which the batswoman hooks for four in anger. The umpire blows her whistle, stops play, tells the player that she is booking her for repeatedly infringing the rules by deliberately handling the ball, shows her a yellow card, and awards a direct free kick to the opposition. The bowler, being uncertain how to take a free kick, instead sends down the third delivery, which the batswoman cuts backward of square on the off side for four. The umpire blows up, pulls out a yellow card immediately followed by a red for a second bookable offence. The batswoman has to leave the field of play.
This continues down the batting order. The first side is dismissed for 17 runs, all no balls or byes. The same happens with the opposition. All the batswomen are sent off for persistently infringing the new rule. Cricket is reduced to a shadow of its former self. The players are angry; the fans furious. Understandably they feel that the game is being strangled, its uniqueness and its difference is being systematically undermined. Indeed, they feel that they are being persecuted. All that they consider to be important about the game, its excitement, its skill, its history and its meaningfulness are overlooked in the interests of something that is alien and foreign, and which is being imposed on them without reference to what they consider to be important. As if that is not bad enough, in their struggle to play the game, neurosurgical units throughout the country fill up with batswomen with fractured skulls, brain injuries and brain haemorrhages. The British Medical Association lobbies parliament, claiming that cricket is now more dangerous than boxing. Look at this barbaric sport, the doctors say. It is primitive, dangerous and should be banned. The government acts and the game is banned. Cricket is no more.
Now this isn’t just a bizarre tale; it is a thought experiment. Thought experiments have been used by philosophers for thousands of years to employ imaginary situations to help us understand aspects of reality. This thought experiment is based in the ideas of the Austrian philosopher Ludwig Wittgenstein, whose work has yielded important insights into the nature of language. Wittgenstein was born into a wealthy Viennese family in 1889, and in 1908 he came to England to study for a PhD in aeronautical engineering at Manchester University, but became interested in mathematics, and ended up studying with Bertrand Russell in Cambridge three years later.
One aspect of Wittgenstein’s early philosophy was concerned with the relationship between language and reality. He proposed that language represents the world by depicting it in much the same way that a picture may depict a real life scene. Take the sentence ‘Water is in the glass’. We can see that a sentence like this in very simple terms describes a state of affairs in the world. Wittgenstein’s early philosophy shows how the structure of the sentence and the logical rules it implies reflects the physical state of affairs. However, an important conclusion of this work was that in philosophical terms it was only possible for language to function this way when we talk about the physical world. This poses a serious problem. It means that in this view it is not possible for language to represent ethics, morals, beliefs, and feelings in the same way. This places restrictions on what we might consider the purpose of language to be, because it can only be meaningful if it relates to factual states of affairs in the world. We can get a better grasp on this difficulty by comparing the two sentences:
These sentences are very similar; they are structurally identical. However, common sense tells us that whatever the sentences’ structures may be, they are concerned with very different aspects of the world. The first relates to the physical world. We can see the water, touch it, feel it, measure its volume and its temperature. The second concerns the metaphysical world. We cannot touch and feel sadness. This means that a great deal of human communication, such as our use of language to convey emotional states, or to talk about ethics and values, is impossible to fit into his early theory. The book he wrote at this time, the Tractatus Logico-Philosophicus famously ends with the statement ‘Whereof one cannot speak, thereof one must be silent.’
What makes Wittgenstein’s philosophy so interesting is that in his later work he attends specifically to those things of which he had remained silent in his early work. In Philosophical Investigations, Wittgenstein (1967) views language primarily as a human and social phenomenon. Language is a tool that serves the primary purpose of enabling us to communicate socially. For this to happen he points out that speakers of a language must share the same set of rules about how language is to be used, what can be said about what, under which particular circumstances. The amazing thing is that as native speakers of languages, we just know the rules and take them for granted, without ever being aware of them. We just know that when we say my glass is full of water, we are using one set of rules, whereas when we say my heart is full of sadness, we are using a different set of rules, those that apply to metaphor. In other words, to use Wittgenstein’s expression, we are engaging in different language games. It doesn’t make sense to say that we can touch, feel and measure sadness in the same way that we can touch, feel and measure water.
But hang on a minute. Over the last 100 years, psychology and psychiatry have devoted an enormous amount of time and energy trying to devise different ways of measuring our emotions, feelings and beliefs. Depression and sadness are particularly good examples. There are dozens of rating scales designed to measure the ‘amount’ of depression that a heart contains. So, Wittgenstein’s later philosophy of language suggests that attempts to ‘measure’ depression in this way represents the use of one language game (talking about physical things) in a situation where the person who is sad may well be trying to use a different type of game, such as talking about his or her experiences in terms of loss, or a spiritual crisis. And this is where the thought experiment comes in.
The thought experiment tries to do a number of things. First, it shows how important rules are if we are to understand and respect each other. Did the cricketers feel understood and respected? Certainly not! The experiment demonstrates how ludicrous it is to apply the rules of one game to a completely different game. Everyone knows that cricket and football are different games with different rules; trying to mix them up this way is daft. Second, and this is really important, it draws our attention to the importance of games, whether sporting or language, as forms of shared human activity. Wittgenstein described language games as ‘forms of life’, referring to forms of human life, or in other words, culture and cultural difference. The rules of cricket are different from the rules of football because they are situated in different forms of life, or tradition. The history of human activities that gave rise to cricket did not give rise to the game of football. Likewise, the human activities that over many, many years resulted in the words associated with cricket and the rules of cricket, did not give rise to the rules of football. The games of football and cricket have different terminology and rules because they originated in different traditions with different histories, and this leads to the third point.
Tradition, or culture, matters to us. It carries our values, and helps us to make sense of our worlds. Playing cricket, like any game, has meaning for those who play it in terms of a shared history in which the game, its rules, actions, and terminology, bind us together as human beings with a shared sense of meaning. Again, just imagine how frustrated, upset, and annoyed cricketers must have felt. Finally, the thought experiment shows that it is not necessarily the case that there is equivalence between concepts and words in different cultures or languages. In general terms, the word ‘ball’ has meaning in cricket and football, but the concepts tied to the words are quite different. The head injuries attest to that. Even more significant for my purpose is that we cannot necessarily assume that there are universal concepts, or words linked to concepts, that have precisely the same meaning across cultures.
Now you may say well this is all very good, I can see the relevance of your thought experiment in some situations such as custom, manners, and etiquette, but what is the relevance of this to mental health. Surely depression is depression is depression? Anyone can get depressed, and depression is much the same in any culture. The word depression, and the concepts linked to it are universals. The anthropologist and psychiatrist Arthur Kleinman writes as follows:
‘A word, after all, is a sign that signifies a meaningful phenomenon. That phenomenon…exists in the world mediated by a cultural apparatus of language, values, taxonomy, notions of relevance, and rules for interpretation.’
Now you may be forgiven for thinking that Kleinman in his book Rethinking Psychiatry, is influenced by Wittgenstein, but he isn’t. Wittgenstein’s name doesn’t appear in his book. And why should it? Kleinman is not a philosopher. But he knows having studied sadness in different cultures, in Taiwan and elsewhere, that when we talk about our inner worlds, our hopes, our fears, our disappointments, our struggles, we are using language games whose rules are deeply enmeshed in culture. So, when we have a particular set of experiences, part bodily or physical, part emotional and psychological, we can only talk about them with others in ways that are given to us by our cultural tradition. We follow the particular rules, values, notions of relevance that are given to us by the cultural tradition in which we were brought up. In other words it is a serious mistake (Kleinman calls this a category fallacy) to assume that the concept that is called ‘depression’ in the West has the same meanings to non-Western people. Wittgenstein’s notion of language games helps us to understand why this is the case.
So, as doctors, nurses, whatever, we can’t assume that a word like depression which has a particular meaning in the language game of Western psychology, or more generally, Western culture, has a direct equivalent in non-Western cultures. Indeed, in most South Asian languages there is no word equivalent to depression. Instead, there are different language games that people use to talk about their unhappiness, such as having a sinking heart, none of which implies when they utter such phrases that they expect to be given cognitive behavioural therapy or Prozac. In other words, respecting cultural diversity in mental health requires an acute sensitivity to the limitations of language. It means being able to step beyond the confines of our own culture, and a readiness to acknowledge the importance of the other’s culture in shaping meaning, and, more important, the sort of responses to distress that meaning expects. This is but one small way in which philosophy can help us to think through more clearly the challenges we face in respectfully and sensitively engaging with cultural difference.
Kleinman, A. (1991) Rethinking Psychiatry: From Cultural Category to Personal Experience Free Press, New York
Wittgenstein, L. (1967) Philosophical Investigations. Third edition (Trans. G.E.M. Anscombe) Oxford, Blackwell.