N. Kirsch, J. Jeffrey, A. Putman, & P. Zeiger
What does it mean for a C-E description to have pragmatic value? Given that in the DP Community C-E descriptions are so often viewed with a deprecating eye, why does it even matter at this point to be considering this, and just as importantly, why is it worth our time?
One reason is that in certain worlds C-E descriptions are both ethically and clinically necessary, and critical in regard to other States-of-Affairs that someone might be hoping to achieve (for example, a medical outcome). It is, in our estimation, therefore important to understand how they are used, how they “fit in” and how they are to be pragmatically considered. It is certainly reasonable to say that the conceptual status of “cause” is, at best, uncertain, but since the value of C-E descriptions is to say, “If I do X, Y will happen,” they play too large a role in human life to do without them.
For this post, we’ll focus on pragmatics. We’ll return to the conceptual primacy of Persons at a later time, but even for this discussion, it is important to keep that primacy in mind.
As a first step, consider that C-E descriptions identify specific events, or more technically, events as components of States-of-Affairs (Ossorio, 2005, pp. 27-66), with the describer either implicitly or explicitly claiming that the outcome, the effect, is necessarily a result of that event. In its extreme form, a C-E description makes the claim that the relationship between the C and E is a relationship that is non-probabilistic – that is, that the E invariably results directly from the C.
Let’s consider an example, including some of its implications.
DiGeorge Syndrome is a genetic disorder that is associated with the gene deletion 22q11.2 (meaning the long arm of chromosome 22, region 1, band 1, sub-band 2). The clinical presentation of this syndrome can vary (which will be an important consideration later), but it is most commonly associated with specific patterns of observable changes, including palatal abnormalities, a characteristic pattern of cognitive/behavioral impairments, and several other critical medical conditions.
Geneticists would not have considered the possibility that there was a chromosomal change associated with a pattern of clinical symptoms if it were not for the fact that a specific clinical syndrome had already been observed over and over again. In this regard, the world of Persons takes methodological and conceptual precedence. The significance of the gene deletion is only understood (i.e., its significance is only recognized) because a systematic pattern at the Person level was first observed. However, once the clinical pattern is observed, and since the clinical pattern is distinctive enough across individuals, a geneticist’s interest will be to find a relatively invariable biological correlate for that clinical syndrome. Once the chromosomal pattern is found, the geneticist then makes the claim that the cause for the syndrome has been found and then “confirms” this by demonstrating a consistent and replicable relationship between deletion and syndrome.
Once that relationship has been demonstrated, the genetic anomaly is treated as the cause for the clinical syndrome, and to clinicians – i.e., in the clinical world – it is and always has been the cause. However, the value of the causal description, and the reason that it retains the status of cause, is that the relationship between the deletion and the syndrome is reliable – that is, when one is present the other will be present as well.
As in many such examples, it is therefore pragmatically important for clinicians to recognize the genetic deletion as a cause, relative to a pattern of clinical findings. A pediatric geneticist who does not do this would be catastrophically remiss. It may not be that recognizing this cause leads to curative treatment, but recognizing the gene deletion offers the hope, at some future time, that intervention may be possible. More importantly, recognizing the deletion as a cause increases the chances that a range of symptoms will be recognized as being associated with the deletion, and that treatments will potentially become clearer relative to those symptoms, or more systematically guided because the underlying “reason” for those symptoms is understood. For the clinician, it is therefore imperative both ethically and medically to describe and treat a specific state-of-affairs as the “cause (i.e., what may be referred to as the “etiology”), because in not doing so, treatment may be misguided.
However, there are many reasons that may lead to alternative descriptions of the deletion/syndrome relationship, including alternative descriptions that may, at times, even be offered by the behavioral geneticist. Jeffrey & Putman (in press, p. 20) note the importance of recognizing the pragmatic contingencies associated with choosing or not choosing a C-E description vs. some other type of description, as a choice of “figure” vs. “ground”. For a genetic disorder such as DiGeorge Syndrome, or any illness for that matter, say cancer, heart disease, or progressive neurodegenerative illnesses such as Alzheimer’s disease, the clinician may choose as the “figure” the embodiment alteration that is associated with the clinical syndrome. Doing so provides a basis for the physician to recommend treatment. However, the symptoms and the treatments have an impact on the person, so at other times, in other circumstances, or for other members of a treatment team, the physician’s “figure” may shift to “ground”, to be replaced by concerns about the person or the person’s world that may be just as critical as the underlying disease and attempts to treat it. As an example, given the methods available, it may not be possible at this time to remediate (that is, “cure”) a significant perceptual reasoning impairment associated with DiGeorge syndrome. However, because the perceptual impairment is well understood by clinicians, it may be treated as, in turn, the “cause” for a young person’s daily life distress. It may then be possible, despite the genetic deletion (and the associated genetic causal description), to teach a young person compensatory strategies, or to assist teachers and parents to modify the young person’s environment so that functioning can be improved.
Consistent with the analysis in Jeffrey & Putman, the “figure” and the “ground” may change multiple times in many different ways during the course of an illness and it’s treatment, based on the pragmatic focus of the health care providers, changing needs and desires of the patient and caregivers, psychosocial circumstances (such as insurance status, the availability of medical care), and others.
At the risk of loosing everyone even more than may already be the case, there is, of course, a more technical way to describe the “figure-ground” relationship that derives directly from Ossorio’s State of Affairs System (SoA; Ossorio, 2005; Ossorio, 1971/1978Ossorio (1982). For those outside the DP community who are not familiar with the SoA System, each descriptive component of the SoA system (States of Affairs themselves, as well as Events, Processes, and Objects) can be meticulously represented as including, among other features: (a) sub-components, (b) the relationships between and configuration of those sub-components, and (c) “representations which extend from any one level to any other, or which connect facts at one level with facts at another other level” (Ossorio, Embodiment, 1982, pp. 15-16). Given these technical resources, an observer’s decision to change the figure-ground focus can be technically represented by choosing one level of description rather than another, whether for an Object, Process, Event or SoA. It is by attending to the organization of an object, its components and the relationship between those components (or similarly to a process, event, or state of affairs) at any specific level, that the figure and ground can change, while still maintaining the value of descriptions at multiple levels. In the case of DiGeorge syndrome (or any other state of affairs that represents an embodiment change) an observer’s “figure” can shift from Person to embodiment, without ignoring the state of affairs of which the sub-description is a part or degrading the status of either the Person or the embodiment.
In summary, C-E descriptions serve a purpose and they can guide action, including further inquiry. To the degree that debates about cause and effect are a “rigged” language game, it may never be possible to challenge definitively the ontological significance of a C-E description for certain users who attribute causal significance to the embodiment level of description (i.e., the level they choose as their “figure”). However, even if we, in our community, reject such status assignments, a more relativistic appreciation of C-E descriptions affirms their pragmatic value.
In subsequent posts, our intention is to move on to further considerations of ways in which C-E descriptions can be “extended”, including ways in which they can serve as one methodological approach to Ossorio’s concept of pragmatic research. We also intend to return to discussions that further clarify the conceptual relationship between Embodiment and Persons, and the related concept of “provides for” – which may include yet additional elaborations of C-E descriptions.
Jeffrey, J. & Putman, A. (in press). Subjective Probability in Behavioral Economics and Finance: A Radical Reformulation. Journal of Behavioral Finance. Also available as a pre-print at: http://www.descriptivepsychologyinstitute.org/SubjProbBehEconAndFin.pdf
Ossorio, P.G. (1971/1978). State of affairs systems (LRI Report No. 14). Whittier CA & Boulder, CO: Linguistic Research Institute. (Original work published 1971 as RADC-TR-71-102, Rome Air Development Center, New York)
Ossorio, P.G. (1982). Embodiment. In K. Davis & T. Mitchell, 1982, Advances in Descriptive Psychology, Vol 2, pp. 15-16)
Ossorio, P.G. (2005). “What actually happens”. Ann Arbor, Descriptive Psychology Press.