Louise Cummings

The “Trust” Heuristic: Arguments from Authority in Public Health

The work of public health depends on a relationship of trust between health workers and members of the public. This relationship is one in which the public must trust the advice of health experts, even if that advice is not always readily understood or judged to be agreeable. However, it will be argued in this article that the pact of trust between public health workers and members of the public has been steadily eroded over many years. The reasons for this erosion are examined as are attempts to characterize the concept of trust in empirical studies. The discussion then considers how a so-called informal fallacy, known as the “argument from authority,” might contribute to attempts to understand the trust relationship between the public and health experts. Specifically, this argument enables the lay person to bridge gaps in knowledge and arrive at judgements about public health problems by attending to certain logical and epistemic features of expertise. The extent to which lay people are able to discern these features is considered by examining the results of a study of public health reasoning in 879 members of the public.

Rethinking the BSE Crisis

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Considering risk assessment up close: the case of bovine spongiform encephalopathy

Risk assessment studies often adopt a quantitative approach and analyse decisions or judgements in relation to risk at one specific point in time. These studies certainly have their merits but their preponderance in the literature on risk has been to the exclusion of qualitative studies that seek to examine judgements of subjects over an extended period of time. I seek to redress this imbalance by examining how scientists assessed risk in the context of a significant public health problem in the UK: the emergence of bovine spongiform encephalopathy (BSE) in cattle. This disease first emerged in British cattle in 1986. Yet over 20 years on, its implications for human health are still being assessed by scientists. In this paper, I examine the reasoning strategies that scientists employed to make risk assessments in relation to BSE in the period between 1986 and 1996. Two arguments in particular (analogical argument and the argument from ignorance) were the mainstay of scientific reasoning in the period under investigation. The rational standing of these arguments varied over time in relation to evidence that was emerging from experimental and other studies. It is argued that it is not possible to capture the factors which are necessary to understanding scientific risk assessments in relation to BSE within the type of quantitative, static study that is typically pursued within research on risk.

Clinical Pragmatics and Theory of Mind

Theory of mind (ToM) describes the cognitive ability to attribute mental states both to one’s own mind and to the minds of others. In recent years, ToM has been credited with playing a significant role in developmental and acquired pragmatic disorders. In this way, ToM deficits have been linked to pragmatic deficits in individuals with autism spectrum disorders (e.g. Martin and McDonald, Journal of Autism and Developmental Disorders, 34, 311–328, 2004), emotional and behavioural disorders (e.g. Buitelaar et al., Development and Psychopathology, 11, 39–58, 1999), intellectual disability (e.g. Cornish et al., Journal of Intellectual Disability Research, 49, 372–378, 2005), right-hemisphere damage (e.g. Winner et al., Brain and Language, 62, 89–106, 1998), schizophrenia (e.g. Brune and Bodenstein, Schizophrenia Research, 75, 233–239, 2005), traumatic brain injury (e.g. McDonald and Flanagan, Neuropsychology, 18, 572–579, 2004) and neurodegenerative disorders such as Alzheimer’s disease (e.g. Cuerva et al., Neuropsychiatry, Neuropsychology, and Behavioral Neurology, 14, 153–158, 2001). In this chapter, I examine the central role of ToM reasoning in utterance interpretation. The chapter addresses what is known about ToM development during childhood and adolescence as well as changes in ToM skills as part of the aging process. The role of ToM in developmental and acquired pragmatic disorders is discussed. The contribution of ToM research into pragmatic disorders is critically evaluated. Finally, several ToM theories are examined. The question is addressed of which, if any, of these theories is able to capture the pragmatic features of utterance interpretation.

Theory of mind in utterance interpretation: the case from clinical pragmatics

The cognitive basis of utterance interpretation is an area that continues to provoke intense theoretical debate among pragmatists. That utterance interpretation involves some type of mind-reading or theory of mind (ToM) is indisputable. However, theorists are divided on the exact nature of this ToM-based mechanism. In this paper, it is argued that the only type of ToM-based mechanism that can adequately represent the cognitive basis of utterance interpretation is one which reflects the rational, intentional, holistic character of interpretation. Such a ToM-based mechanism is supported on conceptual and empirical grounds. Empirical support for this view derives from the study of children and adults with pragmatic disorders. Specifically, three types of clinical case are considered. In the first case, evidence is advanced which indicates that individuals with pragmatic disorders exhibit deficits in reasoning and the use of inferences. These deficits compromise the ability of children and adults with pragmatic disorders to comply with the rational dimension of utterance interpretation. In the second case, evidence is presented which suggests that subjects with pragmatic disorders struggle with the intentional dimension of utterance interpretation. This dimension extends beyond the recognition of communicative intentions to include the attribution of a range of cognitive and affective mental states that play a role in utterance interpretation. In the third case, evidence is presented that children and adults with pragmatic disorders struggle with the holistic character of utterance interpretation. This serves to distort the contexts in which utterances are processed for their implicated meanings. The paper concludes with some thoughts about the role of theorizing in relation to utterance interpretation.

Reported speech: a clinical pragmatic perspective

For any speaker, the ability to report the speech of oneself and of others involves a complex interplay of cognitive, linguistic and pragmatic factors. Depending on the form of reporting used, a speaker must be able to produce utterances which contain embedded clauses (e.g. Fran said that she wanted to leave early), employ intonational and other devices which represent prosodic features of another person’s speech (e.g. Bill said, “Yes, I would LOVE to come”), and use lexical devices beyond simply verbs of saying (e.g. Sally went, “Not a chance!”). Apart from these linguistic resources, a range of complex cognitive and pragmatic skills underpins the reporting of speech. A speaker must be able to recall what another person said and how it was said. This requires verbal memory not just of the explicit content and prosodic features of a linguistic utterance, but also of any implied meanings raised by that utterance. The speaker who utters ‘Jack shouted at me, “I really appreciate your unhelpful response to this problem!”’ can only be said to have captured the sarcastic intent with which Jack delivered his utterance if that intent is conveyed in the speaker’s report of Jack’s speech. These implied or pragmatic meanings are only recoverable through intricate processes of reasoning which involve, amongst other things, theory of mind skills.

The scientific reductionism of relevance theory: The lesson from logical positivism

Abstract In the postface to the second edition of their book Relevance: Communication and cognition , Sperber and Wilson describe the intellectual impact which has followed from the first edition of their text: “The book has been translated into several languages, its implications for pragmatic theory have been explored in a growing number of books and articles; it has inspired work in neighbouring disciplines, including linguistics, literary studies, psychology and philosophy.” (Sperber and Wilson, 1995: 255) The appeal of relevance theory within certain academic circles is beyond doubt. Its acceptance within pragmatics and related subjects is to be expected given the scientism which pervades cognitive disciplines. The scientism of these disciplines, scientific reductionism, has in recent years come under increasing attack in the form of the philosophical arguments of Hilary Putnam. Putnams (1981) critique of the logical positivist account of rationality is particularly pertinent to this discussion. In this paper I demonstrate the exact nature of the reductionism within Sperber and Wilsons account of relevance. To this end, I examine their description of (1) the logical or analytic entries of concepts, (2) the deductive device, and (3) the functional concept of confirmation. In each case I will indicate how a reductionist analysis brings about the destruction of the very notions which demand explanation.

The public health scientist as informal logician

Few fields have been as receptive to ideas from other disciplines as public health. Sociological concepts and theories have helped to shape our understanding of the pervasive influence of class, race and gender on the health of populations. In the same way, I want to argue in this commentary that a branch of logical study known as informal logic can bring new insights to public health. Informal logic is the study of those forms of reasoning which are not amenable to analysis within formal (deductive) logic. This discipline emerged as a result of dissatisfaction with the privileging or idealising of deductive reasoning in logic, a tendency known as ‘deductivism’ (Johnson 2011). Whilst informal logicians acknowledge that people can and do engage in deductive reasoning, they argue that in everyday affairs they are much more likely to employ plausible or presumptive reasoning. Although this type of reasoning does not conform to deductive ideals of validity and soundness, it is particularly well adapted to epistemic features of the contexts in which arguments are advanced. These features include the lack of knowledge and uncertainty that attend many public health problems. The emergence of a distinct discipline of informal logic resonates with developments in public health. In their introduction of a novel synthetic epidemic paradigm, Christakos et al. (2005, p 22) acknowledge a role for modes of reasoning ‘that may not be found in formal logic’. These modes or styles of reasoning are manifest in, and adapted to, the uncertainty which pervades public health: ‘one can hardly overestimate the importance of the argumentation modes and styles of reasoning under conditions of uncertainty, for they form an essential part of the background intellectual context of public health inquiry’ (Christakos et al. 2005, p 55). An emphasis on reasoning strategies in the management of uncertainty is now evident in public health (Plant 2008; Vaughan and Tinker 2009). In Cummings (2002, 2009, 2010, 2011), I examined a group of reasoning strategies used by scientists who were called upon to make assessments of the public health risks posed by the emergence of bovine spongiform encephalopathy (BSE) in British cattle. These strategies, which included arguments from ignorance and analogical arguments, were commonly found in the reasoning of scientists who sat on expert scientific committees such as the Spongiform Encephalopathy Advisory Committee (SEAC). Although these arguments have traditionally been characterised as ‘fallacies’ (i.e. weak forms of reasoning), it was demonstrated in these studies that they enabled scientists to bridge ‘gaps’ in knowledge. To this extent, they were not so much logical flaws in reasoning as facilitative strategies that allowed scientists to form judgements about complex problems in the absence of knowledge. Two uses of these strategies during BSE risk assessments are shown below:

Coping with uncertainty in public health: the use of heuristics

The observation that experts and lay people use cognitive shortcuts or heuristics to arrive at judgements about complex problems is certainly not new. But what is new is the finding that a group of reasoning strategies, which have been maligned by philosophers and logicians alike, have demonstrable value in helping members of the public come to a judgement about public health problems. These problems, which span food safety crises, immunization scares and risks associated with exposure to environmental toxins, presuppose knowledge and expertise which falls outside of the epistemic and technical competence of most members of the public. Notwithstanding the complexity of these problems, they are not perceived by lay people to be wholly unintelligible or incomprehensible. This short communication reports on the findings of a questionnaire-based investigation into the use of these reasoning strategies by 879 members of the public. The results reveal a rational competence on the part of lay people which has been hitherto unexamined, and which may be usefully exploited in all aspects of public health work.

Public health reasoning: much more than deduction

The deductive paradigm has produced notable successes in epidemiology and public health. But while deductive logic has made a substantial contribution to the public health field, it must be recognized that there are also limits to that contribution. This report examines one such limit: the need for non-deductive models in public health reasoning. The findings of a study of public health reasoning in 879 members of the public are reported. Four non-deductive strategies were chosen for their capacity to bridge gaps in one’s knowledge. It emerged that subjects were adept at using these strategies in the absence of knowledge to arrive at judgements about public health problems. The implications of this finding for public health communication are discussed.