Thursday, 15 November 2018

Altered States of Consciousness

This post is by Marc Wittmann, Research Fellow at the Institute of Frontier Areas of Psychology and Mental Health in Freiburg, Germany. Here, he writes about his new book on altered states of consciousness.

Subjective time emerges through the existence of the self across time as an enduring and embodied entity. This is clearly revealed in everyday states of consciousness such as transiently being in states of boredom or flow. An increased awareness of the self is associated with an increased awareness of time when we are bored. In contrast, we lose track of time and the self when fully immersed in challenging activities accompanied by the feeling of enjoyment – experienced in the state of flow.

The relation between self-awareness and time is even more prominently disclosed in anecdotal reports and empirical studies on altered states of consciousness such as in meditative states, in music-induced trance, and after ingestion of psychedelic substances. In peak states the experience of ‘timelessness’ is reported together with a loss of the sense of self. This is in fact a universal spiritual experience where time is not experienced at all and the self becomes one with the world.

In my book Altered States of Consciousness: Experiences out of Time and Self, just published by MIT Press, I explore these facets of changes in consciousness awareness. After a prologue containing a warm-up with reports of extreme experiences by novelists and Nobel Prize winners, the first chapter covers phenomena under scientific investigation such as the experience of time expansion in moments of terror and accidents (the slow-motion effect), under the influence of drugs, in spiritual moments, and in near death when the heart and brain have apparently stopped functioning. In the second chapter I cover the experience of time and self in meditation.

An abundance of neuroscientific studies exist on meditation effects; and I interview a highly experienced meditator on what he can report to us about his states of “awakening”. In the third chapter I investigate the case of a puzzling psychiatric patient who has lost her emotional feelings, her bodily feelings and the sense of time. Depression and schizophrenia and the latest research on disturbed temporal processing in these patients as well as in certain individuals with epileptic auras are reported. Finally, the latest breathtaking studies on psychedelics such as psilocybin, LSD, and ayahuasca are discussed.

Tuesday, 13 November 2018

Intellectual Servility and Timidity

Alessandra Tanesini is a Professor in Philosophy at Cardiff University (UK). She is the author of An Introduction to Feminist Epistemologies (Blackwell, 1999), of Wittgenstein: A Feminist Interpretation (Polity, 2004), and of several articles in epistemology, feminist philosophy, the philosophy of mind and language, and on Nietzsche. 

Her recent work lies at the intersection of ethics, the philosophy of language, and epistemology with a focus on epistemic vice, silencing, prejudice and ignorance. She is currently a co-PI on a two-year multidisciplinary research project Changing Attitudes in Public Discourse which is dedicated to reducing arrogance in debate. Open access copies of recent publications and work in progress can be found here.

Those who face discrimination, humiliation and intimidation on a daily basis suffer many harms as a result of these wrongful treatments. In my paper “Intellectual Servility and Timidity” I explore how subordination and discrimination damage the character of the oppressed. I argue that those who are repeatedly humiliated are likely to develop feelings of inferiority and a lack of pride in their achievements. They might also become extremely servile. 

I characterise this vice as a damaged form of self-esteem. It occurs when individuals have a low opinion of themselves as this self-evaluation is measured explicitly by means of questionnaires, and at the same time have a positive view of themselves as this is measured indirectly via the Implicit Association Test (IAT) or other implicit measures. These individuals are driven by a desire to fit in with a society that despises them. They are, in response, prepared to adopt the low opinion that others have of them to avoid social exclusion.

Thursday, 8 November 2018

Red Hands

Today's post is by Francesco Filippi (pictured below), an Italian director, screenwriter, and animator whose work can be found here. In this post he tells us about his new film, Red Hands, which addresses the theme of domestic violence.

Can an animated film for teenagers have something to say to the readers of this very interesting blog which explores the boundaries of the human mind? Red Hands, an Italian 30' long film in stop-motion and 2D animation, had his premiere at the Rome Film Festival on October 20th, 2018.

As you can see from the trailer above, it's a story of domestic abuse. Ernesto, a 12 year-old boy, discovers that the magnificent red graffiti appeared on the walls of his street are made by Luna, a girl with a mysterious power. She can emit a blood-like liquid from her hands, but her power is a side-effect of her father's violence at home.

Tuesday, 6 November 2018

What Does it Take to Be a Brain Disorder?

In this post, Anneli Jefferson, Leverhulme Early Career Fellow at the University of Birmingham summarizes her paper on the nature of brain disorder, recently published in Synthese.

A long-standing project pursued by some psychiatrists is to show that mental disorders are brain disorders and that mental dysfunction can best be explained as brain dysfunction. But what exactly is the relationship between mental disorders and brain disorders and when is a mental disorder a brain disorder? This is the question I address in my paper. Some psychiatrists believe that it follows from the acceptance of physicalism that all mental disorders are brain disorders. If all mental states are brain states, shouldn’t all disordered mental states be disordered brain states?

Many philosophers have resisted this conclusion, appealing to the hardware/software distinction to argue that even if dysfunctional mental processes are realised in the brain, this does not mean that the underlying brain processes are also disordered. Just as there can be a software problem without there being anything wrong with the hardware, there can in principle be a mental problem without any systematic problem in brain function.

This argument is often supported by appeal to multiple realizability: one mental dysfunction can be realised by many different brain processes in different individuals or in one individual over time. There may not be a stable underlying brain pattern that realises a specific psychological dysfunction.

In the paper, I suggest that when we do find an underlying brain difference that realises psychological dysfunction, we should characterize this as a brain dysfunction because it realises mental dysfunction. This means that in some cases (for example, amygdala hypofunction) the characterisation of brain difference as dysfunctional is derivative of the psychological level, because the reason the brain anomaly is characterized as dysfunctional is purely that it realises psychological dysfunction.

There is no independent, brain-internal criterion that characterizes these differences as dysfunctional, instead the characterization of brain dysfunction depends on the psychological level. This should not worry us, I argue, because the brain is the organ of thought, so it stands to reason that we look at the interaction between disordered processes of thought and feeling and brain anomaly when figuring out which brain differences constitute brain dysfunctions.

Thursday, 1 November 2018

IMH Inaugural Forum

On 15th October the Institute for Mental Health (IMH) had its Inaugural Forum at Hornton Grange at the University of Birmingham. The event was live-tweeted by the Mental Elf and the IMH. The whole project PERFECT team attended the Forum and this report comes from their collective notes.

In the morning session, Eoin Killackey (Orygen) and Paul Burstow (IMH) started the day with two fascinating talks on youth mental health.

Killackey gave a very international talk, analysing a variety of interventions and forms of support available for young people across the world, reflecting on the many lessons those who wish to improve the UK youth mental health system can learn from these programs. 

Two particularly interesting focal points were on how to improve the transition from youth to adult services, and how to better separate services on the basis of demographic and developmental evidence about the prevalence and nature of youth mental health difficulties. 

Burstow spoke of the need not just to increase spending on youth mental health across the UK, but more importantly of the need to reallocate existing funding towards intervening on the causes of mental ill health, rather than simply tackling the consequences.

From Paul Burstow's talk

Before the lunch break, Karen Newbigging (IMH) and Sophie Stammers (Project PERFECT) facilitated a very interactive session asking what makes coproduction successful. Participants were divided into groups and asked to share their experiences of coproduction. 

Key themes were the need for (a) managing expectations in coproduction; (b) making young people participating in research aware of the remit and the constraints of the project they are asked to help with; (c) offering something back to people participating in research (e.g. training skills); (d) offering expertise to support good ideas coming from people with lived experience of mental health services.

Parallel to this session, Maria Michail (IMH) and Anna Lavis (IMH) facilitated a workshop on how the wide range of disciplines involved in mental health research at the IMH could break out of their own ‘silos’ and work together to better understand and prevent self-harming and suicidal behaviours in youth populations. 

Participants were divided into groups and worked together to begin to develop ways of overcoming existing personal and structural barriers to interdisciplinary research.

In the afternoon, Sophie Dix (Director of MQ) talked about the financial cost of mental illness and the cost in terms of loss of life. There is a lot in the press about raising public awareness of mental health, decreasing stigma, and improving services. But there is very little about making treatment better and research is part of the solution.

Sophie Dix

MQ raises money for research into mental illness. There is great disparity between funding for research for cancer and dementia and funding for research for mental health. And in mental health there is too much ‘trial and error’ and not enough prevention. Further, there is a lack of innovation when it comes to finding the best treatments. No huge progression has been made with psychological treatments either: those we have today were developed in the sixties.

MQ is focused on research that is: (1) multidisciplinary, (2) transdiagnostic, (3) international, (4) focused on impact, (5) aimed at investing in the future. MQ thus applauds the creation of multidisciplinary centres such as the IMH, where scientists from different disciplinary backgrounds work together from the start. 

MQ encourages international collaboration and funds the best research, whether it is based in the UK or elsewhere. Examples of the research they fund includes depression in people with HIV in Uganda; whether women are more responsive to psychological treatment for anxiety depending on where they are in their menstrual cycle; effects of folic acid for protecting people against schizophrenia.

One big focus is on youth mental health: it takes too long for people to get help since they show the first symptoms of mental illness. MQ created a consortium to address the challenges youth mental health poses and coproduce research ideas by people in the physical and social sciences. 

MQ used sandpits to attract people who had expertise in public engagement and collaborative projects. The result was people coming up with ideas (developing a screening tool for mental illness, e.g. suicide prevention and risk scores for depression in adolescents).

Tuesday, 30 October 2018

Phenomenology Imported with EASE

Rolf Hvidtfeldt is postdoctoral fellow at the Humanomics Research Centre at Aalborg University in Denmark. His research is mainly focused on the philosophies of science evaluation, scientific communication, and conflicts of perspective. Currently he is working on a project focused on mapping the various ways in which research (in a broad sense) affects (in a broad sense) society at large.

He has recently published the book The Structure of Interdisciplinary Science in which he seeks to develop a method for examining epistemic aspects of interdisciplinary collaborations. The following blogpost briefly summarises key elements of ch. 8 of this book, which is a case study picked from schizophrenia research.

In the The Structure of Interdisciplinary Science I develop a method, approach-based analysis, for studying interdisciplinary science in deep detail. Chapter 8 of the book is a case study in which this method is applied to a case of interdisciplinary research. The case in question is part of an ongoing research programme, EASE – short for Examination of Anomalous Self-Experience, in which philosophical phenomenology is combined with more traditional (psychiatric and psychopathological) approaches to schizophrenia research. The core ambition of EASE is to link schizophrenia to certain disturbances of basic structures of consciousness. Intuitively, this seems reasonable, since schizophrenia seems to involve obviously abnormal subjective experiences.

Capturing the subjective experience of what it is like to suffer from schizophrenia would certainly enrich our best representations of schizophrenia considerably. And further, if specific disturbances in structures of consciousness could be determined, and these could be shown to be causally related to symptoms of schizophrenia, this ought to attract a lot of attention in psychopathological research. There is little doubt, that such a finding would have considerable impact on future developments in psychiatric nosology and diagnostics.

Thursday, 25 October 2018

Delusions in Context

On 15th October at Hornton Grange Matthew Broome, director of the Institute for Mental Health in Birmingham, chaired the book launch of Delusions in Context (Palgrave Pivot, 2018), a collection of four new papers on delusions. The book is truly interdisciplinary, featuring authors with a background in psychiatry, lived experience, psychology, cognitive neuroscience, and philosophy, and is available open access on the Springer website.

I edited the book. At the launch, I explained how the book fits with the work we have been doing as part of project PERFECT. In the project one of the objectives is to examine whether beliefs that we consider as epistemically irrational (either not supported by existing evidence, or resistant to new counter-evidence) can nonetheless have some benefits for the person who adopts such beliefs. Benefits could be cashed out in terms of increased wellbeing or reduced anxiety, enhanced motivation to pursue epistemic goals, or better performance in some contexts. Can delusions play a positive role at all, maybe one often hidden from view?

The book consists of four chapters, written by Rachel Upthegrove and S.A. (chapter 1), Phil Corlett (chapter 2), Richard Bentall (chapter 3), and myself (chapter 4).

Tuesday, 23 October 2018

A Two-factor Account of False Body Size Beliefs in Anorexia Nervosa

Stephen Gadsby is a PhD candidate in the Cognition and Philosophy lab, Monash University. His research spans a number of topics, including anorexia nervosa, body representation, delusions, psychiatric taxonomy, mental representation and predictive processing. In this post, he summarises his new paper "Self-Deception and the Second Factor: How Desire Causes Delusion in Anorexia Nervosa" recently published in Erkenntnis.

Research shows that anorexia patients don’t hold extreme body ideals, despite common misconception. Indeed, most patients are thinner than what they judge their ideal size to be. In this paper, I advance a two-factor explanation for why patients believe they haven’t yet reached their ideal size. This account attempts to answer two questions: how the content of this belief arises and why the belief is maintained in the face of contradictory evidence. Following from previous work (Gadsby 2017a; 2017b), I answer the first of these question by suggesting that patients experience their bodies as larger than reality.

By itself, however, this experience is insufficient to explain anorexia patients’ beliefs. Although they experience their bodies as larger than ideal, patients are also exposed to significant evidence suggesting the contrary: that they are (dangerously) thin. This evidence comes in a number of forms such as weight scale and clothes size readings and testimonial evidence from family, friends and clinicians attempting to convince them of their true body size. A second factor is thus needed to explain why this contradictory evidence doesn’t change their mind.

Thursday, 18 October 2018

Illness Narratives: Interview with Maria Vaccarella

In this post I interview Maria Vaccarella on her latest project which concerns illness narratives. Maria is Lecturer in Medical Humanities at the University of Bristol. She works at the intersection of literature and medicine, and she is a member of the steering committee of the Centre for Health, Humanities and Science.

Her current research explores the genre of illness narratives, with a special focus on non-linear and non-triumphalistic plots. She is also interested in narrative medicine, critical disability studies, narrative bioethics, comparative literature, and graphic storytelling. Her current project is “Illness as Fiction: Textual Afflictions in Print and Online” and is funded by a British Academy / Leverhulme Small Research Grant.

LB: How did you first become interested in false accounts of illness?

MV: About two years ago, I was reading this article on health-related Internet hoaxes during my lunch break and had a lightbulb moment: these illness accounts, whether produced in cases of Munchausen by Internet/factitious disorder or as part of online scams, were an extreme form of the illness narratives I research and teach in my job as a Lecturer in Medical Humanities. 

This phenomenon has a printed counterpart in books marketed as memoirs and later revealed to be partially or completely fabricated. The best known example is probably James Frey’s best-selling memoir A Million Little Pieces (2003) on his alcohol and drug addiction, selected for Oprah Winfrey's book club in 2005, but later revealed to be only partly true in a tense interview for the same show.

As a literary scholar by training, I had many questions on the modalities of this form of self-narration, but they were inextricable from the psychological and often psychiatric aspects of the act of writing in question. This is how I devised my project Illness as Fiction: Textual Afflictions in Print and Online, as an interdisciplinary investigation of what counts as an illness experience nowadays beyond the clinical environment, without pathologizing, moralising or criminalising intents.

Credits: Julie Jablonski, Reflecting on Words CC BY-NC 2.0

LB: Do you believe that the opportunity most people now have to share personal information on the internet (via blogs and fora) has increased the occurrence and the influence of false illness narratives? Or is the internet just another medium for a pre-existing problem?

MV: I believe that some very elaborated hoaxes (such as Warrior Eli) can only be created and sustained online: they thrive on platforms dedicated to a specific condition or patient population, but at the same time require the corroboration of multiple social media profiles, which very often feature pictures uploaded on other, authentic profiles. 

I’m not sure whether access to the Internet will increase the occurrence or the influence of these false accounts in the long run, though some intricate form of Internet-mediated emulation seems to have played a crucial role in Belle Gibson’s case: apparently, she drew great inspiration from the online success of (real) cancer patient and alternative treatment advocate Jessica Ainscough– in the words of Beau Donelly and Nick Toscano, “For years before Aisncough’s death, Gibson was positioning herself as the next poster girl for holistic health and wellness. And the template she used in her story followed a similar path.”

So, this is a phenomenon that precedes and goes beyond the Internet, but its classification as a “problem” is quite complicated. Online fake illness stories with lucrative aims or promoting ineffective, possibly lethal, treatments are, of course, a problem. But, as psychiatrist Marc Feldman has written in his latest book on Munchausen by Internet Dying to Be Ill (coauthored with Gregory Yates), “It is not illegal to steal someone’s sympathy.” 

The abovementioned Warrior Eli case provides, for example, a perplexing moral conundrum: the woman behind the false story of Wilm's Tumor patient Eli didn’t make any money out of it or discredit evidence-based therapies – on the contrary, she encouraged her many followers to donate to a real charity.

Tuesday, 16 October 2018

'Good' Biases

This post is about a paper by Andrea Polonioli, Sophie Stammers and myself, recently appeared in Revue philosophique de la France et de l'étranger, where we ask whether some common biases have any benefits for individuals or groups.

Our behaviour as agents can have a multiplicity of goals. These might be pragmatic in nature (for example, fulfilling practical goals such as being well fed). They might be psychological in nature (for example, increasing wellbeing or reducing anxiety). They might also be epistemic in nature, and have to do with the attainment of true beliefs about ourselves or the world. Epistemologists have identified different notions of epistemic attainment, and different senses in which one can fail epistemically by being doxastically irrational.

Doxastic irrationality is the irrationality of beliefs. It does manifest in different ways and comprises: (a) beliefs that do not cohere with each other and violate other basic principles of formal logic or pro- bability theory; (b) beliefs that are factually erroneous; (c) beliefs that are not well-supported by, or responsive to, evidence; (d) beliefs that are poorly calibrated because people assign inaccurate degrees of confidence to them; (e) beliefs that are well integrated in people’s behaviour. In this article we are interested in the effects of some biases leading to doxastic irrationality on individual agents and groups of agents.

So, doing well epistemically can mean fulfilling epistemic goals such as: (a) having beliefs that cohere, and which are based on principles of formal logic or probability theory; (b) having beliefs that are factually based; (c) having beliefs that are well supported by, or responsive to evidence; (d) having well calibrated beliefs; (e) having beliefs that are well integrated in people’s behaviour.

Agents’ behaviour may be assessed negatively when it fails to satisfy the epistemic goals above, or other epistemic goals such as attaining beliefs that encourage exchange of information with other agents, or developing an intellectual virtue such as curiosity or honesty. But there are other reasons why a behaviour may be negatively assessed, for instance by failing to fulfill other types of goals (pragmatic or psychological). Sometimes, an instance of behaviour can succeed at fulfilling some goals and fail to fulfil others. Furthermore, new costs and benefits may emerge when the behaviour in question is assessed in the context of groups to which the agent belongs, rather than simply at the individual level.

In the paper, we argue for the need for an analysis that is sensitive to the multiplicity of goals of human behaviour at both the individual and group level, when assessing failures of doxastic rationality. We argue that doing so can reveal some underexplored costs, as well as benefits, that can be pragmatic, psychological, and epistemic in nature. Examples of practices that may lead to doxastic irrationality include the overconfidence bias, biases about one’s own and other social group(s), and optimistically biased beliefs about the self. 

Thursday, 11 October 2018

Interview with Mohammed Abouelleil Rashed

Mohammed Abouelleil Rashed is a Wellcome Trust ISSF Research Fellow in the Department of Philosophy, Birkbeck College, University of London; and a Visiting Lecturer in Philosophy at King's College London. He studied medicine at Cairo University Medical School, then trained in psychiatry in London on the Guy's, King's College, and St. Thomas' Hospitals training scheme. He gained a PhD in Philosophy from University College London in 2012, and is now a full-time researcher.

Sophie Stammers: Welcome to the Imperfect Cognitions blog, Mohammed! Thank you so much for coming on board to tell us more about your work. As readers will see from the bio above, you trained as a medical doctor, with postgraduate training in psychiatry, and have clinical experience in this area, as well as pursuing research in the philosophy of mental health. How did you become interested in philosophy?

Mohammed Abouelleil Rashed: Thank you, Sophie. I became interested in philosophy during my fourth year at medical school at Cairo University. I had come across Leo Tolstoy’s A Confession – a short autobiography where Tolstoy, then in his early 50s, reflected on his life during what we would now refer to as an existential crisis. Tolstoy questioned the value of his accomplishments and the meaning of his life, and reflected on ambition and faith, and this, mind you, was at the height of his success: he had published War and Peace a decade before and Anna Karenina just three years earlier. The book had a significant impact on me, especially that I was going through my own dissatisfaction with some of the givens in my life, and with medicine and with medical education, in particular with rote learning and the lack of critical thinking. A Confession introduced me to some of the big philosophical questions, which I then began to read about. In this sense, philosophy, for me at the time, was as much an intellectual as a personal exploration. A few years later during my psychiatric training in London, my philosophical knowledge found a natural home in reflecting on psychiatry and mental health, and I developed my knowledge further by studying philosophy of mental disorder at King’s College London with Derek Bolton.

SS: How does your clinical experience inform your current research?

MAR: Even though I no longer practice psychiatry, my previous clinical experience is central to my philosophical work both in terms of providing knowledge of mental health phenomena, as well as defining the concerns underlying my research. For example, during my time on the acute wards, rehabilitation units, and outpatient clinics of South London, I had the privilege of witnessing people’s accounts of their lives and their experiences; their detailed descriptions of ‘paranoia’, ‘passivity experiences’, ‘auditory hallucinations’, and other phenomena conveyed to me the richness of these experiences, how much they mattered to people, and the terror that often accompanied them. I was also able to see that while people do suffer cognitive and emotional challenges severe enough to require intensive support, the environment of mental health units and the narratives and therapeutic resources of psychiatry as a medical specialty were not always sufficient, and in some cases were clearly inadequate and even harmful, as a way of responding to these challenges.

Tuesday, 9 October 2018

PERFECT 2018/2019 (Sophie)

As Project PERFECT enters its fifth year, here’s a little bit about what I’ve been up to recently, and what I plan to do over the year to come.

This year just gone has been our Year of Confabulation: we held our confabulation workshop in Oxford in May, where we were lucky enough to have a programme of researchers from around the world, all at the forefront of philosophical and interdisciplinary inquiry into confabulation; we also co-organised a Confabulation and Epistemic Innocence workshop with Elisabetta Lalumera at Milano-Bicocca. Our special issue on confabulation with Topoi is well underway, and we hope it will be ready for you to read in the next few months. In my own work, I’ve been investigating some under-explored benefits of confabulation, and have developed two papers on the topic this year. In one paper I argue that confabulation can have epistemic benefits because it preserves collective cognitive partnerships; whilst in another I explore the psychological and social value of imbuing our accounts with resonant meaning, as we do in confabulation and other explanation-giving behaviour. 

I’ve also continued my research on implicit bias, through a co-written paper (with Andrea Polonioli and Lisa Bortolotti) in which we evaluate the epistemic costs and benefits of doxastic biases in group settings. I’ve also got a paper forthcoming in the Educational Theory special issue on “Cheating Education: The Coherence And Desirability Of Technological Human Enhancement In Educational Contexts” where I argue that the opportunity to selectively erase social biases may be beneficial given their propensity to manifest automatically in cognition; but it would also bypass an important opportunity for reflection on the upstream societal sources of bias, and so ought only to be used in conjunction with public discussion of structural injustice.

Thursday, 4 October 2018

Neuropsychiatry Conference 2018

The Royal College of Psychiatrists hosted its Faculty of Neuropsychiatry Annual Conference on 13-14 September 2018 in London. I was fortunate to attend the first day and I am going to report on some of the interesting talks I listened to.

In the first session speakers focused on neuroscience for psychiatrists, and Paul Johns, author of Clinical Neuroscience, addressed the functional anatomy of the human amygdala.

The amygdala is constantly looking out for dangers and helps us evaluate the emotional significance of events. It facilitates social interactions as it enables us to read other people's minds. Further, the amygdala is involved in learning and episodic memory for important events. It is responsible for an implicit emotional memory of negative events to help us avoid adverse stimuli.

The amygdala is for assessing environmental cues to determine the adequate response to threats. So patients without the amygdala are fearless but it is possible to experimentally induce a panic attack by giving them the impression that they are suffocating. So the amygdala is not necessary for feeling scared (the hypothalamus is).

The second speaker, Nandini Mullatti (King's College London), described the role of neurophysiology in mental health settings with a focus on epilepsy. By looking at some patients' history and at the manifestation of unusual symptoms (e.g., a woman claiming "she was losing her face"), Mullatti showed that clinical neurophysiology provides evidence to decide whether symptoms are organic or functional and further has an important role to play in the evaluation of functional symptoms.

The third speaker in this session, Oliver Robinson (University College London), addressed the history of neuroimaging in mood and anxiety. He focused on depression (unipolar and bipolar) and showed some inconsistent imaging results about whether these conditions are correlated with increased or decreased activity in the subgenual cingulate region of the brain.

Tuesday, 2 October 2018

PERFECT 2018/2019 (Lisa)

We have got to the last year of project PERFECT. In this brief post I will summarise our latest challenges and achievements, and move on to describe our plans for the year to come which we want to make a year to remember!

Our recent past

Our research has continued to focus on memory and confabulation, according to plan. We have managed to secure publication for several original research articles. I authored papers on confabulation and the optimism bias, and co-authored papers on memory and delusion. Sophie, Michael, and Valeria will report on their own efforts in the next few weeks!

As well as organising and participating in academic conferences and writing articles for specialist journals, we have made a real effort to reach wider audiences. One way in which I have attempted to disseminate our work on cognitions that are imperfect but useful is by writing for Aeon (on dementia and confabulation) and IAI TV (on optimism and the self) and, with Kathy Puddifoot, for the Philosophers Magazine (on memory).

Our hopeful future

There is so much we still want to do and it is not clear that we can do it all in the 12 months we have left, but we will give it a try! We start the academic year with two visitors, Chris Moulin and Krystyna Bielecka, who will certainly help us think outside the box and reflect on interesting issues that are at the core of the project. Chris will be talking to us about deja vu and Krystyna about confabulation.

In October we have planned a little celebration, a book launch, for our forthcoming publication, Delusions in Context, a book for Palgrave Pivot. The electronic version will be open access for you all to enjoy! The contributors Richard Bentall, Rachel Upthegrove, and Phil Corlett are well known to our blog readers and have provided original work on delusions in their chapters, telling us about the importance of thinking about delusion in the context of what we already know about belief. Watch the blog for more information!

In summer 2019 we plan a bigger celebration to coincide with the Arts and Science Festival. We hope to showcase some art that addresses issues central to mental health and our understanding of the world, starting from the beautiful and moving artwork by our ex-team member Magdalena Antrobus, now a successful full-time artist!

In terms of research, I am planning to write about the epistemic responsibility we have when we consume stories that are used as arguments in public debates, with Sophie Stammers and Anneli Jefferson. I am also interested in exploring further the literature on choice blindness with long-term collaborator Ema Sullivan-Bissett, and finally completing work on my Epistemic Innocence monograph. A busy year!

Your contribution

The blog has been and will continue to be a very important part of the project, and a straight-forward way to bring our work at PERFECT out of our offices and seminar rooms and into the world. If you have any feedback or comments on what you have read on the blog, especially about the project but also more widely, please let us know. We would like to know whether the views we argue for ring true to you given your experience or knowledge, and whether you think there are relevant areas of inquiry that we should approach next!

You can leave a comment below or email us.

Thursday, 27 September 2018

The Interoceptive Mind

Helena De Preester is assistant professor and researcher at University College Ghent, as well as a visiting research professor at the Department of Philosophy and Moral Sciences at the University of Ghent. Her research focuses on the connection between the human mind, embodiment, technology, and wider society. 

Manos Tsakiris is professor of Psychology at Royal Holloway, University of London, where he leads the lab of Action & Body and the INtheSELF ERC-funded project. His research focuses on the link between body and self and how we become aware of ourselves and others. In this blog post they introduce their new co-edited, interdisciplinary volume on interoception.

Interoception is the body-to-brain axis of signals originating from the internal body and visceral organs (such as gastrointestinal, respiratory, hormonal and circulatory systems), and plays a unique role in ensuring homeostasis. Interoception therefore refers to the sensing of the state of the inner body and its homeostatic needs, that is, to the ever-fluctuating state of the body beneath its sensory (exteroceptive) and musculoskeletal sheath.

By bringing together the perspectives of experimental psychology and cognitive neuroscience, psychophysiology, psychiatry, clinical psychology, and philosophy, this volume aims to go beyond the known role of interoception for homeostasis in order to ask, and hopefully provide, important insights on the role that interoception plays for our mental life and lived experience, for awareness, affect and cognition.

The perspectives in the 17 chapters largely fall within the embodied cognition approach that attempted to ground cognition and the self in the body. Over the last three decades, modern psychology and cognitive neurosciences have focused on the importance of the body as the starting point for a science of the self and the subject. Notwithstanding the influential research that accumulated in this area, it is clear that our fields have neglected another important dimension of the body, namely the interoceptive body, which is the body as perceived from the inside.

There is consensus that interoception research must develop psychologically-relevant and philosophically-sound theoretical foundations, a wider and more grounded measurement model and a fuller characterization of the links between different interoceptive dimensions and systems, if it is to achieve its appropriate place within the life and mind sciences.

The contributions collected in this multidisciplinary volume represent an attempt to provide a reference for the conceptualization of this excitingly deep connection between our body and mind. As such it offers an overview of the state-of-art in psychologcial and neuroscience research, of recent developments in clinical-psychological models for normal and pathological functioning, and of new theories that frame interoception at the intersection between philosophy of mind and the broader context of embodied cognition. To that end, its scope ranges from the psychology and neuroscience of interoception (Part I), to clinical implications of recent research taking into account interoception (Part II), and to theoretical-philosophical frameworks and models of interoception (Part III).

The different chapters included across the three parts are inter-related in various ways, and the synergy between the chapters crosses the boundaries of the disciplines, opening up opportunities for fruitful dialogue between fields that otherwise remain too often separate. The chapters thus share a common concern for what it means to experience oneself, for the crucial role of emotions, and for issues of health and wellbeing, discussed on the joint basis of our bodily existence and interoception, resulting in a more than usual attention for the phenomenology of subjective experience in disciplines outside philosophy.

We hope that the scholarly research presented in this volume will further motivate the much-anticipated coming of age of interoceptive research in psychology, cognitive neurosciences and philosophy.

Tuesday, 25 September 2018

Hypnosis and Automatic Behaviours

Vince Polito is is Postdoctoral Research Fellow at Macquarie University, and member of the Belief Formation Program at the ARC Centre of Excellence in Cognition and its Disorders. His work investigates alterations of agency and body representation associated with hypnosis, virtual reality, flow, meditation, and psychoactive drugs. You can find him on twitter here.

Hypnosis is used clinically as a treatment for conditions such as chronic pain, and is also becoming more commonly used as a research tool in cognitive science. Despite growing levels of interest in hypnosis, the mechanisms that underlie hypnotic effects are still not agreed upon. A common view amongst researchers is that hypnosis can profoundly influence the way that individuals monitor and evaluate their experiences but that it is not able to influence behaviours that are normally outside of conscious control.

A recent study we completed provides evidence that, in certain contexts, hypnosis may actually be able to inhibit typically automatic responses.

Our study adapted an intriguing experimental paradigm developed by Daniel Wegner: the Clever Hands task.

In this task participants are given a series of trivia quiz questions. These are all binary choice, yes/no questions. Most of the questions are incredibly easy (e.g., ‘Is the sky blue?’) but a small number of questions are extremely difficult (e.g., ‘Are there 7107 islands in the Philippines?’ There are not. The correct answer is 7641, in case you were interested). But there is a catch: participants are instructed to answer all the questions randomly. It turns out people are terrible at this task.

Thursday, 20 September 2018

Working With Goals in Psychotherapy and Counselling

Duncan Law is a consultant clinical psychologist at the Anna Freud National Centre for Children and Families and University College London. He is interested in quality improvement across child mental health systems, better collaborative practice, Goals Based Outcomes (GBOs), better use of evidence informed practice, and authentic participation.

Mick Cooper is a professor of Counselling Psychology at Roehampton University. He is the author of Existential Psychotherapy and Counselling (Sage, 2015).

In this blog post, Duncan talks about their new co-edited volume Working with Goals in Psychotherapy and Counselling.

Recent evidence suggests that working with goals in counselling and psychotherapy can support positive therapeutic change. Goals can empower clients and give them hope: helping them feel that they have the capacity to act towards achieving their desired futures. Goals can help focus, and direct, clients’ and therapists’ attention, building a better therapeutic alliance.  Goal-setting and goal-tracking can help to ensure that therapy is personalised to the individual client: so that they are working towards objectives that are of genuine importance to them.

The different motivations for seeking, and offering, counselling and psychotherapy link with the debate around the use and usefulness of goals in therapy.  The best kind of therapy is the one that fits the needs and wishes and preferences and context of the client. But here is the crux of the matter: before therapists can offer the right kind of help or guidance or facilitation, they need to ask the client (perhaps not so bluntly): ‘What do you want?’

‘What do you want?’ is a deceptively simple question that draws on complex psychological processes and requires great therapeutic skills to help a client answer. From the perspective developed in this book, the client’s answer to this question should set the over-arching direction for the therapeutic process itself. Unless we know the client’s reasons for embarking on a therapeutic journey we cannot be as helpful as they or we might wish. 

How we help and how we understand the question, how we support and facilitate the client to find the answer that is right for them and the myriad potential answers to it, is the starting point for how we help and how we go on being helpful. This is about how we help the client start, and how we remain flexible and open to changes in the directions and reasons for travel, and how we seek to work to be as helpful as we can in joining the client on their journey.

Tuesday, 18 September 2018

Vaccine Hesitancy and Trust

This post is by Elisabetta Lalumera (University of Bicocca, Milan). In this post she summarises a paper forthcoming in Rivista di Estetica, entitled: "Trust in healthcare systems and vaccine hesitancy."

Healthcare systems can positively influence our personal decision-making and health-related behavior only if we trust them. What does it take for the public to trust a healthcare system? I propose that the trust relation is based on an epistemic component, epistemic authority, and on a value component, the benevolence of the healthcare system. I argue that it is also affected by the vulnerability of the pubblic on healthcare matters, and by the system’s credibility.

My proposed analysis of public trust in health care systems can be used to better understand the phenomenon of vaccine hesitancy, the tendency to question vaccine policies, and to seek alternative vaccine schedules or refuse vaccination.


Trust in health care is a three-place relation, involving an institution (a community’s health care system), a collective entity (the public), and a field of application, which is what the public trusts a health care system for. The public is the varied group of consumers, seekers and providers of health to which a health care system addresses its services, which in national health care systems virtually coincides with the whole population. Examples of fields of application are information (about, for example, the risks of smoking), prevention (as in immunization campaigns, and screening tests), diagnosis, therapy, hospitalization, but also organ and blood donation.

Public trust in health care involves vulnerability in two respects: (1) we trust someone because we cannot personally take care of all our material and immaterial goods and in particular, we trust an institution because we are unable to manage some area of our life by ourselves, as individuals; (2) we trust healthcare systems with our personal health, and the health of our families and our communities. 

When is it appropriate to trust? First, public trust in health care is grounded on the epistemic authority of health care practitioners, and of the system collectively taken. We can’t expect the health care system to promote, maintain or restore our health unless we assume that it embodies sufficient knowledge, competence, and skills to do so. Second, public trust in health care depends on the confidence that healthcare practitioners will act on the knowledge, competence and skills they possess in order to promote, maintain or restore our health, and not with other goals in view.

Though normatively public trust is founded on epistemic authority and value sharing, in fact it correlates with the credibility of the trusted part. Credibility in this context is the capacity to produce in others the impression that one is epistemically authoritative and benevolent. The public is willing to grant trust if the health care system is credible enough.

Thursday, 13 September 2018

Memory, Narrative, and the Autobiographical Process

Jens Brockmeier is a Professor in the Psychology department at the American University of Paris. With a background in philosophy, psychology, and language studies, he is concerned with the cultural fabric of mind and language - language understood as a form of life and central dimension of human development.

He is the author of Culture and Narrative (Mimesis, 2014) and a co-editor (with L.-C Hyden and H. Lindemann Nelson) of Beyond Loss: Dementia, Memory, and Identity (OUP, 2014). In this blog post he talks about his latest book Beyond the Archive: Memory, Narrative, and the Autobiographical Process

In recent work, Brockmeier has been investigating narrative as psychological, linguistic, and cultural practice. His main interest is in the function of narrative for autobiographical memory, personal identity, and the understanding of time, issues he has explored both empirically and philosophically – empirically, in various languages and sociocultural contexts, and under conditions of health and illness; philosophically, in terms of a narrative hermeneutics.

Brockmeier has summarized much of his recent work in his book Beyond the Archive: Narrative, Memory, and the Autobiographical Process (Oxford University Press, 2015, paperback version 2018). The book’s basic assumption is that our longstanding view of memory and remembering is in the midst of a profound transformation. This transformation does not only affect our concept of memory or a particular idea of how we remember and forget; it is a wider cultural process. In order to understand it we need to step back and consider what is meant when we say “memory.”

Building on a number of far-ranging studies, Beyond the Archive offers such a perspective. It synthesizes our understanding of remembering in various fields (that most of the time work independently from each other): the neurosciences, social, historical, and digital memory studies, and the humanities. This spectrum of studies also includes analyses of key works of life-writing, specifically of autobiographical literature – by Marcel Proust, Walter Benjamin, Samuel Beckett, W.G. Sebald, and others. What’s more, there even is a memory sculpture/installation by the artist Anselm Kiefer, analyzed as meticulously as neuroscientific experimental data. (In a different work, Brockmeier deals with Picasso’s Les Demoiselles d’Avignon as incorporating both individual and collective memories).

The aim of all this is to radically rethink our very notion of memory as a storage, an archive of the past. In a long history of scientific, philosophical, and cultural reflections, this notion has gained an undisputed solidity, suggesting the natural existence of a distinctive human capacity (or a set of neuronal systems) enabling us to “encode,” “store,” and “recall” (or “reconstruct”) past experiences, as the universal mantra of  neuro(cognitive) psychology goes.

However, this is only half of the story and, in fact, half of Brockmeier’s book. The other half presents a new picture emerging out of this transitional phase. There are, in fact, many cultural forms of remembering and forgetting that are different from the traditional archival model, forms and practices embedded not only in the brain or some of its parts, but in a wide range of human activities and artifacts. They now come to the fore, turning into subjects of inquiry. The emerging picture is more complex than any notion of memory as storage of the past would allow.

That is to say, there now are a number of alternatives to the archival memory. One of them is elaborated in this book under the name of the narrative approach (Brockmeier has outlined a slightly different approach shifting the focus to the conversational structure of much of human remembering in another recent publication).

The narrative approach, as Brockmeier demonstrates in Beyond the Archive, via several case studies of autobiographical narratives, not only permits us to explore the storied weave of our most personal, namely, autobiographical form of remembering. It also sheds new light on the interrelations among memory, culture, and self – which opens to a further field of research (and literature), that of “narrative identity.”

Tuesday, 11 September 2018

Ageing Stereotypes and False Memories

Today's post is provided by Katya Numbers. She discusses her recent paper "Ageing stereotypes influence the transmission of false memories in the social contagion paradigm", which is forthcoming in Memory.

I am a Postdoctoral Researcher at the University of New South Wales as well as the Coordinator of the Sydney Memoryand Ageing Study. My research focuses on metamemory (our beliefs about our own and others’ memories) and ageing. Specifically, I am interested in whether peoples’ subjective beliefs about memory and age can predict and/or influence actual memory performance, both in younger and older adults.

If two people are recalling a shared event, and one person misremembers that event, it is very easy for their false memory to change the other person’s memory of what occurred. We call this the social contagion of memory.

It has been well established that the social contagion effect is influenced by how credible a person is seen to be. That is, people are more likely to adopt false memories from someone they view as a credible memory source compared to someone they see as less credible. The logic behind this is simple: if we think someone is credible, there is not much reason to pay close attention to what they are saying. This allows false suggestions to sort of seep into our memory without us noticing. Alternatively, if we don’t see someone as credible, then we are motivated to pay closer attention to what they are telling us. This makes it easier to first detect, and then later reject, any false information they might suggest.

In Western cultures, one way that a person’s credibility is challenged centres on stereotypes of memory and ageing. If you ask someone to describe a “typical old person”, words like forgetful, feeble and confused readily come to mind. Importantly, though, stereotypes of ageing are multidimensional. So, it’s possible that you may doubt the memory of an old person while at the same time appreciating the wisdom that comes with age. In this way, on older person can be viewed as either “feeble and forgetful” or “experienced and wise” depending on the type of information we have about them.

In a recent paper, myself and my co-authors examined whether manipulating stereotypes associated with an older person would influence the social contagion effect. To do this, we paired college-aged students with an older “partner” who was actually a confederate (someone who is in on the experiment). Next, we manipulated the type of age stereotype associated with her by providing participants with bogus background information about her.

For our negative stereotype condition, participants were told our confederate was retired, living in an aged care facility, and partook in sedentary activities (e.g., knitting). For our positive stereotype condition, participants were told the confederate was completing her Bachelor’s degree, living independently, and enjoyed challenging activities like learning German (all things that were true, by the way!).

Thursday, 6 September 2018

The Natural and the Human

This post is by Stephen Gaukroger, Emeritus Professor of History of Philosophy and History of Science at the University of Sydney.

In the course of the eighteenth century, philosophers, physicians, political economists and others began to think about how the study of human behaviour might be taken out of the hands of metaphysicians and theologians, and transformed into an evidence-based scientific enterprise. These projects fall under the general rubric of ‘naturalization’.

The Natural and the Human looks at late eighteenth and early nineteenth century attempts to naturalize the study of human behaviour, and at the way in which this general programmes lead to the naturalization of religion.

Four forms of naturalization of the human are explored. The first is anthropological medicine, in which traditional philosophical understanding of the human condition is replaced with a medical understanding, not least on the grounds that whereas philosophy confines itself to healthy minds and bodies, what is needed is an understanding of the mind and the body in healthy and unhealthy states. In particular, healing the mind becomes, like healing the body, an empirical matter.

Tuesday, 4 September 2018

Emotions, Practical Rationality and the Self

This post is by Tyler Flanagan, and in this post he briefly introduces and outlines his recent publication in Res Cogitans entitled “Emotions, Practical Rationality, and the Self.” He is a first year Master’s student in Philosophy at Virginia Tech.

What I am attempting to do in my paper is defend the view that our emotions are quite amenable to the view of ourselves as rational beings. Rather than throw out the picture of the emotional human, I argue that we should embrace the view instead. Our emotions do not in any way stop us from reasoning properly, and in fact provide us with reasons for action that seem to outweigh even our most thoughtful contemplation (Arpaly, 2002; Jones 2004)

With this view in tow, I suggest that the emotions we have about ourselves, such as regret or shame, act as a guide to how well or how poorly we are attending to our goals and what we care about, and in some instances can show us when we are valuing what we should not. In these ways our emotions are an integral part of our rational agency.

Let me begin by explaining that emotions occur for reasons. When a loved one gets angry or holds a grudge towards us, we do not simply throw our hands up and accept it. We ask why they are angry; we ask them to give us reasons for their emotion, suggesting that emotions are in fact beholden to standards of justification and explanation in just the same way as we justify or explain our beliefs and actions.

Ultimately, our emotions are explained (though not necessarily justified) based on what we value. Whether I become angry or sad, joyful or remorseful, it is because I believe something good or bad has either happened or will happen to something or someone I value. If I see a crocodile rushing towards me and I become fearful, it is not only because I value my life, but also because I think the crocodile will in some way harm my life if he catches up to me. If I become sad over my mother’s death, it is because I valued my mother in many ways, and believe that I have experienced a great loss of what I value with her passing.

Thursday, 30 August 2018

Concern, Respect and Cooperation

Garrett Cullity is Hughes Professor of Philosophy at the University of Adelaide, where he teaches and writes on topics in practical, theoretical and meta-ethics. He taught previously at the Universities of Oxford and St Andrews. 

He is a co-editor (with Berys Gaut) of Ethics and Practical Reason (Clarendon Press, 1997) and the author of The Moral Demands of Affluence (Clarendon Press, 2004). In this blog post he talks about his new book Concern, Respect, and Cooperation.

Three things often recognized as central to morality are concern for others’ welfare, respect for their self-expression, and cooperation in worthwhile collective activity. When philosophers have proposed theories of the substance of morality, they have typically looked to one of these three sources to provide a single, fundamental principle of morality – or they have tried to formulate a master-principle for morality that combines these three ideas in some way.

In this book, I make the case for treating them instead as three independently important foundations of morality. The resulting plural-foundation moral theory belongs to the type pioneered by W.D. Ross. Like Ross, I think that there is a plurality of fundamental moral norms with no master-principle governing their contributions to overall moral rightness. However, my view departs from Ross both in its content and in the type of thing it claims is foundational to morality: it is not a theory of fundamental “prima facie duties”. It also gives a more elaborate account of the ways in which the content of morality is generated from its foundations.

Tuesday, 28 August 2018

The Functional Character of Memory

Today's post is by Jordi Fernández. He is an associate professor of philosophy at the University of Adelaide. Jordi's research interests are mainly in philosophy of mind, epistemology and metaphysics. He is particularly interested in self-knowledge and memory. 

He is the author of Transparent Minds (2013), a monograph on self-knowledge, and he is currently working on a monograph on memory. He is also interested in cognitive science and continental philosophy. Jordi's post is the second of a series on chapters from the New Directions in the Philosophy of Memory collection. (See here for the first in the series.) He discusses his chapter "The functional character of memory".

Consider the question of what is to remember something, as opposed to imagining it. This is a question that I have tackled in a recent article. I try not to appeal to the phenomenology of memories, or the content of memories, or the kind of knowledge that memories provide. The reason is that, once I determine what kinds of mental states qualify as memories, I intend to shed some light on what the typical phenomenological features of memories are, what their characteristic content is, and what knowledge they usually provide. So it would be circular to appeal to those aspects of memory to answer the more basic question of what mental states qualify as memories.

One answer, popular within philosophy, is the causal theory of memory: A mental state representing some event is a memory just in case it causally originates in the subject's past experience of the event. But this condition rules out cases in which the memory is 'reconstructed'. And it rules in cases in which, as far as the person themselves are concerned, the event being represented never happened to them. Neither of those outcomes, I argue, is desirable.

Another answer, popular within psychology, is the narrative theory of memory: A mental state representing some event is a memory just in case the subject can use that representation to tell a story of their own lives. But this condition rules out cases in which we are confident that we witnessed the represented event, but we cannot relate it to any other event in our lives. And it rules in cases in which the subject confabulates and the represented event never took place in the past. Neither of those outcomes is desirable either.

What we learn from those theories is that one needs to walk a fine line between, on the one hand, allowing for some error in a mental state while it still qualifies as a memory and, on the other hand, not allowing for just any mental representation that we can cook up in our minds to qualify as a memory. I draw on the literature on functionalism to try to achieve the required balance. My suggestion is that a mental state is a memory if it is typically caused by an experience of the event, and it typically causes, in the subject, both the belief that the event happened and the belief that they experienced it.

This allows for a memory of an event to be 'reconstructed' as long as, in normal circumstances, the reconstructed memory is the mental representation of the event that the subject would have had, had they witnessed the event. But it does not allow for a confabulatory experience to count as a memory. Typically, if the confabulatory patient had experienced the event that they claim to remember, they wouldn't be representing it mentally now. This last claim, which is crucial for my discussion of memory, hinges on confabulation involving amnesia

Thursday, 23 August 2018

Existential Medicine

This post is by Kevin Aho. Professor Aho is chair of the Department of Communication and Philosophy at Florida Gulf Coast University. He is the author of Existentialism: An Introduction, Heidegger’s Neglect of the Body and co-author of Body Matters: A Phenomenology of Sickness, Illness, and Disease.

The new edited collection Existential Medicine: Essays on Health and Illness gathers together a group of leading figures such as Havi Carel, Shaun Gallagher, Drew Leder, Matthew Ratcliffe, John Russon, Jenny Slatman, Robert Stolorow, Fredrik Svenaeus, and Kristin Zeiler who draw on the methods of existential and hermeneutic phenomenology to illuminate the lived-experience of illness.

The primary aim of the collection is to challenge the detached and objectifying standpoint of mainstream medical science in order to deepen and broaden our understanding of health and illness and offer more sensitive and humane approaches to healthcare. To this end, the volume is not so concerned with the application of medical science to fix the biological body. Rather, the essays are focused on the body as it is lived, and the various ways in which the lived-body’s relationship to the world is modified and disrupted in illness.

The volume is conceived in four parts. Part one, “New Currents in Existential Psychiatry,” examines contemporary issues in the interpretation, diagnosis, and treatment of mental illness, the relationship between mental illness and authenticity, and the importance of situating the experience of psychopathology within the context of a life-world. The second part of the book, “Phenomenologies of Anxiety, Pain, and Death,” explores existential, diagnostic, and relational issues associated with experiences of chronic pain, live organ donation, medically unexplained syndromes (MUPS), and the meaning of death.

The third part of the volume, “Ethics, Medicalization, and Technology,” consists of chapters devoted to the intersection of themes in biomedical ethics, phenomenology, and technology studies. The volume’s final part, “Existential Health,” turns to the ways in which the methods of phenomenology can be employed to critique an overly instrumental and technical approach to healthcare and aging and to reframe our current understanding of what it means to be healthy.

The essays in Existential Medicine illuminate a growing and increasingly influential area of research for philosophers, biomedical ethicists, medical humanists, and health care practitioners. Drawing on the insights of phenomenology, the authors expand our understanding of ‘what it feels like’ to be ill and the ways in which illness disrupts our relationship to the world.