Tuesday, 30 June 2020

The Epistemic Innocence of Irrational Beliefs

Here I am briefly presenting my new book, The Epistemic Innocence of Irrational Beliefs, out today in the UK with Oxford University Press. Research culminating in this book was conducted for several projects that contributed to this blog, including project PERFECT, the Costs and Benefits of Optimism project, and the Epistemic Innocence of Imperfect Cognitions project.


Book cover

In an ideal world, our beliefs would satisfy norms of truth and rationality, as well as foster the acquisition, retention, and use of other relevant information. In reality, we have limited cognitive capacities and are subject to motivational biases on an everyday basis.

We may also experience impairments in perception, memory, learning, and reasoning in the course of our lives. Such limitations and impairments give rise to distorted memory beliefs, confabulated explanations, and beliefs that are delusional and optimistically biased.

In this book, I argue that some irrational beliefs qualify as epistemically innocent, where, in some contexts, the adoption, maintenance, or reporting of the beliefs delivers significant epistemic benefits that could not be easily attained otherwise. Epistemic innocence does not imply that the epistemic benefits of the irrational belief outweigh its epistemic costs, yet it clarifies the relationship between the epistemic and psychological effects of irrational beliefs on agency. 

It is misleading to assume that epistemic rationality and psychological adaptiveness always go hand-in-hand, but also that there is a straight-forward trade-off between them. Rather, epistemic irrationality can lead to psychological adaptiveness, which in turn can support the attainment of epistemic goals. Recognising the circumstances in which irrational beliefs enhance or restore epistemic performance informs our mutual interactions and enables us to take measures to reduce their irrationality without undermining the conditions for epistemic success.

Here is a brief explanation of epistemic innocence:



Six philosophers in the Imperfect Cognitions Research Network, all researching aspects of belief and rationality, have agreed to participate in a virtual book launch for this monograph with the following video presentations:


You are warmly encouraged to watch the videos, and then leave comments and ask questions about the book to them or to me here or on Twitter using the hashtag #EpistInnocence2020.


Tuesday, 23 June 2020

The Insanity Defence without Mental Illness

Today's post is by Marko Jurjako, Assistant Professor of Philosophy at University of Rijeka, regarding the recent paper ‘The insanity defence without mental illness? Some considerations’ that he co-authored with Gerben Meynen, professor of Forensic Psychiatry (Utrecht University) and endowed professor of Ethics and Psychiatry (VU University Amsterdam) and Luca Malatesti, Associate Professor of Philosophy at the University of Rijeka. Marko and Luca’s work on this paper is an outcome of the project Responding to antisocial personalities in a democratic society RAD, that is financed by the Croatian Science Foundation.


Luca Malatesti

In the last decade there has been a resurgence of interest in the insanity defence. One of the apparent moral truisms is that a person should not be blamed for actions they are not responsible for. As an instantiation of this principle, the moral rationale for the insanity defence is to prevent unjustly punishing offenders who are not responsible due to a mental illness.

Across the Western hemisphere, formulations of the insanity defence usually involve two components. One component, that we call the incapacity clause, states that a person is not accountable if, when committing the crime, she lacked some relevant psychological capacities, such as the cognitive ability to understand the nature of her action and the ability to control her behaviour in the light of that knowledge. For instance, if due to a delusion, someone kills a person thinking that he is helping her, he is unaccountable because he did not know the nature of his action. The other component of the insanity defence, that we call the mental illness clause, requires that these incapacities are caused by a mental illness.

Gerben Meynen

Despite the common-sense view that the insanity defence presupposes the mental illness clause, legal scholars and philosophers debate whether this is the case. Some argue that the mental illness clause is not important for determining criminal responsibility because mental illness is neither sufficient nor necessary for determining whether someone should be excused for a crime. A judgment on her mental incapacity should be enough. Moreover, in recent years the Convention on the Rights of Persons with Disability (CRPD) has sparked additional discussion. According to some interpretations of the convention, not only the mental illness clause, but the insanity defence as such should be abolished because it discriminates against disabled individuals.


Marko Jurjako

In the paper, we focus our discussion on the role that mental illness clause should play within legislations that adopt some form of the insanity defence. Thus, we do not directly discuss issues raised by the adoption of the CRPD. After providing a preliminary discussion of the rationale for having the insanity defence, we focus on the proper role of the mental illness clause in it.

We aim to offer a nuanced discussion whether the mental illness clause should be retained as a component of the insanity defence. In this regard, we discuss three principal reasons why the clause is important for adjudicating cases of criminal non-responsibility. 

The first reason relates to our exculpatory practices. In some cases, the presence of a mental illness indicates an internal impairment in decision-making capacities that undermines legal culpability in a way that cannot be attributed to any other cause outside the agent. In this sense, a mental illness can provide a particular cause that explains why the agent is not responsible for her crime.

The second reason pertains to our epistemological practices and practical limitations when trying to determine the accountability of a defendant. We argue that knowing whether a defendant is suffering from a specific mental illness can be especially helpful for establishing whether the agent at the time of the act had relevant incapacities. For instance, if the defendant suffers from schizophrenia, that gives us reason to examine whether she could have committed the crime while suffering from a paranoid delusion.

The third reason pertains to the general relation between legal practice and medical psychological and scientific advancements in the study of human behaviour. We maintain that the mental illness clause keeps a close tie between the relevant sciences of the mind and the law. Thus, it enables an interactive relationship that secures the conceptual and evidentiary relations between the clinical advancements and its scientific overlays with ethically justifiable legal practices. 

For instance, future studies might confirm that a certain subgroup of individuals with antisocial personality disorder suffer from such mental/brain incapacities that their criminal actions may be the result of dysfunctionalities in their neurophysiology. This scientific evidence would give us reason to conclude that despite the appearances of ill will, a subgroup of defendants with severe forms of antisocial personality might not be accountable for some of their crimes. 

The main outcome of our discussion is that an ethically justified formulation of the insanity defence need not necessarily include an explicitly stated mental illness clause. Nonetheless, we argue that the ethically justified formulations of the insanity defence should be able to accommodate the reasons underlying the adoption of this clause. 

Thus, our main conclusion is that different legislations might serve criminal justice solely based on the incapacity defence without a formal adoption of the mental illness clause. Depending on their other safeguards, these legislations should allow, however, that mental illness plays at least an evidentiary role in the incapacity defence.

Tuesday, 16 June 2020

Mental Capacity: A Policy Brief

In this post I report on a recently launched brief, prepared by Sophie Stammers for policy makers and mental health and social care professionals, entitled "Mitigating the risk of assumptions and biases in assessments of mental capacity". The work on the brief was funded by the University of Birmingham and the actual brief was launched with a Webinar hosted by the Mental Elf on 26th March 2020.

Mark Brown introduced the presentations and moderated the discussion. I summarised the main findings of project PERFECT relevant to the brief, and Sophie explained our recommendations, based on her research but also on extensive consultations conducted in January to March 2020.


Sophie Stammers

The conversation continued on Twitter where people made comments and asked questions using the #MentalCapacity2020 hashtag. Alex Ruck Keene wrote a post on the brief which appeared on the Mental Elf blog. Alex is a barrister specialising in mental capacity and mental health law. He is also a Wellcome Research Fellow at King’s College London, and created a website on mental health capacity law and policy.


Alex Ruck Green

What was the rationale for consulting mental health providers, service users, organisations, and policy makers on mental capacity? Mental health and social care professionals routinely assess the capacity of people to make decisions about their lives, in accordance with the Mental Capacity Act 2005 (MCA). 

The briefing note outlines how the functional approach to testing capacity in the MCA underdetermines decisions, describing the risks for stereotypes and assumptions to affect outcomes. It advocates for the need for specific training for professionals using the MCA to enable them to recognise the role of value judgements in capacity decisions, to mitigate the effects of stereotyping and assumptions, and to improve decision making.





If you want to know more, you can watch the Webinar on YouTube, or read the full brief on the Project PERFECT website, easy to download in an accessible PDF. On the website, you also find some quotes with stakeholders' reactions to our recommendations.

For instance, Anneliese Dodds, Labour (Co-op) MP for Oxford East said:
"There is now quite widespread recognition of the biases which affect decision-making, such as negativity bias in our retention of information from the media. Yet our awareness of these biases does not seem to feed in to our understanding of mental health, which often categorises people as ‘irrational’ in an unspecified way. This can be a political issue; I’ve been urged previously not to engage with people with mental ill-health on the grounds that they ‘would not be interested’, yet people suffering from mental ill-health are often not only interested in politics but have a great deal of importance to say and are not less ‘rational’, depending on the type of illness they are suffering from. These issues surely need more consideration, which is why I was pleased to see the progress of the PERFECT research project."

Tuesday, 9 June 2020

Nationalism and Rationality

Today I am reporting from the annual meeting of the Danish Philosophical Society in Odense (6-7 March), which was entitled Nationalism and Rationality, organised by Nikolaj Nottelmann. Unfortunately, I missed the first day of the meeting but here are summaries of some of the fascinating presentations on the second day relevant to themes in political epistemology. (This was my last pre-COVID19 conference!)




Gina Labovic (University of Copenhagen) talked about "Climate change denial and (un)reasonable disagreement". Within the public reason framework, we can justify privileging the warnings of the climate scientists over the views of those who deny climate change. According to Rawls, there can be reasonable disagreement between views (e.g. how to live out lives). To be a good citizen, we need to accept what scientists tell us as long as there is no controversy within the scientific community. So, there is no reasonable disagreement on well-communicated scientific consensus.


Gina Labovic


But the problem is that, because we have different experiences in life, we disagree both about facts and about methods. There is no wide acceptance of the methods (epistemic principles) by which we gain information about the world. So we need a further justification of the methods (e.g., of science). This characterises 'deep disagreements': how do we decide what to believe when we disagree about facts and methods?

Maybe we can identify practical, self-interested reasons for selecting epistemic principles (this is called the Method Game, Lynch 2010, something akin to the Veil of Ignorance). Three assumptions: epistemic ignorance; moral ignorance; and we are to live in Parallel Earth. Practical reasons need to be repeatable, adaptable, public, and widespread. For Lynch, under this epistemic veil of ignorance, we would converge on scientific methods of inquiry. But this is controversial.

Kappel (2012) has some objections: given that under the veil we know no facts, then there would be no reason to choose scientific methods of inquiry over other methods (underdetermination problem). But even if we could select scientific standards, there would still be the issue that citizens are epistemically irrational and would not be motivated to abide by those standards (epistemic irrationality problem). Is it democratic to impose rules on people who do not agree on them when they are epistemic rational?

Klemens Kappel (University of Copenhagen) presented a talk entitled "Science in Public Reason". In many cases (vaccine scepticism, GMO-scepticism, etc.) a part of the population rejects a scientific consensus. What is democratically legitimate in those cases? Can we defend the view that science is part of public reason? Dissenters may argue that the scientific community is corrupted by ideological forces and thus we cannot trust what scientists tell us.

One view, science as public reason, is to commit that there is an obligation to defer to scientific institutions when publicly justifying coercive fact-dependent policies (such as mandatory vaccination). This involves several obligations: for policy makers not to interfere with science in ways that affect policy making; for science to remain politically neutral.


Klemens Kappel


There are several arguments for the view of science as public reason but, according to Kappel, they all fail. One is the argument from extension: as we all commit to epistemic standards and scientific standards are an extension of epistemic standards, then we all commit to scientific standards. But reasonable individuals may not accept scientific standards because scientific standards depend on factual beliefs about the world and not just on epistemic standards.

Another argument is that from hypothetical acceptance. That's the idea that if we all committed to epistemic standards and were rational enough, then we would commit to scientific standards. This may be true, but it is important to appeal to the beliefs and desires people actually have.

In one argument from restraint, you are making a decision together with a friend. You accept p but your friend rejects p and p is relevant to the decision. What will you do? Maybe you should bracket your belief that p. For the purpose of public reason, we need standards that are accessible to everyone (not 'bracketed issues') and only scientific standards are accessible in that way. But sometimes scientific consensus relies on controversial metaphysical views.


On SDU campus

Kappel argued that we need to accept science as public reason even if we can't justify it (dogmatism). Imagine a reasonable citizen (agreeing that her fellow citizens are free and equal and willing to cooperate with them) who believe that the MMR vaccine causes autism. Would this citizen have grounds to complain if the state coerces her to vaccinate her children? Does the policy unduly restricts her freedom? This is for Kappel a difficult question to answer.

The presentation by Michael Jonathan Hannon (University of Nottingham) was called "Political Disagreement or Badmouthing?". Hannon started from the fact that there is a lot of disagreement in politics and the observation that disagreement has extended from ideological to factual issues. But is it true that there is disagreement about facts? The example used was the comparison between photos at the inauguration of Obama and Trump (see below). People were asked which picture had more people. Trump supporters were more likely to say that the photo on the right had more people.




How frequent are these phenomena of partisanship? Maybe people are not providing factual answers but expressing values (cheerleading or badmouthing). Expressive responding signals allegiance to an ideological community and people deliberately misrepresent their beliefs to express their attitudes. So, these cases are not cases of biased believing as some psychologists have suggested. Political supporters are like sports fans.

Elizabeth Anderson also argues that claims against Obama are like 'playground insults': they are not supposed to be accurate or even coherent with other things we believe, but they are ways of saying: "Obama is not one of us, is not a real American". Similarly, phrases such as "Build the wall!" or "Lock her up!" are not actual recommendations but expressions of dislike for people who are believed not to belong or who are disliked for other reasons. In line with this, it is not policy preferences that drives voting behaviour but social identity (see Lilliana Mason's work on politics and identity).

According to Hannon, this diagnosis of apparent political disagreement explains why debates are so unsatisfactory and disputes are intractable, not sensitive to reasons. It also explains why people seem to commit to inconsistent claims and why attempts to correct 'beliefs' backfire.

This was a very interesting meeting, offering plenty of food for thought to people interested in topics at the intersection of epistemology and political philosophy.

Tuesday, 2 June 2020

Thinking, Believing, and Hallucinating Self in Schizophrenia

Today blog post is by Clara Humpston, a Research Fellow at the Institute for Mental Health, University of Birmingham. She summarises her most recent paper co-authored with Matthew Broome in The Lancet Psychiatry. This paper is freely accessible upon registration on the Lancet’s website.


Clara Humpston


We aimed to discuss the history and concepts of self-disturbance in relation to the pathophysiology and subjective experience of schizophrenia in terms of three approaches: 1. The perceptual anomalies approach of the Early Heidelberg School of Psychiatry (with the kind help from Professor Aaron Mishara); 2. The more recent ipseity model by Louis Sass and Josef Parnas; and 3. The predictive coding framework rooted in computational psychiatry.

Despite their importance, there has been a notable absence of efforts to compare them and to consider how they might indeed work together. Self-disturbances are transformations of basic self that form the inseparable background against which psychotic symptoms emerge. Integrating computational psychiatric approaches with those employed by phenomenologists, we understood delusions and hallucinations as inferences produced under ‘extraordinary’ conditions and would be both statistically and experientially as real for patients as other mental events. Such inferences still approximate Bayes-optimality given the circumstances and may be the only ones available to minimise prediction error.

Most people would never wonder, let alone doubt, whether the thoughts they think are indeed their own. However, in cases of self-disturbances found in schizophrenia and related psychoses, the ‘minimal self’ is damaged (but still never truly absent) and susceptible to anomalous experiences such as confusing internal mental events with external stimuli. The Early Heidelberg School of Psychiatry defined self-disturbances as something that did not arise from impaired conscious self-acquaintance (ipseity), but rather would involve unconscious processing. On the other hand, the ipseity model by Sass and Parnas proposes a heightened self-awareness leading to the alienation of mental events and places lessemphasis on unconscious processing. Nevertheless, there was common ground between these models, such as the convergence on the ‘Basic Symptom’ concept.




We previously argued that inserted, alien thoughts and auditory-verbal hallucinations are two sides of the same coin and both are rooted deeply in a fragmented self-consciousness. According to the predictive coding account, enhanced precision weighting of internal events such as thoughts makes the prediction error signal much more salient and calls for an update of the brain’s current hypothesis. In this case the ‘incoming’ thoughts would become akin to sensory data input (likelihood) as the Bayesian framework is not limited to ‘real-world’ sensory data only. This understanding could lead to real-life impacts on how clinicians talk to their patients about their psychotic experiences.

The priority for clinical intervention is misplaced if it focuses solely on the ‘correction’ of the patient’s thoughts and perceptions. Rather, the emphasis should be on how patients can lead a fulfilling life with their symptoms, and over time become better able to control and counteract their perceived influence on the patients. Clinical relationships are best supported when the clinician combines neuroscientific and phenomenological approaches. 

Even from a purely neuroscientific point of view, as shown by the Bayesian inference framework, delusions are still the best hypotheses the patient can generate and to a certain degree defend, given the unusual circumstances. It should be borne in mind that schizophrenia carries the heavy burden of stigma even in the clinic because some clinicians do not (and perhaps refuse to) understand the illness, and not that patients living with the illness cannot understand their clinicians. After all, there are intersects between the patients’ and the clinicians’ experiences of reality. By beginning to seek these intersects, a therapeutic dialogue would surely ensue.

Tuesday, 26 May 2020

Experts in Mental Health

Rosa Ritunnano

This post is by Rosa Ritunnano, consultant psychiatrist and doctoral candidate at the University of Birmingham, reporting from the 21st Annual Conference of the International Network for Philosophy and Psychiatry (INPP). 


The event took place from 22nd-24th October 2019 at the University of Warsaw; it was organised by the Open Seminars in Philosophy and Psychiatry Foundation, with support of the Polish Phenomenological Association and the Phenomenology and Mental Health Network (Collaborating Centre for Values Based Practice, St. Catherine’s College, Oxford). A special thank you note goes to Marcin Moskalewicz (member of the organising committee) for sharing some of photos included in the post.



 

The INPP conference brought together researchers and professionals working at the interface between Philosophy and Mental Health from 32 countries and provided a lively forum to discuss developments and challenges for the next generation – particularly in relation to psychiatric expertise, methodological pluralism, and issues of values and ethics in mental health. This overarching theme provided a broad framework for other assorted topics cutting across cultures of healing, psychiatric models and “psy” disciplines (psychiatry, psychology, psychopathology, psychoanalysis, cognitive psychology, the philosophy of mind and the like). Keynote lectures, parallel sessions and workshops ran enthusiastically over three full on days and across beautiful historical locations in Warsaw such as the Staszic Palace (seat of the Polish Academy of Sciences), pictured above.

Due to the abundance of notable contributions which I cannot address comprehensively in this brief report, I have decided to focus on a few talks in the areas of phenomenology and psychopathology (very much overlapping with my current research interests). Here is a full list of speakers and abstracts.

Louis Sass

In his keynote lecture “Everywhere and nowhere: reflections on phenomenology as impossible and indispensable (in psychology and psychiatry)”, Louis Sass offered some crucial reflections concerning the question of what phenomenology is intended to reveal. Louis addressed the concept of subjectivity as a focus of attention which is both indispensable and–from a certain perspective–impossible. It seems obvious, he argued, that the investigation of consciousness would lie at the heart of the “psy” disciplines as the most important of subjects. However, there is much about the study subjectivity that remains both enigmatic and obscure due to the complex ontological and epistemological nature of this domain. Granted, phenomenology needs to maintain a complex and self-critical attitude towards its own project, so how can we approach the investigation of subjective life?

To clarify this point, Sass discussed how subjectivity should not be approached and guarded against three specific forms of error: 1) prejudice and the failure to “bracket”, 2) problems associated with reflection, and 3) Heidegger’s “forgetting of the ontological difference”–which is arguably the most fundamental error. Following this via negativa, Sass took us through a powerful intellectual journey through the well-know tradition of phenomenology (Husserl, Heidegger, Merleau-Ponty) and offered a critique of logical positivism, reductionist physicalism and other strands of analytic philosophy that might conceive of phenomenology as some kind of ill-defined mysticism, superficial introspectionism or na├»ve foundationalism. 


Bill Fulford and Giovanni Stanghellini

Among others, Giovanni Stanghellini offered precious insights into the nature of the phenomenological endeavour and described it akin to a “dance around the heart of being”, an “infinite approximation to phenomena” (where what really counts is the very art of approximation). It could be also assimilated to architecture, he said (quoting the Italian architect Filippo Brunelleschi), which is concerned with the art of “building columns in the void and turn emptiness into a quasi-liveable space”.

Panel with Francesca Brencio, Veronica Iubei and Valeria Bizzari

Francesca Brencio (Assistant Professor, Faculty of Philosophy, University of Seville) led a panel session along with Veronica Iubei (PhD candidate, Clinic University of Heidelberg) and Valeria Bizzari (Postdoctoral researcher, Clinic University of Heidelberg). The panel aimed at discussing moods, feelings and atmospheres and how their disruptions can affect psychopathological phenomena–such as affective disorders and schizophrenia.

Brencio kicked the panel session off with a talk entitled “How do you feel? Disruption of moods and feelings in affective states”, during which she provided the philosophical framework for a truly interdisciplinary discussion of affective psychopathology. Brencio turned to Martin Heidegger’s analysis of Dasein and his pivotal conception of “disposition” (Befindlichkeit) to develop an understanding of the constitutive role of moods in the context of human existence. Moods, she argued, are the means of access to the world as we understand it and signify it; they cannot be confused with emotions or feelings.

Feelings (which are always connected to our lived body) are the key structures of one’s affective life and the basis for intersubjective attunement and intercorporeality. Psychopathological features of affective disorders can thus be understood as originating from a disruption in moods or feelings, through a transformation of the pathic dimension of human existence. This has significant implications for practitioners, who should be aware of the impact of affectivity on meaning-making processes within the clinical encounter.

Moving on to interaffectivity, Iubei’s talk “Expanded bodies. Atmospheres as collective spaces of affective intentionality”, focused on the phenomenological role of atmospheres as “spatialised feelings”. Atmospheres, she argued, are the “in-between” phenomenon for excellence; they create an emotional space where bodily feelings and environmental features merge into an open and constantly evolving intersubjective landscape. Atmospheric disruptions, occurring for example in the context of schizophrenia, reveal that something has happened in this space in-between, where an “abyss” seems to open up and segregate the subject from the familiar world of everyday life. Iubei's doctoral research aims to enrich the phenomenological-existential approach to psychiatric disorders by drawing attention to atmospheres of living as potential therapeutic targets for patients with psychiatric disorders.

Bizzari closed the panel session with a talk entitled “Atmospheric Corporeal Interactions in Schizophrenia”. She argued that most important core disturbance of schizophrenia lies in the inter-corporeal self, and arises already during the atmospheric phase, when the self is not only embodied, but also already involved in the constitution of the social realm. Bizzari briefly addressed the role of disembodiment in the development of schizophrenia and then went on to argue that embodiment is present both in personal and interpersonal atmospheres. 

To support her claim, she offered an analysis of first-person reports from the book Autobiography of a Schizophrenic Girl by M. Sechehaye (1962), which powerfully describe Renee’s struggle against unreality during the onset of illness. She concluded by arguing that a deficit in the intercorporal self–which is already present in the atmospheric stage–also hinders the development of higher social levels, such as collective emotions.

The conference ended with a closing session: “What are experts for?” involving all keynote speakers, followed by a unique performance of Polish singer, composer and multi-instrumentalist Kasia Tercz.


Tuesday, 19 May 2020

Agency and Rationality Workshop

Mount Fuji from the venue, Komaba campus

On 14th and 15th December 2019 Kengo Miyazono and John O’Dea organised a workshop at the University of Tokyo on themes related to agency and rationality. In this post, I summarise some of the talks presented at the conference.

On day 1, Nikolaj Jang Lee Linding Pedersen (Veritas Research Centre, Underwood International College, Yonsei University) kicked off the workshop with a talk about social media, data analysis, psychological profiling and freedom. Although social media enables connectivity and has a number of other advantages, it represents a threat to privacy. That is because when we register for platforms like Facebook, we give consent to our data being shared, but that does not count as informed consent. 

People are often attributed five personality traits: openness to experience, conscientiousness, extraversion, agreeableness, and neuroticism. Can people be profiled based on their “likes”? It is said that computer-based judgement is better than human judgement about one’s personality if it is based on a large number of likes (based on 10 likes, a computer’s judgement beats one’s co-worker’s judgement; based on 300 likes, a computer’s judgement beats one’s spouse’s judgement).

This raises the problem of unknown, illegitimate influence: this happens when someone wants you to act in a certain way and intentionally does something to make it more likely that you act in that way; now, that person’s action does make it more likely that you act in that way but you would disapprove of your acting in that way in these circumstances if you knew about the person’s influence on your actions and its implications.

According to Pedersen, unknown, illegitimate influence is a phenomenon that should be studied in relation to social media as it appears to be as a limitation of freedom that can happen due to (a) personal information being shared, and (b) data being applied to the personal information that is shared.

The second speaker was Richard Dietz (University of Tokyo) and discussed agency and inconsistency. We make lots of plans in our lives but then we also make choices that conflict with them. One normative question is: What should agents do in order to prevent dynamic inconsistency? One descriptive question is: Why are agents inconsistent?


Richard Dietz


One reason for inconsistency is that preferences are “unruly”, that is, they violate expected utility. We are either risk-averse or influenced by regret avoidance under uncertainty. Moreover, sometimes the options to choose from can be difficult or impossible to compare. Another reason for inconsistency is that we are subject to changes in preferences, due to time bias effects (disproportionate weight on present experiences) or other factors.

Choice can be resolute (the plan with the best prospects is followed) or sophisticated (the feasible plan with the best prospects is followed). Resolution has been defended based on economy of efforts, coordination facilitation, and insurance against biased discounting of long-term benefits and costs. In the second part of his talk, Dietz asked whether rational resolution is possible, in terms of continuing a resolute plan and embarking on a resolute plan, for individual reasoning and team reasoning.

After the lunch break, Akiko Frischhut (Akita International University) talked about the experience of time passage and intelligibility. The question is whether we do experience the passing of time: Frischhut argues for Deflationism, an anti-realist view suggesting that all temporal experiences involve representation of succession that ‘feels like’ time is passing.

The presentation reviewed different accounts of the passage experience and highlighted their weaknesses. For the Realists and the Reductionists, the intelligibility challenge is to explain how we can experience passage in a world where time does not pass.

There is also a problem for the Phenomenal Modifier View, according to which there is a unique feeling of temporal passage (passage quale), but the feeling is not representational. We only feel as if the world is dynamic. On this account it seems that we need conceptual resources to know what we are experiencing as changing. And this is not compatible with phenomenology which should be immediate. What we experience is succession.

This leaves Deflationism. Motion, succession, duration, and persistence are experienced and they give rise to our belief that we are experiencing the passage of time.

Last talk was by Laurie Paul (Yale University) who presented on deliberation and the paradox of empathy for possible selves. She asked how empathy changes when one has transformative experiences, that is, experiences that are both personally and epistemic transformative (e.g., a core preference changes). One example is the choice to become a vampire or have your first child (functionally irreversible choices).


Laurie Paul's slides


To make up your mind whether to become a vampire, you ask a friend who has already become a vampire. Your friend says that it is fabulous to be a vampire, but she cannot explain how—the experience is transformative after all. You lack the information you need to make the choice to become a vampire. That means that these choices cannot be made rationally.

But because we cannot simulate our future (we do not know what it will be like to be the future us), then the risk with transformative choices is that we become alienated from the selves that we are making ourselves into. Paul made an analogy between the incommensurability of the choices we make when we deliberate about undergoing a transformative experience and the incommensurability of Kuhnian paradigms.

When you make a decision for another person, you perform an imaginative act, imagining to have the same cultural background and preferences of the person you want to advise. But, in some cases, you may want to avoid cognitive empathy for fear that by changing perspective you lose control (e.g., opening your mind to one conspiracy theory being true.) You risk ‘cognitive corruption’.

This can be applied to the relationship between us and our future selves. We may become alienated from a future self and refuse to undertake an experience that might change us irreversibly.

Derek Baker (Lingnan University) presented a talk entitled, Deliberation without Authority. He defended a view called deflationary normative pluralism according to which there are multiple different normative domains and widespread incommensurability between kinds of norms and values. There is supposed to be a weak form of normativity in contrast with authoritative normativity but it is not clear what the latter is. Baker argued that the property of authority is either metaphorical or characterised in ways that lead to vicious circularity.


Derek Baker


One objection from Spencer is that pluralism either collapses onto nihilism (standards make no normative difference); or collapses onto subjectivism (some standards make normative difference, those that apply to the domain the agent belongs to). But Baker maintains that pluralism does not work this way; standards do make a difference but there is no overarching normative standard. What is ruled out by the pluralist is an all-things-considered verdict.

The main issue is that critics of pluralism seem to think that arbitrariness needs to be eliminated by normativity but a reflection on the nature of deliberation suggests that arbitrary decision making is necessary to get through life and is there due to epistemic and cognitive limitations.

The conference was very thematically coherent and a great success in terms of speakers exchanging views and learning more about each other's recent work.


Group picture



Tuesday, 12 May 2020

Knowledge from a Human Point of View

This post is by Michela Massimi who tells us about a collection she co-edited with Ana-Maria Cretu, Knowledge from a Human Point of View (Springer Synthese Library), available fully open access, courtesy of the European Research Council OA policy.





Knowledge from a Human Point of View is the second edited volume planned for the ERC Consolidator Grant "Perspectival Realism. Science, Knowledge and Truth from a Human Vantage Point" and in my original intentions it was meant to explore the historical roots and epistemological ramifications of the view known as ‘perspectivism’.

Better known these days among philosophers of science working on scientific modelling and pluralism (albeit not exclusively), perspectivism is a view with a long history. What is at stake in the prima facie platitude that our knowledge is always from a human point of view? Whose else’s point of view if not ours, one might immediately retort? Historically, the shift from knowledge sub specie aeternitatis (think of Plato’s theory of knowledge qua knowledge of eternal and immutable forms, just as an example) to knowledge from a human point of view marks a watershed. When is it that we started caring about the conditions that make us—finite human beings—capable of knowledge?

The first half of this edited collection surveys some of the salient historical moments (with no expectation or presumption of offering a complete treatment, of course) that marked this watershed: Zuckert’s chapter on Kant, Hales’s discussion of Nietzsche, Brown’s analysis of the American Pragmatist tradition and De Caro’s of Putnam. In their diversity of philosophical concerns and goals, these chapters remind us of how perspectivism does not lend itself easily to a single unifying definition. Historically very different figures appealed to views that can be called ‘perspectival’ for a variety of reasons—e.g., as a way of marking the boundaries of metaphysics, or of stressing the situated nature of our human knowledge.

The second half of the edited collection looks at the legacy of perspectivism for contemporary debates in epistemology. And here too perspectivism is a fruitful umbrella for a number of cognate philosophical positions. Khalifa and Millson explore how perspectivism relates to inquisitive truth monism as a more promising view than traditional true-belief monism. Ashton discusses the relation between Giere’s scientific perspectivism and feminist standpoint theory. Carter analyses Sosa’s virtue perspectivism and some of the challenges raised against it by Fumerton, Reed and Stroud. Treanor discusses what he calls the perspectival challenge to a family of views in epistemic normativity that see truth as the aim of knowledge.

Michela Massimi


The book concludes with an essay by Barry Stroud that raises the following invitation to aspiring perspectivalists: “can we really understand what we most want to understand about the enterprise of human knowledge by thinking of those who investigate the world as exercising only the concepts needed for the less-committal epistemic attitudes and responses that perspectivism concentrates on, not a concept of knowledge that implies truth and so apparently resists perspectival treatment? This is a question I recommend to aspiring perspectivists. As I think I have found with philosophical scepticism, I think it promises, at the very least, a deeper understanding of the puzzles that confront us.” Barry sadly passed away before this book got published. We dedicate the book to his memory as a little token of gratitude for sharing with us some of the long journey ahead to better understand perspectivism, its promises and challenges.

Tuesday, 5 May 2020

Group Identification, Joint Actions, and Collective Intentionality

In this post Alessandro Salice (UCC) and Kengo Miyazono (Hiroshima) summarise their new paper “Being one of us. Group identification, joint actions, and collective intentionality”, in which they defend a minimalistic account of joint actions that is based on a theory of group identification. 




In the relevant literature it is generally assumed that, in order to explain joint actions (in contradistinction to actions in strategic equilibrium), one needs to appeal to shared intentions. To use Margaret Gilbert’s famous example, if Pam and Sam are walking together (rather than walking in parallel), then Pam and Sam’s collective action is explained by the fact that they share the intention of walking together (Gilbert 1990). However, the question immediately arises as to what it means for several individuals to share intentions.

One way of understanding shared intentions is by identifying the conditions under which standard individual intentions (intentions in the I-form: “I intend…”) interlock or mesh (Bratman 2014). Although this understanding of shared intentions seems able to shed light on a large number of joint actions, it has been claimed to have important limitations: not all joint actions can be explained by invoking intentions shared in that sense. First, joint actions modelled by certain coordination games (most notably, the Hi-Lo) are not amenable to that treatment: the solution of these games seems to require the capacity to frame the game from the perspective of a group, rather than from the perspective of the individual players (Bacharach 2006). Secondly, the conditions for sharing intentions in the I-form appear to be cognitively too taxing to accommodate joint actions performed, e.g., by infants: the fulfillment of these conditions requires complex mentalizing skills that are not yet fully developed by pre-school children (Tollefsen 2005).

To fill these gaps, some authors have suggested that intentions can also be shared on the basis of group identification. Group identification, as the name suggests, is a psychological process by means of which the subject conceives of oneself as a group member (Turner 1982). Based on this process, subjects can form intentions in the we-form (“we intend…”): intentions in the we-form (which differ from intentions in the I-form the previous account operates with) appear to offer a solution to the challenge raised by the Hi-Lo (Petersson 2017). But also, group identification, being a rather unsophisticated process, promises to pave the way for an understanding of joint action among young children (Pacherie 2013).

In our recent paper, we develop a theory of group identification that delivers on those two goals. The account distinguishes two elements that are often collated together in various accounts of group identification: transformation of self-understanding (or self-transformation for short) and adoption of the group’s perspective (or we-perspective). Self-transformation relates to the way in which the individual experiences and understands oneself in group identification: this notion captures the idea that, when one has group-identified, one sees oneself as similar to other in-group members (self-categorization) and one de-emphasizes one’s idiosyncratic traits in favor of a stereotypical self-representation. We call the representation of oneself as a group member a “social self” (Brewer 1991). By contrast, taking the group’s perspective is the ability of evaluating the world from another agent’s perspective, which happens to be a group agent’s (rather than another individual agent’s) perspective. This perspective secures an understanding of the group’s preferences and sustains deliberation on the best course of action (from the group’s perspective) to achieve the group’s goals.

By drawing on recent findings in developmental and social psychology (esp. related to the so-called ‘black sheep effect,’ Abrams et al. 2009, Schmidt et al. 2011), we conjecture that the adoption of the group’s perspective is an ability that children develop from the 3rd year of age, but more reliably from the 8th. Under this assumption, the adoption of the group’s perspective cannot be factored in in the explanation of joint actions among infants (of which we know that they take place from the 21st month of age, Brownell 2011). Therefore, self-transformation (or, rather, the outcome of that process: the social self) seems the only factor to do the explanatory work. But how does it? And what is, exactly, a social self?

In the paper, we reject the idea that the social self is a doxastic representation: one could believe (as one indeed believes) to be member of a myriad of groups without this belief having any impact on one’s action. In addition, the social self can’t be a conative representation either: we have already seen that standard individual intentions, to be shared, require complex cognitive abilities. Moreover, the formation of we-intentions presupposes the ability of adopting the we-perspective and, thus, to set for oneself the goals pursued by the group, which again is a capacity that children acquires only later in development.

At this stage, we introduce the idea that the social self is a representation of a hybrid kind, as it were, because it is descriptive and directive at the same time. We adopt here Millikan’s idea that this hybrid kind of representations (Pushmi-Pullyu Representations or PPRs, Millikan 2004) is phylogenetically and ontogenetically prior with respect to purely doxastic or purely conative representations. According to our hypothesis, to acquire a social self is to describe oneself as a group member and, concomitantly, to be directed to act as such. Of course, actions that are motivated by the social self will only be rudimentary as the agent does not yet activate more sophisticated cognitive states. However, they will also be sufficiently structured to count as joint actions proper.

Endorsing this view ultimately entails relaxing two assumptions usually made in the current debate about joint actions. The first assumption is that a bodily movement is either a reflex or an intentional action. The paper supports the idea that in between these two extremes there is a wide territory populated by various forms of quasi-intentional actions. The second assumption to revise is that the explanation of joint actions has to invoke the notion of intention. If we are on the right track, more primitive presentations (like PPRs) can explain joint actions of the kind one can observe among young children.

Tuesday, 28 April 2020

The Ethics of Philosophising from Experience

This post is by Abigail Gosselin (Regis University). Here she is telling us about her paper, "Philosophizing from Experience: First‐Person Accounts and Epistemic Justice", published in Social Philosophy in 2019.




Many philosophers appreciate hearing the first-person accounts that philosophers sometimes give when they disclose their personal connection to the topic about which they are philosophizing. First-person accounts are valuable for many reasons, including the fact that they establish the first-person authority of the speaker, who has privileged access to and hermeneutical command over their first-person experience. Sharing first-person accounts can also be harmful in many ways, however, such as by exposing the speaker to various vulnerabilities, and must be employed cautiously.

First-person accounts of experience that is potentially epistemically impairing—such as accounts of mental illness, intellectual disability, or brain injury—can undermine a speaker’s credibility when listeners assume that the potential impairment is global rather than specific. Knowing that a speaker has some impairment in rational capacity, self-control, and/or knowledge can lead to false or misguided assumptions about the scope and severity of impairment, potentially leading to judgments of credibility deficit and prejudicial treatment which undermine the speaker’s professional credibility.

At the same time, many philosophers are well-intentioned and want to avoid being judgmental or dismissive, so they sometimes try to avoid the danger of discrediting by over-compensating in their acceptance of a person’s testimony, accepting it at face value without critically interrogating it. Such uncritical acceptance is a form of credibility excess, however, reducing a person to being a witness of their own experience. While they are regarded as having authority to speak about their personal experience, they are not seen as a credible authority in academic inquiry.


Whether philosophers automatically discredit a speaker who discloses having a mental impairment or whether they try to overcompensate by accepting the speaker’s testimony uncritically, they commit an epistemic injustice to the speaker when they do not treat the speaker as an equal participant in philosophical discourse by not critically engagement with the speaker’s testimony. When philosophers philosophize from firsthand experience, they want their testimony to be regarded as a contribution to philosophical discourse, subject to the kinds of philosophical inquiry and scrutiny to which other contributions are subject. When firsthand accounts are offered as part of philosophical dialogue, they should be taken up by others in the spirit in which they are intended to be shared.


Responding to firsthand accounts in a philosophical context requires both listeners and speakers to adopt certain epistemic virtues that enable thoughtful appraisal. Listeners should be open-minded and respectful, and interpret the speaker’s contributions with charity, assuming best intentions. Listeners should engage with the speaker’s ideas with epistemic humility, making suggestions in a kind and helpful way.

Speakers should share their firsthand accounts with epistemic conscientiousness, desiring their stories to be engaged with critically, and with detachment, without being personally invested in how their story is taken up by others. Speakers also need to be epistemically courageous in making themselves vulnerable through their contribution. By being mindful of how we share and receive firsthand accounts in philosophical discourse, we can enable such accounts to play an important role in how we philosophize from experience.

Tuesday, 21 April 2020

The Meaning of Travel

Today's blog is by Emily Thomas, Associate Professor of Philosophy at Durham University, and Honorary Fellow at ACU’s Dianoia Institute of Philosophy. She is the author of Absolute Time: Rifts in Early Modern British Metaphysics (OUP, 2018) and The Meaning of Travel: Philosophers Abroad (OUP, 2020). She tweets @emilytwrites.

The Meaning of Travel has been reviewed in The Spectator, and Literary Review. Emily has written about the connections between travel and philosophy in The Conversation, and about the philosophy of walking for OUP's blog. She has been interviewed about the book on BBC Radio 4’s Start the Week, and BBC Radio 3’s Free Thinking.





You might think travel and philosophy don’t have much in common. Travel involves flights, bad sandwiches, train tickets. Philosophy is all about books and bearded Greeks. The Meaning of Travel argues that, despite appearances, they have a lot in common. Travel and philosophy share long, tangled histories, and each have effected the other.

The book explores their history. For example, it explains how philosophers became interested in travel around the Age of Discovery. It looks at what Descartes thought travel could do for us; and the role that travel played in the debates about philosophy of science between Francis Bacon, the Royal Society, and Margaret Cavendish. It explores the effect that Henry More’s theory of space, and Henry Thoreau’s Walden, had on mountain tourism and wilderness travel.

The book also looks to some of philosophical issues facing travel today. For example, it asks whether ‘last chance to see’ travel, to ‘doomed’ places like glaciers and coral reefs, is ethical. It argues that ‘travel’, and ‘philosophy’, are male concepts: this helps us to understand the under-representation of women in these fields, and the way women travellers have traditionally been treated. The final chapter looks forwards and upwards - to space travel.

This is a popular book, and the writing is quite different to my previous, scholarly book on early modern metaphysics. It’s loosely assembled around a travelogue, a trip I took to Alaska. That means it’s written in the first person, and I am much more in the book than I’m accustomed to. It was a lot of fun to write, partly because it offered the opportunity to collect ideas I found amusing.

For example, Plato’s Republic has the following pieces of advice for the (male) traveller. On returning home, Plato writes he must report to a council of state where, if the traveller has become ‘appreciably better’, he will be rewarded with higher recognition. However, if the traveller has ‘returned corrupted’, he must talk to no one ‘young or old’. If he later meddles in some educational or legal question, ‘he must die’.


Tuesday, 14 April 2020

Does Choice Blindness imply Ignorance?

In this post, I discuss the relationship among confabulation, choice blindness, and self knowledge. That is the theme in a new open access paper by Ema Sullivan-Bissett and myself, published in Synthese, as part of a special issue entitled: "Knowing the Unknown: Philosophical Perspectives on Ignorance".


Ema and Lisa


When subject to the choice-blindness effect, an agent gives reasons for making choice B, moments after making the alternative choice A. Choice blindness has been studied by the Choice Blindness Lab in Lund in a variety of contexts, from consumer choice and aesthetic judgement to moral and political attitudes. Below you see an image of the set up of one of the studies where people were shown photos of strangers and asked to choose the most attractive face.


Which face is most attractive?

Choice blindness is often described as a form of confabulation. When people confabulate they tell a story that they believe to be correct, but the story is not grounded in the evidence. That is because people are not aware of some of the causal factors responsible for their choice. Clearly, there are important similarities between confabulation and choice blindness, and both phenomena have been discussed in the philosophical literature to argue for the limitations of self-knowledge claims.

However, we believe that the phenomena of confabulation and choice blindness are significantly different. In confabulation Anna chooses chocolate ice-cream because her sister did, but when she is asked about her choice, she explains it by appealing to different reasons, e.g., that chocolate is her favourite ice-cream flavour. There is no doubt that Anna is aware of what her choice was, but what she gets wrong is the causal process leading to her choice. Anna confabulates reasons for her choice.

In choice blindness Anna is asked by her mum whether she wants vanilla ice-cream or chocolate ice-cream and she says: “Chocolate”. Her mum mishears her and replies: “Vanilla is an excellent choice, my dear. Why did you choose it?” Anna answers that vanilla is a more delicate flavour than chocolate. Now, it is not clear whether Anna knows what her choice was, because she seems to consent to her mum’s incorrect choice attribution and, further, provides reasons for a choice that is different from the choice she explicitly made.

In the second scenario, to say that Anna confabulates reasons for her choice does not sound right. Rather, there are two ways in which we can describe what happens to Anna. She either attributes to herself (and gives reasons for) a choice she did not make, ignoring what her ‘real’ choice was (choice error); or she makes two different choices in quick succession, and she only gives reasons for the latter (choice change). 

Not only is the challenge to self-knowledge different in the two scenarios—as confabulation does not threaten the correctness of one’s choice attribution but simply the groundedness of the explanation provided for it—but it is also unclear in what respect choice blindness involves confabulating reasons.

Tuesday, 7 April 2020

How To Be Trustworthy

This post is Katherine Hawley, Professor of Philosophy at the University of St Andrews. Here she introduces her new book, How To Be Trustworthy (OUP 2019).




I set out to write a book about trust, that powerful attitude we sometimes adopt towards other people, towards social institutions, sometimes even towards inanimate objects. But instead I ended up writing a book about trustworthiness, and about the ways in which tough circumstances can make it difficult for us to be trustworthy, no matter how well-intentioned we are. I was led from trust to trustworthiness by thinking about situations where trust is absent, and about what can happen when trust is misplaced.

When we think about misplaced trust, we often think first about deception or inadequacy: our trust is misplaced if we direct it towards dishonest manipulators, or towards well-meaning types who nevertheless cannot live up to our expectations. Either way, when we’re faced with untrustworthy people, distrust rather than trust helps protect us from harm, whether emotional or practical.

But in other situations our trust is misplaced not because it is directed towards someone who is untrustworthy, but because that trust is an unwelcome, uninvited imposition into the lives of others. Unwanted trust can be a burden. Even when people have the capacity to live up to our expectations, doing so can distort their own priorities, big or small. But when people resist the pressure of unwanted trust, that often means that we regard them – unfairly! – as untrustworthy. In such situations, our trust is misplaced, but we shouldn’t be distrusting either: we should refrain from both trust and distrust.

In How To Be Trustworthy, I argue that trustworthiness requires us to avoid unfufilled commitments and broken promises. But where others misunderstand a person’s commitments, they may mistakenly regard her as untrustworthy for not acting as they expect. In my view this really is a mistake: being trustworthy does not mean living up to other people’s expectations even when they are unreasonable. But such mistakes are common, and are not easy to correct, especially when the mistaken person wields more social power.




There is no straightforward resolution to this problem, no recipe for being trustworthy. One option is to be clear and careful to a fault about exactly which commitments we’re taking on, and which we reject. But that kind of fastidiousness is tedious for all concerned; it doesn’t make for relaxed working relationships, friendships, or neighbourly good cheer. Another option is just to go with the flow, trying to conform to others’ expectations whether they are reasonable or not. But that will soon lead to disaster, as we try to jump in several different directions at once, with no time left to cultivate our own interests and projects.

Instead, we must muddle along in the middle, trying to say a clear ‘no’ when that’s important, yet acknowledging that we cannot always control what commitments we incur, nor micro-manage other people’s opinions of us. That’s life. But whilst I explore this middle ground in the book, I also illustrate the many ways in which this balancing act is made easier for people who live in stable, supportive social environments, for people with predictably good health, and for people who are materially comfortable. When you have insurance – literal or figurative – it is easier both to control your commitments and to cope with unwanted trust. Being trustworthy is not a simple matter of ‘good character’, it is a practical challenge for all of us, and especially those whose lives are difficult through no fault of their own.

Tuesday, 31 March 2020

Into the Abyss

This post is by Anthony S. David, Director of the Institute of Mental Health at University College London. Here he talks about his new book, Into the Abyss: a neuropsychiatrist’s notes on troubled minds (Oneworld Publications, 2020).



When I submitted a title for my first non-academic book I did so with some trepidation. Apart from sounding somewhat negative, wouldn’t people think it was something about mountaineering, a cautionary tale perhaps? As I explained to my concerned editor, the intended readership like those of this blog would be, “interested in themes at the intersection of philosophy, psychology, and psychiatry” and would instantly pick up the reference to Jaspers, the early 20th Century philosopher-psychiatrist. Somehow he wasn’t reassured. 

But the abyss metaphor is a powerful descriptor of the challenge of understanding the experience of the person who is mentally ill – to reach out across the abyss into what Jaspers called ‘an impenetrable country’, the mind of the disordered – especially where the disorder is in some sense extreme or severe, as in psychosis. Anyone of those interested in the 3 Ps mentioned above, and especially if they have a therapeutic role, will see this as the essence of our job description.

That job description, to put it grandly, to understand the human condition especially in extremis is always of course a challenge and perhaps an impossible one, yet one many of us find hard to resist. So whether it is a person suffering from nihilistic delusions following a brain injury, or someone with an unusual eating disorder, or, a functional neurological disorder so extreme that it renders the person comatose, there has to be, or so we believe, a way of comprehending and even explaining. And maybe, every so often, we may find jointly, a pathway, a bridge, reconnecting their world with ours. 

In writing these extended case histories it is clear that finding a narrative is not just novelist’s work as German psychiatrist Kurt Schneider once put it, but something mental health professionals and indeed every one of us tries to do to make sense of our lives – particularly when faced with adversity or loss. It cannot be a mere fiction, a gloss or a re-writing of history but there is a creative element which fills in gaps and which provides at least a framework for understanding what would otherwise be, in Jaspers words, un-understandable.


Anthony David


One of the most notorious counteractions to Jaspers’ un-understandability of psychosis claim came from R.D. Laing who in The Divided Self (1960/2010; Modern Classics. Penguin Books, London) sought to make psychosis ‘more socially intelligible’ than had hitherto be thought possible by delving into individuals’ ‘existential phenomenology’ and their family interactions. He did so with great sensitivity and skill but not always in ways which were transparent and replicable. It is the bio-psycho-social approach which is now our all-purpose methodology and explanatory model.

The model proposed in the 1970s by George Engel, a psychologically minded US physician, has come under fire from all sides as being, both too obvious (like motherhood and apple pie), and too vague and indefinable. Thankfully, we now have Derek Bolton and Grant Gillett’s exposition (The Biopsychosocial Model of Health and Disease: New Philosophical and Scientific Developments. Palgrave, 2019) and intellectual underpinning of the model to help us bolster our adherence to it. 

In some ways what I was trying to achieve in Into the Abyss was an illustration of the subtle power of the biopsychosocial approach. How all the constitutive elements must be considered in any presentation but each has to be weighted differently as appropriate. We can only do this by attempting an empathic understanding, by working collaboratively with the person in distress in front of us; by examining our own assumptions and being receptive to what’s going on in our brains, our minds and our society. When we do this we find that the abyss closes before our very eyes and that we are all part of the same world after all.