Critical Phenomenology and Hermeneutical Injustice in Mental Health

Today's post is by Rosa Ritunnano (University of Birmingham and Melbourne), consultant psychiatrist and PhD candidate at the Institute for Mental Health, Birmingham, UK. Here she talks her recent paper which has been awarded the 2021 Wolfe Mays Essay Prize for Early Career Researchers by The British Society for Phenomenology (BSP) and the Journal of the British Society for Phenomenology (JBSP). 

Rosa Ritunnano

In this paper, I argue that the adoption of a critical phenomenological stance may improve conditions of hermeneutical marginalisation as experienced by individuals who have attracted a diagnosis of psychosis (although I believe that the suggested approach can be transferrable to other conditions).

In cases of hermeneutical injustice, one is unable to understand their own experience or effectively communicate it to others because they lack an adequate conceptual framework for making sense of this experience. The classic example used in the literature on hermeneutical injustice is women’s inability to adequately understand or describe experiences of sexual harassment before the concept ‘sexual harassment’ was coined and entered popular usage.

In mental healthcare, hermeneutical marginalisation may occur for different reasons. On the one hand, the person may start from a position of disadvantage when it comes to having adequate interpretive tools at their disposal. This is because they may already belong to a (environmentally, economically, socially) disadvantaged group whose access to hermeneutic resources is limited, or because their interpretations are (systemically or individually) dismissed. In the latter situation, individuals may have developed their own hermeneutical tools or equipment to make sense of a certain experience but, despite such understanding, their perspective is not given uptake by the listener(s). This is what philosopher Kristie Dotson has called ‘contributory injustice’. To illustrate, contributory injustice in psychiatry can be found in reports of service users who hear voices, where clinicians (for varied reasons) may refuse to acknowledge alternative ‘non-disease’ ways of understanding these experiences, such as those that draw on spiritual or religious narratives.

In either case, the clinical encounter (i.e, the consultation between mental healthcare professionals and patients) can become a “hermeneutical hotspot”. That is a location in social life “where a group’s unequal hermeneutical participation will tend to show up in a localised manner” (Fricker, p. 152). In this situation, rather than thinking about clinician and patient as two separate epistemic agents, I suggest that we also look at the role of the relational context (and the communicative dynamics) in mitigating or amplifying the hermeneutical hotspot created over time by certain cultural and clinical practices.

I suggest that correcting for hermeneutical injustice requires that both clinicians and patients engage in a form of hermeneutical humility and sincere attentiveness towards the person’s own subjectivity and situated meaning-making processes. As well as paying attention to psychopathological experiences linked with a certain mental health condition, clinicians should be alert to the ways in which contingent historical, autobiographical and social structures (such as colonialism, anti-Black racism, and heteropatriarchy) may shape the lived experience and meaning of such a condition.

I argue that critical phenomenology, intended as a praxis of freedom in seeking a deep transformative societal change, may help address hermeneutical marginalisation even within the limited confines of the clinical encounter. Adopting this stance requires the ability, on the part of the listener, to perceive the other as an expressive and trustworthy epistemic agent, even when their experiential world differs in fundamental ways from their reality (as in the case of psychosis). In these circumstances, rather than trying to avoid the epistemic asymmetry by labelling it as a “problem to be treated”, it may be more helpful to actively navigate and manage it with care, empathy and respect.

Knowledge Resistance: An Interview with Åsa Wikforss

In today's post I interview Åsa Wikforss about her Knowledge Resistance program. Åsa is a professor of theoretical philosophy at Stockholm University, whose research sits at the intersection of philosophy of mind, language and epistemology.

Åsa Wikforss

Kathleen Murphy-Hollies: Hi Åsa. First of all, could you talk a little bit about what the knowledge resistance project is about and what kind of key questions it addresses?

Åsa Wikforss: So it's a large cross disciplinary program with about 30 researchers involved. The full name is ‘Knowledge Resistance: Causes, Consequences and Cures’, and we investigate knowledge resistance from four different disciplinary angles. Philosophically, we do the foundational work of spelling out what we are even talking when we’re talking about knowledge resistance. At a first approximation, we say it's a kind of irrational resistance to evidence, but there's a lot to unpack there. What is the evidence? What kind of irrationality? What kind of resistance? In terms of psychology, we look experimentally at the types of psychological mechanisms involved in resisting the evidence. And how you think of knowledge resistance affects how you design experiments, so we have a close collaboration with the psychologists.

Importantly, knowledge resistance involves psychological mechanisms in interaction with the external environment. What has changed recently isn’t so much the psychology but the environment. In particular, the information environment and the political environment.

For this reason, we also have media and communication scholars who research the new media situation and what that means for how we respond to evidence. They look at how disinformation is spread and the complex role of trust, among other things. And there is a political science team that investigates things like partisanship and polarisation and how those things shape belief formation. From the beginning we thought that we need to have all these disciplines involved, and I think that's proven to be exactly right.

KMH: That all sounds fascinating and very relevant nowadays – so what was it that first got you interested in these issues?

ÅW: Well it was kind of backwards, in that it started with me writing a popular book on these topics. After the political developments in 2016 we saw lack of knowledge, ‘fake news’ and ‘alternative facts’ all have huge political consequences, and I thought this is such philosophical nonsense and I can’t just sit and listen to it! So I wrote a book called ‘Alternative facts: On Knowledge and its Enemies’ where I explore, from the point of view of philosophy and psychology, what's going on!

I also felt very strongly that theories within some parts of the humanities and social sciences which questioned the very idea that there is such a thing as truth or facts added to the unclarity of the situation. The book came out in 2017 in the middle of quickly increasing interest in these issues and I was lecturing everywhere about it. The research on these topics started to really grow around then and I thought, now's the time for a research program which brings all this together! Because the research had been here and there across different disciplines, and no one had brought it together and provided a coherent framework for the study of knowledge resistance.

KMH: As you say, the project so far seems to have only become more and more relevant given political developments in the world. What findings have surprised you the most so far?

ÅW: It’s hard to pick something! Just this morning I read a study by the media group about how conspiracy theories are spread on social media and what kind of platforms are worst for it. You might think that it's all the same but actually the design of various social media platforms matters. Twitter does much better with conspiracy theories but it does worse when it comes to hate and threats. Facebook, on the other hand, is particularly bad for the spread of conspiracy theories. This is important because governments everywhere need to address what we can do to stop this. It might be that tweaking the design matters a lot for how things spread. Another finding by the media group is that people typically learn about fake news from mainstream media. This can be because of fact checking efforts, so it’s well-intentioned, but it shows that there are risks here.

Of particular interest, of course, are questions concerning how to remedy knowledge resistance. The psychologists have been carrying out studies showing that reducing information ambiguity helps. And the political science group has found that people in general are rather skilled at discriminating bad argumentation from good argumentation, even if this is somewhat diminished when it comes to arguments with a strong ideological tendency.

Another interesting thing has been the philosophy of what exactly knowledge resistance is. As we construe it, knowledge resistance involves a form of irrational resistance to available evidence. But people can fail to accept the evidence for other reasons, not because they are irrational but because they have weird background beliefs, perhaps as a result of disinformation. It actually gets very complicated disentangling the two, namely what is knowledge resistance from what is a rational rejection of the evidence. And, how to design experiments to keep these things distinct and avoid confounds.

KMH: This pre-empts my next question which is - what kind or kinds of irrationality do you think are in play when it comes to knowledge resistance?

ÅW: It’s epistemic irrationality, that is the irrationality of belief. Dan Kahan has done a lot of interesting experimental work on motivated reasoning, and in particular on identity protective reasoning which is this idea that we hold on to beliefs that have become marks of identity of the group that we care about. So, if these beliefs are threatened by evidence against them, we will find ways of protecting them and that of course is epistemically irrational, because you don't update beliefs in the light of evidence. But then he also suggests that this is sort of rational because the group is so important to you. Here it is essential to be clear on the distinction between epistemic rationality and practical rationality. Practically it can be rational to resist the evidence if it allows one to reach this goal of being a valued member of the group, but it doesn't mean that it's epistemically rational.

KMH: Do you think that not keeping epistemic and practical rationality distinct can cause problems?

ÅW: There are problems philosophically, but also sort of politically. If it is described as perfectly rational to not alter the beliefs of your group or your conspiracy beliefs because it serves you well, then that obscures what's going on here in a bad way, I think.

A related issue concerns where in the reasoning process the epistemic irrationality is to be located. Going back to the case where a subject fails to accept available evidence in a way that seems irrational but actually is rational given her prior beliefs. Then, usually, there's irrationality ‘upstream’. So, for instance, there might be irrationally placed trust which makes you read and believe bizarre conspiracy sources and as a result you end up with beliefs that make it rational for you to reject evidence from climate scientists. However, if there isn't irrationality upstream either then it's not knowledge resistance, even if the belief seems totally crazy. 

An interesting question is under what conditions this could be the case. One can imagine fundamentalist conditions where the subject lives in an utterly closed, sect-like environment, with no information coming in from outside. Then, you can end up with really bizarre beliefs and totally, but rationally, reject available knowledge. But I think it’s important to stress that fundamentalist conditions are extremely rare. Even in isolated areas in the US where everybody just listens to Fox news, they know that the New York Times exists and that there are other sources ‘out there’ that they do not have reasons to distrust. So, even if someone could in principle have a crazy set of beliefs in a fully rational way, I think that would be an outlier and very rare. But it is of course an empirical question.

KMH: Great. So, last question, what are your future plans or future directions for the program?

ÅW: We are halfway through now, so we have another three years. We’re continuing to develop the cross-disciplinary work because that’s the strength of the program. We have a new volume just out with Routledge called ‘Knowledge Resistance in High-Choice Information Environments’, which brings together people from all the disciplines involved so we're excited about that.

We also have a big mid term conference in August. The conference has the same name as the volume, and it brings together researchers from the four disciplines involved, internal and external. (Info will appear on the Knowledge Resistance website soon). 

KMH: They sound great and I’ll look out for them! Thank you so much for talking with me.

Agency Intersections Conference Report

In this post, Jessica Sutherland (University of Birmingham), Kathleen Murphy-Hollies (University of Birmingham), and Sean Shields (University of Nottingham) report on their two-day conference “Philosophy at the Intersection of Moral Responsibility, Agency, and Regulation”. This conference was held in-person (with online provisions) at the University of Birmingham on 9th-10th May 2022. The conference brought together graduate students and early-career researchers working in the areas of moral responsibility, agency and regulation of behaviour broadly construed.

 
Day 1

The first keynote talk of the conference was given by Dr Anneli Jefferson (Cardiff University) on “What’s the Point of Blaming the Dead?”. Jefferson offered some reflections on how current discussions of the role of blame do not seem to capture the ways in which we blame the dead. Jefferson offered a prototype theory of blame and argued that blaming the dead is not a paradigmatic case as it does not include some of the key instrumentalist features beyond a minimal moral assessment of the deceased.

Dr Anneli Jefferson

Then, Kathleen Murphy-Hollies (University of Birmingham) stepped in to give a talk after Hannah McHugh (University College London) was unable to present. Murphy-Hollies talked about the ‘know-how’ involved in consistently embodying virtue despite the prevalence of confabulation in a presentation titled “The Know-How of Virtue”. This is a tendency to construct ill-grounded reasons for one’s behaviour after the fact.

Kathleen Murphy-Hollies

Next, Baris C Kastas (Bilkent University) spoke on “Anger Towards Men and Non-Agential Collective Responsibility: A Vindication”. Kastas argued that anger towards men expressed by women and minority groups is a form of backward-looking responsibility-as-accountability aimed at a large and unorganised collective. Kastas then developed an account, drawing on Debe’s empathic sentimentalism under which responsibility practices aimed at disorganised groups makes sense.

Baris Kastas

Christiana Eltiste (Northwestern University) then gave a talk titled “Wronging the Wrongdoer: An Obligation to Hold Wrongdoers Responsible”. Eltiste argued that one’s standing towards a wrongdoer affects their obligation to hold that wrongdoer responsible, and in particular gives them a reason to hold them responsible. In these cases, one does something immoral in failing to hold that wrongdoer responsible and wrongs them.

Christiana Eltiste

The final talk of the first day was given by Thijs Heijmeskamp (Erasmus University Rotterdam) on “Virtues, Situationism, and the Moral Demands of Others”. Heijmeskamp drew on a Deweyan psychology of individuals which emphasises their embeddedness in environments to argue that virtue ought to be seen as essentially comprising our relations with others and the context of our social environment.

Thijs Heijmeskamp

Day 2

In the second keynote talk of the conference, Professor Victoria McGeer (ANU/Princeton) gave a talk on “Empathy Internalized: On the Scaffolding Power of Self-directed Emotion”. McGeer described how empathy can scaffold our own moral agency by generating self-castigating emotions of guilt, shame and remorse. She argued that this process is best facilitated by agents having an empathetic, scaffolding, developing sense of self-blame, rather than a non-empathetic, retributive, final sense of self-blame.

Prof Victoria McGeer

Next, Eric Brown (Tulane University) spoke on “The Best Apology is Changed Behavior: A Signaling Account of Apology”. Brown discussed a number of features we commonly (and not so commonly) see in apologies and argued that a signalling account of apology, which assigns apology the function of regulating our moral relations, best captures them all.

Eric Brown

Next, Dominik Boll (Vrije Universiteit Amsterdam) gave a talk titled “Responsible Persons, Positive Reactive Attitudes, and the Function of Taking Responsibility”. Boll discussed responsibility-taking and proposed that its function is to strengthen and/or shape norms, which in turn gives rise to positive reactive attitudes such as praise or forgiveness.

Dominik Boll

Next, Kristoffer Moody (University of Edinburgh) spoke on “The New Confabulationist Threat to Moral Responsibility”. Moody described a new confabulationist threat to moral responsibility as confabulation masks automatic social mindshaping which commonly takes place despite agents having no control over it. What agents may have to focus on instead is keeping rational control over their belief formation.

Kristoffer Moody

The final presentation of the conference was Emese Havadtői (Eötvös Loránd University) with a talk titled “Can we let go of our Regrets? Should we?”. Havadtői distinguished between constructive and non-constructive regret, arguing that we should aim to keep only the former. In this form, regret improves well-being, motivates us to repair social relationships, and contributes to moral behaviour.

Emese Havadtoi

A full list of speakers (and abstracts) can be found on the conference website.

A special thank you goes to Midlands4Cities and Mind Association for funding this conference.

Are Conspiracy Beliefs like Delusions?

In recent months, conspiracy beliefs such as COVID-19 denialism have often been described as delusional. Psychologists have suggested a correlation between the acceptance of conspiracy theories and schizotypal traits, that is, traits characterized by psychotic symptoms (Douglas et al. 2017). 

Anna Ichino

In this post, I (Lisa Bortolotti) discuss some of the similarities and differences between conspiracy beliefs and delusions—this is the topic of a paper co-authored with Anna Ichino and Matteo Mameli for Reti, Saperi, Linguaggi.

Surface features 

Both conspiracy beliefs and delusions of persecution involve attributing evil intentions or responsibility for adverse events to an individual or a group that the person does not trust. Conspiracy beliefs, but not delusions, are typically developed as an alternative to an official, authoritative version of the events (Ichino and Räikkä 2020). Both types of belief are regarded as implausible by those who do not share them.

In terms of being supported by evidence, there is considerable variation. Generally, conspiracy beliefs and delusions are poorly supported by the available evidence. However, the suspiciousness or mistrust may be partially explained by adverse experiences in a person’s life (Gunn and Bortolotti 2018) or by the marginalization of the minority group to which the person belongs (Levy 2019). 

In terms of being responsive to evidence, both conspiracy beliefs and delusions are characterized as unshakeable (Shearman 2018): people acknowledge challenges and respond to them but are not open to abandoning or revising their beliefs. Often the belief becomes more elaborated and entrenched when it is challenged (Sunstein and Vermeule 2009).

 

Causal history

Both types of belief have been explained by predictive processing theories and two-factor models of belief formation. For predictive processing theories (Reed et al. 2020), conspiracy beliefs and delusions of persecution are inferences under uncertainty, a response to situations characterized by ambiguity or threat.

Lisa Bortolotti

For two-factor theories (Pierre 2020), conspiracy beliefs and delusions are explained by two factors: factor one is usually an anomalous experience in the case of delusions and epistemic mistrust in the case of conspiracy beliefs; factor two lies in cognitive biases and motivated reasoning for both types of belief.

Neither account necessarily implies that a cognitive dysfunction is responsible for the adoption of conspiracy beliefs or delusions.

 

Downstream effects

Conspiracy beliefs are shared and tend to strengthen group belonging and affiliation, whereas delusions are typically idiosyncratic and deeply isolating. So, whereas delusions of persecution can be extremely distressing and disrupt a person’s life, the acceptance of a conspiracy theory is generally comforting. 

But not all persecutory delusions are disruptive, and some can be a source of relief or empowerment (Ritunnano et al. 2021). Moreover, some conspiracy beliefs result in individual and collective harms (Douglas et al. 2019).

 

Conclusions

It is difficult to draw general conclusions from the comparison between conspiracy beliefs and delusions.

Matteo Mameli

One worry is that highlighting the similarities may lead to an unwarranted pathologization of people who endorse conspiracy beliefs. It is undesirable to extend further the already regrettable stigma commonly associated with having a mental illness for the purposes of excluding dissenting voices from public debate and limiting some citizens’ participation in collective discussion and deliberation.

Empathy, Altruism, and Group Identification

Today's post is by Kiichi Inarimori and Kengo Miyazono at Hokkaido University on their recent paper “Empathy, Altruism, and Group Identification” (2021, Frontiers in Psychology).

Kiichi Inarimori

Empathy causes helping behavior. When your best friend in the same college is in financial trouble and has been evicted from her apartment, for example, you might empathize with her (e.g., feel sorry for her) and decide to let her stay in your apartment for a while (e.g., Batson et al., 1981). 

Is empathy-induced helping behavior altruistic? Are you genuinely altruistic when your empathy causes you to let your friend stay in your apartment? According to “the empathy altruism hypothesis” (Batson 1991, 2011, 2018), empathy causes genuinely altruistic motivation for helping others. According to “the self-other merging hypothesis” (Cialdini et al. 1997), in contrast, empathic helping is due to the “merging” between the helping agent and the helped agent. When the helping agent and the helped agent are “merged”, the traditional dichotomy between egoism and altruism is blurred. Empathy-induced behavior is not altruistic, nor egoistic, but nonaltruistic.

Although the self-other merging hypothesis nicely explains empathy-induced helping behaviour, it faces a serious conceptual question; what does it mean exactly to say that the helping agent X and the helped agent Y are “merged”? May (2011, 2018) examines and rejects possible interpretations of self-other “merging”; some interpretations attribute psychologically unrealistic beliefs to the helping agent, while others fail to explain the helping behaviour exhibited in experimental settings. May’s challenge suggests that a plausible interpretation of self-other “merging” must successfully predict and explain the helping behaviour exhibited in experimental settings, and must not posit psychologically unrealistic beliefs, desires, etc.

Kengo Miyazono

Our new paper “Empathy, Altruism, and Group Identification” offers a new interpretation of self-other merging. According to our interpretation, “the group identification interpretation”, self-other merging involves group identification, where group identification is understood as the process in which one achieves a form of self-conception as a group member (Brewer 1991; Turner 1982; Salice & Miyazono 2020). 

X’s act of helping Y is explained by the fact that when X empathizes with Y, X group-identifies with Y and thereby comes to conceive of Y’s welfare as being constitutive of X’s first-person plural (“our”) welfare. The group identification interpretation of the self-other merging hypothesis does not posit psychologically unrealistic beliefs, desires, etc. Also, this interpretation successfully predicts and explains the helping behaviour in the experimental settings.

Empathy-induced helping behaviour, when interpreted by the group identification interpretation, does not fit comfortably into the traditional egoism/altruism dichotomy; it is neither purely altruistic nor purely egoistic. We thus argue that empathy-induced helping behaviour is both altruistic and egoistic at the same time. More precisely, it is altruistic at the individual level (because X is motivated by the concern for Y’s welfare at the individual level) and egoistic at the group level (because X is motivated by the concern for Y’s welfare in so far as it is constitutive of X’s first-person plural welfare).