Tuesday 31 August 2021

Discounting Responsibility as Epistemic Injustice

This post is by Kelly Saunders. Kelly did an undergrad degree three decades ago. She completed a Bachelor of General Studies at Simon Fraser University in greater Vancouver. Philosophy was by far her favourite. After her degree she worked at a few jobs, including as a mental health worker, before ultimately deciding to open a small business. 

During all the years of running her business, she never quite lost the feeling of wishing she had pursued philosophy to a greater extent. When she came to a "fork in the road" a year ago, she discovered the M.A. in Philosophy of Religion and Ethics at Birmingham. Her hope is to use her M.A. to work as a philosophical counsellor.

When it comes to the issue of responsibility and psychopathology, Hanna Pickard's contributions are immensely valuable for the subject of addiction. She helpfully differentiates between responsibility and blameworthiness in addiction. That is, she maintains that while it may be unhelpful, and morally questionable to blame an addict for their behaviour, the opposite is the case when it comes to responsibility. This distinction paves the way for a practically, as well as morally constructive means to approach addiction, and offers actual hopefulness for the addict.

Clinical practice in addictions and the rehab industry, as well as societal opinion, in large part operate on and accept an approach that eliminates all responsibility from the addicted individual. Addiction practice and philosophy generally follows a predominantly biological model, wherein agential choice is by-passed. Alcoholics Anonymous is a very well known example of this. The first tenet of their program is to admit that "we were powerless over alcohol." Interestingly, although statistics are not easily obtainable, a 2014 book about the efficacy of 12-step programs such as A. A., reports a 5 to 10% "success rate". Another in-depth article debunking myths surrounding the success of A. A.'s approach, can be found in this 2014 article in The Atlantic.

Along with Pickard, I suggest that denying agency to the addict is wrong-headed. At bottom, we have available to us our agency - the possibility to say yes, or the possibility to say no. Exercising this agency may be difficult, but it is not impossible. It is a grave disservice to struggling addicts to further the narrative that it is impossible. I see such treatment of addiction as representing a form of what Miranda Fricker has referred to as "epistemic injustice". 

Epistemic injustice can manifest as testimonial injustice (unwillingness to accept the addict at their word, as a "knower"), or as hermeneutic injustice (an inability or unwillingness to understand or interpret the addict's experience - this can occur in both the addict as knower, and the clinician as "hearer"). When hermeneutic injustice results in the addict being poorly understood, this contributes to the oversimplified view that an addict cannot change. This results in a loss of opportunity for the addict to understand her addiction in a way that recognizes her agency.

When the addict is a priori attributed a lack of agency, this "controls" their personal narrative in a way that is unjust. Arguably, what prevents the addict from making changes is lack of awareness of responsibility, and the accompanying lack of awareness of actual ability to exercise options. It is not so much the addiction being in control of the addict's behaviour, but rather a belief that addiction controls their behaviour that is maintaining the status quo.

With her clear-eyed approach to addictions and responsibility, Pickard nicely swims against the tide of common assumptions that addicts have no responsibility for their addictions. By returning agency to the addict, Pickard does the addict a great service, and helps to work against epistemic injustice.

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