Tuesday, 9 August 2022

Loneliness and Mental Health Public Engagement Event

On 18th May 2022, the Philosophy Department at the University of Birmingham hosted a public engagement event organised by Francesco Antilici and sponsored by the Royal Institute of Philosophy on Loneliness and Mental Health.

Ian Kidd

The event featured three talks and a question and answer session with the audience. In this brief report, I summarise the main contributions of the speakers.

What is the difference that makes a difference to loneliness?

Michael Larkin (Psychology, Aston University) described how our conception of loneliness is moving away from concerns about an isolated self and is reconfiguring loneliness as a social problem that needs to be solved. Rather than focusing on a deficit that affects the lonely individual, we are now much more interested in loneliness as a disruptive social force—acknowledging the importance of social relationships for health and for wellbeing. 

Data driving this new focus includes the proven link between social isolation and mortality: people who are lonely have worse health prospects and they die sooner. Larkin showed how policy documents start taking notice of how the subjective experience of loneliness impacts people’s quality of life. However, psychological accounts of loneliness examine only underlying factors, life triggers, and personal thoughts and feelings.

What is missing? According to Larkin, we need a reflection on structural issues, and in particular issues surrounding the capacity to connect (attachment, emotional regulation, trauma) and the opportunity to connect (social capital, context of equity and equality).

Interventions should not be exclusively aimed at changing people’s behaviour (e.g. by reducing anxiety); they should also aim at changing social policies (e.g. by offering support to people struggling due to parenting or unemployment).

Epistemic injustice and loneliness in late-stage dementia

Lucienne Spencer (Institute of Mental Health, Birmingham) discussed loneliness as a mental health issue and explored the role of non-verbal communication. When we ignore other people’s attempts at communicating with gestures or in other non-verbal ways, they may become vulnerable to non-verbal testimonial injustice which is a serious risk for people who are neurodiverse.

Testimonial injustice occurs when people are not allowed to contribute to the production of knowledge due to negative stereotypes associated with some aspect of their identity: a person who cannot engage in verbal communication may be thought of as stupid or childlike, and thus excluded from exchanges of information. However, they may be able to communicate effectively in a non-verbal way.

Spencer offered examples of residents with late-stage dementia for whom the capacity to communicate verbally is impaired and the opportunity to communicate non-verbally is compromised by other people’s failure to recognise non-verbal expressions of approval or discomfort. 

Loneliness and interpersonal connection

Ian Kidd (Philosophy, Nottingham) argued that there are different types of loneliness that should not be run together: for instance, we can distinguish situational loneliness (which is a temporary experience) from chronic loneliness (with is a more permanent state of being). We can also distinguish the absence of fleeting social encounters from a disruption of close relationships. Finally, in some cases of loneliness the desired connection is absent whereas in other cases it is out of reach. 

But what if some experiences of loneliness don’t just involve absence but the sense that what is absent for us is present for others, the sense that things are out of reach for us but not for everybody else. This absence/presence structure common to many experiences of loneliness—the sense of exclusion—can help us with three tasks: 

  1. identify different types of loneliness and genuine kinds of human experience; 
  2. understand the psychology of loneliness—e.g., whether it is due to individual differences or prejudice; 
  3. capture the moral and emotional dimensions of loneliness—such as bitterness, resentment, envy, and jealousy.

Tuesday, 2 August 2022

Madness: A Philosophical Exploration

Today's post is by Justin Garson. Justin is professor of philosophy at Hunter College and The Graduate Center, City University of New York. He writes on the philosophy of madness, the evolution of mind, and purpose in nature. He also contributes to PsychologyToday.com. Today he writes about his new book, "Madness: A Philosophical Exploration".

Since the 1970s, Western psychiatry has been locked into a disease paradigm of madness. This paradigm has such an ironclad grip on our thinking that it’s sometimes hard to see outside of it. I call this paradigm madness-as-dysfunction. In essence, it sees the forms of madness – delusions, dissociative episodes, depression – as so many different ways that the mind can break down, or fail to function as it should.

We all know the slogans. “Depression is like diabetes.” “Schizophrenia is like cancer.” These give voice to madness-as-dysfunction while investing it with the force of an ethical imperative.

Justin Garson

But what if madness-as-dysfunction is fundamentally limited? What if this perspective is actually beginning to stifle research, produce inefficient treatments, and increase stigma?

What if some forms of madness are designed responses to the problems of life, not diseases? What if they’re purposeful, not pathological? What if delusions, depression, and dissociative episodes, represent the proper functioning of our minds, not their malfunctioning? In short, what if mental disorders are more like calluses than cancer?

I call this paradigm “madness-as-strategy.” We see glimmerings of madness-as-strategy in some contemporary research trends. For example, some see delusions as having a protective role. Or depression, as nature’s signal that something in our lives needs to change. Or autism, as an evolved cognitive style that emerged among early humans to benefit the group.

Such research heralds the birth of a massive paradigm shift.

As a rule, however, contemporary workers in this field don’t see themselves as the cutting edge of a rich intellectual legacy – a legacy with its own founders and figureheads. The purpose of my book, Madness: A Philosophical Exploration, is to unearth that legacy, from the ancient Greek physicians to the evolutionary psychiatrists of today.

Simply being able to see madness-as-strategy as a distinctive intellectual tradition that has always run alongside madness-as-dysfunction is the first step in dislodging the silent dominion of the latter.

Some important figures in this intellectual legacy include Robert Burton, George Cheyne, Johann Christian August Heinroth, Philippe Pinel, Sigmund and Anna Freud, Frieda Fromm-Reichmann, Harry Stack Sullivan, Kurt Goldstein, and recent evolutionary thinkers like Vivette Glover and Randolph Nesse.

In the course of my research, I found academic historians of psychiatry to be of little help – not because their work isn’t valuable, but because they simply haven’t addressed the question that I’m after. They tend to approach the history of madness in terms of a clash between “mental” and “bodily” perspectives, rather than function and dysfunction perspectives. Instead, my book centers around careful readings of primary texts, some well-known and some obscure.

My goal in this book is not to destroy madness-as-dysfunction, but to force it to make room for another way of seeing, madness-as-strategy. Put differently, I want to make it possible to even raise the question of whether madness-as-dysfunction applies in any particular case. Allowing it to persist as a silent default is bad for research, and it’s bad for people who seek professional help.