Tuesday, 30 August 2022

Eating Disorders and Irrational Beliefs

Today's post is by Stephen Gadsby. Stephen is a Fonds Wetenschappelijk Onderzoek (FWO) postdoctoral fellow, based at the Centre for Philosophical Psychology, Antwerp University. His research employs theoretical and empirical methods to explore a broad range of topics within philosophy, psychology, and psychiatry. These include eating disorders, delusions, self-deception, imposter syndrome, and body representation.

Stephen Gadsby

Sufferers of anorexia and bulimia often believe that their bodies are larger than reality. This appears undeniably irrational. Given that their bodies are not as large as they claim, such beliefs appear untethered to evidence. In my recent paper, I suggest that those who suffer from these disorders are not as irrational as they appear.

The first clue comes from first-person reports. These individuals often report experiencing changes in the physical size of their body, as if their stomach and legs were extended, expanding, or blown-up. Taking these reports at face value generates the question of how such illusory experiences could arise. The answer lies in a particular form of bodily awareness.

Close your eyes and focus on your body. That feeling of your bodily boundaries is your proprioceptive awareness. Proprioception helps us locate our bodies and navigate our environments, but it can also deceive us. For example, when you hit your thumb with a hammer and feel it enlarging.

Proprioception is facilitated by a mental map of the body called the body model. We experience our bodies as a certain size because this model represents us as that size. When the model changes, our experience of body size changes with it.

A clever way to measure the body model is by measuring how people move when navigating environments. Experiments using this method on participants with anorexia and bulimia find that their body models represent them as larger. For example, when walking through variously sized doorways, these participants turn their shoulders as if their bodies were wider. 

An example experimental setup (Metral et al., 2014)

We know that many sufferers of anorexia and bulimia report experiencing their bodies as larger. We also know that the kind of dysfunction that would cause such an experience (an oversized body model) is associated with these disorders. Perhaps then, sufferers believe that their bodies are larger because they experience them that way, through proprioception.

There are a few features of this kind of misperception that are relevant to the question of rationality. Firstly, its persistence. Many sufferers report feeling this way every time they eat, see friends, or even all day long. Secondly, proprioception is a generally reliable source of information about the body. Contrary to appearances, then, sufferers of anorexia and bulimia do have evidence in support of their body size beliefs—a lot of evidence from a reliable source. Consequently, their beliefs are not as irrational as they appear.

Sufferer’s reports of proprioceptive misperception are often dismissed. As a result, attempts to convince them of their true size are unsuccessful. If we hope to change sufferers’ minds about their body size, I suggest, we must engage with the unsettling evidential circumstances that they find themselves in. We must focus on body model distortion and the proprioceptive misperception it induces.

Tuesday, 23 August 2022

Dysfunction and the Definition of Mental Disorder

Today's post is by Anne-Marie Gagné-Julien. Anne-Marie is a postdoctoral fellow at the Biomedical Ethics Unit at McGill University and also affiliated with the École normale supérieure (ENS). She works on philosophy of psychiatry and medicine, social epistemology and epistemic injustice. Here, she discusses her recent paper on dysfunction and the definition of mental disorder. 

Anne-Marie Gagné-Julien

One big question in North-American psychiatry (at least) is the meaning of “mental disorder”. This is an issue that goes back to the 1960s-1970s when the discipline was the subject of heated debate. At that time psychiatry was under attack from all sides, but one of the most important criticisms was to show problems with one of its central concepts, “mental disorder”. One of the arguments was that the concept of mental disorder was not based on anything scientific or empirical and was therefore only a tool of social control to regulate social deviance (e.g., depression would not be a “real mental disorder”, but a behaviour socially disvalued in a productivist society).

Since this crisis that psychiatry encountered in the 1960s and 1970s, there has been a desire on the part of psychiatry to demonstrate that its concept of mental disorder was not just a tool of social control, but rather an objective and therefore scientific concept. In the face of these tensions, psychiatry has offered an official and formal definition in the Diagnostic and Statistical Manual of Mental Disorders (DSM), stating that a mental disorder must not only be the result of a disagreement between the individual and society. Rather a condition must cause suffering/disability or have an impact on functioning, and it must be the result of an internal underlying dysfunction. This definition has remained more or less the same throughout the years, including in DSM-5 (2013). This was an attempt by psychiatry to counter the previous accusations of medicalization of mere social deviance.

One problem with this definition is that the DSM does not say what a dysfunction is, it simply postulates that a mental disorder should be explicable by the presence of a dysfunction (psychological, neurobiological, etc.). But this notion is what was supposed to ground the scientific and objective basis of the definition. So this might appear to be an incomplete endeavour. Many philosophers have found interest in this issue and have tried to develop accounts of “dysfunction” that would prove its objectivity and scientificity. So far however, most of these accounts have been seen as unsatisfying, since it seems that what a dysfunction is is often related to social and cultural values (e.g., we can identify some psychological or neurobiological processes related to symptoms of depression, but seeing depression or its symptoms as a dysfunction ultimately amounts to normative aspects such as suffering or harm).

My objective in the paper is to demonstrate that it is possible to think that the concept of mental disorder and the notion of dysfunction associated with it are indeed a reflection of our social and cultural norms, but that in spite of this influence, psychiatry can still claim to be a science (with certain modifications to its current practices). Based on recent work in feminist philosophy of science about what “objectivity” means, I claim that recognizing the influence of social and cultural values in psychiatry and on the notion of dysfunction does not mean that it ceases to be objective. If we adopt what is now called “social objectivity”, the notion of dysfunction could reflect social and cultural values, and therefore be value-laden, but also objective if the procedures through which psychiatry defines these concepts were amended. That is, if the DSM revision process was to become more inclusive, transparent, and open to criticisms from different actors in the way “mental disorder” is defined, it would enhance the objectivity of the concept.

Tuesday, 16 August 2022

Narrative, Second-Person Experience, and Self-Perception

Today's post is by Grace Hibshman at University of Notre Dame on her recent paper “Narrative, Second-Person Experience, and Self-Perception: A Reason it is Good to Conceive of One’s Life Narratively” (The Philosophical Quarterly 2022).

Grace Hibshman

In the Lord of the Rings trilogy, when Frodo and Sam are struggling to persevere on their quest, they turn to remembering the tales of old and wondering whether their journey will one day be put into songs and tales and told by the firesides of their people. Conceiving of their life narratively in this way as part of a great web of stories helps the hobbits find meaning and courage, and it seems that it can be similarly helpful for people in general as well.

But why might this be? Why might conceiving of one’s life narratively be conducive to one’s flourishing? In my paper, I argue that conceiving of one’s life narratively as a part of the songs and tales of old can prompt one to imagine how an audience might experience hearing one’s life narrative, mediating how someone from a second-person perspective might perceive oneself. This process can yield valuable second-personal productive distance from oneself, enabling one to acquire aspects of a direct I-thou experience of oneself and as result valuable self-understanding.

There are at least two important practical implications of my argument. First, if imagining how an audience would hear our life narratives can transform how we ourselves see ourselves, then we must choose carefully which people we regard as the audience of our lives. If Sam in the Nameless Lands had kept at the front of his mind how someone like Denethor would see his quest, Denethor who had called it ‘madness’ and ‘beyond all but a fool’s hope,’ he may have despaired of his quest after all. Instead, his imagination of how the hobbits in the shire would retell his adventure gave him new hope for his pilgrimage, reshaped how he experienced it, and gave him the strength to in fact bring his quest to a successful completion.

A second practical implication is that if the kind of life narratives we imagine having can shape how we perceive and experience ourselves, then we must choose carefully what narratives to steep ourselves in. The narratives we internalize shape what kind of narrative arcs we can envision for our lives. By steeping himself in the noble tales of old, Sam equipped himself to imagine his life enfolding in a similarly noble fashion, which in turn transformed his experience of the arduous parts of his journey and helped him set his mind on becoming the kind of person who would not turn back. Sam inherited his way of understanding what he was experiencing from a great web of narratives handed down to him by his community. 

The web of narratives in which we choose to immerse ourselves can similarly shape our understanding of our lives. It is worth asking: What stories do we tell ourselves? What stories do we tell those we love?

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.