Masked, Alone, and in the Dark

Today's post is by Nuria Gardia, a Mental Health Master’s student at University of Birmingham with a newly discovered passion for Philosophy. Her interests lay in the intersection between philosophy and psychology to better understand how the mind “overcomes” trauma and the relationships between mind-body and self-world. Specifically, how trauma affects human experience and thus, human reality. 

This is part of a series of posts by students of the Philosophy and Ethics of Mental Health and Wellbeing module at the Institute for Mental Health. They share some of their views on key topics discussed in the module.

Nuria Gardia

Autistic women navigate a world made by-and-for neurotypicals within a society that ignores their strengths (Russell et al. 2019), and wrongfully denies their capacity as knowers (Catala et al. 2021), by underdiagnosing them and excluding them from research (D'Mello et al. 2022).

Moreover, without a diagnosis, autistic women are wrongly deprived vital knowledge, that could help them comprehend their social experiences (Fricker 2007, chapter 7) and be socially understood. Whilst, also denied access to social support (Stagg and Belcher 2019).

Thus, inspired by Catala (2021), and guided by Laing's Divided Self, I propose that masking is imposed by a socially MAD world (Mandy 2019).

Currently, autism remains a misconceptualised term imbued with wrongful assumptions, which society maintains. Classified a disorder to characterise its associated social interaction, communication, and behavioural difficulties. Autism’s diagnostic criteria focus solely on its related deficits. Hence, autism is perceived negatively, and society discriminates, marginalises, and negatively impacts autistic individuals and their mental health (Catala 2021). 

Yet, autistic strengths, such as passion, creativity, and great expertise in areas of interest, are dismissed. Moreover, one could postulate, that autistics display socially normative behaviours, such as honesty and trustworthiness, which neurotypicals do not (often) display. However, society interprets them as not conforming to social norms, and feels threatened.

Emphasising that this assumed threat is due to the lack of understanding surrounding autistic individuals, specifically women and their gender-specific characteristics. I suggest autistic women-led research and consider autism as gender biased at all possible spheres. Conceptually, society associates autism with males and excludes autistic women from research (D'Mello et al. 2022). 

Medically, diagnostic criteria is based on male traits. Also, psychosocially, autistic women display different, not-medically-considered, behavioural traits. Thus, it raises ethical and moral considerations and epistemic injustice at testimonial levels (Fricker 2007, chapter 1). Their word is not considered valuable for research or clinically trustworthy for no logical reason –just their gender. However, it also accounts current underdiagnosis rates (Gessi et al. 2021).

In line, underdiagnosis raises epistemic injustice at hermeneutical levels. Without a diagnosis, autistic women do not receive diagnostic or community-service-level autism-related information. Which is extremely valuable and helps autistic women comprehend the complexities within their social worlds. 

Thus, autistic women can view diagnosis as bearer of valuable knowledge, reducing, among others, undeserved feelings of disconnection, inadequacy, oddity, shame, and self-blame. Conversely, a lack of knowledge raises ethical concerns at individual levels, with the self-stigmatisation of misunderstood thought processes and sensory and behavioural self-identified differences. Also, at societal levels, misguided assumptions enhance and exacerbate the stigmatisation surrounding autism.

Furthermore, non-diagnosis also leads to social injustice. Without a diagnosis, there is no access to community-based services or access to extra support. Thus, many autistic women are socially conditioned into masking, hiding their true selves to form a socially expected version of themselves, at a high cost. However, over time social masks get tired and violate demarcating boundaries, impeding diagnoses. 

Socially Masked by Ainara Gardia

Concluding,  ethically and morally, difficulties or differences are not equal to deficits. Thus, diagnostic criteria should be modified to include autistic difficulties as much as their strengths. Also, informed by autistic women-led research to account for their gender-characteristic differences. 

Thus, I propose that masking, imposed by a socially MAD world, makes the urgent plea for epistemic growth.

Responsibility and Blame in Practice

Today's post is by Jen Garbett, a part-time Mental Health MSc student at the University of Birmingham. Jen is interested in all aspects of mental health in psychology, especially in moral responsibility in psychopathy and the nature of delusions in psychosis and other psychiatric disorders. 

This is part of a series of posts by students of the Philosophy and Ethics of Mental Health and Wellbeing module at the Institute for Mental Health. They share some of their views on key topics discussed in the module.

Jen Garbett

The concepts of responsibility and blame naturally go hand in hand for many of us. For real blame to be executed and appropriate consequences to follow, such as a prison sentence, one must be considered responsible for their actions. However, if one is to take responsibility for their actions, does this undoubtedly mean they should be blamed for them too?

In 2011, Hanna Pickard created a framework that separates responsibility and blame, based on her experience with patients suffering from Cluster B (or “bad”) personality disorders.

Responsibility is regarded as an individual’s accountability for their actions. If one is responsible, they are aware of the actions they have taken and choose to perform these actions willingly. On the other hand, Blame is separated into two types: detached and affective. Detached blame consists of an emotionless judgement as to whether an individual is “to blame” for an action they took and is usually followed by some sort of consequence, such as prison time, whereas affective blame, the harmful type, consists of “negative reactions and emotions” toward the blamed individual.

Pickard believes that affective blame has a detrimental effect on treatment outcomes and thus should be separated from responsibility and discarded from therapeutic practice. But how do we go about putting this into practice?

Group therapy

Pickard (2016) argues that, when administering therapeutic treatment to an individual with a PD, clinicians can put this framework into practice by understanding their patients as whole persons, as “victims” and “perpetrators” in the same body, by acknowledging their past history and their individual reasons for why they may act in morally objectionable ways. However, how does this translate for those who have performed unquestionably morally objectionable behaviour, such as criminal activity? I would argue that this translation has already occurred in prison systems such as Norway’s.

This is because Norway takes a rehabilitation approach to the treatment of inmates while serving their sentence. Similar to the UK and US, the amount of individuals with personality disorders in inmate populations is significantly higher than the general population (Cramer, 2016). However, prison in Norway consists of what Pickard refers to as holding them accountable “but in an environment that [...] may do better to help them address their offending behaviour and enable learning and change”. 

Halden Prison

Norway’s inmates are given freedoms such as working and taking part in training programmes across all prisons, from low-security to maximum. This system works to reduce rates of recidivism as statistics show, with Norway achieving an impressively low recidivism rate after 5 years (25%) as compared to the US (76.6%) and the UK (72%).

The statistics speak for themselves in regards to the usefulness of the Responsibility without Blame framework in several areas where the percentage of individuals with personality disorders and general psychiatric disorders are high. These concepts are separable and the separation leads to successful outcomes regarding the aforementioned populations. In future, it would be exciting to see how this framework could apply to further systems.

Rethinking Conspiracy Theories

Today's post is by Matthew Shields at Wake Forest University, on his recent paper “Rethinking Conspiracy Theories” in Synthese. 

Matthew Shields

What do you think of when you think of conspiracy theories and conspiracy theorists? The first image that typically comes to mind are individuals on dark corners of the internet spinning bizarre tales to explain some major event: that the moon landing was faked, that 9/11 was an “inside job”, that Sandy Hook was a false flag, or that Princess Diana was assassinated. You’re in good company: a great deal of the academic research on the topic takes just these cases to be paradigmatic of what and who conspiracy theories and theorists are. Many philosophers have followed suit. Researchers then go on to defend claims such as the following: conspiracy theorists are political extremists, not well-off socioeconomically, less educated, amateurs who lack and repudiate the relevant expert credentials. The problem of conspiracy theories, in turn, should be solved via state interventions and improving our practices of intellectual and moral education.

In my paper “Rethinking Conspiracy Theories”, I argue that these claims are all false or in need of radical revision, and I argue that this is so by these researchers’ and philosophers’ own lights. 

To see why, consider the two most influential views according to which conspiracy theories are inherently flawed. On the first, conspiracy theories are epistemically self-sealed: no amount of counterevidence will change the conspiracy theorist’s mind. On the second, conspiracy theories are primarily forms of political propaganda and therefore fall prey to a host of epistemic flaws. 

Suppose these views, or some combination of them, are right. Are the cases we started with the best examples of this phenomenon? Note a striking feature they have in common: they are all views espoused by individuals who are not part of the dominant political, economic, media, or educational institutions of their societies. (I call them ‘Non-DITs’: Non-Dominant Institution Conspiracy Theories and Theorists.) Perhaps this is no coincidence. It’s at the margins, some would argue, where we should expect to find uniquely flawed beliefs. But defenders of these philosophical views also concede, if only in passing, that individuals who are part of the dominant institutional landscape can also be conspiracy theorists, as they understand the latter.

In the paper, I argue that this is not only possible, but that conspiracy theories fabricated and promoted by those in positions of dominant institutional power are by far the best examples of the phenomena these philosophers take themselves to be identifying. I look in-depth at the Iraq-Al Qaeda conspiracy theory created and promoted by the Bush administration and the domestic and global McCarthyism scares promoted by both major American political parties. Both are ‘DITs’ (Dominant Institution Conspiracy Theories and Theorists). DITs, I show, are a much clearer form of political propaganda because they have a far more coherent political agenda in contrast to the mishmash of political beliefs behind Non-DITs. DITs are also more epistemically insulated because there is enormous institutional pressure not to dissent from the theory.

Moreover, DITs cause the most harm, and researchers tell us that we should study conspiracy theorists and theories precisely because of the harms they cause. By their very nature, DITs are produced by institutions with the largest share of resources and power, and their harms reflect this fact: wars are fought because of them, countries destroyed, atrocities committed.

Given philosophers’ own arguments regarding the flaws of conspiracy theories and the harms they cause, we therefore have excellent reason to treat DITs as our central examples rather than the cases that have dominated the academic literature. But if we do make this shift in paradigm cases, we will end up with very different conclusions: conspiracy theorists, it turns out, are primarily produced by those who adopt “mainstream” political ideologies, rather than the supposed extremists; they are often created and pushed by the best educated and most well off socioeconomically, by those widely viewed as experts and who have the backing of our most prestigious intellectual institutions. 

Our understanding of who conspiracy theorists are, why they believe what they believe, and how resulting harms should be combatted must therefore all change radically if researchers in this literature are to remain true to their central claims.

Participatory Interactive Objectivity in Psychiatry

Today's post is by Şerife Tekin at University of Texas at San Antonio on her recent paper “Participatory Interactive Objectivity in Psychiatry” in Philosophy of Science.

 

Şerife Tekin 

As evident from the compelling body of scholarship featured in the Imperfect Cognitions blog, the last decade has been a very exciting time to be doing philosophy of psychiatry. What has been even more exciting for me, as a philosopher who has long been promoting the view that giving uptake to the first-person perspectives and testimonies of individuals diagnosed with mental disorders is necessary for enhancing rigorous research and ethical clinical practices, is the increased philosophical interest in thinking about how to include service users/ patients/ex-patients/survivors into enhancing research. 

As can be seen, for example, from the line-up of speakers and their abstracts, in a recent conference organized by Sam Fellowes on “Philosophically Analysing the Role of Service Users in Psychiatric Research,” I am delighted that this topic is garnering a lot more interest and attention from scholars and service users in the field. While we still have a lot of work to do to convince psychiatric research and clinical treatment circles, I am encouraged to see the increased collaboration between philosophers and the service users to push this approach forward.

In “Participatory Interactive Objectivity in Psychiatry,” I focus specifically on the creation and revision processes of the Diagnostic and Statistical Manual of Mental Disorders (DSM), a document produced by the American Psychiatric Association (APA) that identifies the properties of mental disorders and thereby guides research, diagnosis, treatment, and various administrative tasks. 

I challenge the exclusion of patients  from epistemic practices, through a historical overview of the DSM development since its inception in 1952. (I use the word "patient" to refer to the individual who is in a position of need due to the distress she is experiencing and who seeks help from a professional to address her condition. I recognize that “patients” are not homogenous, and some prefer being referred to as service-user/survivor/ex-patient. For my purposes in this article, I use these terms interchangeably.) 

I respond to the objections provided by the APA on the inclusion of patients in the DSM creation process, on the grounds that it would impede psychiatry’s scientific aspirations for arriving at objective knowledge. I argue that there are epistemic – rather than exclusively social/political – reasons for including individuals with first-person experiences in the DSM revision process. Service users/patients/ex-patients/survivors are indispensable resources to enhance psychiatric epistemology, especially in the context of the crisis, controversy, and uncertainty surrounding mental health research and treatment. 

My argument unfolds as follows. 

• First, I outline the development process of the series of DSMs. 
• Second, I examine the APA’s position that the inclusion of patients in the DSM’s epistemic practices would impede psychiatry’s goal to be objective. 
• Third, I demonstrate that the notion of objectivity operant in the APA’s statements is insufficiently developed, and it leans heavily towards a logical positivistic understanding of what science is and how it can be objective.
• Fourth, I develop an alternative approach to thinking about objectivity in psychiatry, Participatory Interactive Objectivity (PIO), according to which patients’ inclusion is necessary for objectivity in psychiatry. 

PIO takes cues from feminist epistemology, feminist philosophy, and science and technology studies, and promotes the idea that knowledge about mental disorders must be generated by a community of experts, including those with training-based expertise and those with experience-based expertise (e.g., Longino 1990, Collins and Evans 2002, Douglas 2004, Solomon 2015, Wylie 2015, Whyte 2018, Bueter 2021, Gagné-Julien 2021). Engagement between different kinds of experts would allow a diversity of standpoints to go through a process of transformative criticism, enhancing objectivity while also increasing public trust in the DSM.

Renewing Phenomenological Psychopathology: The Launch

This post is by Lucienne Spencer (University of Birmingham). In this post she is reporting on the launch of a new project, Renewing Phenomenological Psychopathology. 

The project aims to apply interdisciplinary approaches to phenomenological psychopathology and diversify the field more broadly. It is funded by a Wellcome Trust International Exchange Award and will run from April 2022 to April 2024. The project leads are Matthew Broome and Giovanni Stanghellini. Lucienne Spencer is the post-doctoral researcher on the project, and Roxana Baiasu is research fellow and network convener. 

Organisers Lucienne Spencer,
Matthew Broome, and Roxana Baiasu

Thanks to the generous support of the Wellcome Trust, the Renewing Phenomenological Psychopathology project was formally launched last week at the University of Birmingham and via Zoom. This was a one-day hybrid event, with online and in-person panels running simultaneously. Through this launch event, we invited critical reflection on new directions for the field of phenomenological psychopathology. In total we had fifteen excellent speakers from multiple backgrounds and of all career stages. We had around fifty in person attendees and over 100 online attendees.

Following introductions from the project team, our launch event was kicked off by our first keynote speaker Dr Robert Chapman from Sheffield Hallam University, with their talk entitled ‘Marx and Mental Health: Alienation in a Post-Fordist Era’. In this talk, Robert focused on experiences of mental illness and disablement in a post-Fordist era, with an emphasis on this era’s heavy reliance on cognitive and emotional labour.

Presentation by Robert Chapman

This was followed by our second keynote, Dr Lucy Bolton from Queen Mary University of London, with her talk entitled ‘Fear Itself, and Not the Statement “I Am afraid”: Film Phenomenology: Consciousness, Bodies, and Lived Experience’. Here, Lucy traces back the development of film-phenomenology in order to demonstrate that phenomenology as an approach to film is enabling for both the film and those who encounter it. She argued that this open, receptive, and inclusive orientation is grounded in the recognition of a variety of possibilities, not all of which are reducible to neat theoretical categories.

The launch event was brought to a close by our final keynote speaker, Professor Kevin Aho from Florida Gulf Coast University in the U.S., with his talk entitled: Phenomenological Psychopathology in the Age of Anti-Depressants. Kevin argued that the medicalisation of mental illness and the overprescribing of antidepressants is a very real problem and that antidepressants can be valuable from a phenomenological perspective insofar as they act on the meaning-structures that are disrupted in mental illness.

The RPP team would like to say a *big* thank you to all those who participated in our launch event, included those who presented talks in the parallel sessions and whose talks I could not summarise here. 
For those who missed our launch event, you’re in luck! We will be uploading all the talks onto our website. If you would like to sign up to the mailing list for the RPP project to get updates on our latest funding calls and events, we warmly encourage you to contact us.