Wednesday 10 April 2024

Experiences of Loss conference report

In this post, Kathleen reports from the 'Experiences of Loss' Conference which took place on the 26th and 27th October 2023, at Vrije Universiteit Amsterdam. The conference was organised and ran by Sabrina Coninx (VU Amsterdam). The selection of talks over two days all spoke to the theme of loss in different contexts, addressing self, illness, and memory. 

Day 1

Regina Fabry


Regina Fabry (Macquarie University): Sharing experiences of loss through self-narration: possibilities and limitations. (online)

Regina first clarified the concept of a self-narrative. Individuals might also draw on master narratives, which are widely shared in a socio-cultural community or society. These are value-laden, usually reflecting systems of power and oppression in play. Individuals might push back against these master narratives with alternative narratives, as a form of resistance. In cases of Major Depressive Disorder (MDD), there is a sense of loss or absence which is very much felt by the individual. This is a loss of possibility of change, of interactions with one’s environment, and of interpersonal connection. This affects one’s capacities for crafting one’s own self-narrative, but the practice of writing a memoir of one’s experience can help regain these capacities. However, given that there are master narratives and literary genre expectations in play when writing a memoir, this sets limits on how these experiences can be shared in this form.


Eleanor Byrne


Eleanor Byrne (University of Birmingham): Narrative Deference

Eleanor talked about how distributed memory can affect one’s self-narratives. Group memory enables greater recall than individual memory, this might happen amongst married couples, for instance. Sometimes, an individual has no memory of an event at all, and in these cases, they might defer to another who can remember. This means that their self-narrative is also significantly deferred to another. This narrative deference demonstrates how intimate others not only can play this role for us, but this affects our experience of them. We experience them as people who have the possibility of ‘taking hold’ of our self-narratives when it comes to matters we cannot directly remember ourselves. One way of understanding this is to see these people as affective scaffolds. They are trusted over time to reliably make possible an understanding (through narrative) of phenomena which could be otherwise missed or overlooked. They can help make sense of quite difficult and unarticulated phenomena.


 

Lilith Lee (VU Amsterdam): Love and Friendship: Daoist Partnership and Zhuangzi’s two losses

Lilith talked about various possible losses in cases of death. One is the loss of a life partnership, and the second is the loss of intellectual partnership. In the Zhuangzi, Zhuangzi grieves the loss of his wife and Huizi, despite death being seen otherwise as simply one of the many transformations that take place in the world. There are couple of ways that scholars try to make sense of this, but Lilith emphasised the depth of loss of an intellectual partner or foil. Given the loss of a fundamentally discursive skill here which may be integral to one’s life and livelihood, one arguably loses a part of oneself as well. These friendships and partnerships themselves also help individuals make sense of loss.


Peter Stilwell


Peter Stilwell (McGill University): The Self and Suffering: From Theory to Pain Practice. (online)

Peter discussed the difference between pain and suffering, and explored a newer concept of ‘pain-related suffering’, and this draws on experiences of loss. One difference seems to be that people can coherently say that their pain doesn’t bother them too much, but cannot say that their suffering doesn’t bother them too much. From qualitative interviews on pain-related suffering, it was found that people experienced disruption to the minimal self insofar as they experienced alteration or loss of perceived agency and ownership over their actions and experiences, and disruption to the narrative self insofar as they experienced loss or threat to valued life roles, relationships and aspirations.


Leon DeBruin


Leon DeBruin (Radboud University): Neurodiversity and Identity Formation.

Leon discussed the possible sources of harm when it comes to mental health conditions, which are teased apart in Wakefield’s hybrid account of disorder. One source of harm is the dysfunction itself, within some underlying psychological, biological or developmental process. But another source of harm is still deviating from socio-cultural norms, and the reactions which come from that. Many struggle with self-illness ambiguity; distinguishing between oneself and between what is often referred to as one’s mental illness. There may be spectrum, wherein some identify fully with their illness, whereas others do not identify at all. Individuals may ask themselves whether their own desires, actions and emotions can be attributed to themselves or to their illness. But many proponents of neurodiversity see their mental illness as actually a manifestation of natural variation and integral to their selfhood.

Day 2

Gerrit Glas


Gerrit Glas (Amsterdam UMC): Experiences of Loss in Mental Illness

Gerrit discussed the many links and interrelations to pay attention to between the patient as a person, the patient with an illness, and the patient in a context, whether that be individual, institutional, or societal. Senses of loss could appear in any of these dimensions. In particular, individuals also have a fundamental I-Self relation - one’s ‘self-referential pole’ in relating to the world. This relation is not explicitly felt by people but it is not an illusion either, and senses of loss here are very deeply felt and sometimes referred to as ‘disorders of ipseity’.


Lucy Osler


Lucy Osler (Cardiff University): Losses and Loneliness in Anorexia Nervosa

In Lucy’s talk, she emphasised the experiences of social loss, particularly of recognition and understanding, which can underlie cases of anorexia nervosa. There can be a somewhat cyclical relationship between experiences of social loss and anorexia nervosa, where each can contribute to the continuation of the other. In particular, feelings of loneliness can bring individuals to enter and remain embedded in communities based around the condition, such as pro-anorexia forums online. Lucy described these place as ‘affectively sticky’, in that they are very difficult to leave even when they cannot offer any new information or insights. These communities can give a sense of control, connection, purpose, emotional regulation and so on, but they also provide affective scaffolding for the condition itself.

 

Lieke Schrijvers


Lieke Schrijvers (VU Amsterdam): ‘Loss’ and ‘Gain’ Amongst Women Becoming Jewish, Christian or Muslim.

Lieke discussed her PhD study which looked at women who converted to Judaism, Christianity, or Islam in the Netherlands. The traditional conception of these conversions are strongly characterised by associated ‘losses’– loss in autonomy, in freedom, and of the emancipation that the women would otherwise have. Lieke emphasised that the real picture of conversation is more complicated, and involves transformation of their identity, daily lives, emotions, agency, and social circumstances. These processes of transformation mean that convert women themselves were less likely to have a clear sense of ‘before’ and ‘after’ their conversion, with their sense-making of the process contributing to the process itself. All of this means that using a framework of losses and gains is inadequate.

 

Marta Carava


Marta Carava (Purdue University): Norm-Induced Forgetting

Marta suggested that there are some cases of forgetting which take place despite agents having the cognitive resources required to retrieve the information, and so cognitive explanations of this forgetting are not adequate. She suggests that norm-induced forgetting helps explain these cases instead. In these cases, forgetting is caused and underpinned by some relevant social norms. This captures that there are normative elements to the mechanism of forgetting, which we can see in cases such as the tendency for women’s contributions to conversations to be forgotten. Culturally shared biases about the social group, ‘women’, can be triggered by the content of the memory (i.e., what the woman said) when the agent tries to access it.



Wednesday 3 April 2024

Philosophy of Mental Disorder: An Ability-Based Approach

This post is by Sanja Dembić. Sanja is a research associate at Humboldt-Universität zu Berlin and a member of the “Human Abilities” Centre for Advanced Studies in the Humanities. Here, she discusses her recent book 'Philosophy of Mental Disorder: An Ability-Based Approach'. 



What is it to have a mental disorder? There are many different answers to this question in the literature, the most prominent being those that refer to the concept of biological dysfunction. These views are usually developed with reference to clear cases of bodily disorders (or: diseases). The idea behind them is that if we have an adequate analysis of the concept of bodily disorder, we will also have an adequate analysis of the concept of mental disorder. In contrast, my aim was to develop a concept of mental disorder that is developed with reference to clear cases of mental disorder.

In this book, I offer an ability-based view of mental disorders. I argue that an individual has a mental disorder if and only if they are—in the relevant sense—unable to respond adequately to their available reasons in some of their thinking, feeling or acting and they are harmed by the condition underlying or resulting from this inability. I call this the “Rehability View”. I develop a detailed analysis of the concept of inability that is relevant in the psychiatric and psychotherapeutic context by drawing on the most recent literature on the concepts of ability, reasons and harm. The Rehability View does not imply that an individual with a mental disorder cannot learn to respond adequately to their available reasons. It suggests that therapy aimed at “cure” should, at its core, empower the affected individual.

Sanja Dembić

The Rehability View is developed by the method of explication. The goal of an explication is to formulate a concept that is fruitful to us for certain purposes. I argue that we need the concept of mental disorder for (a) the theoretical purpose of scientific classification and (b) to help us settle certain practical or normative questions concerning treatment and responsibility. In light of these purposes, I propose the following set of adequacy conditions for an explication of the concept of mental disorder: to capture the distinction between (1) mental health and disorder, (2) mental and bodily disorder, (3) mental disorder and deviances from social, legal or moral norms, as well as to clarify (4) what about having a mental disorder it is that may justify certain normative consequences (such as eligibility for treatment or excuse from moral responsibility).

The Rehability View has various normative aspects. Normative considerations are relevant to determine (1) what class of abilities is relevant to mental disorders; (2) at what threshold an inability can be attributed; (3) what constitutes psychiatrically relevant harms; and (4) whether an individual’s actions or mental states are adequate responses to their available reasons. I see this as an advantage of this approach because I believe that it is better to make clear (and discuss) the normative aspects of the attribution of mental disorders than to deny them.

In sum, my aim was not to offer just another conception of mental disorder, but to develop a systematic approach that incorporates insights from philosophy of psychiatry and adjacent philosophical disciplines.