Diversity Reading List

Diversifying Syllabi: Thesis: Those affected by mental disorders whose actions are episodically influenced by their disorder are often overlooked by philosophers of moral and ethical responsibility. Allen gives us reasons for thinking it is inappropriate to either: a) “summarily exclude people with mental problems out of the universe of moral agents, reducing them to the status of rocks, trees, animals, and infants” b) “include the group on the false assumption that their moral lives are precisely like the paradigmatic moral lives of the epistemically-sound and well-regulated people never personally touched by a mental condition” We must explore a revised approach to moral and ethical responsibility and obligation for this group.

Diversifying Syllabi: Bordo claims that the recent increase in women with Anorexia is a symptom of the “central ills” of our culture. Bordo discusses three sources of this “cultural illness” which leads to anorexia: the dualist axis, the control axis, and the gender/power axis. She spends the bulk of the paper discussing each “axis” or problematic component of society which is reflected back to us in the increasing diagnosis of anorexia. These “psychopathogolgies” are expressions of the culture, she claims.

Abstract: "How can one die in Vietnam or fail to survive a death camp and still live to tell one's story? How does a life- threatening event come to be experienced as self- annihilating? And what self is it who remembers having had this experience?" By examining the lived experience of survivors from traumatic events, Brison sets to explore what exactly "the self" is. According to Brison, the self is "both autonomous and socially dependent", which makes it prone to be disrupted by traumatic events, but also, can be healed through safe and healthy relationships.

Abstract: Do we have a duty to use moral neurointerventions to correct deficits in our moral psychology? On their surface, these technologies appear to pose worrisome risks to valuable dimensions of the self, and these risks could conceivably weigh against any prima facie moral duty we have to use these technologies. Focquaert and Schermer (Neuroethics 8(2):139–151, 2015) argue that neurointerventions pose special risks to the self because they operate passively on the subject-s brain, without her active participation, unlike ‘active- interventions. Some neurointerventions, however, appear to be relatively unproblematic, and some appear to preserve the agent-s sense of self precisely because they operate passively. In this paper, I propose three conditions that need to be met for a medical intervention to be considered low-risk, and I say that these conditions cut across the active/passive divide. A low-risk intervention must: (i) pass pre-clinical and clinical trials, (ii) fare well in post-clinical studies, and (iii) be subject to regulations protecting informed consent. If an intervention passes these tests, its risks do not provide strong countervailing reasons against our prima facie duty to undergo the intervention.

Publisher’s Note: Publisher: Classifying Madness concerns philosophical problems with the Diagnostic and Statistical Manual of Mental Disorders, more commonly known as the D.S.M. The D.S.M. is published by the American Psychiatric Association and aims to list and describe all mental disorders. The first half of Classifying Madness asks whether the project of constructing a classification of mental disorders that reflects natural distinctions makes sense. Chapters examine the nature of mental illness, and also consider whether mental disorders fall into natural kinds. The second half of the book addresses epistemic worries. Even supposing a natural classification system to be possible in principle, there may be reasons to be suspicious of the categories included in the D.S.M. I examine the extent to which the D.S.M. depends on psychiatric theory, and look at how it has been shaped by social and financial factors. I aim to be critical of the D.S.M. without being antagonistic towards it. Ultimately, however, I am forced to conclude that although the D.S.M. is of immense practical importance, it is unlikely to come to reflect the natural structure of mental disorders.

Publisher’s Note: Publisher: Psychiatry and Philosophy of Science explores conceptual issues in psychiatry from the perspective of analytic philosophy of science. Through an examination of those features of psychiatry that distinguish it from other sciences - for example, its contested subject matter, its particular modes of explanation, its multiple different theoretical frameworks, and its research links with big business - Rachel Cooper explores some of the many conceptual, metaphysical and epistemological issues that arise in psychiatry. She shows how these pose interesting challenges for the philosopher of science while also showing how ideas from the philosophy of science can help to solve conceptual problems within psychiatry. Cooper's discussion ranges over such topics as the nature of mental illnesses, the treatment decisions and diagnostic categories of psychiatry, the case-history as a form of explanation, how psychiatry might be value-laden, the claim that psychiatry is a multi-paradigm science, the distortion of psychiatric research by pharmaceutical industries, as well as engaging with the fundamental question whether the mind is reducible to something at the physical level. "Psychiatry and Philosophy of Science" demonstrates that cross-disciplinary contact between philosophy of science and psychiatry can be immensely productive for both subjects and it will be required reading for mental health professionals and philosophers alike.

Content: The paper examines various arguments looking at the responsibility psychopaths bear for their immoral actions, using neurological knowledge about psychopathy.

Abstract: Summary (from Introduction of Autonomy and Mental Disorder, Radoilska ed.): In 'Mental disorder and the value(s) of autonomy', Jane Heal identifies and critically examines a form of thought which is implicit in discussions about what we, as a society, owe to people with mental disorder. This form of thought builds upon intuitions which link respect for a person with respect for a person's autonomy. In light of these intuitions, the issue of how to treat a person with mental disorder may seem to revolve around the question whether or not this person has the capacity for autonomy. However, Heal argues, inquiries that share this logical form are methodologically inappropriate and potentially unhelpful in answering either of the questions they put together: what we owe to people with mental disorder and what is involved in autonomy as a capacity. The reason for this is twofold. Firstly, the apparent consensus about autonomy as a capacity for self-determination that ought to be protected from interference by a corresponding right to self-determination is too shallow to ground a coherent course of action in terms of respect for autonomy. Even if we work with the assumption that autonomy is part of the Enlightenment project, we face an important dilemma since we have to choose between a Kantian or rationality oriented and a Millian or well-being oriented take on the nature and significance of autonomy. Secondly, even if we were to reach a substantive consensus on the concept of autonomy, it would arguably require an intricate array of mental capacities, outside the reach of at least some people with mental disorder. Getting clearer on what autonomy is will not help us find out what it means to treat these people respectfully.

Abstract: Cognitive neuroscience can offer us new explanations of episodes human behavior that, unlike many explanations traditionally available, do not draw on questionable past theories arising from cultures and traditions that are in fact patriarchal. At the same time, feminists have had a number of reasons for regarding it suspiciously as, among other things, reductive and dehumanizing. In this paper, new work on borderline personality disorder provides an illustrative example of the first. It is also used in an extended argument against the second. Cognitive neuroscience is interested principally in explaining how creatures function well in their niches. It is replete with covert references to values and interests. The paper draws an important distinction between cases in which culture creates new conditions for old functions to be realized and those where it creates new functions.

Summary: In this paper, Kittay advances a conception of justice that 'begins with an acknowledgement of dependency and seeks to organise society so that our well-being is not inversely related to our need for care or to care' (576). Her motivation for advancing this view is that ideals of citizenship in liberal society, including independence and productivity, perpetuate the victimisation, social exclusion, or stigmatisation of people with mental retardation and their carers. This is because liberal definitions of personhood do not provide resources for responding in a morally adequate way to the mutual dependence of people with mental retardation and their carers/advocates. People with mental retardation are inescapably dependent because of their central need for attentive care. And, carers' work is so deeply other-directed that they also do not fit the liberal model of the rationally self-interested actor. Thus, both carers and their charges are vulnerable and need to be advocated for so that they can be seen as having important entitlements to public resources and claims to justice. To this end, Kittay proposes a conception of personhood that is based on relationships. Although those with mental retardation are inherently dependent, they still count as persons because they are able to participate in relationships. This makes them entitled to the satisfactions that make life worth living. To achieve the twin goal of achieving justice for familial or paid carers, Kittay advances a new principle of justice, doulia, which calls for larger society to support those who care for the inexorably dependent. Kittay takes her relational conception of personhood and her principle of doulia to ensure that appropriate forms of social organization exist to support all those who become dependent. She claims her view is needed because principles of charity and beneficence are not adequate since they are consistent with the continued stigmatization of mental retardation and care work, and ground only low-priority social obligations.

Abstract: This article will examine how the notion of emotional authenticity is intertwined with the notions of naturalness and artificiality in the context of the recent debates about ‘neuro-enhancement- and ‘neuro-psychopharmacology.- In the philosophy of mind, the concept of authenticity plays a key role in the discussion of the emotions. There is a widely held intuition that an artificial means will always lead to an inauthentic result. This article, however, proposes that artificial substances do not necessarily result in inauthentic emotions. The literature provided by the philosophy of mind on this subject usually resorts to thought experiments. On the other hand, the recent literature in applied ethics on ‘enhancement- provides good reasons to include real world examples. Such case studies reveal that some psychotropic drugs such as antidepressants actually cause people to undergo experiences of authenticity, making them feel ‘like themselves- for the first time in their lives. Beginning with these accounts, this article suggests three non-naturalist standards for emotions: the authenticity standard, the rationality standard, and the coherence standard. It argues that the authenticity standard is not always the only valid one, but that the other two ways of assessing emotions are also valid, and that they can even have repercussions on the felt authenticity of emotions. In conclusion, it sketches some of the normative implications if not ethical intricacies that accompany the enhancement of emotions.

Abstract: Contrary to influential medical and cognitivist models governing how mental disorder is usually understood today, the socially embedded, disordered "mind," or subject, of feminist theory leaves little room for idiopathic causal analyses, with their narrow focus on the brain and its functioning, and reluctant acknowledgment of symptoms. Mental disorder must originate well beyond the particular brain of the person with whom it is associated, feminist analyses imply. Because the voiced distress of the sufferer cannot be reduced to the downstream, "symptomatic" effects of brain dysfunction, symptoms can be seen differently, as central to the diagnostic identity, and constitutive of (at least some) disorders. And new attention is required for the testimony of women diagnosed with mental disorder, vulnerable as it is to epistemic injustices. Corrected explanations of women's mental disorder leave remaining concerns, both epistemological and ethical, over the madwoman narrating her symptoms.

Abstract: The significance of critical phenomenology for psychiatric praxis has yet to be expounded. In this paper, Rituanno argues that the adoption of a critical phenomenological stance can remedy localised instances of hermeneutical injustice, which may arise in the encounter between clinicians and patients with psychosis. In this context, what is communicated is often deemed to lack meaning or to be difficult to understand. While a degree of un-shareability is inherent to subjective life, Rituanno argues that issues of unintelligibility can be addressed by shifting from individualistic conceptions of understanding to an interactionist view. This takes into account the contextual, historical and relational background within which meaning is co-constituted. She concludes by providing a corrective for hermeneutical injustice, which entails a specific attentiveness towards the person's subjectivity, a careful sensitivity to contingent meaning-generating structures, and a degree of hermeneutical flexibility as an attitude of openness towards alternative horizons of possibility.

Abstract: In recent years, autopoietic enactivism has been used to address persistent conceptual problems in psychiatry, such as the problem of demarcating disorder, that other models thus far have failed to overcome. There appear to be three main enactive accounts of psychopathology with subtle, although not incompatible, differences: Maiese characterizes disorder as distinct disruptions in autonomy and agency; Nielsen characterizes disorder as behaviors that relevantly conflict with the functional norms of an individual; De Haan emphasizes patterns of disordered sense-making, that are transformed through the existential dimension. Given that these accounts are intended to provide not only an ontologically richer account of psychopathology but also reduce the stigma experienced by individuals with mental disorders by accounting for lived experience, a critical analysis of these approaches is needed. Russell provides a problematization of enactive accounts of mental disorder, showing that this particular framework does not, as it stands, necessarily reduce the harm and suffering experienced by individuals with mental disorder because of its ontological openness; enactivism leaves much to be interpreted and applied by the clinician (or patient) such that practical and ethical problems in its use arise.

Abstract: This paper defends a desire-based understanding of pleasurable and unpleasant experiences. More specifically, the thesis is that what makes an experience pleasant/unpleasant is the subject having a certain kind of desire about that experience. I begin by introducing the 'Desire Account' in more detail, and then go on to explain and refute a prominent set of contemporary counter-examples, based on subjects who might have 'Reflective Blindness', looking particularly at the example of subjects with depression. I aim to make the Desire Account more persuasive, but also to clear up more widespread misunderstandings about depression in metaethics. For example, mistakes that are made by conflating two of depression's most prominent symptoms: depressed mood and anhedonia.