Wednesday 25 September 2024

Understanding Oneself through Others Day 1

Winterbourne House and Garden

This is a report by Jodie Russell. On 23rd and 24th September Eleanor Byrne and Kathleen Murphy-Hollies organised a workshop at the University of Birmingham, bringing together researchers interested in the area of the intersection of epistemic injustice and distributed cognition. The venue for the workshop was the beautiful Winterbourne House and Garden. 

On day one, postdoctoral researchers on EPIC Kathleen Murphy-Hollies, Eleanor Byrne, and Jodie Russell and EPIC project partner Michael Larkin introduced project EPIC and talked about their research to date. Kathleen is interested in how our self concepts and our relationships with others shape our identities. Eleanor is working on affective injustice, a type of injustice that relates to how a persons’s emotions are given (or denied) uptake by others. Jodie aims to establish an intersectional, feminist approach to psychiatry. Michael is going to work with the EPIC Birmingham team to develop a case study on epistemic injustice in young people with psychosis and his own research is about the importance on relationships for youth mental health.


Some key information about project EPIC


Our first speaker was our keynote Allan Køster from the Danish National Centre for Grief with a talk titled "Consolation: a fundamental existential category". Køster made the case for a new understanding of the phenomena of consolation to better capture how it relates to grief and loss. 


Slide from Køster's presentation


Køster noted, for example, that doctors are often faced with instances where they must inform a terminally ill patient of their prognosis. In such cases, there is little hope the doctor can offer the patient which raises the question of how we are to face such situations when inevitable and where little comfort can be offered. 

This is where we often turn to the practice of consolation, but what consolation is, is not yet clear. 
Køster thus presented an existential account of consolation based on the work of Heidegger. On this account, life is felt to be overwhelmingly burdensome, and this isn’t something we live in spite of, but, instead, it’s a fundamental aspect of our existence. 

Consolation should then be seen as, according to Køster, the attempt to unburden oneself or another from the weight of existence. This can be achieved through a kind of “delegating” or distributing the weight of that burden onto the world and others. For example, when we feel consoled by a walk through nature, part of the burden of existence is offloaded onto our environment. 

Our next presentation was given by Zuzanna Rucińska from the University of Antwerp. Her talk was titled "Understanding suicidality as a situated phenomenon" and focused on the cognitive and affective scaffolding of individuals with suicidal ideation. 

Rucińska began by presenting a puzzle around suicidality; individuals who experience suicidal thoughts are often ambivalent about life. Rucińska noted that in attempting to takes one’s own life, individuals often change their mind in the act. There is, nevertheless, for many individuals, an authentic desire to die that can come and go over a lifetime. Given this ambivalence, the question is raised as to why some people attempt to end their lives. 


Rucińska's presentation


Rucińska then proposed to answer this question through providing an account based on the interplay of the individual and her situation. Rucińska noted, for instance, the significance of the method of suicide; individuals do not change methods when their preferred method isn’t available, and studies on the restriction of particular products which are used in culturally preferred methods of suicide showed a reduction in suicide mortality. 

From this, Rucińska suggested that the environment can afford for suicidal actions; a suicidal person will perceive and attend to the features of her environment that will assist her in taking her life. These are features others might not necessarily notice due to our individual histories which have shaped how spaces are meaningful to us in specific ways. Moreover, the desire to die and to live are not contradictory but reflect the very dynamic relationship all individuals have with the environment where, for the suicidal, the opportunity to take one’s life might appear and recede as they navigate the world. 

Rucińska’s analysis implies further that a different environment will afford for different actions. Therefore, on a situated view, not only do we better understand the phenomenology of suicidality but this also potentially opens up new avenues for suicide prevention. 

After a hearty lunch break, our morning session was followed up by an interesting talk by Zamir Kadodia from the University of Exeter on a joint project with Joel Krueger on "Epistemic Injustice, Niche Construction & Neurodiversity".  

Kadodia introduced the neurodiversity paradigm from which their critique stems. This paradigm characterises neurodiversity as cognitive difference and states that the idea of a “healthy” or “normal” brain or mind is a construction. This is in contrast to the pathology paradigm which has characterised neurodiversity as disorder.  

According to the neurodiversity paradigm, neurodivergent individuals, such as those that are autistic, should be considered as a minority group. This is especially important to consider, Kadodia notes, as neurodivergent voices have been historically excluded from attempts to understand neurodivergence itself.

Kadodia and Krueger’s goal, however, is to highlight more surreptitious forms of marginalisation experienced by neurodivergent individuals. Kadodia discussed here an example from Miranda Fricker; in this case, an individual mistakes a shy person for being insincere because their shy behaviour (e.g. avoiding eye contact) makes the individual appear to be untrustworthy. Fricker counts this as a case of bad luck, not epistemic injustice, but Kadodia argued that this case looks different when we swap in the shy person for an autistic person. 


Slide in Kadodia's presentation


In this new example, Kadodia argued that this is a case of epistemic injustice because the neurodivergent person is being judged by norms of trustworthy behaviour that are determined and enacted by neurotypical individuals. As marginalised individuals, neurodivergent people don’t get to contribute to these epistemic norms, but are nevertheless expected to conform to them. This is worrisome because it means that norms of communication for neurodivergent individuals are given less credibility, which leads to a "neurotype identity prejudice", meaning that neurodivergent needs are neglected or, in the worst cases, stigmatised. 

Kadodia then problematised this further by translating this discussion around neurotypical norms to the framework of niche construction, arguing that stereotypes about neurodivergent people in the social imagination become entrenched in material practices, e.g. habits and interactions with the physical and social environment, just as neurotypical norms also become part of the habitual and embodied ways of being in the world.  

Kadodia thus called for the need for neurodiversification, which entails a greater representation of neurotypes and even a clash between different norms in order to facilitate a constructive conversation over the niches we live in. 


Slide from Latham's presentation


Afterwards, Sally Latham from Birmingham Metropolitan College talked to us about "Why self-help is not always helpful". Latham began with some self-help examples in popular culture we are all too familiar with, for instance, the idea of changing how you think in order to transform your situation. 

Latham made the case that much pop culture self-help emphasise a narrative of personal responsibility and individual choice; it is through our own efforts, these narratives suggest, that we will overcome our circumstances. However, drawing on Frank and Foucault, Latham argued that these narratives perpetuate a "ruse of liberation". This is achieved through technologies of the self, what are techniques used to understand oneself and even transform oneself.  

These technologies themselves can be used to control individuals through self-monitoring. In this way, Latham compared self-help to the panopticon; it becomes a way through which to constantly monitor and measure our 'selves' through the various exercises self-help prescribes. Self-help is given normative force for this purpose from its proximity to psychology and the authority of wellbeing 'experts'.  

The flip side of this, Latham described, is that reactions to negative life events that don't follow the positive, self-actualising framework of self-help become taboo. This is tantamount to epistemic injustice by excluding particular social experiences, which marginalises individuals who cannot face, e.g., illness with positivity. Due to the focus on individual responsibility, this may also lead to the blaming of vulnerable people for their negative outlook on life. Latham proposed, as one solution, that we should change the definition of self-help itself so that it might be more fruitful in future. 

Lastly, presented in a hybrid format, Lucy Osler (Cardiff University) and Louise Richardson-Self (University of Tasmania) closed the first day of the workshop with the talk “It Just Goes to Show That You Actually Need to Listen to Your Patients Sometimes: Distributed Cognition, Epistemic Injustice, and the (Under)diagnosis of Endometriosis".

Slide from Osler and Richardson-Self's presentation


Osler and Richardson started by informing us on some statistics on endometriosis. Shockingly, 1 in 7 people assigned female at birth are diagnosed, and diagnosis can take more than 8 years in the UK. The consequences of a delayed diagnosis involve a range of physical and social harms. Osler and Richardson, however, were focussing on epistemic and affective harms. 

They argued that there are persistent, systematic identity-tracking prejudices within wider western healthcare practices. In particular, women experience disproportionate levels of bias in diagnosis and treatment of health conditions. Richardson noted further that the level of confidence gynaecologist and women’s health GP’s have in their skills in managing patients with chronic pelvic pain is worryingly low. Moreover, gynaecologists report that they are not likely to consider patient beliefs and goals in regards to managing chronic pelvic pain.

Not only can this lead to physical and social harms, patients with endometriosis also suffer epistemic and affective harms as their testimony is overlooked or discredited. These patients are thus left with feelings of self-doubt, abandonment, shame, and mistrust of the medical establishment. This raises the question of what features enable the dynamic between medical practitioner and patient to play out in ways that perpetuate epistemic harms in the case of endometriosis.

Osler framed this issue in terms of niche construction and scaffolding; medical knowledge is often distributed among healthcare professionals, medical tools and textbooks which come together to form the niche of western healthcare. The underdiagnosis of endometriosis in women can be understood, Osler argued, in terms of the failure of this medical niche to epistemically support those with endometriosis. 

Rounding off their talk, Richardson and Osler then introduced the symbol of the “Endo Warrior” as a form of resistance of epistemic injustice through empowerment. The use of social media is critical this process as a safe space and efficient medium for sharing expertise and experience.

This talk closed the first day of the workshop. Next week we will report from the second day of the workshop. Watch this space!

Wednesday 18 September 2024

Health and epistemic injustice at Festivalfilosofia

The Festivalfilosofia is a three-day public event held in the city of Modena and the nearby towns of Carpi and Sassuolo in Italy. It's a highly attended festival, drawing about 95,000 participants last year, with its YouTube channel boasting 45,000 subscribers. 


Official image of the 2024 edition of the Festival


This year, among the 52 philosophers and cultural figures invited to speak was Elisabetta Lalumera, who works at the University of Bologna and is part of the EPIC project team. On Sunday morning, September 15th, Elisabetta gave a lecture on the different concepts of health and well-being in medicine. Each concept not only describes facts but also conveys values, meaning that selecting a particular concept of health influences choices in care, research, patient support, and the doctor-patient relationship. The audience was large and diverse.


Elisabetta Lalumera at Festivalfilosofia


Later in the afternoon, Elisabetta shared the stage with Claudio Vagnini, Director of the University Hospital of Modena, where they discussed the humanization of healthcare. On this occasion, Elisabetta focused on epistemic injustice in healthcare. The audience, primarily composed of healthcare professionals, listened as she explained how this form of injustice often arises from unconscious biases. 


Panel discussion on humanizing medicine


Like cognitive biases, negative stereotypes toward certain groups, including patients, are hard to overcome, but healthcare professionals can learn to recognize and address them. Becoming familiar with the concept of epistemic injustice—without perceiving it as a reason to blame—can help healthcare professionals live their roles with greater awareness and fulfilment.

A chapter written by Elisabetta Lalumera on the promises of digital health in tackling epistemic injustice will be published in a forthcoming open-access book entitled Epistemic Justice in Mental Healthcare: Recognising Agency and Promoting Virtues Across the Life Span (Palgrave).


Wednesday 11 September 2024

Navigating difficult emotions in interpersonal contexts

Eindhoven


This is a report of a symposium at the OZSW Philosophy Conference in Eindhoven in August 2024. The symposium was entitled: "Navigating difficult emotions in interpersonal contexts", and featured three presentations.


The Affective Injustice of Therapy-Speak by Carme Isern-Mas and Manuel Almagro (University of Balearic Islands)


Carme Isern-Mas's presentation


When we break up with people we tend to use therapy-speak: this was highlighted in a viral tiktok video on how to to best tell a friend that we no longer want to hang out with them. Therapy-speak is weaponised to promote and perpetuate epistemic and affective forms of injustice.

What is therapy-speak? Therapy-speak is use of therapeutic language and concepts into everyday communication: "He's such a narcissistic!", "I need to set some boundaries." 

It can have advantages: it enables us to share some experiences that we might not have acknowledge before we had terms for them (think about the important notion of "post-partum depression"). 

But therapy-speak is also problematic because it exploits the epistemic power of medical evidence and causes us to conflate descriptive and normative terms. Moreover, when the speaker is challenged, the fact that they used therapy-speak enables them to say that their view is not just one view on the matter, which can be disputed, but the correct account of the situation. If someone does not share that account, then it must be because they do not understand the situation.

According to Carme, the use of therapy-speak illustrates three forms of affective injustice: affect-related testimonial injustice, affective injustice or emotion policing, and emotional imperialism. Carme reviewed each form of injustice, using examples.


Epistemic Justice as Care in Trauma-Sharing by Kathleen Murphy-Hollies (University of Birmingham)


Kathleen Murphy-Hollies's presentation


There are situations where we do not believe what people tell us and yet we feel bad about dismissing their reports. For instance, when people recall traumatic experiences and they have disorganised memories; or when a friend tells us about a painful break up and does get all the details of the failed relationship right; what can we do?

In those cases when a person makes a statement we do not believe, two credibility assessments are needed:
1. one concerns the propositional content conveyed by the statement; and
2. the other concerns the perspective of the person making that statement.

In agential accounts of self-knowledge, the agential capacity to make up our own mind is central. This is what makes self-knowledge special, the capacity to regulate our behaviour, not necessarily the capacity to introspect accurately. If our claims about ourselves do not get uptake, then we are robbed of an exchange with other people about those claims, and of the possibility to gain self-knowledge in this regulatory sense.

Even false claims about the self can embed know-how and dismissing them can be a case of epistemic injustice. Engagement with those claims is the best policy: so even if the propositional content of the person's statement is something we do not believe, we may still engage with the person's perspective and see where they are coming from when they make that statement.


Hermeneutical Crowding and Moving on from Non-Bereavement Loss by Pilar Lopez Cantero (Tilburg University)


Pilar Lopez Cantero in Q&A


What happens when we refuse to move on when love ends or we suffer from unrequited love? Couldn't we educate ourselves out of this sort of self-victimisation? Are we just irrational? Building on work on narrative identity theory, Pilar Lopez Cantero argues that we experience a lack of narrative competence. 

We have story making capacities that we use to interpret the world and in particular the events that happen to us, and we can be better or worse at exercising those capacities. Such capacities include:
  1. multiperspectivalism 
  2. diachronic projection 
  3. unification 
In a break up, those capacities do not work so well. We fail at multiperspectivalism because we can only take the perspective of the sufferer. We fail at diachronic projection because we can't look to the future. We fail at unification because we can't see the good things that happen to us, only the bad ones.

So the solution seems to be that we need to foster our narrative competence. But once the break up happens, we still see it the end of love as being a tragedy. This situation can be better understood via the notion of hermeneutical crowding

There are a number of cultural narratives that crowd out an alternative narrative: "there is only one love", "the end of love is a failure", "divorce is a disaster"... these prevent us from telling ourselves a different story about the break up.

For Pilar, we have a duty to foster narrative competence before break ups occur, and learn to recognise our narrative incompetence in everyday life to prevent feeling like a victim when a crisis occurs. 

Wednesday 4 September 2024

An Introduction to the ESPEECHI Project

In this post, Manuel Almagro and Carme Isern-Mas present a recently funded project on epistemic and speech injustices. The project is led by Manuel Almagro, and it features Carme Isern-Mas as researcher, together with Gloria Andrada (NOVA Institute of Philosophy), Virginia Ballesteros (University of Valencia) and Pilar Terrés (University of Valencia).

ESPEECHI (Epistemic and Speech Injustices) is a two-year research project funded by the government of the autonomous region of Valencia (Generalitat Valenciana), Spain. ESPEECHI aims to further explore the nature of different types of epistemic and speech injustices from two different angles.

First, we will address the relationship between the epistemic and the linguistic dimensions of different forms of injustice. Our general hypothesis is that analyzing forms of injustice from both domains can reveal important aspects of the nature of such injustices.

The working hypothesis of this first part of the project include:

  1. Social structures and practices are especially relevant to account for, and intervene in, cases of epistemic and speech injustices.
  2. Deep disagreements, properly understood, could be helpful in alleviating epistemic and speech injustices.
  3. There are alternative approaches to speech act theory that can address and account better for speech injustice cases.
  4. Offensiveness and certain speech injustices are two sides of the same coin if approached from a certain view on normativity.

In the second part of the project, we will study the particularities of epistemic and speech injustices in specific contexts. One of the features that makes research on epistemic and speech injustices so complex and interesting is that each of these injustices may have both an epistemic and linguistic dimension. Moreover, studying these injustices in specific domains can reveal previously unnoticed unjust practices and enhance our understanding of such phenomena. In this part of the project, we will further explore the presence of these injustices in two contexts: mental health, and STEM domains.

The working hypotheses of this second part of the project include:

  • The psychiatric context, given its implications, has specific particularities that, although they can help us better understand epistemic and speech injustices, the conclusions and policies derived from research within this context cannot be generalized and extrapolated to other contexts.
  • Appealing to subjective interests to explain gender and race gaps in STEM is misleading and harmful, because it hides some discriminatory practices and institutional structures, which foster epistemic and speech injustices, that contribute to these gaps.

We plan to organize two workshops on these topics that will be held at the University of Valencia, one in November of 2024 and the other at the end of 2025. We will publicize them through the project’s website, so be sure to check it regularly. Stay tuned for more updates!


Manuel Almagro is Assistant Professor of Logic and Philosophy of Science at the University of Valencia, Spain, specializing in political epistemology, political philosophy of language, and experimental philosophy. Manuel works on political polarization, disagreement, offensive meaning, expressivism, epistemic injustice, and Wittgenstein’s philosophy.

Carme Isern-Mas is Assistant Professor of Moral Philosophy at the University of the Balearic Islands, specializing in moral psychology and applied ethics. Carme works on blame, empathy, moral motivation, and self-deception, and has an interest in the bioethics of mental health, particularly epistemic and affective injustice, and the ethics of fame.