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!