Wednesday, 2 April 2025

Stigma, Compassion, and Recovery in Borderline Personality Disorder

Stigma plays a significant role in shaping how people with Borderline Personality Disorder (BPD) relate to both themselves and others. While much has been written about the damaging effects of stigma, its impact on compassionate acts, whether showing compassion to oneself, to others, or accepting it, remains underexplored. Yet compassion is critical for recovery, helping to foster social connection, emotional resilience, and well-being. If stigma prevents people with BPD from accessing these benefits, we need to take notice.

In a recent paper, I explore how stigma, public, institutional, and internalised, creates barriers that discourage people with BPD from engaging in compassion. These barriers are not simply personal struggles; they are embedded in societal structures and reinforced by harmful misconceptions. Addressing them is not just about promoting kindness; it is about removing a major obstacle to recovery.

How does stigma limit compassion?

Public stigma, rooted in societal attitudes, portrays people with BPD as manipulative, unstable, or even dangerous. These stereotypes do not just shape opinions, they affect how individuals with BPD are treated. Media portrayals and casual conversations reinforce the idea that they are difficult or untrustworthy, leading to social exclusion. Given that interpersonal struggles are already a core challenge for people with BPD, this exclusion only deepens their difficulties in forming meaningful, compassionate connections.

Institutional stigma is equally harmful. Many mental health professionals view BPD as a "difficult" diagnosis, leading to frustration or reluctance to treat individuals with the disorder. Service users often report their distress being dismissed as attention-seeking; having care withheld; or even being told they are beyond help. If mental health services themselves communicate that individuals with BPD are not worthy of compassion, it is not surprising that many disengage from seeking help altogether.

Then there is self-stigma: the internalisation of these negative messages. People with BPD frequently struggle with low self-worth and intense self-criticism. When the world reinforces the idea that they are undeserving of kindness, self-compassion becomes even more difficult. If you believe you are broken or unworthy, how likely are you to be kind to yourself? How likely are you to believe others’ kindness is sincere? For many, the answer is: not very.

Compassion and recovery

Yet research consistently shows that engaging in compassionate acts, towards oneself, towards others, or accepting compassion from others, can improve mental health, reduce distress, and promote recovery. So how do we dismantle the barriers preventing people with BPD from accessing these benefits?

Challenging public stigma requires changing how we talk about BPD. The harmful stereotypes surrounding the diagnosis must be replaced with a more accurate understanding. People with BPD are not manipulative or untreatable; they are individuals navigating profound emotional distress, often shaped by trauma.

Tackling institutional stigma means changing attitudes in mental health services. Clinicians need training to approach BPD with the same empathy and evidence-based care as other conditions. No one should be denied appropriate treatment because of their diagnosis.

Addressing self-stigma is perhaps the most complex but crucial step. Interventions such as compassion-focused therapy can help individuals with BPD develop self-kindness and challenge the belief that they are undeserving of care. Encouraging social connection in spaces where they feel accepted can also counteract the isolating effects of stigma.

The bigger picture

The barriers to compassion that people with BPD face are not just individual struggles; they reflect a deeper societal issue. When certain individuals are treated as less deserving of care and kindness, their path to recovery becomes exponentially harder. If we are serious about supporting people with BPD, we must take stigma seriously. More than that, we must recognise that fostering compassion, both towards and from individuals with BPD, is not just ethically important, but a necessary step in dismantling the obstacles that stand in the way of recovery.


Catrin Street-Mattox is a PhD researcher in psychology at the University of Birmingham, exploring the relationship between challenging social experiences and compassionate engagement for individuals with borderline personality disorder (BPD). Before beginning her doctoral studies, she was a specialist further education lecturer, supporting students with mental health conditions and special educational needs. Her academic interests lie at the intersection of psychology, philosophy, and mental health reform, particularly in addressing stigma and improving care systems. More about her research can be found here, and those interested in participating in her BPD study can visit bpd.cesmresearch.com.

Wednesday, 26 March 2025

Special Issue: Renewing Phenomenological Psychopathology

 

The Renewing Phenomenological Psychopathology project is an International Exchange Award funded by the Wellcome Trust that acts as a catalyst for innovative and interdisciplinary in the field of phenomenological psychopathology. The project leaders are Professor Matthew Broome and Professor Giovanni Stanghellini

Through this grant, we created a network of diverse international scholars from across disciplines and career stages. This was formed through awards (including international exchange fellowships, small grants, and knowledge exchange events). The aim of the project is to revitalize phenomenological psychopathology for the 21st century as a democratic discipline with a historicised and inclusive account of the experience of mental illness.

While we had made some significant headway in disrupting this field, more work needed to be done. For this reason, we sought to create a special issue on the theme of Renewing Phenomenological Psychopathology. Through this special issue, we ask: What is the future of phenomenological psychopathology? We invited contributors to shake up previously sedimented ideas in phenomenological psychopathology and reconstruct this vital phenomenological tradition. Due to the volume of high-quality submissions, the special issue was split into two parts. 

The first part focused on how phenomenological psychopathology can be applied in new ways to gain a deeper understanding of specific psychiatric conditions. One of the core achievements attributed to phenomenological psychopathology has been a richer understanding of an array of psychiatric experiences that had previously been limited to biological accounts. However, not only has our understanding of these conditions drastically transformed since the conception of phenomenological psychopathology in the early 1900s, but entirely new conditions have been recognised and defined. 

Section one of the special issue explores the following mental health conditions (or neurodiversities): Schizophrenia, Depression, Autism and Post-Traumatic Stress Disorder. The papers in the first section either challenge hitherto engrained ideas attached to a given condition or apply phenomenological psychopathology to conditions that have been overlooked by the discipline thus far. 

The second section of the special issue strives to revitalise the very methodology of phenomenological psychopathology. Although the vestiges of phenomenology can be found across disciplines, phenomenological psychopathology has done little to engage with fields outside of philosophy and psychiatry. Advances in disciplines such as anthropology, sociology, neuroscience, critical race theory, and linguistics offer exciting new opportunities which are missed by such a guarded approach.

The second section of the special issue coalesces around three key themes. The first theme involves addressing and ameliorating inequalities in phenomenological psychopathology. The second theme involves examining the role of value and virtue in phenomenological psychopathology. The third theme focuses on fusing phenomenological psychopathology with new approaches across disciplines. 

After a long period of obscurity, phenomenological psychopathology has re-emerged. A new focus on the patient’s voice has given the approach a valued place among once more dominant methodologies. The aim of this special issue is not to sever our roots. Rather, we hope to bring all that is fruitful in the tradition of phenomenological psychopathology into the present, opening it up to new possibilities.


Dr Lucienne Spencer is a Postdoctoral Researcher in Mental Health Ethics located within the Neuroscience, Ethics and Society (NEUROSEC) Team in the Department of Psychiatry, University of Oxford. Her research primarily focuses on phenomenology, epistemic injustice and the philosophy of psychiatry.


Wednesday, 19 March 2025

Playfulness for Justice in Chronic Pain Care

A field note that reads "how many squats/lunges can you do before you want to die? - laughter"
"How many squats/lunges can you do before you want to die?"


I suggest that we consider how to encourage playfulness in chronic pain care. Drawing on the framework provided by feminist philosopher Maria Lugones, I conceive of playfulness as an attitude, not an activity. Playfulness requires a) openness to co-creation and improvisation – a willingness to engage with others in a flexible and unscripted manner, b) openness to surprise – being receptive to unexpected outcomes and expressions, rather than striving for control of the situation, and c) openness to being a fool – rejecting perfectionism and expertise and allowing oneself to be vulnerable. Taken together, playfulness builds increased sensitivity to the world’s differences. Honing this attitude can safeguard against the injustices faced by people living with chronic pain.

Two common themes throughout the scholarship on pain are invisibility and un-shareability. The first, invisibility, refers to the idea that the pain of another is, in principle, inaccessible. The second, unshareability, refers to the challenges involved in expressing pain - bringing it out of concealment so that it might be accessed. These two themes are linked, and they create a lacuna, a lack of vocabulary with which to express and understand how chronic pain feels, what it does, and how it changes people’s lives. 

Medical paradigms and their associated technologies play a massive role in this perennial problem. Thus, these are examples of pathocentric epistemic injustice: injustices that are sustained by dominant medical systems and the theoretical conceptions of health that underpin them. Biomedical approaches to chronic pain mobilize a specific theoretical understanding of pain, and these understandings shape who is thought to be a credible speaker and what forms of expression and speech are intelligible. According to this framework, conceptions of health themselves can be unjust.  

While the field of pain studies has made progress in complicating narrow biomedical explanations of pain, as Patsavas (2014) notes, these communicative norms have yet to find their way into popular understandings of pain. For example, adjectives found on the McGill pain questionnaire, the most frequently used questionnaire for the multidimensional assessment of pain, have crept into the common lexicon. We may ask our friends to describe their pain with these familiar qualifiers, such as burning-, tingling-, or shooting-. We might also ask our friends to rate their pain on a scale of zero to ten, drawing on the Visual Analogue Scale used by medical professionals. 

But what if the person experiencing pain wants to describe their pain as a wave or a colour? What if I want to express my pain by making a long, guttural sound? In her creative non-fiction titled “The Pain Scale”, Eula Bliss reflects, “Although the distance between one and two is finite, it contains infinite fractions”. When patients are unable to express more than pain intensity, this may lead to guilt, shame, and alienation, all of which should be understood as affective determinants of health. That is, these emotional experiences can make one’s pain worse. Pain relief comes not only in the form of excising pain (should this be possible) but also in understanding it. There is thus a pressing need to carefully consider how we might expand, invent, and promote new modes of creative expression.


Field notes that read "You only get one jiggle - use it wisely.", "Laughing is important!!", "I know you know your body" and "You know your body way better than I ever will."
Field notes that capture participants' emphasis on laughter and play


My paper draws on fieldwork conducted at a somewhat unconventional chronic pain clinic located in Toronto, Canada. Instead of offering one-on-one interactions (between a ‘credible’ pain expert and ‘less-credible’ patient in pain), the clinic operated more as a support group. No pain was measured, and no medicines were prescribed. Instead, patients showed up to talk about how their pain was affecting them spiritually, physically, and existentially. They laughed, they opined, they meditated, and they moved around the room doing silly strength- and mobility-building exercises. 

At the beginning of my observations there, I was mesmerized by the playfulness and levitous mood of the clinic. Mastery was eschewed by the physician (Dr. C) – he frequently reminded participants that they, not him, were the masters of pain. From dark jokes to improvised seating arrangements to casual coffees afterward, this landscape marked a notable departure from biomedical contexts that contribute to pathocentric epistemic injustice in chronic pain care. I characterize MB clinic as imbued with the playful attitude described by Lugones, which is antithetical to the rigid and expert-driven models of healthcare.

This approach may serve as a potential reform that emphasizes patient participation and emotional well-being. In the future, I am interested in exploring how medical educators might encourage this sensibility in training, as well as how playfulness might be better incorporated into the tools that are used in diagnostic and therapeutic encounters. 

Michelle Charette is a PhD candidate in the Science and Technology Studies Program at York University. Her work draws on science studies, phenomenology, and feminist theory to consider how bodies and technologies interact. Her doctoral project examines e-health approaches to chronic pain care, and how these tools (games, applications, virtual reality) introduce novel issues and questions about chronic pain, technology, and ethics in medicine.


Wednesday, 12 March 2025

What is Public Engagement with Science?

Public Engagement with Science: Definingthe Project, coauthored by Melissa Jacquart and me, was published with Cambridge University Press in January 2025. This volume represents the culmination of years of Melissa’s and my efforts to explore the contours of what it is for academics to do public-facing work about science.

A man in a speech bubble explains nuclear physics to a woman in a speech bubble
Engaging the public in science: what does this look like?


Way back in 2017, I received initial approval from my institution, the University of Cincinnati (UC), to develop a Center for Public Engagement with Science. Melissa Jacquart, also a philosopher, soon joined me at UC to co-develop the center. Initially, a lot of the work was identifying patterns in how academic science—broadly construed to include natural and social sciences, as well as other STEM disciplines—interfaces with public life. 

And, while we were interested in engagement opportunities created by the internet, our main focus from the start was how academic science interfaces with the local communities its embedded in. We quickly realized that we want to conduct and support public engagement that is (1) participant-centered, (2) interdisciplinary, and (3) community partnered. So that is the basic recipe for the UC Center for Public Engagement with Science, or PEWS.

One of Melissa’s and my early activities was to host a 2021 workshop convening academics interested in public engagement with public engagement practitioners (supported by NSF Award SES-1946951). Videos of this workshop are available on the PEWS YouTube channel. This newly published Element is our first of two planned publications summarizing our learning from that workshop—and, really, our learning from our years spent laying the groundwork for PEWS.

I like thinking of our Element as a tour of resources for and important considerations bearing on attempts to engage with the public about scientific research. Many academics, including Melissa and me, find themselves wanting to use their academic skills to engage not just with other academics but with public audiences as well. This can be motivated by the desire to share scientific content, to encourage more connections with science, or even to shift scientific research priorities toward topics of public concern. We wanted to create a volume accessible to readers from a wide variety of backgrounds who want a window into getting started with public engagement with science.




In this Element, we consider how public engagement with science is defined and what aims it might have (section 1) and explore the wide range of academic disciplines with resources to offer public engagement with science (section 2). We then consider the aims and techniques of collaborating across disciplines and with practitioners on public engagement initiatives, and we consider university structures that can support public engagement (section 3). We outline a goal-directed approach for developing public engagement with science initiatives (section 4). Finally, we consider the variety of forms public engagement can take and how public engagement can feature in research and teaching efforts (section 5).

Cambridge University Press developed the Elements format of publication to be midway between an academic journal article and a full-length book. Elements come in thematic series, all sharing the same cover illustration, and all curated by a series editor (or coeditors). Our Element is actually the first in a new series, also edited by Melissa and me, Elements in Public Engagement with Science. Together with an interdisciplinary and international Editorial Board, we are commissioning Elements on topics like STEM learning ecosystems, citizen science, children’s engagement in science, indigenous science, and more.  You can learn more about the series at its website.

Public Engagement with Science: Defining the Project is available open access, here: https://doi.org/10.1017/9781009475105


Angela Potochnik is Professor of Philosophy, Head of the Philosophy Department, and Director of the Center for Public Engagement with Science at the University of Cincinnati.  She is the author of Idealization and the Aims of Science (2017) and Science and the Public (2024), as well as coauthor of Recipes for Science: An Introduction to Scientific Methods and Reasoning (2018, 2nd Ed. 2024) and Public Engagement with Science: Defining the Project (2025). She earned her PhD from Stanford University in 2007. 

Saturday, 8 March 2025

Endometriosis in Later Life: A Hidden Healthcare Inequality

In honour of International Women's Day, Elisabeth Langmann highlights the importance of talking about women's healthcare through an intersectional lens in discussing her recent open-access paper, co-authored with Anna-Christina Kainradl, Merle Weßel, and Alekszandra Rokvity, "Endometriosis in Later Life: An Intersectional Analysis from the Perspective of Epistemic Injustice":


Two women sit discussing health; images of breasts, the heart and uterus are on the wall in the background alluding to key health issues women face.

Endometriosis has long been framed as a disease of reproductive age – something that affects menstruating individuals and supposedly disappears with menopause. But what happens when these assumptions mean that suffering goes unnoticed, and necessary care is withheld? What happens when postmenopausal individuals continue to experience symptoms, yet the medical system fails to recognize or address their suffering?

In our recent paper, Endometriosis in Later Life: An Intersectional Analysis from the Perspective of Epistemic Injustice, we critically examine how sexism, ageism and epistemic injustice shape the experiences of postmenopausal individuals with endometriosis. 

We argue that the invisibility of endometriosis in later life is not just a gap in medical knowledge – it is a systemic injustice with real, harmful consequences.

Endometriosis is a chronic inflammatory condition affecting an estimated 10% of biological women. Despite its prevalence, it remains largely misunderstood. 

One of the most persistent myths is that endometriosis vanishes after menopause due to the decline in estrogen levels. This belief is deeply ingrained in both medical literature and public discourse. However, research shows that a significant number of individuals continue to experience symptoms well into perimenopause and beyond.

A generation of women dance together, from childhood into older age.

Yet major menopause guidelines, including those from the European Menopause and Andropause Society and the North American Menopause Society, fail to mention endometriosis – leaving postmenopausal individuals without recognition, research, or care. 

This silence has consequences: when healthcare professionals do not recognize endometriosis in postmenopausal individuals, symptoms are dismissed, misattributed to other conditions, or outright ignored.

Our research highlights how gender and age intersect to shape the marginalisation of older women with endometriosis. While gender bias in endometriosis diagnosis has been well-documented, where individuals are told that their pain is “normal” or “all in their head”, less attention has been given to how ageism compounds this issue, making older women more vulnerable to dismissal and misdiagnosis.

This erasure is reinforced by the perception that older women are unreliable sources of knowledge about their own bodies. Their reports of pain are dismissed not only because of long-standing biases about female pain, but also because of assumptions that postmenopausal individuals are no longer affected by reproductive health conditions. This results in testimonial injustice – where individuals are denied credibility due to prejudiced assumptions about their age and gender.

At the same time, the medical system lacks the necessary interpretive frameworks to recognize endometriosis in later life. When postmenopausal women seek medical care for pelvic pain or other symptoms, their experiences are often filtered through ageist and sexist biases. 

Instead of investigating endometriosis as a possible cause, healthcare providers may attribute symptoms to “normal ageing” or conditions unrelated to endometriosis. This is an example of hermeneutic injustice, where a lack of shared knowledge prevents individuals from making sense of and communicating their experiences.


Three women protest, one with a megaphone and another with a placard that reads "GIRL PWR"


Why This Matters: A Call for Change

The exclusion of postmenopausal individuals from endometriosis research, clinical guidelines, and public health discussions is more than an oversight, it is a structural injustice. As long as endometriosis remains framed as a disease of reproductive age, those who experience symptoms later in life will continue to be disbelieved, misdiagnosed, and left without adequate care. 

To address this, we argue for a lifespan approach to endometriosis, one that recognizes the possible persistence of the disease beyond reproductive age, integrates postmenopausal individuals into research, clinical guidelines, and public health policies, and challenges ageist and sexist biases in healthcare that shape medical knowledge and practice. 

Endometriosis does not end with menopause – but the belief that it does continues to shape who receives care and who is left suffering in silence. Thus, if endometriosis can last a lifetime, so should our commitment to recognizing, researching, and addressing it.

 

Elisabeth Langmann is a postdoctoral researcher in bioethics at the Institute of Ethics and History of Health in Society (IEHHS) at the University of Augsburg, Germany. Her research focuses on structural inequalities in health, particularly ageism, ableism, and the systemic exclusion of marginalised groups in healthcare. She is currently part of the DFG-funded project "Centring Marginalisation for Effective and Just Public Health Policy and Practice," examining how public health policies engage with marginalisation, whose experiences remain unrecognized, and what shifts are needed for more inclusive approaches. Rooted in feminist bioethics and social justice, her work explores how power, knowledge, and institutional biases shape health experiences.

Wednesday, 5 March 2025

Why agency is not compromised by delusional or conspiracy beliefs

This post is by EPIC investigator Lisa Bortolotti.


Young woman talking about the fact that she just saw a dinosaur

It may be surprising to realise how many researchers from various disciplines are interested in the relationship between clinical delusions and beliefs in conspiracy theories: on the surface, the former often have bizarre contents and signal a psychological disruption to the person's life that is often explained by a psychiatric diagnosis, whilst the latter seem to be deeply embedded in societal debates, are shared by groups (even by entire sub-cultures), and are not usually accompanied by distress.

In a recent paper, I argue that one thing they do have in common is how delusions and beliefs in a conspiracy theory are received. People who report delusional and conspiracy beliefs tend to be excluded from common epistemic projects. What do I mean by that?

Although there is a recognition that all speakers have a unique perspective and interests, and the capacity to pursue goals and make decisions, exploring delusional or conspiracy beliefs is not considered worthwhile. And it is considered a waste of time and resources to engage with people's goals and decisions of people when these are informed by delusional or conspiracy beliefs. That is because, in the eyes of the interpreters, those beliefs do not just happen to be false but undermine the confidence in the speakers' capacity to exercise their epistemic agency. 

But is this stance justified? I argue that it is not. It is a mistake to think that the presence of a belief that has some characteristics (e.g., a belief that we find implausible but that the speaker holds onto strenuously and identifies with) is sufficient reason to doubt the capacity of the speaker to exercise their agency. Rather, the endorsement of a delusional or conspiracy belief is usually a direct manifestation of the speaker's epistemic agency.

When do we endorse beliefs that are deemed delusional? When we have an unusual experience that demands an explanation. When we attempt to impose meaning on a confusing and distressing reality. When we need to manage overwhelming emotions to avoid an entire paralysis of agency. When we make sense of unexpected and distressing events. When we intend to show loyalty or affiliation to groups characterised by a certain ideology. When alternative explanations seem somehow unavailable or disempowering to us.


Two young women talking and smiling to each other


There are many reasons why people may endorse a belief that appears implausible to others and yet becomes important to how they see themselves and the world around them, to the point that it becomes difficult to give up the belief or recognise the strength of the evidence against it. But there is no good reason to think that the belief formation process or its outcome are themselves signs of irremediable irrationality or even of a pathology.

As I show in the paper, many of the cognitive biases and psychological needs that have been identified as antecedents of delusions and conspiracy theories characterise human belief formation more generally, though their influence can be heightened in some people due to background knowledge and reasoning style, or to their experience of adverse and stressful circumstances.

What does this have to do with epistemic injustice, you may ask. I think it is at the core of it. Epistemic justice is not achieved when people believe each other's testimonies uncritically or accept that all hermeneutical resources are equally good. Rather, epistemic justice is achieved when all epistemic agents are treated as such, and not as broken records, puppets or sheep: their views are not dismissed before being explored, but they are listened to with interest and curiosity. Agreement is not the goal, engagement is. 


Wednesday, 26 February 2025

How Psychiatrists Navigate the Complexities of Diagnostic Reasoning

 

A man sits in an armchair talking to his therapist.

With mental health problems being more openly discussed in public, and individuals with mental health issues becoming an increasingly important and sometimes critical voice in mental health care, the way psychiatrists practice their craft has also become an object of deeper interest for a broader audience. One central aspect of psychiatric practice is diagnostic reasoning. 

When you visit a psychiatrist because you are suffering, you expect them, among other things, to determine whether you suffer from a mental disorder and, if so, which one. While it's crucial to recognize that this is part of a psychiatrist's job description, what is not trivial is the further question: how exactly does a psychiatrist arrive at the diagnostic conclusions they write in their reports and communicate to their patients? How does the psychiatrist know what the patient’s mental disorder is?

A swift response that someone at least vaguely familiar with psychiatry might give is, “Well, they ask the patients for their symptoms and compare these to the list of mental disorders in the DSM/ICD, which tells them what the diagnosis is,” or something along those lines. Though tempting to close the matter here, it is not that easy. Criteria and symptom lists do not apply themselves to patients; it has to be judged whether they apply to the patient. Furthermore, patients are imperfect sources of information. Imperfect in the sense that they will not automatically and correctly tell you all their symptoms, and sometimes they may claim to have symptoms but misjudge their problems. 

For example, some patients think it is normal to be socially isolated as they have been so for many years, so they will not mention social isolation as one of their problems. On the other hand, patients may say they ruminate about something, while the pattern of cognition that constitutes their “rumination” is more accurately classified as generalized worrying, in the language of psychopathology. These cases show that the process of psychiatric diagnostic reasoning implies more complicated patterns of reasoning and information gathering. A truism for any clinician supporting this is: You can't just pick up a DSM and be good at diagnostics; diagnosing is a skill to learn.


A man points to a book (and the book is blank!)
Just picking up the DSM isn't enough; diagnosing is a skill!


If this is so, how does proper psychiatric diagnostic reasoning work? Not many philosophers of psychiatry have attempted to provide a theory of this practical aspect of the epistemology of psychiatry. Some work can be found among scholars committed to the Phenomenological Tradition of psychiatry, some in the works of those focusing on the interpersonal quasi-hermeneutic sense-making processes between clinicians and patients, and finally, some thoughts are to be found among philosophers of psychiatry approaching the field from the perspective of philosophy of science.

In my recent book “How Does The Psychiatrist Know?”, the first book-length treatment of psychiatric diagnostic reasoning, I side with those approaching it from a philosophy of science perspective. I argue we should consider how the procedures of clinical psychiatric diagnostics typically look, i.e., what is taught in many of the central textbooks on psychiatric diagnostics and the standards of the leading psychiatric expert communities. Based on this, psychiatric diagnostic reasoning can largely be seen as a cognitive modelling process, quite similar to the procedures we see in scientific modelling.

For clinicians, philosophers, and anyone else willing to dig through an academic textbook to get an idea of the whole story I put forward, the book is available open access.

 

Adrian Kind is a postdoctoral researcher at the Charité Medical University in Berlin, Germany. He holds a PhD in Philosophy and master degrees in Philosophy as well as Psychology. He is a psychodynamic psychotherapist in advanced training. His main areas of interests are philosophy of psychiatry, philosophy of psychology and philosophy of medicine. He also works on philosophy of sports and philosophy of religion.

Wednesday, 19 February 2025

Workshop report: Feeling and Being Understood (Day 2)

 On the 6th and 7th of February, EPIC project members Lisa Bortolotti and Jodie Russell spoke at the conference "Feeling and Being Understood" which was organised by the Phenomenology of Health and Relationships (PHaR) group at Aston University and took place over two days. 

You can read about the first day here.

The second day involved a series of talks on delegates' work in order to stimulate further discussion and thought along the themes of the previous day.



The first event was a lively workshop, led by Charlie Gunn (Aston University), that participants could really sink their teeth into, titled “A better recipe: collaborative, accessible study design and participant information through the use of edible and creative methodologies when working with vulnerable participants”. Delegates were invited to use a range of edible materials, including iced biscuits, fudge, icing sugar and food colouring, in order to construct a response to the prompt “What does good workplace mental health support look like?” 

In this process, we got first-hand experience of working with an accessible experience-making activity designed by Charlie to find that ‘sweet spot’ of a research method that encourages communication with vulnerable adults. Charlie also introduced us to the participant information sheets she created for the project with accessibility in mind. You can see them here and learn more about the project here.


"Eyes are windows to the soul": inspired by the concept of 'sonder' one group interpreted good workplace mental health as acknowledging that everyone has a rich inner life.


This workshop was followed by the first talk of the day, titled “The use of creative prompts to support an IPA interview”. Speaker Laura Martin (Sheffield Hallam University) led us through her work with probation officers, highlighting how it is a job with complex associations attached to it. For example, Laura described how probation is often thought of as “dirty work”, and for one participant her decision to become a probation officer was highly disruptive to family dynamics. This raises the question of why people train to become probation officers in the first place. 

In order to investigate and capture the journeys to this profession, Laura introduced us to the life map exercise where participants would trace their journey to becoming probation officers. The maps themselves were constructed in diverse ways, reflecting a diversity of narratives.

The third talk of the day was given by Valeria Motta (University of Birmingham) and titled “From participant to co-researcher: Navigating different levels of knowledge production with young people”. Valeria described her work within the ASP Belong Project, which focuses on using augmented reality through smartphones to help young people strengthen their sense of belonging. 

In conducting this research, she noted that the way we conceptualise ‘vulnerability’ has important consequences for framing research questions, as it can imply that an individual is inherently vulnerable regardless of policy change. 

However, Valeria argues that this obscures the role of systems, institutions and elites in effecting someone’s vulnerability, and, ultimately, their health. From this, Valeria aims, in her first study, to investigate experiences of belonging in young people with an integrative and functional account of vulnerability. 

Valeria then plans to undertake a co-researched study with young people to find the best arts-based methods for eliciting, expressing, and communicating vulnerable experiences. Both of these studies, she notes, involve different ways of working with young people.

Jess Webster (Aston University) led the fourth talk, titled “From Lego-balancing to Information Sharing – how do you make the jump?” Jess notes that early intervention for mental health is sorely needed, especially in the case of young people and children. 

To this end, a series of protective factors were introduced to pupils in schools to investigate which were the most important and effective, and therefore which ones could be implemented. Pupils were given Lego, a set of scales, ‘daily stressors’ and ‘protective factors’. 

Pupils then used these to represent how they felt a particular protective factor would mitigate (or balance) the stressors. For example, “self-kindness” and “school connectedness” where two such factors said to be effective by pupils. This information could then, Jess says, be turned into a PSHE lesson with a take-away tool kit. Conference delegates where then invited to participate in an activity practicing self-kindness, which involved decorating a hand with affirmations.



Ainhoa Rodriguez-Muguruza (University of the Basque Country) then presented on her research in collaboration with Arantza Etxeberria-Agiriano (University of the Basque Country) on “The Concept of “Relational Health”: How menstruating bodies are key for understanding health”. Ainhoa argues that women’s health is been neglected in medicine, in part, due to structural gender biases in science at large. 

Moreover, as medicine has become more specialised, the body has increasingly been conceptually carved up by function; menstruation is then relegated to the ‘reproductive function’, which is seen as just a woman’s problem. This then treats menstruation in isolation of other functions of the body. 

However, as Ainhoa highlights, the body cannot be understood in a a static and isolated way; menstruating bodies not only get sick differently, but they also react differently to drugs and treatments. In their work, Ainhoa and Arantza argue that a concept of health is needed to capture the dynamic nature of menstruating bodies, i.e. how bodies can change over the cycle of month and a lifetime. They refer to this notion of health as “dynamic, differential and relational”.

Jo Billington (Reading University) and Shioma-Lei Craythorne (Aston University) followed up a second zine-making session over lunch with their talk “Adapting IPA to work inclusively with diverse ways of being”. Jo led the delegates in a discussion on what “diverse ways of being” could mean, noting that while diversity exists in abundance in nature, academia itself lacks diversity. 

This discussion was based on the speakers’ recently submitted paper “Toward epistemic justice: using a multimodal Interpretative Phenomenological Analysis methodological approach in research with autistic children”. 

Jo and Shioma-Lei note in this paper that the double empathy problem – the idea that autistic and non-autistic individuals experience with world in very different ways – can be a useful lens for approaching research with autistic people. 

They note a resonance with the concept of the ‘double hermeneutic’ in IPA, where the investigator is trying to make sense of the participant’s account, which is itself the participant trying to make sense of their own experience. 

Following this, Jo led us to reflect on what adaptations we might need to make to facilitate this investigation and described to us her own experience of an interview with one of her participants which was able to continue successfully over email after problems communicating in person.

Joanna Farr (Birbeck University) introduced us to her research which explored the everyday experiences of adolescent girls in her talk, “Understanding young people’s everyday experiences using mobile phone video diaries, film and IPA”. Joanna asked participants to report their daily reflections using video diaries captured on their mobile phones. She noted that that this captured spontaneous, familiar and temporal experiences for rich data, but, importantly, it also gave participants a greater sense of choice and control as to what they shared. 

This method made the experiences of adolescent girls more accessible but were coupled with qualitative interviews in order to further explore the participant’s emotional experiences. Participants were also invited to a workshop where they were given their diaries back and taught to edit complications of them into longer videos.


Michael Larkin's "monster manual" for challenges in qualitative research


In the last block of afternoon sessions, Michael Larkin (Aston University) set to outline a unifying set of key challenges we face as qualitative researchers in his talk, “Attunement and Perspective through Collaboration: finding an ethical and just way forward for phenomenologically-informed qualitative research in psychology”

Drawing on the tropes of table-top roleplaying games like Dungeons & Dragons, Michael argues that we can understand these challenges to be like tests as we undertake the quest of our research, like gateways to other realms of knowledge, or like side quests that distract us from our main objective. 

Michael then reframes these challenges as classic D&D monsters; for example, the Rigour Zombie represents those individuals who police discourse about what counts as science. Rigour zombies are dangerous in that they can push the quest off course, and as adventurers we can become unhelpfully preoccupied with monsters that ultimately can’t do much harm. 

To keep on the right path, however, we need only rely on the equipment we already have in our trusty bag-of-holding, i.e., our skills in attunement, collaboration, and perspective taking.

Sally Latham (Open University) followed with a discussion of the problem of self-deception in her talk, “Narrative therapy and the falsehood objection”. Sally notes that Narrative Therapy is built on the premise that stories influence identity and life opportunities, and so to combat a self-narrative about the individual’s deficiencies and problems Narrative Therapy seeks to identify unique events that challenge that narrative. 

However, Sally argues that there is a risk of self-deception; the individual receiving the therapeutic treatment might develop false memories or the therapeutic process might misleadingly (or falsely) imply that the event they are pointing to generalises to the rest of someone’s life. Sally argues this is unethical because it violates autonomy; you cannot fully consent to being deceived. Because of this, it wouldn’t be sufficient to merely disclose that false memories and false implied generalisations are possible with Narrative Therapy. A different solution is needed.

Lastly, Jodie Russell (University of Birmingham), postdoc in project EPIC, closed the day with her talk, “Intersectional invisibility and its impact on belongingness and being understood”. Her goal was to give a phenomenological account of “intersectional invisibility” and discuss its implications for qualitative research. Intersectional invisibility refers to when a person has multiple group identities and belonging to one group renders them ‘invisible’ with respect to some of the social structures that affect other groups. 

For example, men who experience mental disorder may be rendered invisible because of patriarchal expectations about what constitutes the group ‘men’; this may not include men who show vulnerability or emotion, which might be typical for people with mental disorder. 

These men may then be invisible with respect to the group ‘men’, but they might not be seen as fully fledged members of the group ‘people with mental disorder’ either as they may still hold some patriarchal norms and values not typically shared by the rest of the group. 

Intersectionally invisible groups, like men with mental disorder, might not then be able to participate in group activities, like generating and sharing knowledge for self-understanding, simply because the norms of one group may conflict with the norms of another.

Wednesday, 12 February 2025

Workshop report: Feeling and Being Understood (Day 1)


Last week, EPIC project members Lisa Bortolotti and Jodie Russell spoke at the conference "Feeling and Being Understood" which was organised by the Phenomenology of Health and Relationships (PHaR) group at Aston University and took place over two days. 

The first day was filled with a number of inspiring workshops to introduce attendees to new methodologies in health research, new ways of working and new ideas to consider in our projects. Here is a brief summary of each talk, including links to further information.

Workshop 1, titled “Dialogical Co-analysis: a new methodology for conducting qualitative analysis with young people as co-researchers” was presented by Michael Larkin (Aston University), Rachel Temple (McPin Foundation), and the Agency-in-Practice team, including members of the Young People Advisory Group (YPAG). The speakers described their experience as part of the Agency-in-Practice Project, which is made up of an interdisciplinary team of researchers as well as young people with lived experience of mental disorder. 

This project started as a collaboration between young people and researchers to analyse transcripts and videos of interview participants that blossomed into a methodology for co-analysing research. Members of the YPAG described their input into the methodology, for example, by calling out unhelpful jargon, and the creation of a space where everyone can be heard. Rachel Temple also emphasised the importance of agency, which inspired the project, and the necessity to balance this with safety by, for example, signposting, debriefing and taking breaks. Rachel also notes that this is important for both the young people involved and for the academics too. You can read more about the project here.

Workshop 2, titled “Photovoice, with and without the voice: combining collaging, phenomenology and photographs”, was led by Will Day (Aston University). In this workshop, Will introduced delegates to the photovoice methodology, showing us how he used such a method himself in the development of his PhD project which focused on the lived experience of those with invisible chronic illnesses. He noted that, in the context of welfare reforms, these individuals faced significant stigma and were not often discussed in the psychological literature. 

Will sought to capture the day-to-day lived experience of this group during the pandemic by asking participants to take and submit photos that represent their days. Each photo was then analysed using Boden & Eatough’s (2014) framework for analysing drawings, generating an individual analysis for every photo. The photos were also cut up and collaged to group them by mood, generating group experiential themes. It is in this way that photo voice is embedded into Interpretative Phenomenological Analysis (a qualitative research method) for a rich discussion of the participants lives.


Our thematised statements from workshop 3


Workshop 3 developed and expanded on the use of the photograph in qualitative research. In their talk, “Polyphonic Photo Analysis in phenomenological research”, speakers ‪Mikołaj Zarzycki (Liverpool Hope University), Shioma-Lei Craythorne (Aston University) and Kisane Prutton (Derby University) walked us through their new methodology for analysing photographs. The speakers note that photos are usually used to elicit verbal data but with Polyphonic Photo Analysis it becomes possible to analyse the photos themselves. Inspired by Dostoevsky, the method involves being open to multiple perspectives at the same time. Using photos collected for Kisane’s PhD project on experience of peacebuilding for women in Northern Ireland, the conference delegates were split into roughly 3 groups, each attempting a stage at the analysis. 

Group 1 focused on the first stage: observing the visual features of the photo, including its composition, colour, and framing. Group 2 focused on the next stage, which involved interpreting the photo from the research perspective (i.e. an outsider perspective) to look for possible meanings in the photo without the context of the participant. Group 3 then took on the analysis state which involved interpreting the photo alongside the participant’s narrative to explore further features of the participant’s lifeworld. The last stage, completed by the speakers themselves, involved taking the statements we made in the analysis process and synthesising them (see photo above).

During the lunchbreak, Julie Kane (Aston University) lead a pop-up workshop on “Exploring sense of belonging through zine making” where Julie talked us through some of the history of zines, introduced to some beautiful examples and gave us free rein to create our own!


A range of colourful zines from which to draw inspiration!


Workshop 5 was delivered by Lisa Bortolotti on her work with the Agency Project and EPIC, co-authored with Rose McCabe. In her talk Epistemic injustice, agency, and youth mental health, Lisa argued that when responsibility is associated with blame, blame can damage the relationship between the patient and their healthcare provider, undermining knowledge exchange and mutual trust. As agency can be threatened by a number of environmental factors and factors outside our control, we never have full responsibility for an event .

Drawing on the work of Brandenburg (2018), Lisa argues that in the therapeutic context responsibility should be replaced by the affirmation of the person's capacity to contribute to change. This is important because it reduces the risk of burdening young people experiencing a mental health crisis with responsibility for past events and implying that they are to be blamed. For more information on enhancing the agency of young people in mental health, see the post on the McPin blog here.

Workshop 6 introduced us to a narrative development of Interpretative Phenomenological Analysis (IPA). Nathan Thomas (University College London) led this talk, titled “Understanding Experience using a Narrative Variation of Interpretative Phenomenological Analysis (NIPA)”, which took us through the adapted steps to generate a narrative analysis of a qualitative interview. Nathan’s account draws on both narrative and hermeneutic phenomenology (as developed from Paul Ricœur) which looks at experience as it presents itself in a narrative text (in this case, an interview transcript). 

Narrative gives our experience a kind of order, and so when we analyse narrative we also analyse an aspect of experience itself. So in Nathan’s narrative variant of IPA, the narrative structure needs to be maintained. To do this, instead of breaking down the order of a participant’s account to group statements into themes (as is done in IPA), Nathan suggests developing a narrative description of the account. This should read as if the participant were telling their story, capturing the essence of the interview and amplifying key information. Participants can also be involved in the process to give them the chance to craft their story. The resulting narrative replaces the transcript in the rest of the analysis, informing the themes which are compared and contrasted with other participants.


A floorplan of where medication is kept in the home


The last workshop of the day was a powerful discussion lead by Zoë Boden-Stuart (Open University) titled “Medications and care: a reflexive workshop exploring embodiment, spatiality and meaning”. In this workshop, delegates were invited to participate in three creative exercises. For the first, we drew floorplans of our living spaces, noting where in our homes we kept medications and the factors that have led to them being there. In discussion, we noted many similarities and differences in locations as well as the implicit reasons that go behind choosing these places. In the second exercise, we chose a medication box from a selection, reflected on some of the phenomenal features of the box (e.g. its texture, weight, size) as well as its meanings to us. This culminated in the third exercise where we reflected on a situation in which we were to give these medications to someone else.

Wednesday, 5 February 2025

Psychiatry as mind-shaping

 In this post, project EPIC postdoc Jodie Russell summarises her recent paper “Psychiatry as Mind-shaping”, published in Erkenntnis:


A man looks wistfully into an empty fridge

I make the case that researchers in mental health, clinicians and the wider public participate in a process called mind-shaping. By highlighting the involvement of these individuals in shaping the minds of people with disordered experiences, we can better understand phenomena like looping effects (when the behaviour of the person being labelled changes in response to that label, which in turn changes the meaning of the label). Moreover, characterising psychiatry as mind-shaping also helps us understand harms like epistemic injustice in a new light. But, first, let me unpack what I mean by psychiatry as mind-shaping.

Mind-shaping is a particular theory of social cognition – the study of how we understand each other. In contrast to traditional theories of social cognition, where we try to ‘read’ the minds of other people, the mind-shaping thesis proposes that understanding occurs through trying to get another person to conform to some set of shared rules. For example, I understand that my partner is hungry because their behaviour conforms to certain norms of being a ‘hungry person’, i.e., they rub their stomach, look wistfully at the kitchen, or graze on near-by biscuits. In this example, I try to understand what ‘type’ of person my partner is trying to be, assuming their behaviour conforms to some norms of that ‘type’ that I also adhere to.

In this way, I argue that researchers and clinicians are trying to understand what kinds of people individuals with disordered experiences are. In other words, clinicians and researchers might try and understand whether someone is a ‘well’ or ‘unwell’ person, a person with schizophrenia, or a person with a brain disease etc.

However, under the mind-shaping view, this process of categorizing people comes with certain expectations; in order for social understanding to be successful, it may be necessary to conform to certain norms. For example, for my partner and I to successfully coordinate over our shared task of making food for dinner, I really need to know that my partner is hungry. If they act hungry when they aren’t, we’ll make food for no reason. If they don’t act hungry when they are, my partner starves (if they are feeling melodramatic). Either way, if my partner is unreliable in conforming to norms, it makes working together to make dinner more difficult, and communication in general might struggle if they are not in some way reliable. There are therefore certain expectations at play in social understanding; if you are a hungry person, you should act like it. This is what it means to be mind-shaped.

A silhouette of a head and brain, and the brain is covered in simple shapes

This has, however, some unintended consequences when it comes to mental health research, namely, that individuals with mental disorder who are labelled may be prone to particular “expectancy effects”. In other words, by being labelled or studied in a particular way, as a particular kind of person, people with mental disorder may be obligated to act in certain ways. One such case study of this can be seen in a study conducted by Örmonet al. (2014). They noticed that the women in their study who had experienced abuse did not often have their experiences validated by clinicians, with their history of abuse considered irrelevant to diagnosis, and thus the women did not receive what they felt was the appropriate care. As such, the women responded to this treatment by changing their behaviour to conform to particular disorder categories that were seen as worthy of care (such as bipolar disorder). In this case, I argue that the women conformed to norms of being mentally unwell that clinicians typically expected to find; by understanding their patients as unwell, the clinicians were then able to provide some kind of care for these women. In this way, both the patients and clinicians were mind-shaped in order to coordinate on some goal (getting care for the women).

The consequences of this particular case study, however, was that the struggle of the women to have their abuse acknowledged was then interpreted by clinical staff through the lens of mental illness. This struggle was then either a mental health problem or secondary to the mental health problem. It is in this way that I think we should pay closer attention to the effects of mind-shaping, and how it may perpetuate epistemic injustices. Given that a core part of social understanding is the expectation we conform to shared norms, we may not only present very narrow options to individuals with mental disorder if they want to be understood by others (e.g. through the lens of specific disorder categories that may or may not fit their experiences), we may also exclude as irrelevant, or un-understandable, those behaviours, thoughts and feelings, which don’t fit our expectations but that are nevertheless important to the individual in question. The solution, I would want to propose, is giving people with mental disorder more agency to determine what norms are in play so that they might be better understood on their own terms.