Who knows what in mental health? The conference (part two)

This is a brief report of some of the talks presented on the second day of the conference on expertise in mental health hosted by Radboud University. If you want to know what happened on day one, please check out this post.

Nijmegen

I started the programme with a talk on the relationship between epistemic injustice and expertise. One way of making sense of an expert agent is to think of them as agents who can provide evidence on the basis of which other agents form judgements and make decisions. I distinguished three ways in which we can see other agents as a source of evidence: (1) they offer an insight into their feelings and thoughts; (2) they acquired a competence by using knowledge obtained via training or education; (3) the acquired a competence by using knowledge obtained via another type of experience, such as work experience or an experience of illness. 

Slide from Lisa Bortolotti's presentation

All forms of expertise are afforded and perspectival, as they depend not only on the competence of the agent, but also the opportunity the agent has been afforded to share their perspective or reflect on their experience in the surrounding environment, and the values of the agents who seek evidence. Epistemically unjust practices can prevent agents from making an epistemic contribution as experts, offering some examples from recent research in youth mental health.

Next, work on lived experience by Owen Chevalier, Shannon Mahony, Anne Marie Gagné Julien, and Sarah Arnaud was presented in the context of anorexia nervosa. The presentation supported the epistemic argument that participatory research produces more objective, accurate, and rich knowledge about mental disorders; and offered preliminary suggestions for developing a participatory method in the philosophy of psychiatry (research needs to be collaborative, patient-directed, and interactive). By reviewing the literature on anorexia nervosa, Mahony and Chevalier provided evidence for the epistemic value of participatory research. 

Presentation on anorexia by Chevalier and Mahony

First-person accounts of anorexia highlight the epistemic tension between traditional researcher perspectives of the disorder and patient perspectives to identify areas where a participatory philosophy may be useful in resolving conflict. However, one concern was raised: philosophers, who often advocates for participatory research in psychiatry, have yet to adopt participatory methodology in philosophy as well.

The topic of anorexia was also discussed by Stephen Gadsby who focused on what it might mean to identify as anorexic. Questions about self-identification might change across time: initially a person may identify as someone who values and pursues thinness and only later they may see themselves as someone who has anorexia. Occasionally, in biographies about living with anorexia, the illness is separated by the self and personified. Maybe conflicts of identity are prompted by the illness itself. But this turns out to be also a treatment strategy, where users of service are encouraged to see their illness as distinct from the self ("There is the anorexia inside me and then there is the real me, the logical part of me").

Stephen Gadsby on first person accounts of anorexia

So one issue is how to interpret these reports. And this becomes a problem when lived experience advisors participate in research as there is self-selection: it is more likely that participation is offered when the person sees themselves as an anorexic and a person with a mental illness. People who don't see their condition as an illness or do not accept the way anorexia is framed in healthcare are less willing to participate in research which leaves us with skewed evidence. It is difficult to solve this problem and participatory research may be the way forward.

The last talk of the day (and of the conference) was by Ian James Kidd. The research question was what role epistemic injustice should have in efforts to understand negative epistemic experiences typical of depression. Kidd decided to focus on hermeneutical injustice which can be described as a lack of hermeneutical resources, an absence of apt resources, the presence of of inapt resources, and a lack of uptake. Sometimes, the resources don't exist. At other times, there are no good institutional or interpersonal places where the hermeneutic game can be played. Hermeneutical injustice can be extended or limited in breadth or depth.

Ian James Kidd

Depression experiences present hermeneutical disruption but should those be characterised in terms of hermeneutical injustice? Some of the hermeneutical frustration and inability related to depression might be integral to certain kinds of human experience and not cases of injustice as such. For phenomenologists, experience is a space for possibilities which for people with depression is altered so that possibilities and kinds of significance are reduced and the world becomes flat and empty. Depression might come with loss of self-esteem and epistemic self-trust, diminished positive epistemic emotion, and loss of aspirational hope. Standard epistemic injustice models do not accommodate these existential changes, this (as Kidd put it) "phenomenological drama".

The second day of the conference was as stimulating and varied as the first, and it inspired interesting conversations about future research goals and collaborations.