Episodicity, Mental Illness and Epistemic Injustice

In today's post, Dr Sally Latham summarises for us a chapter in her recently defended PhD thesis on narratives of the self, mental illness and epistemic injustice:

Self-narratives, especially in illness, have become a social expectation. However the assumption that being narrative is the normal, psychologically healthy human condition, and regarding non-narrative experience as somehow deficient, risks epistemic injustice.

I identify several forms of philosophical narrativism, the position that self-narratives are necessary for some individual good. One of these positions is metaphysical narrativism, the view that having self-narratives is necessary for an individual to have personal identity (for example see Antony Rudd and Marya Schechtman). I argue that metaphysical narrativism underpins the psychological position that not being narrative is symptomatic of mental illness.

Episodic Experience 

Galen Strawson first introduced the concept of episodicity, when rejecting what he calls Psychological Narrativity, which is the empirical claim ‘that human beings typically see or live or experience their lives as a narrative or story of some sort, or at least as a collection of stories’.

Strawson makes a distinction between an episodic and diachronic sense of self. A diachronic self-experience is an experience of oneself as ‘something that has relatively long-term diachronic continuity, something that persists over a long stretch of time, perhaps for life’. An episodic, in contrast ‘has little or no sense that the self that one is was there in the (further) past and will be there in the (further) future, although one is perfectly well aware that one has long-term continuity considered as a whole human being.’ Strawson counts himself amongst episodics, and claims others include Bob Dylan, Iris Murdoch and AJ Ayer. Importantly, as episodics lack an extended sense of self, they will not be narrative, meaning they will not experience events narratively, or understand them as part of an extended life-story.

The existence of non-pathological episodics with personal identity, as Strawson claims he has, undermines metaphysical narrativism.

Counterargument to Strawson: Episodicity as Pathological 

In response, Mackenzie and Poltera (2010) argue that a truly episodic experience is always harmful, and precludes personal identity. They refer to the biography of Elyn Saks, The Centre Cannot Hold, in which she documents her struggles with a lack of identity and with alienation when suffering with schizophrenia. Her experience is one of randomness and disorder, rather than temporality and unity, and lacks a concept of ‘me’.

MacKenzie and Poltera claim that ‘this theme resonates with narrative approaches to identity’ and that Strawson’s own experience is not genuinely episodic. Rather, ‘the case of Saks shows what genuinely episodic self-experience is like and why it is identity-undermining’.

Episodicity and Epistemic Injustice

This dismissal of accounts of non-pathological episodicity can be understood as either testimonial or hermeneutical injustice. Testimonial injustice occurs when prejudice causes a hearer to give a deflated level of credibility to a speaker’s word, with prejudice in the economy of credibility (Fricker 2007). It is assumed that the episodic experience of self precludes personal identity, and must be pathological. Therefore the testimony of an episodic claiming personal identity and no mental distress is dismissed as being wrong about either their episodicity or their personal identity and mental wellbeing.

The irony is that narrative movement in healthcare aims to give the ill a voice. Yet here a testimony is dismissed as inauthentic because it has been predefined as impossible. The episodic faces a catch-22: if you are really an episodic, this is pathological and you do not have personal identity, but if you are mentally well and have personal identity you are not really an episodic. Either Mackenzie and Poltera are claiming that Strawson is fundamentally mistaken about his own experience, or they are redefining episodicity as identity-undermining, which begs the question.

This situation could also reveal hermeneutical injustice, which occurs at a prior stage, when a gap in collective resources puts someone at an unfair disadvantage when it comes to making sense of their social experiences. Narrativism is so dominant that we have failed to develop the resources for understanding non-narrative, episodic accounts of experience and identity as coherent and non-pathological. Many episodics are operating without Strawson’s hermeneutical toolbox for understanding episodic experience. In narratively dominant environments their experiences are not comprehended, leaving them misunderstood by others and even themselves.

Unless we recognise different experiences of the self (or lack thereof) as the starting point for approaching mental wellbeing, we risk seeing episodicity as illness instead of thinking about what episodic wellbeing and illness might look like, and this could have far-reaching and damaging implications.

Sally Latham is a Visiting Academic at the Open University and Research Assistant at the University of Birmingham. She recently defended her thesis in which she argues against the dominant narrative approach to mental illness, arguing that in many cases a non-narrative, Buddhist-inspired approach is preferable.