Narrative Deference

This blog post is a write-up of a paper by project postdoc Ellie Byrne which was published in Topoi in September as part of a special issue entitled Scaffolding Bad: Varieties of Situated Cognitive Harm edited by David Spurrett, Giovanna Colombetti and John Sutton. 

When I worked on the project Grief: A Study of Human Emotional Experience (PI Matthew Ratcliffe) at York, we obtained hundreds of first-person testimonies from grieving people about their experiences. I think regularly about some of the things people wrote, but there’s one in particular I keep coming back to: “My childhood is now only remembered by me. I’m an only child. So that time seems completely inaccessible.” (#208)

To me, this quote drew attention to the extent to which having other people available to corroborate our memories influences how we understand ourselves. We do this all the time and all throughout our lives: we might ask our parents to corroborate some significant childhood experience of ours, or ask a sibling to confirm that we’ve remembered something correctly. Later in life, we may ask a friend to corroborate how we remember coping with a breakup or our partner to remind us of a certain order of events in a particularly busy period.

We also enlist others to fill in the gaps for things we do not remember well. We might not really remember much at all about these experiences; perhaps just diffuse ‘feelings’ associated with certain events. In such cases, we might end up pretty reliant on our friends, family and partners to tell us what happened, how we felt about what happened and how those feelings have shaped who we are today.

According to the philosopher Richard Heersmink, autobiographical memories are the building blocks of our autobiographical self-narratives. Heersmink, situating some of his work within the field of ‘distributed cognition’, has emphasised that since our memories are distributed between people, it makes sense to say that our self-narratives are too. In my paper, I followed Heersmink in drawing attention to the extent to which we can rely on others for our autobiographical self-narratives, and the ways that this can be both good and bad for us. My paper introduces a concept which I call ‘narrative deference’, defined as the phenomenon whereby one is more dependent upon another person for central aspects of one’s autobiographical self-narrative than on oneself.

As I started to present this idea at conferences and workshops, there was a consistent theme in Q&A discussions: each time, multiple people in the audience had thought of contexts in which this phenomenon is harmful. This led me to think about the phenomenon in terms of another one of my research interests: affective injustice.

Affective injustice scholar Shiloh Whitney connects affective injustice to a distinctively affective form of gaslighting, the phenomena whereby casting doubt on someone is the means through which they are made to doubt themselves: “in gaslighting, the way others respond to me begins to impair an aspect of my relationship to myself. In particular, the noncooperative response I receive from some second person(s) when I express my experiences to them begins to impair some aspect of my ability to make sense of my own experience to myself in the first person” (Whitney 2023, pp.31–32). 

Understood this way, we can see how the affective influence others have on us can be used to undermine our self-trust over time such that our autobiographical self-narrative possibilities are restricted. While gaslighting is primarily discussed in the context of romantic relationships, it is being increasingly recognised how gaslighting can also occur in healthcare settings.

In a variety of contexts, an ill person might narratively defer to another because it presents itself as the best immediate option. Perhaps narratively deferring to my parents allows me to maintain a coherent or desirable autobiographical self-narrative. Perhaps deferring to my doctor allows me to make sense of an otherwise overwhelming and confusing situation. Perhaps deferring to my partner prevents conflict and maintains my bond with the person who cares for me. This deference can surely help me to secure lots of things that are good for me, but my most fundamental sense of self is also made vulnerable by it.

I think there is a lot of interesting and important future work to be done in exploring how this phenomenon operates in both epistemic and affective injustices in healthcare.

Eleanor Byrne

Eleanor is a postdoctoral research fellow at the University of Birmingham and part of Project EPIC. She specialises in affective and existential dimensions of illness experiences, particularly Functional Neurological Disorders. She has worked on grief in illness and experiences of post-viral fatigue such as Long Covid. She is currently developing a project on phenomenology and functional seizures. 

Eleanor Byrne joins EPIC!

Eleanor Byrne will join project EPIC in 2024 as a research fellow in the Philosophy Department at the University of Birmingham. Here she tells us about her research and her interest in epistemic injustice.

Ellie Byrne

Hi Ellie! What are your main research interests?

Hi! I’m a philosopher working mainly in the philosophy of medicine and psychiatry. Within this, I focus primarily on the emotions and the types of medical conditions where there appear to be strong affective components that are not very well understood. 

My PhD focused on fatigue syndromes, and my first postdoc in Sweden focused on Long Covid. I have since been working a little bit on non-epileptic seizures. This understanding gap about the affective lives of patients relates to a host of scientific and social issues which I seek to unpick philosophically. 

Often with tools from phenomenology and the enactivist tradition under my arm, I try to develop a more complex and dynamic framework for understanding the emotions in medicine. My first explicit attempt at that can be found here. I also do a little bit of work on grief, emotion regulation and narrative.

Why do you think it is important to study epistemic injustice in healthcare?

A consistent theme in my own research is how lack of understanding about the emotions in illness causes a significant epistemic burden for patients. For instance, Long Covid patients with anxiety and depression symptoms are often stuck trying to arbitrate between competing explanations about what causes their symptoms, which nonetheless do not seem fully satisfactory. Uncertainty and confusion about one’s emotional life also brings challenges for one’s self-concept: is this the virus or is it me? Who am I now? This epistemic burden relates to all manner of epistemic injustices in healthcare which deserve careful study.

What I find exciting about the study of epistemic injustice in healthcare is how it is progressing: it’s incredibly encouraging to see new distinctions and concepts are coming to fruition that enable us to better capture a subtle dynamic or problem that has long caused significant harm and suffering. I think there is remarkable ameliorative potential, as well as philosophical interest, in the study of epistemic injustice in healthcare.

What are you working on right now?

I’m currently working on a newer concept intricately connected to epistemic injustice: affective injustice. These are injustices that relate to how a persons’s emotions are given (or denied) uptake by others. Uptake failures generally reflect credibility deficits. For instance, the anger of a woman will be given less uptake than the anger of a man because being a woman affords her less credibility.

I am developing a framework of affective injustice that is sensitive to not only discrete emotions like anger, but also to longer-term and diffuse affective experiences like moods, malaises and existential feelings. These affective experiences are common in illness, and failures to give such experiences uptake is responsible for a significant amount of suffering, alienation, shame and self-concept distress. I hope that this work can be a useful part of the wider project goal to develop ameliorative strategies for epistemic injustices in healthcare.

Silence

This post is by Dan Degerman, Leverhulme Early Career Research Fellow at the University of Bristol. Dan is soon to join project EPIC. 

Some members of team EPIC: Matthew Broome, Ian Kidd, 
Dan Degerman, Havi Carel, Kathleen Murphy-Hollies, and Fred Cooper.

Silence is an important phenomenon in mental health. But while philosophers have had much to say about the social silencing of people with psychiatric diagnoses, other ways in which silence can feature in psychopathology have been underexplored. In a recent workshop at the University of Bristol, generously funded by the Leverhulme Trust, we sought to begin to address this neglect by exploring the different faces of silence in psychopathology.

Ian Kidd opened the workshop with a talk that explored painful silences common in bereavement grief. In particular, he focused on four silences, each characterised by a loss of communicative possibilities that follows the death of a loved one. This included, for example, silence as the loss of the distinctive communicative style of the deceased and silence as the permanent absence of narrative closure. For the person subject to these silences, they are painful for three reasons, Ian explained. Firstly, these silences cannot be filled. Secondly, they involve the awareness that the ways of being in the world the relationship with the deceased made possible are now impossible. Thirdly, they involve the awareness that one can no longer be the same person that one was with the deceased.

Ian Kidd

The second speaker, Richard Stupart, drew on accounts of investigative journalists working in South Sudan to shed light on some of the mental dangers of being silent. He argued that journalists are at a heightened risk of moral injury, referring to the negative psychological impact a person experiences when they are unable to respond to a situation in what they consider a morally appropriate way. Journalists in conflict and crisis situations are particularly vulnerable to such injury because they often find themselves subject to structural pressures that may prevent them from communicating their knowledge about morally charged stories.

Richard Stupart

Inner speech in mental disorders was the subject of the next talk by Sam Wilkinson. He defended what he called a strong dialogical account of inner speech, which entails that all inner speech is directed at a recipient, namely, ourselves. This account also suggests, among other things, that inner speech plays a central role in shaping our identity. Sam then outlined some ways this account can help clarify the implications of inner speech and its absence in different mental disorders. For example, the strong dialogical account indicates that negative inner speech in anxiety and depression is not just an epiphenomenon of pre-existing a person’s feelings but that it can create a downward spiral of those feelings.

 

Sam Wilkinson

The fourth talk by Anna Bortolan examined experiences of silence in social anxiety. Drawing on some distinctions proposed in a recent paper on silence in mood disorders, Anna showed that these capture experiences described by people with social anxiety as well. She then went beyond that account to argue that a further two experiences of silence can be discerned in accounts of social anxiety. The first is characterised by a perceived inability to fill certain silences when one wants to do so, and the second is accompanied by a diminished sense of agency over how silences are filled.

Anna Bortolan

Finally, in my talk, I argued for the importance of attending to first-person experiences of silence in psychopathology through a case study drawn from accounts of depression. Using a phenomenological framework inspired by the work of Merleau-Ponty, I described an experience common in first-person accounts of depression that I termed empty silence. This is an unpleasant experience that involves a solicitation to speak and a breakdown in a person’s habitual relationship with words, which confronts them with their own outward and inner silence. I proceeded to argue that if lived repeatedly, it may give rise to bodily doubt in one’s ability to speak.

Dan Degerman

If you are interested in learning more about the talks, presentation materials from most of them can be found here. The talks were followed by wonderful discussions with the interdisciplinary audience that was in attendance in the room and online, and I want to extend heartfelt thanks to all those who participated.

The workshop was the capstone event for my Leverhulme Early Career Fellowship. However, it also served as an informal launch event for the EPIC project, with many of its team members in attendance, including Ian Kidd, Havi Carel, Matthew Broome, Fred Cooper, Kathleen Murphy-Hollies, and myself. The conversations and explorations that began during this workshop on silence and psychopathology will continue as part of the project, and if you are interested in contributing or participating in some way, please do get in touch.