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.

The Role of Curiosity in Healthcare

Empathy, kindness, and trustworthiness are among some of the virtues commonly associated with physicians and other healthcare professionals. However, might the virtue of curiosity also have a role to play in medicine?

Lisa Bortolotti and Kathleen Murphy-Hollies (2023) offer an extensive and thoughtful treatment of how curiosity can be a virtue in healthcare, especially within the physician–patient relationship. They describe curiosity as a disposition to attain new information, with it manifesting as a moral virtue when it helps one to view others as speakers with a valuable perspective. Importantly, they argue that when curiosity is directed towards the experiences of others, it becomes a form of caring, encouraging one not to dismiss the experiences of others.

Girls being curious about botany

Curiosity in Healthcare

Curiosity may thus have a crucial role to play in healthcare, “opening us to questions and, if fortunate, knowing more deeply both patient and disease” (p. 138). It may help physicians to practice a more patient-centered care and to ensure that the perspectives and experiences of patients are not lost or dismissed even when views differ. Moreover, it may be particularly fruitful in situations where testimonial injustice is common, such as the doubting or discrediting of a patient’s pain, or the disbelieving of female reproductive symptoms.

However, it is also important for physicians to not stray into inappropriate curiosity, which can take the form of question-asking solely to satisfy the personal interest or curiosity of the physician. This inappropriate curiosity can lead to patients being subjected to intrusive questions irrelevant to their medical care, or breaches of privacy and the violation of patient confidentiality.

Barriers to Curiosity and Ways Forward

Although it may play a valuable role, several barriers may prevent or hinder the practice of curiosity in healthcare. Practically, the decreasing time for physician–patient encounters presents a logistical barrier—to what extent can one exercise curiosity in another’s life within the short span of 5 to 10 minutes?

Another obstacle to the cultivation of curiosity is what Martyn Evans calls the “foreseeable, unremitting, and unsung”” (p. 125). These, for a physician, may be patients with unremarkable or routine symptoms and stories that provoke little surprise. In these situations, “curiosity is dulled by familiarity”. However, even if medically unremarkable, such patients are still deserving of sustained moral attention. To combat this, , Evans proposes adopting an attitude of openness to wonder, potentially allowing a physician to see the patient in a new and extraordinary light, and thereby facilitating the exercise of curiosity.

People looking quizzical

Overconfidence and a lack of epistemic humility can also be an obstacle to curiosity, as physicians may sometimes be reluctant to acknowledge uncertainty or ignorance to their patients or peers. For this, medical education and institutions can help by emphasizing a culture of curiosity, and fostering an environment where physicians can constantly learn and adopt the perspectives of others, even post-graduation.

With these obstacles in mind, working towards the practice of curiosity in healthcare may contribute to broadening one’s perspectives and contribute to a more empathetic and well-rounded practice of medicine that includes the experiences of all.

Katherine Cheung

Katherine Cheung is a PhD student in Bioethics and Health Policy at Johns Hopkins, and previously worked as a Health Science Policy Analyst on data sharing, stationed with the NIH. Her current work focuses on bioethical issues related to psychedelics, such as the value of the psychedelic experience and the place of meaningfulness in medicine.

McPin Young People's Network

In this post, Lisa Bortolotti interviews Rachel Kimberley Temple, Public Involvement in Research Manager (Youth Involvement Lead) at the McPin foundation.

Logo of McPin's Young People's Network

LB: Hello Rachel! What is the McPin Young People's Network and what is your role in it?

RKT: Hi Lisa! The young people’s network consists of over 400 young people from across the UK, aged 13-28, who identify as having lived experience of a range of mental health issues. Everyone in the network has signed up because they wish to get actively involved in mental health research. Researchers can contact us and share their youth involvement opportunities with the network. The network is essentially intended as a resource for both young people and researchers who are seeking to work together. 

My role is to manage a small team who oversee the network; raising awareness about it, building membership, and sharing key findings from projects connected to the network. We also collaborate directly with researchers who wish to engage with the network, advising and facilitating youth involvement in their projects.

LB: Why do you think is important that young people are actively involved in mental health research?

RKT: I think it’s vital that young people have a role in research that will directly impact them. By applying their expert knowledge, the research becomes more relevant, accessible and appropriate. This not only improves the quality of the research but also makes it more likely to achieve the desired impact. Research therefore benefits hugely for involving young people.

LB: How do young people benefit from involvement in mental health research?

RKT: Young people we have worked have told us that they value learning new skills and find it empowering to apply their expertise to something that will positively benefit others. I think this is so important, because having mental health issues can make you feel powerless. Therefore, being actively involved in research can offer a sense of control - a feeling like you can make a difference. 

We’ve also been able to see young people grow in the role; becoming more confident, making valuable connections with external partners and building their own careers.

LB: Can you give us an example of a research project you have been involved with, and of what the young people helped achieve?

RKT: One example that comes to mind is the agency project. On this project, we worked with young people and academics to co-analyse video data of young people’s mental health interactions within emergency departments. We drew on our unique perspectives and expertise, and combined this to make some important discoveries: how to maximise young people’s agency in interactions about their mental health. We translated those findings into various resources targeted at professionals, young people and other researchers.

To learn more about the Young People's Network visit their website or follow them on X and Instagram. 

If you are a researcher seeking to involve young people in your project or collaborate with McPin, visit this page. 

McPin Young People's Network has contributed to several outputs for the Agency Project including a podcast called "How to give young people agency in mental health" and a poster entitled "What I wish my younger self knew about mental health" aimed at secondary school students. Check them out!

Logo of the Agency Project

Epistemic Injustice: Caution and Complexity

Epistemic injustice has become a ‘hot topic’ in philosophy since the 2007 publication of Miranda Fricker’s book. Project EPIC is one product of the now-enormous field of epistemic injustice studies, which extends into other academic disciplines. This industry and interest, while welcome, brings with it the usual hazards of concepts that ‘go viral’. Over time, rich concepts are reduced to slogans or single-sentence definitions. A specific vocabulary becomes widespread but decoupled from its underlying theoretical machinery (think of Kuhn on ‘paradigm shifts’).

Academic fashions are unavoidable, as are trade-offs, such as that between the complexity and the communicability of a concept. Conceptual uptake is to be encouraged where it is productive: we should not want to lock ourselves into our specialist silos. Moreover, good work can often be done with simple versions of complicated concepts. The challenge is to use concepts, like epistemic injustice, while also maintaining sensitivity to complexity, detail, and nuance.

With that in mind, here are some problematic tendencies to note in epistemic injustice studies:

1. the tendency to use the term ‘epistemic injustice’ in over-generalised ways to mean ‘anything epistemically bad’. Granted, epistemic injustices are heterogenous, but there are lots of epistemically bad things in the world. Not all of them are epistemic injustices. Other normative concepts and evaluative vocabularies are available, which may better fit different cases. Defaulting to epistemic injustice might obscure the normative details of certain cases. We must use the right concepts for the task at hand, not just the ones we are have become accustomed to using.
2. a tendency to use overly simplistic accounts of the nature, causes, harms, and wrongs of epistemic injustice. Negative stereotypes, for instance, are a cause of testimonial injustice, but not the only one. Stereotype-centred accounts are sometimes right for the case at hand, but if used carelessly can disguise the many causes of epistemic injustices. Similarly, while many hermeneutical injustices fit Fricker’s original account of the lack of relevant interpretive resources, others involve the presence of distorting resources. Other cases will involve both lacks and presences of different kinds of resources. These sorts of distinctions are vital to capturing the particularity of different cases.
3. a tendency to rely on under-articulated accounts of epistemic injustice. It is now standard to define an epistemic injustice as ‘a wrong done to someone specifically in their capacity as a knower’. However, this gloss sets up complicated questions – about the nature of the wrong, for instance, or what it means to be a knower. Sometimes, a gloss is enough, but there are many cases where the detail really matters. Many details of Fricker’s original account are not taken up, including in cases where they would help (such as the idea of ‘economies of credibility’ or her virtue-epistemological framing of testimonial justice).
4. a tendency to default to the original 2007 Frickerian framework without considering its subsequent amendments (such as the idea of structural testimonial injustice) or criticisms of the original Frickerian account or the alternative forms of epistemic injustice (such as contributory injustice) offered by other scholars. Granted, the epistemic injustice studies scholarship is enormous, and, if the original account will do the work, that’s fine. But there is much more in epistemic injustice studies than the 2007 book.

In describing these four tendencies, I am not impugning work in epistemic injustice studies. The tendencies indicate hazards to recognise and avoid. 

Here are some others, including problems particular to studies of epistemic injustice in relation to illness and healthcare:

• Doctor-bashing. Epistemic injustice within healthcare is a clear problem and there are important criticisms to make of healthcare systems. However, there is a temptation to put the concept in the service of ‘doctor-bashing’. Sometimes, individual healthcare practitioners are at fault. Even where they are, though, there can be complex causes, many involving major structural problems of healthcare systems like the NHS. Rushing to ‘bash’ individuals risks obscuring the messy personal, interpersonal, and institutional realities of healthcare practice.
• ‘Grab-bag’ approaches. Epistemic injustice as a concept clearly resonates with many people, who are then tempted to ‘grab’ the concept and immediately put it to work. However, using a concept properly means respecting its nuances and the constraints on its use. Contrary to some claims, epistemic injustices can, but need not, be systematic or lead to dehumanization. Over-defining a concept is one consequence of grab-bagging. This is not to say that only trained epistemologists should be allowed to use the concept. But it does mean that concepts, like tools, must be used with due care.
• Contesting claims. Many people experience epistemic injustices in the course of their lives. As Fricker emphasises, the concept helps those people to recognise and understand these kinds of injustice. However, not everything that one calls an epistemic injustice is an epistemic injustice. One can interpret an encounter as being epistemically unjust when it is not. It is not an epistemic injustice, for instance, if a healthcare practitioner does not automatically believe the patient’s own interpretation of their symptoms. There may be epistemically good reasons for their doing so. Questioning someone’s interpretations of their experiences is not necessarily epistemically unjust. After all, interpretations can be and are appraised – as plausible or implausible, strained or sensible, and so on. Moreover, interpretation is often be a shared task, not something a person does by themselves and then reports to others. Now, contesting claims of epistemic injustice is a delicate task. However, we will need to get better at it as the concept of epistemic injustice becomes more widely used.
• Lived experience. Epistemic injustice is often used in conjunction with the popular concept of ‘lived experience’. Unfortunately, that term is too often either undefined, underdefined, or defined in banal terms – as, say, ‘experience from the first-person perspective’. Definitional vagary is often accompanied by a tendency to draw further, very contestable epistemological claims. For instance, having ‘lived experience’ is often interpreted as a conferral of expertise. But expertise involves social roles, systems of training and accreditation, and a defined institutional context for one’s conduct. In other cases, ‘lived experience’ is asserted or implied to be something others must accept, as if being epistemic just to someone entails a generalised policy of credulous deference. Epistemic life is too complex for that. It is a matter of contexts, roles, trust and distrust, uncertainty and doubt, – of interaction, discussion, questioning, and delicately structured activities of criticism, affirmation, challenge, clarification, agreement and disagreement. We ignore all this by taking epistemic justice to involve little more than nodding along to whatever one hears.

These tendencies and challenges can all be resisted. It is perfectly possible to use the rich conceptual resources of epistemic injustice studies in ways that honour the moral and epistemic complexities of life. In the case of healthcare, such carefulness matters all the more. Much good work remains to be done – if one is careful, rigorous, and respectful of the messy complexity of our concepts and, indeed, our lives.

This post is by Ian James Kidd. 

Kidd is associate professor in the Department of Philosophy at the University of Nottingham and investigator in project EPIC. Kidd has a variety of research interests, including phenomenology, epistemology, feminist philosophy, and the philosophy of healthcare.