BIO

PHD THESIS

Abstract

This thesis is a collection of papers which together put forward a non-classical explanatory framework through which to understand the symptoms and features of Depression (specifically anhedonia, impaired social cognition, and motivational pathology) as well as the treatment of psychiatric service users in clinical contexts. The non-classical framework I use to guide my investigations encompasses insights from ecological psychology, embodied and situated cognition, predictive processing, and epistemic injustice.
The first paper argues that current psychological theories of anhedonia are committed to the view that anhedonia cannot generally be satisfactorily explained without recourse to features of the agent’s natural and social environments, and their embodied activities within them.
The second draws on an embodied account of empathy offered by Joshua Shepherd (2012) to argue that Matthew Ratcliffe’s suggestion (2015) that depressed people are not typically better able to understand the mental lives of other depressed people is most likely false, or at least overstated.
The third proposes an embodied, predictive-processing approach to the characteristic operation of motivational mental states. This paper supports the fourth, in which I argue that psychological, somatic, and (ecological) perceptual factors all contribute, in ways and degrees that vary from case-to-case, to depressed agents’ struggles and failures to initiate and sustain actions (what I label agential pathology). I suggest that these problems should not all be thought of as disorders of motivation per se, but rather as broader kinds of motor dysfunction that may all contribute to the explanation of agential pathology.
Finally, I broaden the scope of my investigation to psychopathology in general, and argue that the notion of epistemic injustice applies in many important ways to service users’ experiences of psychiatric services. I argue that many such injustices occur because of an over-reliance in medical contexts on neurocentric explanations and understandings of mental distress. This suggests that more radical theories of psychopathology, such as those articulated in previous papers, may be important not just for achieving the end of accurate psychiatric explanation, but also for ensuring the ethical treatment of service users.

PALLIATIVE CARE IN PSYCHIATRY

Conceptual & Ethical Foundations

There have been recent calls amongst some practitioners and researchers for Psychiatry to adopt a palliative approach to the treatment of certain service users (e.g. Berk, Singh & Kapczinski 2008; Lopez, Yager & Feinstein 2010; Trachsel et al 2016). This would, they say, involve focusing on maximising the wellbeing and quality of life of such service users, while avoiding often subjectively unpleasant interventions aimed at 'curing them'. This also contrasts sharply with current standard psychiatric practice, which (so these authors claim) mostly aims at finding a cure for psychiatric disorders.
The goal of palliative interventions would be to help a service user come to terms with the potential for their illness to be lifelong or even (in some cases) terminal, and to assist as far as possible in the management of symptoms. This raises a host of philosophical questions related to the nature and guiding principles (both ethical and practical) of an approach to psychiatric care that is explicitly not curative.
This project aims to construct a thorough theory of what a palliative psychiatry should be like, by examining, in the psychiatric context, a range of critical epistemological and ethical questions that arise from either essential or common features of existing palliative practice. Previously, most of these questions have been left open, answered only in the context of very specific cases, and/or dealt with in a piecemeal manner, without due attention paid to the way in which answers to certain questions have an effect on how we may wish to answer (or even ask) others. Sufficient attention has also not been paid to the philosophical implications of survivor-activist’s political and ethical demands for broadly palliative approaches to Psychiatry. This project will put these perspectives at its heart.