PAPERS

Titles and abstracts of my recent work are shown below. Please contact me if you would like the most recent draft of a paper in preparation.

 

CONTRIBUTORY INJUSTICE IN PSYCHIATRY

2019 Journal of Medical Ethics (45:2): available here

I explain the notion of contributory injustice, a kind of epistemic injustice, and argue that it occurs regularly within psychiatric services; in particular, I argue that it affects those who experience auditory hallucinations of voices. I argue that abstract effort on the part of clinicians to avoid perpetrating this injustice is an insufficient response to the problem; mitigating the injustice will require open and meaningful dialogue between clinicians and service user organisations, as well as individuals. I suggest that clinicians must become familiar with and take seriously concepts and frameworks for understanding mental distress developed in service user communities, such as Hearing Voices Network, and by individual service users. This is especially necessary when these concepts and frameworks explicitly conflict with medical or technical understandings of users’ experiences. Further, I defend this proposal against the claim that it might produce conflict with clinicians’ responsibility to inform service users of all medically pertinent information prior to obtaining consent for treatment.

A PREDICTIVE PROCESSING THEORY OF MOTIVATION

2019 Synthese: available here

In this paper I propose minimal criteria for a successful theory of the mechanisms of motivation (i.e. how motivational mental states perform their characteristic function), and argue that extant philosophical accounts fail to meet them. Further, I argue that a Predictive Processing (PP) framework gives us the theoretical power to meet these criteria, and thus ought to be preferred over existing theories.
The argument proceeds as follows – motivational mental states are generally understood as mental states with the power to initiate, guide, and control action, though few existing theories of motivation explicitly detail how they are meant to explain these functions. I survey two contemporary theories of motivational mental states, due to Wayne Wu and Bence Nanay, and argue that they fail to satisfactorily explain one or more of these functions. Nevertheless, I argue that together, they are capable of giving a strong account of the control function, which competing theories ought to preserve (all else being equal).
I then go on to argue that what I call the ‘predictive theory’ of motivational mental states, which makes use of the notion of active inference, is able to explain all three of the key functions and preserves the central insights of Wu and Nanay on control. It thus represents a significant step forward in the contemporary debate.

ANHEDONIA AND THE AFFECTIVELY SCAFFOLDED MIND

2019 Ergo (6:23): available here

Anhedonia, roughly defined as the diminishment or absence of the capacity to experience pleasure or joy in the performance of daily activities, is a core symptom of Major Depressive Disorder, as well as other psychiatric illnesses. I argue that the two major psychological theories of anhedonia are committed to the view that anhedonia cannot, in the general case, be explained with reference only to neurobiological states and processes. This is despite the overwhelming explanatory focus on neurobiological factors in the existing literature. Instead, it is to be understood as the breakdown in the function of what Colombetti & Krueger (2015) term a subject's affective niche. Since affective niches are composed of elements of a person's natural and social environments, including artefacts, activities, and other people, anhedonia turns out to be a phenomenon deeply integrated into a subject's environment, inscrutable within the boundaries of skin and skull. I briefly discuss ramifications of this view for diagnosis and treatment.

NARRATIVE COHERENCE AND MENTAL CAPACITY IN ANOREXIA NERVOSA

2020 American Journal of Bioethics: Neuroscience (11:1): available here

I comment on Goldberg's proposal to add a narrative coherence requirement to capacity assessments, in order to better handle 'hard cases' (2020). I argue that many service users with Severe and Enduring Anorexia Nervosa will still meet this enhanced criterion for capacity. This provides additional evidence for the view that such service users are often capacitous to refuse nutrition and hydration, despite the ill-founded conviction of many ethicists and clinicians to the contrary. I briefly discuss the ramifications of this view.

ON GROUNDS, ANCHORS, AND DISEASES: A  REPLY TO GLACKIN

(with Tom Davies, forthcoming, The Philosophical Quarterly, final draft available here)

Shane Glackin’s 2019 Philosophical Quarterly article aims to (a) offer a framework for understanding the philosophical debate about the nature of disease and (b) utilise this framework to reply to several standard objections to normativist (particularly social constructivist) theories of disease. Specifically, Glackin claims his model avoids three central challenges to normativism, which we term the ‘Flippancy Problem’ (which charges that normativism implies diseases can be cured by adjusting our attitudes towards them), ‘Repugnancy Problem’ (which charges that normativism implies we must endorse repugnant historical views regarding ‘conditions’ like Drapetomania as ‘genuine diseases in their day’), and the ‘Explanatory Problem’ (which charges that normativism cannot explain why diseases warrant certain kinds of medical intervention without lapsing into vicious circularity). Although we find Glackin’s framework helpful in clarifying the terrain of the debate, we argue these three challenges continue to afflict his preferred construal of the normativist/social constructivist position.

DISABILITY DISCRIMINATION IN PANDEMIC RATIONING

Under Review at Journal of Medical Ethics. Draft available here

In the wake of the COVID-19 pandemic’s effect on hospital ICU resource (especially ventilator) availability, influential bioethicists, lawyers, and professional organisations are currently defending pandemic rationing guidelines on the basis of ‘capacity to benefit quickly’ that will predictably deny acute care to disabled people more often than their abled counterparts. These proposals are wholly Utilitarian in their justification – if implemented correctly, they should lead to fewer deaths overall, though proportionally more amongst individuals with (certain kinds of) disabilities.
I argue in this paper that these kinds of guidelines are ethically dubious at best, for reasons that are well-established in the philosophical bioethics literature. Methods of quickly determining capacity to benefit quickly that are not directly discriminatory and are possible to implement in the hectic context of acute pandemic care are hard to come by. It is much more likely in practice that judgments will be made that either explicitly or implicitly take certain kinds of disability to imply lack of capacity to benefit quickly, which is wrongfully discriminatory. Moreover, I argue that removing the Utilitarian blinkers that have overcome authors of many guidelines during this pandemic will allow us to see that even when implemented in an 'ideal' fashion, such practices grotesquely assign only instrumental, as opposed to intrinsic, value to disabled lives much more often than they do to abled lives.

EMPATHY, REASONABLENESS, AND TRANSFORMATIVE EXPERIENCE

Under Review at Ethical Theory and Moral Practice

Jason Stanley (2015: 102-3) has suggested that if we endorse the work of Laurie Paul on transformative experience then it appears that we cannot, even in principle, be reasonable citizens in Rawls’ familiar sense. This poses serious difficulties for anybody who endorses. reasonableness as an achievable or regulative norm of public reason. Stanley only sketches an argument for this conclusion. The aim of this paper is to give the problem more of the careful attention that it deserves. I will firstly clarify the nature of the challenge and, secondly, argue that it depends on a popular but misguided view of the nature of empathy. Thus I provide a defence of the possibility of democratic reasonableness that should be of interest to anybody who thinks that empathising with one’s fellow citizens is an important prerequisite for democratic practice.

PERCEPTION, ACTION, AND DEPRESSION

Under Review at Philosophy of Science

There is good and increasing evidence that our ability to act effectively on and in our immediate environments depends on our sensitivity to environmental affordances – opportunities to act that our environment offers us. For instance, chairs afford sitting-on, clothes afford getting dressed, and mugs of coffee afford grasping and drinking-from. Sensitivity to affordances consists in two sub-capacities; affordance perception and potentiation. I argue that a pathological failure of affordance perception and potentiation underwrite agential pathology – a core symptom of depressive disorders whereby individuals struggle and fail to undertake day-to-day activities absent any organic motor abnormality. What I call the affordance insensitivity hypothesis gains much of its plausibility from its ability to satisfyingly explain four aspects of the phenomenology of agential pathology that extant theories struggle to deal with all at once. This illustrates the importance of paying close attention to the phenomenology of psychiatric conditions and ensuring that candidate explanations are phenomenologically adequate.

THE COLLECTIVE HARMS OF PSYCHIATRIC DETENTION

Under Review at Kennedy Institute of Ethics Journal

Debates surrounding the harms and appropriateness of psychiatric detention and compulsory treatment focus primarily on harms to the minority of service users who are detained. Though widespread disagreements exist regarding exactly where to draw the line on the appropriateness of detention and involuntary treatment, the central thought is that the harms that require balancing (including potential rights violations, preference violations, and risk of self-inflicted injury) are those that will (or may) accrue to those being actively considered for detention.
In this paper, I argue that this focus will tend to underestimate and (in part) incorrectly locate the harms involved in the clinical response to service users presenting to primary care in crisis. Deploying Kristie Dotson’s concept of testimonial smothering (2011), I argue that current responses will tend to result in the unjust silencing of all service users, including those who are not actually subject to detention. This indicates that significantly more ethical attention should be paid to the atmosphere in which primary psychiatric care operates, including the reasons for failures of trust between clinicians and service users, rather than merely the permissibility or advisability of detaining individual service users.

FUTILITY IN PSYCHIATRY

In Preparation

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