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, 2020, The Philosophical Quarterly, 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.

RETHINKING THE ETHICS OF PANDEMIC RATIONING: EGALITARIANISM AND AVOIDING WRONGS

Under Review at Cambridge Quarterly of Healthcare Ethics.

I argue in this paper that we ought to rethink the harm reduction prioritisation strategy that has shaped early responses to acute resource scarcity (particularly of ICU beds) during the COVID-19 pandemic. While some authors have claimed that “[t]here are no egalitarians in a pandemic”, I note that, to the contrary, many observers and commentators (myself included) have been deeply concerned about how prioritisation policies that proceed on the basis of criteria such as survival probability or capacity to benefit quickly may unjustly distribute the burden of mortality and morbidity, even while reducing overall numbers of deaths. I further argue that there is a general case in favour of a broadly egalitarian approach to resource rationing, even in a state of acute emergency – egalitarian approaches to resource rationing minimise wrongs, and wrongful harm. I defend this claim against a prima facie objection and go on to explain why we should consider the possibility that avoiding wrongful harm is more important than avoiding harm simpliciter.

EMPATHY, REASONABLENESS, AND TRANSFORMATIVE EXPERIENCE

In Preparation

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.

AFFORDANCE SENSITIVITY IN DEPRESSION

Under Review at Studies in History and Philosophy of Biological and Biomedical 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, alongside explaining the functional outcome of action failure. This illustrates the importance of paying close attention to the phenomenology of psychiatric conditions and ensuring that candidate explanations are phenomenologically adequate.

UNJUST SILENCING IN THE PSYCHIATRIC ENCOUNTER

Under Review at Journal of Medical Ethics

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EXPLAINING DEATH FROM PSYCHIATRIC ILLNESS

In Preparation

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