The focus of this paper is the moral and scientific value of ‘expertise by experience’, that is, knowledge based on personal experience of ill mental health as a form of expertise in mental health research. In contrast to individualistic theories of personal autonomy and the first-person in bioethics, my account of shared decision-making is focussed on how a relational approach to the ‘person’ and ‘patient values’ can throw new light on our understanding of ‘voice’ in mental health research. The mistake, (...) I argue, is to think that a commitment to listening to the patient voice in the process of perspective taking implies a threat to ‘objectivity’ in clinical practice and the very concept of evidence in the philosophy of science more generally. Instead, I use Helen Longino's account of epistemic validity in philosophy of science to argue that narrative experience and ‘patient perspective’ should be understood as an ongoing dynamic partnership working between the different stakeholders’ knowledge perspectives. I also address the connection between expertise by experience and the psychiatric significance of the personal self for the entrenched topics of agency, self-hood, personal identity, and self-knowledge in psychiatric diagnosis. In contrast to identity politics, my model of shared decision-making preserves a critical distance between perspective-taking and value itself in self/other appraisal as the gold standard for good clinical practice. (shrink)

Many worry about the over-medicalisation of mental illness, and some even argue that we should abandon the term mental illness altogether. Yet, this is a commonly used term in popular discourse, in policy making, and in research. In this paper I argue that if we distinguish between disease, illness, and sickness (where illness refers to the first-personal, subjective experience of the sufferer), then the concept of mental illness is a useful way of understanding a type of human experience, inasmuch as (...) the term is (i) apt or accurate, (ii) a useful hermeneutical resource for interpreting and communicating experience, and (iii) can be a good way for at least some of us to establish a liveable personal identity within our culture. (shrink)

I suggest that the diagnosis that an individual self-diagnoses with can be influenced by levels of public awareness. Accurate diagnosis requires consideration of multiple diagnoses. Sometimes, different diagnoses can overlap with one another and can only be differentiated in subtle and nuanced ways, but particular diagnoses vary considerably in levels of public awareness. As such, an individual may meet the diagnostic criteria for one diagnosis but self-diagnoses with a different diagnosis because it is better known. I then outline a potential (...) negative consequence of this. Psychiatric diagnoses can grant access to what I call social resources, namely, political advocacy, campaigning for support, participating in scientific research, building diagnostic cultures, and opportunity for social interactions with people who have the same diagnosis. The strength of the social resources for a particular diagnosis can be made stronger when more people have that diagnosis. As such, inaccurate self-diagnosis can result in the social resources for one diagnosis being strengthened whilst not being strengthened in relation to another diagnosis in comparison to accurate diagnosis. This shows how inaccurate self-diagnosis can alter the distribution of social resources. We need to consider whether this is unfair to people who are diagnosed with less well-known conditions. (shrink)

This chapter introduces values-based practice as a resource for working with individually diverse values in health and social care, and describes its origins in an on-going development through the resources of philosophy. The chapter is in two main sections. Section I, Values-Based Practice, builds on two brief interactive exercises to introduce and explain the key features of values-based practice. As a relatively recent addition to the range of resources for working with values in health and social care, values-based practice is (...) distinctive in focussing on the diversity of values comprising individual lived experience. Like evidence-based practice, values-based practice is a process-driven rather than an outcome-driven methodology. That is to say, rather than offering prescribed answers, both approaches offer processes that support decision-makers in coming to answers for themselves based on the particular circumstances presented by the situation in question. Although entirely complementary, the processes involved are of course different. Where evidence-based practice relies on meta-analyses of the results of high-quality clinical trials to inform a consensual model of decision-making, values-based practice builds on learnable clinical skills and other process elements to inform a dissensual model of decision-making rather than seeking to overcome value-conflicts in reaching consensus. Working within a premise of mutual respect for differences of values, and guided by three key principles linking values and evidence, values-based practice, as described in the chapter, supports dissensual decision-making, balanced according to the circumstances presented by the decision in question, within frameworks of locally-set frameworks of shared values. Section II, The Theory-Practice Dynamic, then outlines the theory-practice dynamic on which values-based practice is based. The origins of values-based practice in mid-twentieth century ordinary language philosophy of the Oxford School are outlined. As the chapter illustrates, although a limited area of analytic philosophy, many aspects of values-based practice are informed by ordinary language philosophy, ranging from its premise, through the training exercises and other process elements described in Section I, to its role in hybrid empirical studies supporting its model of service delivery. The development of values-based practice, furthermore, as section II goes on to describe, is ongoing, with key initiatives drawing not only on both analytic and Continental traditions of European philosophy, but also on non-European philosophies such as those of Africa and the Caribbean. (shrink)

The world of mental health has become used to the notion of co-production as a good thing. While the paper is not a critical analysis of co-production, the authors make the case that while it is a good thing, it is not the only good thing; and it is neither sufficient, nor necessary for good things to happen in mental health services. Alternative concepts of progressive innovation in this field are introduced. Real world case studies (most of them previously unpublished) (...) are then worked through to test which concept(s) – co-production, or the alternatives, or neither – are the better fit, bearing in mind the complex relationships to be negotiated, not just between service users and mental health professionals, but between service users and members of other professions, and of the general public. Finally, the question is raised as to whether there is anything (such as the flattening of hierarchies or stigma reduction) which all these innovations – co-production and the alternatives – have in common. (shrink)

The medical and social model of disability is discussed and debated among researchers, scholars, activists, and people in general. It is common to hold a mixed view and believe that some disabled people suffer more from social obstacles and others more from medical problems inherent in their bodies or minds. Rachel Cooper discusses possible ‘test environments’, making explicit an idea which likely plays an implicit part in many disability discussions. We place or imagine placing the disabled person in a range (...) of different environments. If there is a relevant test environment in which they do fine, their problem was societal/external; if there is not, it was medical/internal. Cooper admits that deciding on the appropriate range of test environments is an ethical and political question. In this chapter, I argue that we often ought to widen our scope when discussing psychiatric disabilities. (shrink)

Among the different approaches in mental health activism, there is an ongoing concern with the concepts and meanings that should be brought to bear upon mental health phenomena. Aspects of Mad Pride activism resist the medicalisation of madness, and seek to introduce new, non-pathologizing narratives of psychological, emotional, and experiential states. This essay proposes a view of Mad Pride activism as engaged in no less than the creation of a new culture of madness. The revisioning and revaluing of madness requires (...) transformations in the basic concepts constitutive of current mental health narratives. This process is illustrated with the concept of self and its relation to passivity phenomena (thought insertion). The essay concludes with some of the challenges facing Mad Pride's ambition to enrich the cultural repertoire. (shrink)

Abstract‘The co-production of meaning’ is a phrase that has become entrenched in the field of public mental health, adopted almost as a slogan within the literature. But what does it actually mean? Current definitions gesture toward the very broad idea that co-production involves a collaboration between ‘service users’ and healthcare professionals, each contributing their knowledge to better understand and treat mental health problems. Yet, terms such as ‘equal’ ‘reciprocal’, and ‘partnership’ fail to clarify the nature of this ‘co-production’, and how (...) it can be achieved.To better understand the co-production of meaning, we shall attempt to develop an account of co-production through phenomenological psychopathology. Through Hans Georg Gadamer's remarks on ‘the hermeneutic problem of psychiatry’ two key obstacles to ‘co-production’ emerge: 1) contingent problems, and 2) intrinsic problems. In calling attention to these obstacles, we problematise the concept of ‘co-production’ in public mental health, revealing it to be more complex than originally thought. We conclude by arguing that new developments in phenomenological psychopathology can be used to overcome the limitations of ‘co-production’. (shrink)

Mental health has become a key concern within social discourse in recent years, and with it, the discussion about the lived experience of pain. In dealing with this experience there has been a shift away from merely relying on medical care towards more holistic approaches involving community support, public awareness, and social change. However, little if any attention has been paid in this context to the contribution of aesthetic experience engendered by art that expresses and publicly shares with others the (...) lived experience of pain. With reference to Phantom Limb, an art exhibition curated by Euan Grey and held at the Victoria Galleries and Museum Liverpool in 2016, I argue that aesthetic experience plays a crucial role in making sense of pain and suffering, thus breaking new ground in the appreciation of the significance of art for public mental health and holistic approaches towards patients. (shrink)

Co-production, in the field of mental health, aims to bring together academic and clinical researchers and those with lived experience. Often, research projects informed by this methodology involve the meeting of opposing attitudes, whether to the legitimacy of psychiatry, determinants of mental ill health, or the most appropriate interventions. This has meant that whilst some have reported positive experiences of co-production, many people with lived experience of mental ill health, sometimes referred to as ‘experts by experience’ (EbE), report harms which (...) have taken place or been perpetuated during co-produced research projects. In the literature, nearly always, this is understood as a kind of epistemic injustice in Miranda Fricker's sense. In this paper, I argue that whilst Fricker's view does provide a plausible explanation of what's at play, we can gain more insight into the structural factors which exclude EbE by applying a framework of epistemic oppression. By highlighting the systemic and structural factors which work to keep certain knowers and their contributions out of our collective epistemic resources, we begin to understand the enormity of the task required to redress injustices in our knowledge production systems. (shrink)

In this paper, I cover some ideas first developed during a research year that took me, among other countries, to Bulgaria, where I enjoyed a Fulbright scholarship in 2018–2019. At a conference in Plovdiv (ancient Philippopolis), I gave a talk entitled ‘Neither Clash Nor Dialogue: We Are Each Other's Guardians’.2 A journalist in the audience became irritated and asked me, ‘What do you mean by “neither/nor”? What else is there?’ I answered that the explanation was in the subtitle ‘We Are (...) Each Other's Guardians’. It proposes a third course, one resting on the notion of ‘guardianship’ – as a moral obligation. In what follows, I elaborate further on this concept by relating it to the notion of hospitality, not the Derridian variant, but one that is conceptualized as a transformative event for both the host and the guest, which is why I call it ‘deep hospitality’. (shrink)

The classical Greeks give us a substance ontology grounded in ‘being qua being’ or ‘being per se’ (to on he on) that guarantees a permanent and unchanging subject as the substratum for the human experience. With the combination of eidos and telos as the formal and final cause of independent things such as persons, this ‘substance’ necessarily persists through change. This substratum or essence includes its purpose for being, and is defining of the ‘what-it-means-to-be-a-thing-of-this-kind’ of any particular thing in setting (...) a closed, exclusive boundary and the strict identity necessary for it to be this, and not that.In the Yijing 易經 or Book of Changes we find a vocabulary that makes explicit cosmological assumptions that are a stark alternative to this substance ontology, and provides the interpretive context for the Confucian canons by locating them within a holistic, organic, and ecological worldview. To provide a meaningful contrast with this fundamental assumption of on or ‘being’ we might borrow the Greek notion of zoe or ‘life’ and create the neologism ‘zoe-tology’ as ‘the art of living’. This cosmology begins from ‘living’ (sheng 生) itself as the motive force behind change, and gives us a world of boundless ‘becomings’: not ‘things’ that are, but ‘events’ that are happening, a contrast between an ontological conception of the human ‘being’ and a process conception of what I will call human ‘becomings’. (shrink)

The Royal Institute of Philosophy volume of which this paper is an introduction is on the theme of ‘Expanding Horizons’. But what does it mean for philosophy to fruitfully expand its horizons? The contributions to the volume suggest at least five profitable ways. First, by looking to other philosophical traditions for new perspectives on familiar questions and alternative methods, questions, and ways of understanding. Second, by looking to what has been neglected or overlooked in our own histories of thought. Third, (...) by developing novel methods, in addition to argument, for investigating philosophical issues. Fourth, by embracing different modalities for doing philology, such as the literary. Fifth, by reflecting on the practice of comparative philosophy to better understand the extent to which philosophy can and should be universal. Together, these approaches both increase the range of voices heard in philosophy and the scope and ambition of the discipline. (shrink)

How can philosophy expand to be a discipline via which young people from diverse backgrounds feel they can make a direct and positive contribution to their communities? In this chapter I suggest some creative methods by which philosophers can support community-led change. Collaborators and I have been developing the approaches described here through work on issues of racial justice, but they can be applied to campaigns or public debate on any topic. Developing more community-led, socially engaged methods has the potential (...) to make philosophy a more attractive discipline for young people from diverse backgrounds who are keen to use their skills to make a positive difference to their communities. (shrink)

In classical South Asia, most philosophers thought that the self (if it exists at all) is what the first-person pronoun ‘I’ stands for. It is something that persists through time, undergoes conscious thoughts and experiences, and exercises control over actions. The Buddhists accepted the ‘no self’ thesis: they denied that such a self is substantially real. This gave rise to a puzzle for these Buddhists. If there is nothing substantially real that ‘I’ stands for, what are we talking about when (...) we speak of ourselves? In this paper, I present one Buddhist answer to this question, an answer that emerges from the work of the Abhidharma thinker Vasubandhu (4th to 5th century CE). (shrink)

Philosophers often write in a particular mood; their work is playful, strident, strenuous, or nostalgic. On the face of it, these moods contribute little to a philosophical argument and are merely incidental. However, I will argue that the cognitive science of moods and emotions offers us reasons to suspect that mood is relevant for philosophical texts. I use examples from Friedrich Nietzsche and Rudolph Carnap to illustrate the role moods play in their arguments. As readers and writers of philosophical texts, (...) we do well to attend to mood. (shrink)

Fernando Pessoa (1888–1935) lived what was in many ways an astonishingly modern, transcultural, and translingual life. He was born in Lisbon, the point of departure for Vasco da Gama's voyage to India as commemorated by Pessoa's forebear, the poet Luís de Camões. Pessoa grew up in Anglophone Durban, acquiring a lifelong love for English poetry and language. Returning to Lisbon, from where he would never again leave, he set himself the goal of travelling throughout an infinitude of inner landscapes, to (...) be an explorer of inner worlds. He published very little, but left behind a famous trunk containing a treasure trove of scraps, on which were written some of the greatest literary works of the twentieth century, mainly in Portuguese but also a substantial amount in English and French. Pessoa is now acknowledged as one of the greatest poets of the twentieth century, and he has emerged over the last decade as a forgotten voice in twentieth-century modernism, taking his rightful place alongside C.P. Cavafy, Franz Kafka, T.S. Eliot, James Joyce, and Jorge Luis Borges. Pessoa was also a serious student of philosophy and himself a very creative philosopher, yet his genius as a philosopher has as yet hardly been recognized at all. (shrink)

What does it mean for philosophy to be ‘colonised’ and what are some of the challenges involved in ‘decolonising’ it in philosophical and political terms? After distinguishing between philosophy and its practice as a professional enterprise, I explore six ways in which philosophy, at least as understood in its Euromodern form, could be interpreted as colonised: (1) Eurocentrism and its asserted racial and ethnic origins/misrepresentations of philosophy's history, (2) coloniality of its norms, (3) market commodification of the discipline, (4) disciplinary (...) decadence, (5) solipsism, and (6) appeals to redemptive narratives of colonial practice. The remainder of the article examines conditions for decolonising philosophy, which include unlocking its potential as a liberatory practice, identifying its humanistic dimensions, rethinking metaphysical assumptions, and embracing political responsibility wrought from the production of knowledge. (shrink)

In The Conservation of Races, Du Bois advocates that African Americans hold on to their distinctiveness as members of the black race because this enables them to participate in a cosmopolitan process of cultural exchange in which different races collectively advance human civilization by means of different contributions. Kwame Anthony Appiah and Tommie Shelby have criticized the position that Du Bois expresses in that essay as a problematic form of racial essentialism. This article investigates how Du Bois’ 1924 book The (...) Gift of Black Folk escapes or fails to escape that criticism. It is easy to worry that the diversity of what Du Bois in this book is willing to treat as a black contribution to the development of America pushes us from the problem of essentialism to the other extreme: a lack of any conceptual constraints whatsoever on what can count as a black gift. I will argue that recognizing the cultivation of historical memory as a form of cultural activity is key to understanding the concept's unity. (shrink)

Philosophical aesthetics is to some extent beholden to what I will call personal aesthetics. By personal aesthetics, I mean the phenomena of individual aesthetic sensitivity: how each of us discerns and responds to elements of experience. I take that sensitivity to be finely woven into feeling to some degree at home in the world. There is something extremely local, and in a certain sense unreflective, about personal aesthetics – it is hard to notice one's own, historically specific aesthetic formation. Philosophical (...) aesthetics, meanwhile, aspires to understand aesthetic life in a more reflective and general way. Aesthetic theories in the Western tradition, like most philosophical theories, try to articulate universally relevant and illuminating theoretical concepts and values. But can a theory of this kind acknowledge what is important at the level of personal aesthetics? Can aesthetic theories find fruitful application while also respecting the locality and variability of aesthetic sensitivity? What kinds of theoretical ambition and humility are called for in philosophical aesthetics? (shrink)

The methods of philosophy may be associated with practices such as rational dialogue, logical analysis, argumentation, and intellectual inquiry. However, many philosophical traditions in Asia, as well as in the ancient Greek world, consider an array of embodied contemplative practices as central to the work of philosophy and as philosophical methods in themselves. Here we will survey a few such practices, including those of the ancient Greeks as well as examples from East Asian traditions. Revisiting the contemplative practices of philosophy (...) can help us to rethink the boundaries of the discipline, the nature and scope of scholarly methods, and the role of philosophy in everyday life. (shrink)

What would it mean to do justice to testimonies of traumatic experience? That is, how can experiences which do not fit the customary scripts of sense-making be heard? Whereas processes of official memorialization or legal redress often demand that victims and survivors convey their experiences through familiar modes of narration, in my project on ‘grammars of listening’ or ‘gramáticas de lo inaudito’ I want to ask how it might be possible to hear these experiences on their own terms and what (...) the challenges are that we encounter when trying to do so. What I ultimately want to argue is that doing justice to trauma requires a profound philosophical questioning of the conditions that allow us to listen to testimony, and a true reckoning of the responsibility that we bear as listeners. (shrink)

Although Plato studies occupy an important place in academia, the empiricist stance in considering reality, the modern epistemology of the self-identical ego, the devaluation of the image and imagination, and the restrictions on philosophy within academic research sometimes cause us to lose sight of the essence of Plato's texts and thought when analysing them. Discussing Plato from a Japanese perspective, this paper will introduce three Japanese thinkers, Sakabe Megumi, Izutsu Toshihiko, and Ino-ue Tadashi, who have critically examined modern Western philosophy (...) from their own philosophical backgrounds and provided valuable suggestions. Taking into account the arguments of these Japanese thinkers, this paper emphasizes the notions of separation, purification, and transcendence as core concepts of Plato's philosophy. (shrink)

Early Confucian philosophy is remarkable in its attention to everyday social interactions and their power to steer our emotional lives. Their work on the social dimensions of our moral-emotional lives is enormously promising for thinking through our own context and struggles, particularly, I argue, the ways that public rhetoric and practices may steer us away from some emotions it can be important to have, especially negative emotions. Some of our emotions are bad – unpleasant to experience, reflective of dissatisfactions or (...) even heartbreak – but nonetheless quite important to express and, more basically, to feel. Grief is like this, for example. So, too, is disappointment. In this essay, I explore how our current social practices may fail to support expressions of disappointment and thus suppress our ability to feel it well. (shrink)