Prescribing the mind: how norms, concepts, and language influence our understanding of mental disorder
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Date
21/02/2023Author
Russell, Jodie Louise
Metadata
Abstract
In this thesis I develop an account of how processes of social understanding
are implicated in experiences of mental disorder, critiquing the lack of
examination of this phenomena along the way. First, I demonstrate how
disorder concepts, as developed and deployed by psychiatric institutions,
have the effect of shaping the cognition of individuals with psychopathology
through setting expectations. Such expectation-setting can be harmful in
some cases, I argue, and can perpetuate epistemic injustices.
Having developed this view, I criticise enactive accounts of mental disorder
for failing to consider how such terms like ‘dysfunction’ are open to
interpretation and can come embedded with normative expectations.
Enactive accounts consequently run the risk of perpetuating injustices in
their account of the sociality of mental disorder. Similar concerns arise when
we consider the attachment of enactivism to the medical model, I argue.
But by adapting enactivism to consider other experiences of disorder, such
as those described as ‘madness’, enactive psychiatry may genuinely provide
ethical groundwork for a better conception of disordered experience.
Then, I consider a further concern with a distinctly medicalised conception
of mental disorder from the perspective of self-illness ambiguity, arguing
that self-illness ambiguities appear to form a special class of ambiguities
due to their proximity to disorder concepts which mark them as appropriate
targets for therapeutic treatment. However, I argue further that we should
be critical of the idea that self-illness ambiguities necessitate
disambiguation, as, in cases where self and illness are demarcated,
individuals may still experience distress because simply having a mental
disorder can be socially alienating. The medicalised focus in self-illness
ambiguity, and the explicit need from the medical perspective to
disambiguate it, might then exacerbate the distress someone experiences
in mental disorder. Moreover, drawing on Mad Studies, I suggest that one
might not need a coherent self-narrative to live well. Because of this, one
may not need to adopt a medicalised view of the self in the case of selfillness
ambiguity.
In order to support this analysis, I provide a phenomenological account of
language and argue that the very thoughts implicated in mental disorder
shape the individual’s perception of the world due to the way that language
foregrounds particular aspects of our world. This demands a critical
examination of the language adopted and used by both clinicians and
disordered individuals. I thus conclude with some thoughts on how to
approach research and developing understanding of mental disorder given
that we, as people, are always implicated in this process and therefore
socialisation of some kind will always be taking place.