Jo Bervoets (UAntwerp) did research into Tourette’s from a theoretical and an ethical perspective.
“Letting Tourette’s be?”
Tourette’s is getting more and more in the news headlines, for instance when famous people like Billy Eilish open up about their diagnosis. “Tourette’s might be the new autism or ADHD,” says Jo Bervoets. “With the recognition that it is more common than initially assumed, its stereotypical portrayal can also be adjusted.” Bervoets’ doctoral research shows that acceptance of Tourette’s must replace mere focus on its suppression. Tourette’s is named after the French neurologist Gilles de la Tourette who made the first diagnosis at the end of the 19th century. People with the ‘Gilles de la Tourette Syndrome’ (as it is officially called) have multiple tics. These are involuntary movements, such as blinking the eyes, as well as movements that cause noises, such as blowing raspberries. Jo Bervoets (Centre for Ethics, University of Antwerp) looked at current theories about Tourette’s and checked whether these were compatible with the experiences of people with Tourette’s.
Stereotypes and stigmatisation
Tourette is often and incorrectly identified with cursing. “A small percentage of people with Tourette’s do curse or act in other ways that are considered socially inappropriate or disturbing,” says Bervoets. “Whilst this is not something to sweep under the rug given it is a part of the experiences of people with Tourette’s, we should not narrow Tourette’s to this aspect only. If we do so, it quickly becomes a caricature that is too often exploited to get an easy laugh. In conversation with Touretters, as they often refer to themselves, it becomes clear that the stereotypical and stigmatising view is the main risk factor for their mental health.”
In the last decades, Tourette’s has been seen as an individual neurological problem. “This view is an advance over the moralizing ideas about tics when the diagnosis was still unknown. However, my research makes clear that reducing Tourette’s to ‘a brain condition’ does injustice to the experiences of Touretters. In these experiences the expectations of others as to what constitutes ‘normal behaviour’ take a central place. Not only do these expectations lead to social isolation, but they also increase the frequency and intensity of tics.”
Beyond the Catch-22 of Tourette’s
One of the Touretters interviewed by Bervoets strikingly catches this complexity: “Exams put me in front of an impossible choice: either to disturb others with my tics or to hinder myself by inhibiting them.” To avoid such dilemmas, Bervoets proposes to look at Tourette’s through the lens of neurodiversity. “I am autistic myself and, thanks to the neurodiversity movement, a scientific revolution in autism research is already taking place,” says Bervoets. “Instead of focussing on what we are according to stereotypes unable or unwilling to do (like social interaction), autism is seen as a different, an atypical, way of dealing with our environment. Based on this research I propose that spontaneity, vitality, and an urge to get things ‘just-right’ (for instance: organising them in specific ways) are the basic characteristics of Tourette’s.” Does this mean that Tourette’s suddenly becomes a superpower? “No, tics are often painful and disturbing, even without an audience. But recognising that the environment plays a role in how Tourette’s comes to the surface allows us to gain a broader view on it. For instance, it helps in bringing the attention to how Tourette’s manifests differently in women or what connection it has with OCD and ADHD. And most importantly: when onlookers can let Touretters just be, then they actively contribute to their mental wellbeing.” This ‘letting be’ obviously does not mean that there is less need of diagnoses or support. On the contrary, it is only in recognizing Tourette’s in all its nuances that we can empower Touretters.
Name and contact details: Jo Bervoets, jo.bervoets@uantwerpen.be, +32476471298
You will receive the zoom link to the event one day before the lecture
Abstract
The “mad genius” has since long been a trope in literary history. Whereas the male genius’s accomplishments are emphasised over possibly accompanying shortcomings, the female genius and her deviance from the norm have been tolerated to a far lesser extent. As a result, exceptional literary creativity continues to be studied mainly from a masculine perspective. In recent years, experimental features of male authors are increasingly linked to patterns of neurodiversity, but these continue to be seen as strokes of genius, whereas female authors with similar eccentricities suffer heavily from stigma.
Our project can be situated in the field of Literary Studies, but takes cues from several other fields such as Neurophenomenology and Disability Studies to strengthen its interdisciplinarity. The main goal of the project is to re-evaluate four female German and Austrian literary authors through the lens of Neurodiversity and of theories of embodied, enacted, and extended (4E) cognition. The application of this analytical toolkit to literary texts and egodocuments allows us to provide an alternative to deficit-based definitions of neurodivergence and to the undiminished, spectacularized ‘othering’ of female literary and artistic talent. Specifically, we aim to find out how and why neurodiversity surfaces in the literary text by way of formal-narrative and thematic analysis, studying stylistic strategies and motifs of childhood and social non-conformism.
In this interdisciplinary lecture, we will highlight the methodological underpinnings of the project and present the case study of the German author and poet Else Lasker-Schüler, who embodied diversity in multiple facets. In particular, we explore her focus on visual and auditory aspects of language in its idiosyncrasy against the backdrop of patently transgressing borders not only between countries, but also between private and public, male and female, word, image, and sound. We hypothesize that the propensity to wrestle free from orthodox upbringings and to engage in polemical and polarizing communication, as well as to embody contrarian positions, may have come more “natural” to some women than to others.
Finally, we will situate the relevance of this project against the background of a discussion concerning the educational system, in which “efficient” teaching methods (especially of reading and writing skills) are increasingly promoted at the expense of more inclusive approaches. We witness a trend among specific scholars, especially austerity-minded education economists, to “hijack” the arguments of the neurodiversity movement in order to deny the reality of conditions like autism and dyslexia and to argue for the legitimacy of cutting down on accommodations. A renewed understanding of creative, literary communication as a spontaneous coping strategy can provide an antidote against the ongoing attempt to streamline and normalize cognition.
For those who stumble across this page: the recording is meanwhile available on YouTube.
This on-line lecture will take place Thursday 18/11/2021 from 16:00 to 18:00 Central European Time.
If you want to join, please send a mail to jo.bervoets@uantwerpen.be. Zoom details will be sent a couple of days prior to the event.
Abstract:
The focus in Tourette’s research and therapy lies on the question ‘how to combat tics?’. in this talk, Jo Bervoets, Diana Beljaars & Hanne De Jaegher argue that innovative person-centered research into Tourette’s – in line with taking up Tourette’s as part of neurodiversity – allows to reorient from a purely negative framing towards one productive of a generative and positive understanding of it. Insights from human geography and enactive philosophy together with lived experience reports result in the title question, which is both a provocation and a way out of the clinical, empirical and ethical stalemate in which the reality of Tourette’s is reduced to stereotypical tics.
After this talk three respondents will engage with the argument and its conclusion:
Jean Steyaert – professor neurodevelopment disorders, child psychiatrist and Tourette’s expert,
Christine Conelea – assistant professor child mental health, clinical psychologist and Tourette’s researcher, and,
Daniel Jones – PhD researcher human geography, Tourette’s researcher and expert with experience. There’s time for a Q&A of at least 30′ from the audience.
A short 8′ introduction to the topic is available here.
We will be discussing this pre-print (reading it in advance of the meeting is recommended & at the same time entirely optional as we will present a summary of it starting the meeting).
Agenda:
16:00-16:10: Welcome and Introductions Kristien Hens
16:10-16:45: Letting Tourette’s be? Jo Bervoets, Diana Beljaars, Hanne De Jaegher
This conference was held online September 9th-10th. Recordings of most talks are available as a playlist on ‘our’ YouTube channel. Below you find an overview of purpose, program and abstracts (corresponding to an initial call for registration).
Registration is free. If you want to attend, please mailto: jo.bervoets@uantwerpen.be. Zoom details will be sent to all registered participants a couple of days before the conference.
The conference is organized by the University of Antwerp’s Department of Philosophy, the KU Leuven’s Institute of Philosophy and the ERC Starting Grant Project NeuroEpigenEthics.
The main aim of the conference is to cross-fertilize research in what are up to now separate fields. On the one hand there is the blooming field where philosophy of responsibility meets theories of psychopathology, specifically addressing the question to what extent and in what way people diagnosed with a mental illness are to be excused for certain behaviors. On the other hand, there is an interesting line of psychological research on the link between stigma and neurological explanations of psychopathology.
We have selected 7 abstracts from 3 continents, considering the cases of delusions, autism & ADHD, as well as addressing topics as diverse as neurodiversity, Strawsonian approaches to responsibility and 4E approaches to mental illness. Unless otherwise noted (by a * after the talk title) the talks will be recorded and subsequently shared on the NeuroEpigenEthics Youtube channel.
This results in the following program (browse to bottom of the page to see abstracts):
(all times are CEST, keynotes: 45’+15′ Q&A, selected talks: 25’+15′ Q&A)
Thursday September 9th, AM Session:
Keynote: 09:00-10:00 AM: Prof. Nick Haslam, University of Melbourne * Title: Folk Psychiatry and Stigma
Selected talks:
10:20-11:00: Anna Hartford: Behavioural Genetics & Assessments of Moral Responsibility * 11:20-12:00: Marie van Loon: Delusions Are Responsive to Reasons 12:20-13:00: Caroline Bollen: Towards an inclusive notion of empathy: addressing the paradox of empathy in autism research
Thursday September 9th, PM Session:
Keynote: 15:00-16:00: Prof. Hanna Pickard, Johns Hopkins University * Title: Addiction and the Meaning of Disease
Selected talks:
16:20-17:00: Laura Matthews: A 4E Approach to Responsibility in Mental Disorder 17:20-18:00: August Gorman: Neurodiversity and Responsibility for Omissions
Friday September 10th, AM Session:
Keynote: 09:00-10:00: Prof. Maureen Sie, University of Tilburg * Title: Playing Seriously. The Two Faces of our Moral Sentiments
Open discussion/further work/follow-on conference: 15:00-16:00 CEST: all interested registered participants
Unfortunately, Prof. V. McGeer of Princeton University had to cancel her keynote because of a personal issue. We have added a closing talk by one of the organizers as a replacement.
Although the conference will be conducted online, the option is provided for participants to attend the conference physically at the University of Antwerp. These participants will follow all the presentations via Zoom in rooms provided by us and will, in between talks, be able to physically interact during breaks and lunch. If you are able and willing to attend physically in this way, please mention this explicitly in your registration mail.
The Organizing Committee: Prof. K. Schaubroeck (UA), Prof. P. Adriaens (KUL), Prof. K. Hens (NeuroEpigenEthics), Jo Bervoets (NeuroEpigenEthics)
Full Abstracts
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Title:Folk Psychiatry and Stigma Abstract: In this talk I will present a line of research and theoretical work on what I call ‘folk psychiatry’. My model of folk psychiatry offers an account of the psychological processes that underpin laypeople’s thinking about mental illness. These processes are implicated in judgments of which behaviours and experiences are disordered (‘pathologising’) and in the explanations they provide for those phenomena. I propose that these explanations take three primary forms: ‘medicalising’ explanations grounded in essentialist thinking, ‘moralising’ explanations grounded in everyday folk psychology, and ‘psychologising’ explanations that invoke causal histories. These dimensions of folk psychiatry have complex and ambivalent implications for stigma, understood as a varied set of exclusionary or discrediting attitudes. ‘Medicalising’ explanations that invoke biogenetic causes may problematically increase social distancing from people with mental health conditions, but also beneficially diminish moral blame. ‘Moralising’ explanations, in contrast, may be more inclusive but also assign personal responsibility in demeaning ways. A greater tendency to view unusual experiences and actions as mental health problems may normalise mental illness and promote help-seeking, but also undermine agency. These claims will be supported by some meta-analytic work on the implications of genetic and neuroscientific explanations for mental illness stigma. I will conclude with some reflections on the role of essentialist and natural kind thinking in psychopathology, and on the mixed implications of continuum models of mental illness in that field.
Title:Addiction and the Meaning of Disease Abstract: Is addiction a brain disease? Cards on the table: I don’t know. The aim of this talk is to clarify what it would mean for the brain disease model of addiction (BDMA) to be true, rather than to argue decisively for or against it. This requires (1) distinguishing the question of whether addiction is a brain disease from the question of whether labelling it thus has beneficial consequences, such as, e.g., combatting addiction stigma; (2) differentiating possible models of disease and their relationship to the BDMA; (3) understanding the challenges of providing an account of normal brain function by which to measure brain dysfunction; and (4) addressing the complexity of establishing the hypothesis that brain dysfunction is the cause of the personal-level observable signs and experienced symptoms characteristic of addiction. I conclude by arguing for agnosticism and heterogeneity; in some cases addiction may be a brain disease, in others not. Either way, we should not rest our hopes on the brain disease label as a means of combatting addiction stigma, but rather fight directly against drug moralism and moralistic policies.
Title:Playing Seriously. The Two Faces of our Moral Sentiments. Abstract: Kate Manne in her book on misogyny, criticizes “Oxford Don”-Strawson for only paying attention to the salutary aspects of the moral sentiments, resentment, blame, praise, gratitude and the likes of them (preface, Manne 2018). She points out that the moral sentiments can and often are used to uphold the existing social order which might be oppressive and unjust. Potentially aggravating this danger, social media has brought us a magnifying tool for what Linda Radzik has dubbed “informal social punishment,” a practice closely tied up with the moral sentiments, that, according to her, we desperately need to critically reflect on (Radzik 2020). As Radzik rightfully notes, this practice also targets those who, according to feminist and other activists, try to uphold an unjust, discriminatory, social order. So called social justice warriors one could say, use guerilla tactics of naming and shaming to set desperately needed change in motion; #metoo is a case in point. To set change in motions, as Calhoun has argued forcefully, might well be the whole point of moral responsibility (Calhoun 1989). It is clear that Strawson’s seminal essay Freedom and Resentment, managed to put the social dimension of our practices of moral responsibility firmly on the philosophical agenda (Strawson 1962, Cf Walker 2007, 34). In a wide array of philosophical discussions, the main issue of concern is not what conditions an agent has to fulfil in order to qualify as a responsible agent and whether these conditions obtain in our world, but rather about the value and disvalue of the moral sentiments to our society. In this talk I will elaborate on this social dimension building upon my own answer to the skeptical (pessimist) challenge Strawson originally addressed, emphasizing the value of understanding actions as potential disagreements with the normative expectations that regulate our shared practices (Sie 2005). In that view mental illness, like many other conditions put forward as candidates for exculpation, is not considered to be exculpating as such (Sie 2018). I proceed by explaining how we can understand the function of certain social and other categories that enable us to navigate our complex moral lives, and articulate what is worrisome about them as well, i.e., that they can lead to potentially harmful stereotypes, prejudices and stigma’s. I conclude by outlining two faces of the moral sentiments that seem to pull in opposite directions. On the one hand, the moral sentiments function as ammunition in the fight against or defence of certain moral frameworks, on the other hand as moves in an open, but serious dialogue about how to live our shared lives. Striking the right balance by no means is an easy task though a bit of playfulness (Lugones 1987), might help us get there.
Title:Behavioural Genetics & Assessments of Moral Responsibility Abstract: Genetic attributions of certain behavioural conditions, such as addiction, have been shown to reduce ascriptions of blameworthiness. As evidence of genetic and gene-environment influences on human behaviour expands, some have speculated that genetic attributions of behaviour might have this effect across the board, and generate mitigation even for criminal and antisocial behaviour.
Such evidence has increasingly been introduced in courts; a practice which may grow with new developments in genetics and gene technology. As various empirical studies have demonstrated, however, genetic attributes for behaviour play a much more complicated relationship to assessments of moral responsibility, and the empirical evidence generates a picture of “inconsistent, contradictory, or seemingly irrational intuitions” (Tabb et al, 2018).
A crucial related question is how such information should affect assessments of responsibility. In the first place, there are significant empirical concerns regarding what can currently be determined from such evidence, and some have argued on this basis that it should have little or no bearing on our moral and legal assessments. But even where, and to the extent that, such information is, or becomes, genuinely predictive of behaviour, there is still no straightforward conclusion to be drawn with regards to moral responsibility.
This paper will consider the implications of behavioural genetics for prominent normative theories of moral responsibility, as well as with regard to positions concerning the minimal conditions for moral responsibility, including rational capacities, conscious control and moral competence.
As I will explore: given that different genetic information bears so differently on the various foundations for moral responsibility posited by these theories, there is no straightforward route from the fact of genetic attribution to any particular assessment with regard to moral responsibility. In particular, while some genetic attributions might undermine these foundations, other genetic attributions might underwrite them. In turn, even a theoretically and normatively cogent response to the significance of genetic attributions would not necessarily generate a uniform response with regards to its effects on assessments of moral responsibility.
I will further explore whether this normative and theoretical discussion sheds any light on some of the central inconsistencies, contradictions and “seemingly irrational intuitions” observed in empirical studies.
Title: Delusions Are Responsive to Reasons Abstract: Delusional beliefs are often taken to be paradigmatic cases of belief for which subjects are not responsible. This very idea even motivates the thought that, in spite of beliefs not being under direct voluntary control, we should differentiate between beliefs for which we are responsible and beliefs for which we are not responsible. Prima facie, this idea seems more than fair. After all, delusions very often co-occur with severe mental disorders and common sense tends to closely associate pathology and lack of control. For example, in ordinary discourse when we call a certain behaviour “pathological”, what is being captured is that the behaviour in question seems compulsive, or that the agent has very little control over it. Such lay practices explain the intuition that we lack control over delusional beliefs in a way that is different than the way in which we lack control over beliefs according to the Doxastic Involuntarist thesis, where the lack of control over delusional beliefs is seemingly more coercive. This reasoning, I believe, motivates the thesis according to which we are not responsible for delusional beliefs.
Yet, philosophers like Hanna Pickard and Quinn Hiroshi Gibson have urged that it is in fact important to be able to hold individuals with mental illnesses responsible for what they believe and what they do. Pickard stresses that this is especially crucial in the context of the relationship between psychiatric staff and patients. If Pickard and Gibson are correct, i.e. if we can legitimately hold individuals responsible for their behavior, and further for what they think, it must be possible for these individuals to fulfil conditions of doxastic responsibility.
In this paper, I will show that a dominant theory of doxastic responsibility, Epistemic Reasons- Responsiveness, is able to respond to the call to take cases of responsibility in mental illness seriously. According to Reasons-Responsiveness, a necessary condition for being responsible for a certain belief requires that the mechanism which produce this belief be sensitive to evidence. In certain cases of delusional belief, the mechanism of belief formation fulfils the reasons-responsiveness condition. Indeed, a widely shared view in the philosophy of psychiatry is that individuals become deluded as a result of undergoing an anomalous experience. For example, this view takes individuals with the Capgras delusion – where a person believes that a loved one has been replaced by an imposter – to fail to have the proper affective reaction to face recognition and as a result form the belief that the person they see and recognize is an imposter. I will argue that such anomalous experience may count as evidence and that therefore, in some cases of delusion, the subjects fulfils the Reasons- Responsiveness condition for doxastic responsibility.
Title:Towards an inclusive notion of empathy Abstract: It is often held that persons on the autism spectrum lack (or have diminished) empathic capacities. This view excuses autistic persons when they exhibit non-empathic behaviors. This might seem like an accommodating move, but in doing so it stigmatizes autistic persons, even to the point of dehumanizing them. After all, empathy has a profoundly normative societal significance, often getting at the heart of what we think it means to be human.
In my talk I show that this view, which at once excuses and stigmatizes autistic persons as non- empathic, stems from deeply confused conceptual and methodological approaches to empathy in autism research. The way empathy is being understood varies strongly, both in a descriptive sense (on what it means) and in a normative sense (on whether it is something virtuous or harmful). Some refer to empathy as co-feeling, some as mentalizing the context of the other, some define it as inherently good, others as inherently biased, etc. If these properties are not explicitly and critically reflected upon, this can lead to various (methodological) problems, and it already has.
A specific problem surrounding this conceptual ambiguity is that a subset of popular understandings of empathy are founded upon, and support, a certain majority privilege towards neurotypicals. These favor specific modes of expression, behavior and perception by including them as prerequisites for something to be called empathy. Such underlying assumptions implicitly shape autism research, treatment and diagnosis. Consider, for example, negligence in establishing measurement invariance of empathy assessments that are created to assess “neurotypical empathy”. This is especially problematic because the concept of empathy is often value-laden in both academic and societal context. Being empathetic is most often seen as a virtue, a desirable characteristic, important or even essential in morality. Combining the use of an ableist conceptualization of empathy (which are, in fact, often not necessarily virtuous) with the normative connotation the concept enjoys in society supports stigmatization or even dehumanization of autistic persons.
This raises a pressing question for researchers working in this space: what does it mean to engage in such research responsibly? On the basis of my research I argue that the conceptual understanding and use of empathy in psychopathology ought to be reconsidered, learning from what it means to be suggested to be lacking this capacity. In this talk, I would like to present a proposal on this account, consisting of three parts. First, I will demonstrate various ways in which the currently existing confusion and even negligence in defining empathy and the appropriateness of assessment strategies harmfully shapes the understanding of autism in science and society. Second, I will describe and defend a certain normative understanding of empathy and how this ought to shape autism research; reframing empathy as a relational virtue. I will demonstrate how this would interfere with the current research landscape – both on existing theories of autism and methodological practices. Lastly, I will discuss how this conceptualization answers the issues that result from the currently existing ambiguity of the concept, making the focus on empathy in research inclusive and, in itself, empathetic.
Title:A 4E Approach to Responsibility in Mental Disorder Abstract: Among academics and laypersons alike, neurological approaches to mental disorder are seen as a way of reducing stigma. The thought is that if mental disorders are understood as brain disorders, then subjects who suffer from mental disorders cannot be ridiculed or stigmatized for their symptoms or behavior any more than a cancer patient should be held responsible for losing her hair. However, in making this identification between mental disorders and brain disorders, and thereby equating mental disorders with other forms of illness, it is possible that we are also stripping away the subject’s agency. After all, if she cannot be held responsible for her behavior or symptoms, then she must not have any control over them. In this paper, I argue that both these views are mistaken. Mental disorders are not identical to neurological disorders because the mind is not identical to the brain. Recent 4E (embodied, embedded, enactive, extended) approaches to cognition show that the mind emerges from the relations between the brain, the body, and the environment, including the social environment. Mental disorders are then disorders of the subject’s embeddedness in a social context. They are modes of cognition that prevent the subject from autonomously pursuing her own well-being in an intersubjective world. Mental disorders arise from the dynamic relations between the brain, the body, and the social environment. Since mental disorders are dispersed throughout these various factors, responsibility must be dispersed as well. Various factors are at play, including genetic dispositions, neurological irregularities, behaviors that might foster or thwart disordered processes, relationships (in particular, familial relationships), and the support or lack thereof of one’s social environment. Most of what contributes to mental disorder is therefore out of the subject’s control, and the subject is therefore not to be held responsible for having a mental disorder or for struggling in the face of it. However, her behaviors can either contribute to the disorder or contribute to well-being, and we should emphasize the agency that is required for a person to do things like seek help, practice sleep hygiene, exercise, eat well, and refrain from self-medicating. Such an embedded approach to mental disorder allows us to empower the subject to seek her own well-being while also avoiding any ascription of total responsibility. This view reduces stigma, avoids assigning blame, but also promotes agency in the subject.
Title:Neurodiversity and Responsibility for Omissions Abstract: According to one prominent tradition in the literature on moral responsibility, behavior that a person is responsible for communicatively expresses something about that person. This is most explicit in cases in which we are holding someone responsible for a failure to act rather than for acting. For example, you might blame a friend who forgets to call on your birthday because, you think, if she cared enough about me, she would have remembered. In this way, her silence expresses her lack of care.
In this talk I propose that we ought to be more cautious in our interpretive inferences of this kind. I argue that there is no simple algorithm by which you can directly infer a person’s failure to care from her failure to act; by this I mean that you can’t ‘read off of’ a person’s inaction alone that she had an insufficient degree of concern. While how much a person cares about doing something certainly bears some correlation with how likely they are do it, differences in individual patterning of attention, memory, and executive functioning complicate this simple story
We have, I argue, been (mis)led to believe that a simple picture of responsibility for omissions that neglects these factors is sound due to two primary factors. First, we have accepted a paradigm according to which people whose agential functioning differs significantly from the neurotypical norms are seen as outlier cases that may be safely bracketed off when setting our norms of assigning responsibility. There are some people, it is assumed, who are dysfunctional to the point that we simply can’t hold them for responsible for what they do or don’t do since they lack control. Second, the existence of the interpretive norm that ties degree of care so strongly to the likelihood of acting creates a feedback loop: people will use indirect strategies to try to make their behavior conform to the expectation.
For example, it is hypothesized that people with ADHD have attentional systems in which attention is naturally drawn towards what they find most interesting rather than what they take to be most important. But a person with ADHD might try to make a task more interesting that they want to remember to focus on because they know their ability to focus on that task will be interpreted as having a direct correlation with how much they care about it. Given this feedback loop, a person with ADHD’s failure to attend to something may provide a somewhat reasonable (though defeasible) guide to what she most cares about, but operating with this norm puts a disproportionately high burden of psychological management on people who happen to have a certain psychological configuration rather than another.
I show how once we destigmatize differences in memory and executive functioning, this problem generalizes; what we set as our default assumptions about what certain omissions reveal about a person is partly a political matter. I conclude by briefly sketching how we might reconfigure our practices to more justly distribute these burdens.
Title:Exemption, self-exemption, and compassionate self-excuse Abstract: Moral philosophers traditionally distinguish between excuses and exemptions. In the Strawsonian tradition, this distinction is often framed in terms of the participant and objective attitudes (Strawson 1962). We can excuse someone and still see them as a participant in normal human relationships, but when we exempt someone, we rather see them as an object to be managed and handled. Serious mental disorders are typically assumed to ground exemptions, not excuses.
In the moral responsibility literature, it is normally assumed that exemptions apply only to other people, not the readers and writers of philosophy. We discuss whether to take an objective attitude towards them. But what if I have a serious mental disorder myself? Should I, then, take up an objective attitude towards myself, and exempt myself from any wrongful actions, instead of feeling guilty? This is easier said than done.
I can sometimes regard future time-slices of myself, or certain aspects, somewhat like objects to be managed and handled, but I cannot consistently see myself this way. Whenever I choose and act, I experience myself as an agent, and my agency also looms large in memories of what I have previously done (Korsgaard 1996: 162; Jeppsson 2020). I can certainly try to stop feeling guilty and being angry with myself by adopting an objective attitude, but I am doomed to slipping out of it over and over. Every time I do, guilt and self-directed anger threaten to rush back in.
I argue that it is better to opt for compassionate self-excuses than self-exemption. Instead of taking up a detached and objective view on my own past wrongdoings, I should dive into my memories and fully appreciate how difficult certain things were and how much I struggled. Wrongdoing is less blameworthy when abstaining from doing wrong requires a huge effort and/or comes at a serious cost (Nelkin 2016; Wolf 1990: 86-87). Thus, I might often find that I have grounds for a partial or even full excuse for my mentally disordered wrongdoing, while still seeing myself as an agent, not an object to be managed. Furthermore, compassionate and understanding excuses allow for more nuance and growth than blanket exemptions do.
Philosophers have previously argued that mental disorders might ground excuses rather than exemptions, but with a focus on milder cases only (Kozuch and McKenna 2016). I stress that compassionate self-excuse is often a better alternative than self-exemption even for psychosis disorders, and other serious cases. Even in the grip of psychosis, people often make choices and exercise their agency in various ways (Jeppsson forthcoming; Jones and Shattell 2016; Jones et al 2016).
Finally, I discuss neurodiversity as an ideal, and the possibility that some – albeit not all – of my supposedly wrongful actions should be considered justified rather than excused.
Title:Gradated participation Abstract: A large body of empirical research indicates that behavioral traits that are symptoms for psychiatric categories (henceforth Traits Of Interest, TOI) are continuously and unevenly distributed throughout the population. For example, TOI associated with autism are concentrated on the families of autistic people, including on family members who are not classified as autistic. It is not unusual to refer to such family members as being ‘somewhere on the spectrum’, a phenomenon also referred to as ‘the broader autism phenotype’. Similarly, the notion of the schizophrenia spectrum indicates that the lines between schizophrenia and other diagnoses on the psychotic spectrum are blurred, and that TOI associated with these diagnoses, such as hallucinations, also occur in the subclinical population. In brief, it is uncontroversial that TOI occur in the general population; though only under the clinical gaze are these traits labelled as symptoms. And it is furthermore uncontroversial that the extent to which persons have TOI admits of degrees.
How we ought to interpret this continuous, uneven distribution of traits is however not clear. Should participation in a disorder category track participation in associated TOI? If yes, then the possibility of gradated participation in psychiatric categories follows. Whether this result is desirable, however, is highly controversial.
There are two main reasons to resist gradated participation in psychiatric categories and to hold that participation in psychiatric categories should be binary. The first is that gradated participation may result in harms to psychiatric subjects. These include, e.g., harms from stigma or trivialization. Indeed, phrases like ‘he’s a little ADHD’ or ‘I get pretty OCD sometimes’ are often found inappropriate. They can obscure the fact that for autistic people and persons with Attention Deficit Hyperactivity Disorder, Major Depressive Disorder, their disability or illness results in real, significant burdens and requires corresponding accommodations. Secondly, gradated participation can be resisted for reasons that have to do with the aims of psychiatry. Realists about mental disorder categories may worry that gradated participation obscures the joints at which nature ought to be carved; whereas a concern for pragmatists is whether gradated participation would decrease the clinical efficacy of categories qua instruments of diagnostic practice.
However, these worries cut both ways. In this paper, I argue that subclinical TOI is no trivial phenomenon. Rather, for some people, subclinical TOI result in real, significant burdens (e.g., social, well-being, economical). Furthermore, these burdens do not neatly track the degree of participation in TOI. Rather, factors such as overall health, socioeconomic status, and intersectional disadvantage may cause vulnerability due to which quantitatively small participation in TOI results in burdens on par with quantitatively much greater participation. People with subclinical TOI, however, receive neither acknowledgment nor accommodations for that burden. And given these burdens, psychiatry ought to be conceptually equipped to identify subclinical TOI.
I conclude that the above arguments against gradated participation in psychiatric categories fail, and that gradated participation in TOI ought to be acknowledged. However, it does not follow that gradated participation in psychiatric categories would track gradated participation in TOI. Rather, there are multiple ways to conceptualize the relationship of participation in TOI and in psychiatric categories. As TOI-associated burdens demonstrate, however, a need for acknowledgment and accommodations may cross diagnostic boundaries.
Title:Does exculpation stigmatize? Abstract: Biological accounts of psychopathology have been positively received for their exculpatory potential. However, recent experimental surveys showed that biomedical accounts result in a mixed blessing: this type of exculpation seems to come with a stigma of dehumanization. In this paper we address three closely related issues posed by these experimental results. First, in what theoretical framework can these results be predicted? Second, is there a way out of the mixed blessing for those diagnosed with a psychopathology? Third, how can we empirically verify such a way out given the experimental results forming our starting point?
Our answers are respectively: 1. the leading ethical framework to discuss issues related to exculpation and moral participation: Strawson’s seminal paper Freedom and Resentment (2008/1962), 2. the novel Wittgensteinian interpretation of Strawson’s core methodological idea allows for a grammar of exculpation without dehumanization, and, 3. in line with such a Wittgensteinian approach, a ‘therapeutic’ understanding of experimental philosophy per Fischer (2018) makes it possible to dissolve the mixed blessing by demonstrating that it is a pseudo-problem resulting from the misuse of the technical concept ‘biomedical’.
Our argument is developed based on the specific case of Tourette Syndrome. It shows the empirical method required to dissolve the problem needs to start from qualitative research. Anchoring empirical research in the responsibility practice of those directly confronted with psychopathology aligns with the methodological concept-practice reversal of Strawson and Wittgenstein. Truly empirical philosophy of medicine can therefore never be reduced to the quantitative experimental method. Based on our example of Tourette Syndrome, we show that the empirical issue hinges precisely on correctly conceptualizing ‘biomedical’ in a case like ‘Tourette Syndrome’. The static (genetic) conceptualization leads to the mixed blessing whilst a dynamic (epigenetic) conceptualization leads to awarding those diagnosed the full moral responsibility without attracting undeserved blame. To resolve this issue we need to look at ‘all the facts’, including those of everyday practice of living with (Tourettic) people.
Kristien has written a book with ethical and philosophical reflections on autism. It contains many ideas that were the inspiration for this project. It is published in Open Access, so everyone can read it for free. Please click on the banner below to access the book.
Practical: Friday 28th May 15:00-17:00 online, register via mailto: jo.bervoets@uantwerpen.be, the Zoom details will be sent a couple of days ahead of the lecture
Abstract: An implicit assumption in many current debates in the moral responsibility literature is that there is a value-neutral way of identifying a group of agents upon which we can base our assumptions about responsible agency. In reality, the methodology that philosophers often use to identify the capacities possessed by responsible agents is to infer from an intuitive verdict that a neurodivergent person should not be blamed in a particular circumstance that they lack a crucial capacity of agency that responsible agents must have. In this talk I attempt to debunk this way of thinking by showing how it has arisen from decontextualized sympathy towards mental difference in lieu of genuine understanding. I identify several shortfalls of this paradigm of exemption as the explanation for why we ought to sometimes mitigate our blame towards someone when their wrongdoing has come about due to their neurodivergence. I suggest instead that we sometimes ought to alter or mitigate our blame because of the undue burdens of navigating the interpersonal world with a brain that functions outside the paradigm of the currently conventional norms.
Bio: August Gorman is a Values and Public Policy Postdoctoral Fellow at Princeton University co-appointed in the Center for Human Values and the Center for Health and Wellbeing. Their work focuses on how traditional debates about agency, moral responsibility, well-being, and consent intersect with neurodivergent experiences and the lived realities of psychological disability.
Agenda:
– lecture dr. August Gorman: approx. 45′
– responses Prof. Katrien Schaubroeck, Emma Moormann, Jo Bervoets: approximativ. 45′
Organized online by the University of Antwerp’s Department of Philosophy, the KU Leuven’s Institute of Philosophy and the ERC Starting Grant Project NeuroEpigenEthics.
Dates: 9thand 10thof September 2021
Keynotes:
Victoria McGeer (Princeton University)
Hanna Pickard (Johns Hopkins University)
Nick Haslam (University of Melbourne)
Maureen Sie (Tilburg University)
The main aim of this conference is to cross-fertilize research in what are up to now two separate fields. On the one hand there is the blooming field where philosophy of responsibility meets theories of psychopathology, specifically in addressing the question to what extent and in what way people diagnosed with a mental illness are to be excused for certain behaviours. On the other hand, there is an interesting line of psychological research on the link between stigma and neurological explanations of psychopathology. Going back to Peter Strawson’s articulation of the problem in terms of reactive and objective attitudes, many philosophers have thought of mental illness as a reason for exculpation. However, this objectifying treatment of people has important downsides, such as denying agency, and stirring up stigmatisation and other forms of social exclusion. Empirical research has shown that these effects are reinforced by a neurological approach to psychopathology. Exculpation of agents diagnosed with a mental illness thus seems to be a double-edged sword. Can we find a way in which we improve our understanding of psychopathology without at the same time stigmatising those diagnosed with mental illness? Should we create and adopt new forms of semi-reactive attitudes? Would it make a difference if we thought of neurological conditions in a more dynamic or interactive way? By confronting different strands of research from philosophy and psychology, we hope to find inspiration for a more balanced view of psychopathology that optimizes inclusion and acceptance of those diagnosed.
CALL FOR ABSTRACTS:
Given the conference goal of cross-fertilization, we invite contributions from the fields of ethics, moral psychology, philosophy (of mind) or (social) psychology, preferably combining 2 of the 3 themes as per the conference title. We strive for diversity of views and presenters.
Abstracts of 500 words should be sent to jo.bervoets@uantwerpen.be before May 15th 2021. They need to be attached as .pdf and need to be anonymized for reviewing. Please put all your contact information in the body of the email.
Notification of acceptance will be communicated before July 1st 2021.
We plan on organizing a physical follow-up workshop with key contributors in Antwerp, somewhere in 2022.
Organizing Committee: Prof. K. Schaubroeck (UA), Prof. P. Adriaens (KUL), Jo Bervoets (NeuroEpigenEthics), Prof. K. Hens (NeuroEpigenEthics)
About half a year ago I, Lisanne Meinen, joined the NeuroEpigenEthics team. I am working on an interdisciplinary PhD project that studies the depiction of psychiatric diagnoses (autism, depression, psychosis) in video games. In this blog post, I will explain my research and tell something about my plans for the upcoming years.
In my research, I examine how the psychiatric conditions autism, depression, and psychosis are represented in both commercial and ‘indie’ video games. I look at thematic representation, for example through the inclusion of a character with autism such as Symmetra in the RPG Overwatch. Additionally, I analyze how these psychiatric conditions are woven into the rules and structure of a game, as happens in Zoë Quinn’s autobiographical Depression Quest.
In addition, I study how interpreting games critically and ‘playing’ them against the grain can deconstruct and challenge societal prejudices and norms surrounding, for example, healthy bodies and sane minds. Such approaches are important if we want to look beyond just diagnosing game characters or looking for certain symptoms. Ultimately, I want to see how psychiatric diagnoses are incorporated into games—both from the designer’s point of view and from the game itself—but also how that affects the player’s gaming experience.
The character Symmetra in Overwatch
Currently, video games and psychiatric conditions are almost exclusively linked in research with an instrumental (usually therapeutic or educational) approach. Therapeutic studies focus on the potential of ‘gamification’ or ‘serious games’ to control or reduce certain symptoms. In such a case, the video game is used instrumentally and the focus is mainly on the diagnosis and not on the person behind it with all their feelings, thoughts, and experiences.
In the case of an educational approach, video games are seen as a unique means of increasing people’s understanding of certain psychiatric conditions and thus countering stigma. While this is a noble motivation, it also invites some criticism. For example, simulations of a certain psychiatric condition can actually encourage stigmatization. In addition, while the aim of these video games is often to elicit empathy, the term is all too quickly used as a buzzword. It is important to be specific about what is meant by empathy: what kind of emotions does a game evoke exactly?
To question this instrumental approach as a norm, I focus on games designed primarily for entertainment purposes. In doing so, I look with an open mind at the different ways in which a video game can be played, and thus at the different ways and meanings of an enjoyable gaming experience. I want to explicitly take a non-medical approach to autism, depression, and psychosis because I find the medical view too limiting. In this line, insights from fields such as crip studies and neurodiversity studies help me to be critical of dominant societal norms about ‘healthy’ or normal’ minds.
In my research I continually work in two directions. On the one hand, I want to know how our thinking about (dis)abled bodyminds in fields like disability studies can contribute to a more nuanced and better representation of autism, depression, and psychosis (and the experiences of those diagnosed with them) in video games. On the other hand, I want to think from the perspective of video games themselves and study how nuanced games can contribute to broadening the conceptualization of psychiatric diagnoses as dynamic and changeable. Because playing a video game is an interactive affair, all these different sides can be well illuminated.
The interactive autobiographical game Depression Quest
In all these approaches, I cannot do without the insights and ideas of people with lived experience with autism, psychosis, and depression. Therefore, in different ways in my research, I will actively collaborate with people who have a diagnosis themselves. For example, when I interview game designers who have incorporated their experiences with a particular diagnosis into a game. Or when I question people with a diagnosis about their experience when they play a game designed to be about them. Is it alienating to play a game about yourself, does it make you angry, or do you find recognition in it?
Ultimately, then, we can learn a lot from video games, but presumably not in the straightforward way that designers of educational games have envisioned. Instead of games aimed at identification, what we need above all are more games that teach people to respect those who are different from them. With my research project, I hope to define what such video games would look like.
In clinical practice and research, we as professionals, often explain autism by using a number of definite and seemingly neutral sentences. However, can we actually know what autism is in a truly objective sense? Is it moreover justified to put forward persistently the medical-clinical perspective as an explanation?
To answer these questions, our NeuroEpigenEthics team members, Leni Van Goidsenhoven and Gert-Jan Vanaken, recently wrote an essay for Wetenschappelijk Tijdschrift Autisme, a Dutch journal for academic and clinical autism professionals.
In this piece they introduce the interdisciplinary field of Disability Studies, paying special attention to the concept of neurodiversity. Drawing on that field and its insights, they do not only unravel the multiple meanings of autism but also make an argument for an urgent understanding of autism as an ambiguous and political phenomenon. This understanding implies thinking autism in contextual and relational concepts and recognizing the mutability of the phenomenon.
Furthermore, by drawing on concrete examples, Leni and Gert-Jan demonstrate why an ambiguous and political understanding of autism is urgent, both in individual trajectories as in thinking about early autism detection and intervention. Finally, they conclude the article by arguing for an attitude of epistemic humility and offer a set of concrete suggestions on how to implement ambiguity and a political understanding of autism in a clinical and research context. The published version (in Dutch) can be found on the journal’s website. A freely accessible, post-review, authors’ version of the paper can be found here.
Special Issue Guest Editors: Evelien Geerts, Josephine Hoegaerts, Kristien Hens, Daniel Blackie
The recent, and ongoing, COVID-19 pandemic has made explicit what many of us already knew: good health and able-bodiedness are fluid and uncertain states. We can only ever hold them precariously (Butler 2004; Scully 2014), as their value and definition are intrinsically unstable and intersectionally linked to situated intelligibility systems that attribute meaning to gender, race/ethnicity, sexual orientation, class, and many other lived identity categories and labels (Parker 2015). What it means to be dis/able(d) has changed radically over time—and is still changing—under the policing influence of normalcy-dictating medical-psychiatric discourses and neoliberal bio-/necropolitical regimes (Tremain 2006; Chen 2012), while simultaneously being positively impacted by grassroots intersectional disability justice activism (Mingus 2011; Piepzna-Samarasinha 2018), critical disability studies, and critical pedagogical frameworks.
The COVID-19 crisis has had a brutal impact on the world and its population, and specifically on those whose bodies were already constructed to matter less through the intertwined, negatively constructed binaries that uphold the exclusivist notion of the ‘pure’, ‘neutral’ and healthy human subject. At the same time, the crisis also has demonstrated the porosity of these oppositional boundaries, such as the boundaries drawn between the human, non-human, more-than-human, and the perpetually dehumanised, the personal/political, and the able/disabledbodied: The SARS-CoV-2 virus and the patchwork of crises it has created (and reinforced) does not only point at human identity and subjectivity being more in flux and in conjunction with (more-than-human) others than the Cartesian self tells us, but also demonstrates that the condition of vulnerability is an existentially shared one and therefore cannot be subsumed under one linear temporal framework. Long COVID, for instance, demonstrates how vulnerable we all are, in the end, and how the linear temporal framework backing up the (dis)abledness narrative needs to be urgently queered, and also placed in the context of longer histories of crisis, in which experiences of ill health, mutilation, and various dis/abilities have played an important role (Bourke 1996; Nair 2020). Another aspect that the pandemic crisis has underlined sharply, is the fact that both the experience of—and the care for—able and disabled bodies is an intrinsically gendered affair (Forestell 2006). These experiences are furthermore deeply bound up with equally gendered notions of labour, authority, and autonomy (Rose 2017); a topic that has been central to the discipline of gender studies from the outset.
Taking the foregoing into account, this special issue of Tijdschrift voor Genderstudies (Journal of Gender Studies), wishes to explore the intersections between complex lived experiences of dis/ability and gender through an explicit engagement with the links and tensions between the scholarly and activist fields of gender studies and critical disability studies (see e.g., Meekosha & Shuttleworth 2009) while taking stock of important present-day turns and debates in and at the intersections of both fields.
More concretely: What happens, this issue wonders, if we take the call—contested by scholars such as Bone (2017) but at the same time emphasised by Kafer (2013)—for ‘cripping’ scholarship, policy, and practice seriously in gender studies and feminism? What happens if we think beyond transdisciplinary exchange, and purposefully stretch towards a theoretical framework and grounded practice of dis/abling gender studies? How can the insights and methods of critical disability studies, with its radical turn toward vulnerability, diversity, and resilience push gender studies toward new understandings of identity, corporeal praxis, labour, and care? How can gender studies, and specifically, novel approaches within contemporary feminist theory, assist critical disability studies with the intersectional conceptualisation of specific lived experiences, surveillance and (in)visibility regimes, and a more affirmative understanding of identities-in-flux and (reappropriated) labels? In short, can we not only ‘gender’ disability (Smith & Hutchinson, 2004), but also dis/able gender?
We particularly welcome submissions that address the following questions and issues:
The challenges and rewards of interdisciplinary dialogue between gender studies and critical disability studies;
Intersections of gender, dis/ability, and ethnicity/race from a theoretical and/or experiential perspective (e.g., Samuels 2011).
How to study dis/abilities on both an experiential and representational level;
Changes in philosophical, historical (Stiker 1999), and sociological (e.g., Thomas 2007) models of dis/ability;
New materialist, posthumanist, and affective theoretical approaches (e.g., Goodley et al. 2014; Feely 2016);
Changes in terminology within gender studies and critical disability studies (e.g., ‘crip’ as a reappropriated term);
‘Bodies that are made to (not) matter’, for example in the context of health crises;
The potential of historical studies to generate new theoretical insights on dis/ability and gender (e.g., Rembis 2019);
Dis/ability and the questions of labour and care (i.e., who is supposed to request accommodations; provide care; …)
Links and tensions between the women’s and disability rights movements, and the role of activism in practices of dis/abling gender (‘everyday activism’)
References used:
Bone, K. (2017). Trapped Behind the Glass: Crip theory and Disability Identity. Disability & Society 32(9).
Bourke, J. (1996). Dismembering the Male: Men’s Bodies, Britain and the Great War. The University of Chicago Press.
Butler, J. (2004). Precarious life: The Powers of Mourning and Violence. Verso.
Chen, M. Y. (2012). Animacies: Biopolitics, Racial Mattering, and Queer Affect. Durham University Press.
Goodley, D., R. Lawthom, and K. Runswick Cole (2014). Posthuman Disability Studies. Subjectivity 7 (4).
Feely, M. (2016). Disability Studies After the Ontological Turn: A Return to the Material World and Material Bodies Without a Return to Essentialism. Disability & Society 31(7).
Forestell, Nancy M. (2006). ‘And I Feel Like I’m Dying from Mining for Gold’: Disability, Gender, and the Mining Community, 1920-1950. Labor: Studies in Working-Class History of the Americas 3(3).
Kafer, A. (2013). Feminist, Queer, Crip. Indiana University Press.
Nair, A. (2020). ‘These Curly-Bearded, Olive-Skinned Warriors’: Medicine, Prosthetics, Rehabilitation and the Disabled Sepoy in the First World War, 1914-1920. Social History of Medicine 33 (3).
Parker, A. M. (2015). Intersecting Histories of Gender, Race, and Disability. Journal of Women’s History 27 (1).
Piepzna-Samarasinha, L. L. (2018). Care Work: Dreaming Disability Justice. Arsenal Pulp Press.
Meekosha, H., and R. Shuttleworth (2009). What’s so ‘Critical’ about Critical Disability Studies? Australian Journal of Human Rights 15 (1).
Rembis, M. (2019). Challenging the Impairment/Disability Divide: Disability History and the Social Model of Disability. In: N. Watson and S. Vehmas (eds). The Routledge Handbook of Disability Studies, 2nd Edition. Routledge.
Rose, S. F. (2017). No Right to be Idle: The Invention of Disability, 1840s-1930s. The University of North Carolina Press.
Scully, J. L. (2014). Disability and Vulnerability: On Bodies, Dependence, and Power. In: C. Mackenzie, W. Rogers, and S. Dodds (eds.). Vulnerability: New Essays in Ethics and Feminist Philosophy. Oxford University Press.
Samuels, E. (2011). Examining Millie and Christine McKoy: Where Enslavement and Enfreakment Meet. Signs 37 (1).
Smith, B. and B. Hutchinson (eds) (2004). Gendering Disability. Rutgers University Press.
Stiker, H. J. (1999). A History of Disability. University of Michigan Press.
Thomas, C. (2007). Sociologies of Disability and Illness: Contested Ideas in Disability Studies and Medical Sociology. Palgrave Macmillan
Tremain, S. (ed.). (2006). Foucault and the Government of Disability. The University of Michigan Press.
About the Journal:
Tijdschrift voor Genderstudies (Journal of Gender Studies) is a Dutch and English language forum for the scientific problematisation of gender in relation to ethnicity, sexuality, class, and age. The journal aims to contribute to debates about gender and diversity in the Netherlands and Flanders. The journal is an interdisciplinary medium operating at the intersection of society, culture, the humanities, health, and science.
We invite potential contributors to submit an abstract of 500 words by the 1st of May 2021. The final paper should be 6000 words maximum. Abstracts for traditional scholarly articles should outline the theoretical/praxis-related contribution, method of analysis, and a selection of references (the latter do not have to be included in the word count). Suggestions for non-traditional, critically, and scholarly informed contributions are welcome as well. Please include the contact details of all of the contributors on the abstract document. Abstracts (and manuscripts) can be written in English or Dutch. Please note that the initial acceptance of an abstract does not guarantee publication and that the manuscripts will undergo a double-blind review process. We strive toward diversity among our contributors in terms of career-stage, disciplines, self-identification, and scholarly or activist affiliation. We are happy to accommodate different accessibility needs or diverse styles of communication. Please get in touch with (one of) the editors for any of these issues.
