Mental Diversity and Meaningful Psychiatric Disabilities
Guidry-Grimes, Laura K
Carse, Alisa L
This dissertation provides a philosophical investigation of key claims arising from the psychiatric user/survivor movement. Users/survivors insist that psychiatric conditions do not necessarily diminish someone’s agency or ability to flourish; rather, they argue that they can find meaningful agential opportunities in virtue of their psychiatric disability. They believe that their form of difference—mental diversity—deserves institutional and interpersonal recognition. This movement therefore challenges standard ways of conceptualizing mental illness, duties of recognition, and what constitutes a valued mode of being. All of these challenges have implications for health care professionals’ ethical obligations and responsibilities in relation to this patient population. I argue that many of the insights from the disability rights movement can help illuminate the philosophical underpinnings of the psychiatric user/survivor movement, though there are differences in the specific normative demands of these two movements. Similar to how the disability rights movement disputes able-bodied norms, user/survivor activism rejects able-minded or “sanist” norms. The movements are not precisely parallel, however, given the distinctive features of psychiatric disabilities.My focus is on value-laden conceptions of mental illness, preemptive paternalism and conflicting claims to epistemic authority, and the tension between respecting “generative madness” on the one hand and avoiding neglect or abandonment of individuals in need on the other. I show that disability modeling accommodates many of the claims from users/survivors, including the claim that their disability can be a source of value that deserves recognition. I argue that their demands for recognition of mental diversity will encounter significant obstacles, but those obstacles are not insuperable for all of those represented by user/survivor activism. I illustrate how a psychiatrically disabled mode of being can be cared about because it is meaningful, which leads to prima facie obligations that should shape the clinical encounter. The therapeutic relationship provides a critical opportunity for interpersonal recognition. I argue that shared decision-making can be possible when recovery goals accommodate, within limits, modes of being that the patient cares about in virtue of being meaningful.
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A Guide to the Archival Collection of The President’s Commission for the Study of Ethical Problems in Medicine and in Biomedical and Behavioral Research Norton, Charles N; Guidry-Grimes, Laura; Barry, Laura Ruth (2014-03)