The Stigma Associated with Mental Illness. Lisa Bortolotti

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In January 2014 in the UK a new parliamentary enquiry was launched into mental health equality. Mental health charities (Rethink Mental Illness and Mind) and the Royal College of Psychiatrists urged Parliament to investigate how the Government can give mental health equal priority to physical health and improve the quality of life of people living with mental illness. One issue affecting quality of life in general, and health services in particular, is the stigma associated with mental illness. What philosophers can do is to provide cogent arguments to undermine some of the widespread but inaccurate claims that contribute to the stigmatisation of people with mental illness, and inform both psychological research into psychiatric disorders and clinical interventions.

A commonly held view about mental illness is that those who suffer from it are different from the “normal” population in quite radical ways. It is controversial what the difference is. Those attracted to a strong medical model of mental illness tend to believe that people suffering from it are damaged and diseased, due to genetic predisposition or trauma and abuse. Those attracted to a forensic model of mental illness tend to believe that people suffering with mental illness are irrational, weak-willed and prone to other character failures. The radical difference view is that damage, weakness, or a combination of the two compromises the autonomous decision making of people with mental illness, and prevents them from making a valuable contribution to society.

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In the Epistemic Innocence project (funded by an AHRC fellowship awarded to me in September 2013, and featuring Ema as a research fellow), we aim to dispel some of the myths surrounding mental illness by arguing that the cognitions featuring as symptoms of psychiatric disorders (delusional beliefs, distorted memories, confabulated narratives) are on a continuum with cognitions we all experience on an everyday basis. They are “imperfect” as they can be inaccurate, they are not well-supported by the available evidence, and they are often not shared by others. But they may also have benefits of a pragmatic and an epistemic nature. It is widely recognised that, say, an inflated conception of myself will increase my confidence and make me feel better about myself (thus having some pragmatic benefits). But if such a conception of myself is false, it will lead to further false beliefs and inaccurate predictions, and the idea that it might contribute to the acquisition and retention of true beliefs (and thus have epistemic benefits) sounds implausible.

In the next four posts this week Ema and I will attempt to make this idea more plausible by describing how some imperfect cognitions have epistemic benefits and gain a sort of epistemic innocence. Our argument will apply to the beliefs, memories and narratives that are symptoms of mental disorders such as schizophrenia and dementia, but also to everyday beliefs, memories and narratives in the non-clinical population. Distortions of reality are a common feature of human cognition, not the exception to the rule, and any theory of the mind or account of mental illness that does not acknowledge this idealises the capacities of human agents and fails to meet the criteria for psychological realism.

The themes of the Epistemic Innocence project will be further explored in a workshop hosted by the University of Birmingham. It is entitled “Costs and Benefits of Imperfect Cognitions”, and will be held on 8th and 9th May 2014. The workshop will promote exchange between philosophers and psychologists on the potential pragmatic and epistemic benefits and costs of beliefs, memories, implicit biases, and explanations. It is funded by an AHRC Fellowship awarded to myself. The Analysis Trust provided bursaries to the graduate students attending. There may still be some places are available should you be interested (just contact Ema by March 27th at the latest). Speakers include Katerina Fotopoulou (Senior Lecturer, Psychoanalysis Unit, Psychology and Language Sciences Division, University College London), Martin Conway (Professor and Head of the Department of Psychology, City University London), Ryan McKay (Senior Lecturer, Department of Psychology, Royal Holloway) and Maarten Boudry (Post-doctoral Researcher, Philosophy, University of Ghent), Miranda Fricker (Professor of Philosophy, University of Sheffield), Jules Holroyd (Lecturer in Philosophy, University of Nottingham), Petter Johansson and Lars Hall (members of the Choice Blindness Group, Philosophy and Cognitive Science, University of Lund).

Our plan for the week is as follows. Ema will talk about epistemic status of delusional beliefs on Tuesday (tomorrow), I shall address the potential benefits of distorted memories on Wednesday, and Ema will come back on Thursday to discuss beliefs based on implicit bias. On Friday, I shall tell you about what else we are doing to engage junior and senior researchers from different disciplinary backgrounds and the general public in the themes of the project.

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