In this article, I argue that the recent emphasis on compassion in healthcare practice lacks conceptual richness and clarity. In particular, I argue that it would be helpful to focus on a larger concept of empathy rather than compassion alone and that compassion should be thought of as a component of this larger concept of empathy. The first part of the article outlines a critique of the current discourse of compassion on three grounds. This discourse naturalizes, individualizes, and reifies compassion (...) leading to a decontextualized and simplified understanding of failures in healthcare practice. The second part uses resources from phenomenology and contemporary moral philosophy to construct a “hybrid” concept of empathy that includes both pre‐reflective/intuitive and cognitive/imaginative components. This “hybrid” concept of empathy leads to a more complex understanding of the multiple responses to others' distress. I conclude that there are no straightforward normative naturalistic responses to others' distress. Rather than conceptualizing compassion as a naturalistic impulse or a character‐based trait, we need to consider the complexity of our empathic recognition of vulnerable others. (shrink)

Abstract:In this paper, I offer a philosophical critique of the Power Threat Meaning Framework (PTMF). This framework was launched in the UK in January 2018 as a non-pathologizing way of understanding mental distress. It argues that those experiences diagnosed as mental illnesses are better understood as meaning-based threat responses to the negative operation of power. My critique consists of three parts. First, the PTMF argues that it is opposed to a concept of mental distress as illness. However, the PTMF unfolds (...) an account of mental distress that is very similar to other accounts of mental illness in the philosophical literature. The PTMF does not reflect upon, recognize or give an account of its own grounds for judging mental distress as distress. If it were to do so, I argue that it would produce an account of mental distress that is very similar to many other accounts of psychiatric illness or disorder. Second, I criticize the account given of meaning in the PTMF. I argue that this account is ultimately a reductive, behavioral account of adaptation that downplays important existential aspects of experience. Furthermore, the account of interpretive sense-making in the PTMF is conceptually confused. Finally, I outline a critique of the way that the concept of power, the great strength of the PTMF approach, is reduced to a concept of threat. I argue that this tends toward a linear view of causality that is reductive in its search for the meaning of mental distress. (shrink)

This paper analyses three concepts of life in Adorno's philosophy and considers the relationship between these concepts and the idea of a speculative materialism. The paper is concerned with Adorno's late concept of metaphysical experience and articulates a response to two key problems for the interpretation of this concept. First, given Adorno's emphasis on a purely negative philosophy, how does transcendence arise? Second, how can we give an experiential content to this idea of transcendence? A response to these two questions (...) is configured through an analysis of three concepts of life; mere life, damaged life and ephemeral life. (shrink)

In his attempt at a renewal of the concept of reification, Axel Honneth has referred to reification as a kind of forgetting. He uses an epigraph from Adorno and Horkheimer’s work to introduce this theme. This article considers the different accounts that are given by Honneth, on the one hand, and Adorno and Horkheimer, on the other, as to the way that reification is a forgetting of core experiential capacities of intersubjective human relations. It argues that Honneth’s account relies too (...) much on a foundational and undifferentiated notion of ‘empathetic engagement’, and that in order to articulate the damage done by reification, we need to contend with the more radical notion of forgetting that is outlined in Adorno and Horkheimer’s work. (shrink)

Recent debates concerning the abolition of the schizophrenia label in psychiatry have focused upon problems with the scientific status of the concept. In this article, I argue that rather than attacking schizophrenia for its lack of scientific validity, we should focus on the conceptual history of this label. I reconstruct a specific tradition when exploring the conceptual history of schizophrenia. This is the concern with the question of the sense of life itself, conducted through the confrontation with schizophrenia as a (...) form of life that does not live, or as Robert Jay Lifton termed it ‘lifeless life’ (1979: 222—39). I conclude by arguing that the contemporary attempt to deconstruct or abolish the schizophrenia concept involves a fundamental shift in concern. The attempt both to normalize psychotic experiences, and to conceive them purely in terms of cognitive processes that can be mapped onto brain function, results in a fundamental move away from the attempt to understand the experience of madness. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Remnants of SenseAlastair Morgan, PhD (bio)In an interview outlining her approach to understanding mental distress, Lucy Johnstone states that when faced with ostensibly bizarre, irrational or distressing experiences:[T]he guiding principle of "At some level it all makes sense" applies. In fact, I can't immediately think of anyone I've worked with for whom it did not, in the end, turn out to be true.1The two commentaries on my paper (...) point to two levels where this sense-making might operate; a structural and an individual level.Havi Carel (2023) draws attention to the important concept of power in the Power Threat Meaning Framework and suggests a widening of the concept of threat to a concept of vulnerabilization that refers to the multiple factors that expose people to institutional neglect and violence that is interlaced with a range of forms of discrimination, neglect and disadvantage. Whilst the main strength of the PTMF approach is to draw attention to the structural importance of power in contributing to forms of psychic distress, the emphasis on a concept of threat tends towards a reactive and reductive concept of power. Carel (2023) helpfully points to a wider concept of power that can be utilised for further work in understanding the impact of societal violence on forms of mental distress.Such a widening of the concept of power does not only rest on a critique of institutions but also an understanding of the ways in which people can be abandoned and neglected by state support of one kind or another. Power operates through a dual logic of exposure and abandonment. Some people are particularly exposed to forms of institutional power from an early age and vulnerabilized by such exposure, but there is also a logic of abandonment within such exposure; the ever present possibility of neglect. Such an operation of power is not univocal (or embedded in one profession) but dispersed and differentially applied. As Didier Fassin (2018, p. 43) writes: "All lives are precarious but certain lives much more so than others—and above all, quite differently."Psychiatric power is one important focus when trying to understand this process of the exposure and abandonment of power, however, as Carel (2023, p. 75) notes, "the medical realm is not its own kingdom." Psychiatry is inserted into a network of dispersed power that has multiple and differential effects, both positive and negative. The focus on the question of psychiatric diagnosis as the apotheosis of societal power neglects the multiple effects of diagnosis or the lack of diagnosis on people who are particularly vulnerable to the operations of power. In situations where institutional care is crumbling and under-resourced the focus on psychiatric care alone as a problem of power risks just compounding such an institutional neglect. [End Page 77] Veena Das (2020) asks the question of what happens before the arrival of the psychiatrist on the scene of care and after her disappearance. Das (2020, p. 174) is interested in the multiple ways that power flows across and between both formal and informal institutions to produce a "milieu of madness." Such flows of power will also apply to increasingly hegemonic psychological formulations of signs of distress as problems in living, as problems in adaptive reactions to adversity. Such formulations are themselves inserted into a nexus of power relations and processes of vulnerabilization and are not somehow free of the taint of other forms of understanding. Indeed, as Carel notes, the process of demedicalization and de-professionalisation can very easily be inserted into the dual logic of exposure and abandonment that I discussed earlier. People can be exposed to power in a wider range of settings as psychic distress is demedicalized but also subjected to abandonment and neglect as mental distress is no longer thought of as an illness but just one of many wider and non-medical problems in living that does not require state support.The structural account of the determinants of mental distress offers an important corrective to individualised and medicalised approaches to meaning, but doesn't completely erase the problem of understanding and interpreting mental distress. Mohammed Abouelleil Rashed's commentary raises important issues with the... (shrink)

This book equips readers with a sound understanding of the value-base of mental health care and provides them with the skills and knowledge to demystify complex values in decision-making in order to reach outcomes which are focused on the needs of service users. Engaging case examples and exercises link theory and practice throughout.