This paper discusses two perspectives, each of which recognises the importance of environmental resources in enhancing and amplifying our cognitive capacity. One is the Clark–Chalmers model, extended further by Clark and others. The other derives from niche construction models of evolution, models which emphasise the role of active agency in enhancing the adaptive fit between agent and world. In the human case, much niche construction is epistemic: making cognitive tools and assembling other informational resources that support and scaffold intelligent action. (...) I shall argue that extended mind cases are limiting cases of environmental scaffolding, and while the extended mind picture is not false, the niche construction model is a more helpful framework for understanding human action. (shrink)

I introduce the concept pathophobia, to capture the range of morally objectionable forms of treatment to which somatically ill persons are subjected. After distinguishing this concept from sanism and ableism, I argue that the moral wrongs of pathophobia are best analysed using a framework of vice ethics. To that end I describe five clusters of pathophobic vices and failings, illustrating each with examples from three influential illness narratives.

Ill persons suffer from a variety of epistemically-inflected harms and wrongs. Many of these are interpretable as specific forms of what we dub pathocentric epistemic injustices, these being ones that target and track ill persons. We sketch the general forms of pathocentric testimonial and hermeneutical injustice, each of which are pervasive within the experiences of ill persons during their encounters in healthcare contexts and the social world. What’s epistemically unjust might not be only agents, communities and institutions, but the theoretical (...) conceptions of health that structure our responses to illness. Thus, we suggest that although such pathocentric epistemic injustices have a variety of interpersonal and structural causes, they are also sustained by a deeper naturalistic conception of the nature of illness. (shrink)

A family of recent externalist approaches in philosophy of mind argues that our psychological capacities are synchronically and diachronically “scaffolded” by external resources. I consider how these “scaffolded” approaches might inform debates in phenomenological psychopathology. I first introduce the idea of “affective scaffolding” and make some taxonomic distinctions. Next, I use schizophrenia as a case study to argue—along with others in phenomenological psychopathology—that schizophrenia is fundamentally a self-disturbance. However, I offer a subtle reconfiguration of these approaches. I argue that schizophrenia (...) is not simply a disruption of ipseity or minimal self-consciousness but rather a disruption of the scaffolded self, established and regulated via its ongoing engagement with the world and others. I conclude by considering how this scaffolded framework indicates the need to consider new forms of intervention and treatment. (shrink)

Chronic fatigue syndrome or myalgic encephalomyelitis remains a controversial illness category. This paper surveys the state of knowledge and attitudes about this illness and proposes that epistemic concerns about the testimonial credibility of patients can be articulated using Miranda Fricker’s concept of epistemic injustice. While there is consensus within mainstream medical guidelines that there is no known cause of CFS/ME, there is continued debate about how best to conceive of CFS/ME, including disagreement about how to interpret clinical studies of treatments. (...) Against this background, robust qualitative and quantitative research from a range of countries has found that many doctors display uncertainty about whether CFS/ME is real, which may result in delays in diagnosis and treatment for patients. Strikingly, qualitative research evinces that patients with CFS/ME often experience suspicion by health professionals, and many patients vocally oppose the effectiveness, and the conceptualization, of their illness as psychologically treatable. We address the intersection of these issues and healthcare ethics, and claim that this state of affairs can be explained as a case of epistemic injustice. We find evidence that healthcare consultations are fora where patients with CFS/ME may be particularly vulnerable to epistemic injustice. We argue that the marginalization of many patients is a professional failure that may lead to further ethical and practical consequences both for progressive research into CFS/ME, and for ethical care and delivery of current treatments among individuals suffering from this debilitating illness. (shrink)

In this paper we argue that ill persons are particularly vulnerable to epistemic injustice in the sense articulated by Fricker. Ill persons are vulnerable to testimonial injustice through the presumptive attribution of characteristics like cognitive unreliability and emotional instability that downgrade the credibility of their testimonies. Ill persons are also vulnerable to hermeneutical injustice because many aspects of the experience of illness are difficult to understand and communicate and this often owes to gaps in collective hermeneutical resources. We then argue (...) that epistemic injustice arises in part owing to the epistemic privilege enjoyed by the practitioners and institutions of contemporary healthcare services—the former owing to their training, expertise, and third-person psychology, and the latter owing to their implicit privileging of certain styles of articulating and evidencing testimonies in ways that marginalise ill persons. We suggest that a phenomenological toolkit may be part of an effort to ameliorate epistemic injustice. (shrink)

This paper argues that the DSM diagnostic category 'major depression' is so permissive that it fails to distinguish the phenomenology of depression from a general 'feeling of being ill' that is associated with a range of somatic illnesses. We start by emphasizing that altered bodily experience is a conspicuous and commonplace symptom of depression. We add that the experience of somatic illness is not exclusively bodily; it can involve more pervasive experiential changes that are not dissimilar to those associated with (...) depression. Then we consider some recent work on inflammation and depression, which suggests that the experience of depression and the 'feeling of being ill' are, in some cases at least, much the same . However, we add that the phenomenology of depression is heterogeneous and that many cases involve additional or different symptoms. We conclude that 'major depression' is a placeholder for a range of different experiences, which are almost certainly aetiologically diverse too. (shrink)

In this paper, we argue that the concept of environmental scaffolding can contribute to a better understanding of our affective life and the complex manners in which it is shaped by environmental entities. In particular, the concept of environmental scaffolding offers a more comprehensive and less controversial framework than the notions of embeddedness and extendedness. We contribute to the literature on situated affectivity by embracing and systematizing the diversity of affective scaffolding. In doing so, we introduce several distinctions that provide (...) classifications of different types of environmentally scaffolded affectivity. Furthermore, we differentiate eight dimensions that allow us to evaluate the quality and effectivity of scaffolds in particular applications. On that basis, we develop a taxonomy using paradigmatic examples of affective scaffolding. This taxonomy enriches the current debate by emphasizing distinctions that are often conflated and by identifying fields of application that are commonly overlooked. (shrink)

From a phenomenological viewpoint, shame and guilt may be regarded as emotions which have incorporated the gaze and the voice of the other, respectively. The spontaneous and unreflected performance of the primordial bodily self has suffered a rupture: In shame or guilt we are rejected, separated from the others, and thrown back on ourselves. This reflective turn of spontaneous experience is connected with an alienation of primordial bodiliness that may be described as a "corporealization": The lived-body is changed into the (...) objective, corporeal body or "body-for-others." The polarity of "bodiliness" and "corporeality" may further a phenomenological understanding of several mental disorders connected with shame and guilt. This is shown by the examples of body dysmorphic disorder and melancholic depression. (shrink)

Miranda Fricker’s influential concept of epistemic injustice has recently seen application to many areas of interest, with an increasing body of healthcare research using the concept of epistemic injustice in order to develop both general frameworks and accounts of specific medical conditions and patient groups. This paper illuminates tensions that arise between taking steps to protect against committing epistemic injustice in healthcare, and taking steps to understand the complexity of one’s predicament and treat it accordingly. Work on epistemic injustice is (...) therefore at risk of obfuscating legitimate and potentially fruitful inquiry. This paper uses Chronic Fatigue Syndrome/Myalgic Encephalomyelitis as a case study, but I suggest that the key problems identified could apply to other cases within healthcare, such as those classed as Medically Unexplained Illnesses, Functional Neurological Disorders and Psychiatric Disorders. Future work on epistemic injustice in healthcare must recognise and attend to this tension to protect against unsatisfactory attempts to correct epistemic injustice. (shrink)

From a phenomenological viewpoint, shame and guilt may be regarded as emotions which have incorporated the gaze and the voice of the other, respectively. The spontaneous and unreflected performance of the primordial bodily self has suffered a rupture: In shame or guilt we are rejected, separated from the others, and thrown back on ourselves. This reflective turn of spontaneous experience is connected with an alienation of primordial bodiliness that may be described as a "corporealization": The lived-body is changed into the (...) objective, corporeal body or "body-for-others." The polarity of "bodiliness" and "corporeality" may further a phenomenological understanding of several mental disorders connected with shame and guilt. This is shown by the examples of body dysmorphic disorder and melancholic depression. (shrink)