Justice Everywhere

a blog about philosophy in public affairs

Category: Health (Page 2 of 6)

Self-control and socio-economic disadvantage: trickier than it seems

In social psychology, there is a small industry for articles reporting positive correlations between measures of self-control and various measures of socio-economic status and achievement. For example, Tangney, Baumeister and Boone (2008) found that self-control, measured on a self-report scale they devised, is correlated with better grades, somatic and mental health, and stable social relationships such as marriage. Moffitt et al. (2011) conducted a longitudinal study that followed children who had participated in the Mischel “marshmallow tests” to the age of 32 years old, and found childhood performance in that delayed gratification assignment to be correlated with measures of health and economic success, interpersonal adjustment, and  with criminal justice outcomes, even after controlling for childhood socio-economic factors.

Studies like these have been widely publicised, and the message in popular science media often leads with the idea that self-control is a stable trait that some have, some don’t. The ones who were dealt a losing hand in self-control got a losing hand overall, ending up with poor health, poverty, unstable relationships, and crime not out of ill will, but because they simply can’t hold it together. In short, the causal arrow goes from poor self-control to socioeconomic disadvantage.

This line of thinking has received plenty of criticism. Some have pointed out that the studies have been designed from a perspective assuming a middle-class lifestyle, and that self-control may not be as adaptive for people from all backgrounds.

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Why We Can’t Have It All When It Comes to the Future of Work

This is a guest post by Deryn Thomas, PhD Student in Philosophy, Benjamin Sachs, Senior Lecturer, and Alexander Douglas, Senior Lecturer, at University of St. Andrews. It discusses their recent research on a future with fair work for all and some of the trade-offs it involves. 


Two years into a world turned upside down by lockdowns, travel restrictions, and viral mutations, the way people work and make a living has changed dramatically. New challenges are being presented by rising childcare costs, increases in automation, the digitisation of the workplace, and the gig economy. So we need to ask: how do we make the future of work better for everyone?

At the Future of Work and Income Research Network, we’ve been thinking hard about this problem. As part of these efforts, we recently participated in a consultation for the Scottish Government on its Fair Work Goals, set to be implemented by 2025. The consultation document and stated goals offer an optimistic vision for the future of work in Scotland. But it risks being too idealistic: many of the stated goals conflict with each other.

We noticed at least four sets of incompatible goals. As it stands, the documents say nothing about how these compromises will be decided. But we think this leaves out an important step in the process. Therefore, we offer some reflections from philosophy about how to weigh up the values at stake.  In the end, we think that decisions like these need to be made in the context of a national conversation about the trade-offs surrounding work.

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Mental Illness and Microaggression

Not only do people with mental illness frequently encounter negative stereotypes in news, films, books and in everyday speech, others often give misguided advice or are dismissive towards their mental distress. Yet claims by people with mental illness to have experienced discrimination in the form of microaggression might also be too easily dismissed: could not mental distress lead to increased emotional sensitivity, leading them to overreact?

Microaggressions, the small slights regularly experienced by marginalised people, are near daily reminders that someone is an outsider or a second-class citizen. On their own they may be slight, but their cumulative impact is anything but.  As part of a wider social pattern of oppression, they are deeply harmful. Microaggression can be behavioural such as when a store security guard is more likely to accuse a black customer of shoplifting; verbal, such as when a racialised person is regularly asked where they are “really” from; or environmental, such as when all buildings are named after white people and whiteness is assumed as the norm. (Examples of microaggressions related to race, gender, sexuality can be found here.)

People with mental illness regularly encounter negative stereotypes about themselves. Consistently depicting a group negatively, with limited access to positive role models, is an example of environmental microaggression. In both news and fiction, people living with schizophrenia or bipolar disorder are often depicted as violent or as bad parents. In crime novels, the culprit is often mentally disturbed. In her autoethnographic essay documenting how repeated exposure to this material affects her, Jennifer Eisenhauer writes: “The ways in which mothers who have bipolar disorder are portrayed in popular media becomes part of my daily lived experience. This is not because I see these portrayals everyday, but because these images and narratives become part of how I see myself and how others view me.”

Beyond these common negative stereotypes, people experiencing mental illness often encounter comments and behaviour which are insensitive or unhelpful. The many lists and articles about “what not to say to someone with mental illness” can be seen as guides to avoiding microagression. The Australian mental health charity SANE recommends avoiding the following:

– “Get over it / snap out of it”
– “It’s all in your head”
– “Stop whinging”
– “You have the same illness as my…”
– “You don’t seem unwell”
– “They’re so OCD!”
– “Have you thought of trying this, that or the other?”
– “You don’t need medication”
– “You need to be honest”
– “Get a good night’s sleep, exercise and look for the positives”
– “Oh yeah, that’s quite common isn’t it?”
– “Time heals. It will get better”

While stating that a mental illness is quite common seems to indicate acceptance, it can be experienced as minimising one’s distress. “You have the same illness as my…” is not that different from telling a black person that you are ok with black people and are not a racist because you have black friends. Other apparently well-meaning comments are problematic because they place the responsibility for recovery on the sufferer. Telling people to “think positive”, “what do you have to be upset about when your life is so good” or assuming that taking up yoga and eating large quantities of blueberries will solve someone’s problems, make it sound as if people could simply “snap out of it” if only they could be bothered to try. Such examples of insensitivity and rudeness accumulate into a pattern of social assumptions that mental illness can be overcome with application and self-management. This, in turn, moralises mental illness – you would not be depressed if only you tried harder, you are not trying that hard, therefore you are doing something wrong. Such moralisation further undermines the confidence of those with mental illness.

Appeals to microaggression are often dismissed with the claim that people are simply oversensitive. The complainers are snowflakes, self-deluded by victim culture. This criticism appears even more forceful here, as people with mental illness are often prone to interpreting events in a negative light or ruminating on the comments of others. We need not go as far as assuming completely delusional thinking. Depressed people often feel disproportionate guilt, feel as if they have failed or feel unloved. Anxiety can lead us to blow the importance of things out of proportion, or to worry about events that are unlikely to occur. Even psychologists sometimes assume that those with mental illness primarily experience self-stigma and expect discrimination that outweighs the actual stigma and discrimination from others. They claim that the negative attitudes are mostly in people’s imagination. Given this background how can we be sure that experiences of microaggression are not simple misinterpretations of well-meaning acts?

This is where the work of philosopher Regina Rini comes in extremely useful (even though mental illness is not a case she discusses). In her book-length analysis of the concept of microaggression, she gives an “ambiguous experience account of microaggression: what makes an act or event count as microaggression is that it is perceived by a member of an oppressed group as possibly but not certainly instantiating oppression.” Her definition takes into account that microaggressions are both subtle and ambiguous. Part of the damage they do is to make already marginalised people suspicious of their own interpretation of events. While their own interpretations are not always correct, Rini argues that as long as on balance members of a marginalised social group are likely to correctly notice subtle discrimination, we should accept that microaggression does happen, even if we sometimes disagree about whether any individual case is an instance of it.

Are people with mental illness reliable in this way? They are usually knowledgeable about their symptoms, medications and medication side effects. Moreover, most people, even with chronic mental illnesses, are not always unwell and out of touch with reality. Even when unwell, mental illness does not affect all domains of thinking. Experiencing irrational guilt does not imply an inability to recognise condescending remarks. The extensive overlap among “what not to say” lists (not all of which are blatant copies of each other) also indicates a consensus over what constitutes microaggression for people with mental illness.

So, rather than worrying whether an individual instance counts as a microaggression, we should be concerned with identifying the most common forms of microaggression that affect people with mental illness. If people with mental illness identify a set of unhelpful and discriminatory remarks, behaviours or environmental factors, we can safely say that microaggression does affect people with mental illness, regardless of any tendency of some people with mental illness to find social slights particularly painful. Even in these cases, the painfulness of these experiences must not be discounted. Another strength of Rini’s account is that it puts the focus on the experiences of marginalised people. Even though they may at times be mistaken about their interpretation of events, we should still accept the word of those experiencing mental illness about how those events made them feel.

Research shows that microaggression does affect people with mental illness in systematic ways. For example, Yanos et al found that there were “three main categories of experiences in this regard: assumptions of inferiority (for example, statements indicating that it was assumed that the person is not capable of doing what most people can do), patronizing microaggressions (for example, dismissive statements suggesting assumptions that people with mental illness are child-like), and subtle behaviors indicating fear of mental illness (for example, moving away from a person who is known to have a mental illness).”

Thus, we have every reason to accept general claims of microaggression in the case of mental illness. What can we do about this? Rini recommends avoiding, or at least questioning, material with harmful stereotypes in order to avoid internalising these ourselves. For their own part, writers, whether of fiction, non-fiction or journalism, can reduce lazy stereotyping in their work. (There is plenty of advice available. As an example, philosopher Sofia Jeppsson has written a blog post on the common problems with the way mental illness is depicted in science-fiction.) We can follow the advice of “what not to say to people with mental illness” lists. We can assume that someone who lives with an illness has already tried all the obvious remedies. Most importantly, we should listen and if someone says something is unhelpful, accept this instead of trying to convince them that they are mistaken about their own experiences.

What the pandemic can teach us about political philosophy

This post originally appeared on LSE School of Public Policy’s COVID-19 blog on 3rd September. You can access this version here. Political Philosophy in a Pandemic: Routes to a More Just Future, the collection of essays discussed in this post, is out this coming Thursday (23rd September)!


Aveek Bhattacharya (Social Market Foundation) and Fay Niker (University of Stirling), co-editors of a new book on the ethics and politics of the COVID-19 pandemic and our response to it, introduce some of its ideas.

***

Back in April 2020, in the period we now look back on as “the first lockdown”, we gathered together some early reflections from philosophers and political theorists on the ethical dimensions of the developing COVID-19 pandemic. We published these on Justice Everywhere, the blog we help to run. Experts from almost every academic field – epidemiology, statistical modelling, social psychology, economics – were turning the tools of their trades to the growing crisis. What, if anything, did we and our peers have to offer?

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Political Philosophy in a Pandemic: Chapter Preview (Julia Hermann)

Several Justice Everywhere authors have been involved in a book project about the ethics and politics of COVID-19. The volume, Political Philosophy in a Pandemic: Routes to a More Just Future (Bloomsbury 2021), is a collection of 20 essays covering five main themes: (1) social welfare and vulnerability; (2) economic justice; (3) democratic relations; (4) speech and (mis)information; and (5) the relationship between crisis and justice.

The first of three chapter previews that we’ll be publishing over the next few weeks comes from Julia Hermann, who contributed a chapter to the final theme on the relationship between crisis and justice. Her chapter, co-authored with Katharina Bauer and Christian Baatz, is entitled Coronavirus and Climate Change: What Can the Former Teach Us about the Latter? Check out her short video introduction to their chapter below:

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From the Vault: Collaboration with Journal of Applied Philosophy

While Justice Everywhere takes a break over the summer, we recall some of the highlights from our 2020-21 season. This post focuses on our ongoing collaboration with the Journal of Applied Philosophy.

In 2019, Justice Everywhere began a collaboration with the Journal of Applied Philosophy. The journal is a unique forum that publishes philosophical analysis of problems of practical concern, and several of its authors post accessible summaries of their work on Justice Everywhere. These posts draw on diverse theoretical viewpoints and bring them to bear on a broad spectrum of issues, ranging from the environment and immigration to economics, parenting, and punishment.

For a full list of these posts, visit the JAP page on Justice Everywhere. For a flavour of the range, you might read:

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Vaccine Equity and the Responsibility of Rich Countries

What We Owe to Each Other is the title of Tim Scanlon’s famous work on contractualism. As the title reveals, Scanlon seeks to investigate how to treat others with the due respect and dignity they deserve. This post is not about contractualism or about the TV show. Rather, borrowing Scanlon’s book title, I suggest what rich nations should do to address the global vaccine inequity that is hampering poorer nations’ efforts to combat the pandemic. The account sketched here must stand a good chance of being accepted by the relevant rich states. To this end, the following constraints must be accepted. First, governments are primarily driven by concerns for their own citizens and residents. This means that, as non-ideal as it may sound, global egalitarian ideals would not be realised, at least for now. Second, and relatedly, access to vaccines would always likely to be decided by free market principles. Again, legitimate objections, especially egalitarian ones, can be raised against this but this is a constraint that must be accepted, given the dominance of free market thinking in Western countries. Third, as a result, COVAX’s original goal – ‘to ensure that people in all corners of the world will get access to COVID-19 vaccines once they are available, regardless of their wealth’ – was always a wishful thinking.

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Nicotine Vaccines and Childrens’ Rights to an Open Future

That smoking significantly contributes to preventable death and loss in quality of life is obvious, and it is the starting point of many governmental interventions aimed at curbing national smoking rates. Cigarette smoking – and consumption of other nicotine (and tobacco) products – has been and continues to be in the focus of attention of state governments, public policy makers, and public health officials, and remains as one of the main targets of public health interventions.

The most familiar types of tobacco control and anti-smoking interventions include legal age limits, taxation, restrictions on sale and advertisement of nicotine products, educational campaigns, and smoking bans in public and semi-public places. However, the impact of these efforts is far from ideal. Simply put, people start and continue to smoke, thereby contributing to the expected rise in the number of smokers and to the increase of smoking-related fatalities worldwide.

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Dementia, Truthfulness, and Respecting Agency

In this post, Jeanette Kennett and Steve Matthews discuss their recent article in Journal of Applied Philosophy on respecting agency in dementia care.


Years before entering the nursing home Mr Q had been a janitor at a boarding school. With the progression of dementia, he came to perceive the nursing home – with its distinctly institutional décor – as his old place of work. And so, throughout the day he would act out his janitorial role, with its many tasks of checking windows and doors, and making sure that all was running smoothly. The neurologist Oliver Sacks, writing about the case, noted that ‘the Sisters [who ran the home]…though perceiving his confusion and delusion, respected and even reinforced [his] identity. They assisted him [by] giving him keys to certain closets and encouraging him to lock up at night before he retired.’ Did the sisters do the right thing? Perhaps they should have been more truthful by reminding Mr Q that in fact he was a declining patient with dementia. Sacks thought otherwise. Occupying his role helped Mr Q to make sense of his surroundings. In fulfilling this role, says Sacks, ‘[Mr Q] seemed to be organized and held together in a remarkable way…’

The case of Mr. Q raises a thorny problem for caregivers: should truthfulness give way when people with dementia form false beliefs about their circumstances? This moral dilemma is usually presented as a choice between acting on a principle of respect for persons – which requires truthfulness – versus acting out of a concern for their welfare – which might require going along with a false belief. In our recent article, however, we argue that the debate should be framed in a different way. It seems to us, that in going along with Mr Q, the Sisters were scaffolding and protecting his sense of identity, something that thereby respected his agency. This of course had the added effect of attending to Mr Q’s welfare. We argue that when we support a person’s agency in these ways their welfare needs are simultaneously addressed.

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A Puzzle about Disability and Old Age

In this post, Kasper Lippert-Rasmussen discusses their recent article in Journal of Applied Philosophy on the connections between disability-related disadvantages and old-age-related disadvantages.


Many think that being disabled and being old are worse for a person than being able-bodied and being young respectively. However, many think differently about these two disadvantages. Specifically, they think that while the disadvantages of disabled people are (largely) due to ableism, the disadvantages of old age are not due to ageism, but simply reflects a regrettable, unavoidable fact of life. In a recent article, I argue that this view is untenable. More generally, I suggest in the light of how our thinking of one of these forms of disadvantages constrains our thinking about the other that much of the previous debate about the badness of disability and old is misdirected.

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