Compounded Vulnerabilities in Social Institutions: Vulnerabilities as Kinds

1. Compounded Vulnerabilities in Social Institutions: Vulnerabilities as Kinds Laura Guidry-Grimes, Georgetown University Elizabeth Victor, USF & Georgetown University Diotima Conference, 2011

2. Introduction • Vulnerabilities • Rejection of Kantian isolated ‘willers’ account • Reflect the various ways in which we are dependent on others for effective agency • Vulnerability: Our definition • Morally problematic disadvantaged placement of an individual within the context of social practices • Clarifying who is ‘the vulnerable’ • Context and the impact of situations • Overlapping factors Vulnerabilities as kinds

3. Compounded Vulnerabilities: A Concept • Sides of Compounded Vulnerabilities • Agent-side factors • Luna (2009) • Widen scope of applicability & still keep sufficiently narrow definition of vulnerability • Institution-side factors • Shift analysis to social practices and systematic disadvantage • Function of labels in the context of vulnerability

4. Outline of Presentation • Medical labels as interactive kinds • Where and when interactive kinds arise • Diagnostic categories creation of barriers • Limiting capacity toward well-being • Firmer grasp on the interaction of medical practice and other social institutions • PMDD as an example of an interactive kind that can compound vulnerabilities

5. Medical Labels & Interactive Kinds • Hacking on interactive kinds • Distinguishing interactive kinds from indifferent kinds • The problem with causal mapping • Biological determinants vs. social determinates • Why interactive kinds? • Better modeling of relationships by looking at the looping effects between variables • Better starting point for measures & remedy development • Another safety mechanism against perpetuating oppressions

6. Social Construction Model • Interactive Kind Model Methods for Modeling • Medical-Biological Model

7. PMDD as an Interactive Kind • Choosing between models for PMDD • Medical-biological model • Social constructionist model • Rejecting mutual exclusivity of the models • Difficulty in teasing the two apart • Why we wouldn’t want to if we could • What interactive modeling has to offer • Different ways of understanding • Different ways of responding • Recognition of how social groups can be rendered vulnerable upon diagnosis

8. Defining Vulnerability • Vulnerability as a flexible term • Accommodate particularities & circumstantial details • When is a person vulnerable? • When in a position which threatens the holistic person as an agent for developing and achieving the most fundamental dimensions of well-being • Sources of vulnerability • Internal variables • External variables • Narrowing the definition • Distinguishing from susceptibility or loss whatsoever

9. Vulnerabilities & Well-Being • The holistic person • Powers & Faden (2006) & dimensions of well-being • Sufficient level of functioning along all dimensions necessary for decent minimum • All of equal moral importance • Necessary for human flourishing • Health • Personal security • Reasoning • Respect • Attachment • Self-determination

10. Vulnerability, Well-Being , and Labels • Intersecting of dimensions • Medical labels can cut across categories • Vulnerability as too broad or abstract? • Problems with non-ideal theories • Flexibility at the expense of narrowness? • Avoiding blanket labels • Essential/fixed traits do not threaten • Vulnerability enters with • Perceptions of other within the context of normative social practices

11. Ways to Interpret Vulnerability • Distinguishing vulnerability from susceptibility • All humans are vulnerable, but only certain people at specific times are susceptible (Kottow 2003) • Feature of humanity • In our close social relationships, acknowledgement of human frailty is essential for emotional closeness & empathic engagement (Carse 2006) • Forced vulnerability as a social ill • Distinguishing our definition from Kottow & Carse • As the result of • Systematic disadvantage • Asymmetric power relations

12. Compounded Vulnerabilities • When do they happen? • When systemic or institutional conditions intersect in a manner that creates additional barriers to the agent's ability to develop or achieve wellness of being • Particular susceptibility of historically marginalized populations • Tools to identify when and how different kinds of vulnerabilities intersect to give rise to compounded vulnerabilities • Compounded vulnerabilities as layers of vulnerability

13. Mental Illness, labels, and compounded vulnerabilities • When diagnostic categories target historically marginalized and disadvantaged populations • Stigma of mental illness • Building of an institutional barrier • Reinforcement of stereotypes & biases • Effects of psychological oppression • Double effect of compounding vulnerabilities • Bolsters marginalization and adds difficulties for attaining sufficient level of well-being

14. PMDD & Compounded Vulnerability • Controversial medical labels • Designate specific population as an essential feature of the diagnostic criteria • Not explicit in this regard, but de facto apply to a specific population in their diagnostic practices • PMDD as an institutional barrier • Perpetuated stereotype of ‘menstruating women’ • Continues history of women’s pathologization • Compromised legal standing • Compromised medical autonomy • Denied career opportunities • Internalized stigma

15. Conclusions • Interactive kinds as a conceptual tool • Better evaluate how labels are reflective of biological determinants • How social determinants inform the interpretation of biological factors • Mitigating harm • Through understanding how vulnerabilities intersect • Who is susceptible • Harms and barriers confronted by targeted groups

16. Recommendations • NOT suggesting radical changes • Awareness is the first step in • Rethinking classifications • Rethinking research interventions • Rethinking treatments at the institutional level • Recognizing the role of the clinician in enhancing patient autonomy through the presentation of materials • Incorporate contextually rich diagnostic tools • Narrative-focused structured interviews when patient presents symptoms or seeks treatment • Provide fuller context & nuanced details • Explain what symptoms mean to the individual • Explain condition-significant distinctions • Communicate life circumstances

17. Questions? • Diversity of concepts • How can they be bridged? • Historically marginalized populations • Who are they? • Effects of psychiatric labeling Check out our website: http://engage.bioethics.georgetown.edu/mentalillness