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Compounded Vulnerabilities in Social Institutions: Vulnerabilities as Kinds. Laura Guidry-Grimes, Georgetown University Elizabeth Victor, USF & Georgetown University Diotima Conference, 2011. Introduction. Vulnerabilities Rejection of Kantian isolated ‘ willers ’ account - PowerPoint PPT Presentation
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COMPOUNDED VULNERABILITIES IN
SOCIAL INSTITUTIONS: VULNERABILITIES AS
KINDSLaura Guidry-Grimes, Georgetown University
Elizabeth Victor, USF & Georgetown University
Diotima Conference, 2011
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
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
OUTLINE OF PRESENTATION Medical labels as interactive kinds
Where and when interactive kinds arise
Diagnostic categories creation of barriersLimiting 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
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
METHODS FOR MODELING
Medical-Biological Model Social Construction Model Interactive Kind Model
PMDD AS AN INTERACTIVE KIND Choosing between models for PMDD
Medical-biological modelSocial constructionist model
Rejecting mutual exclusivity of the modelsDifficulty in teasing the two apartWhy we wouldn’t want to if we could
What interactive modeling has to offerDifferent ways of understandingDifferent ways of respondingRecognition of how social groups can be
rendered vulnerable upon diagnosis
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
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
VULNERABILITY, WELL-BEING , AND LABELS
Intersecting of dimensionsMedical labels can cut across categories
Vulnerability as too broad or abstract?Problems with non-ideal theories
Flexibility at the expense of narrowness?
Avoiding blanket labelsEssential/fixed traits do not threatenVulnerability enters with
Perceptions of other within the context of normative social practices
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 illDistinguishing our definition from Kottow &
CarseAs the result of
Systematic disadvantage Asymmetric power relations
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 vulnerabilitiesCompounded vulnerabilities as layers of
vulnerability
MENTAL ILLNESS, LABELS, AND COMPOUNDED VULNERABILITIES
When diagnostic categories target historically marginalized and disadvantaged populationsStigma of mental illness
Building of an institutional barrierReinforcement of stereotypes & biases
Effects of psychological oppression Double effect of compounding vulnerabilities
Bolsters marginalization and adds difficulties for attaining sufficient level of well-being
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
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
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
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