Abstract
Martin Luther King Jr. claimed that “the salvation of the world lies in the hands of the maladjusted”. I elaborate on King’s claim by focusing on the way in which we treat and understand ‘maladjustment’ that is responsive to severe trauma (e.g. PTSD that is a result of military combat or rape). Mental healthcare and our social attitudes about mental illness and disorder will prevent us from recognizing real injustice that symptoms of mental illness can be appropriately responding to, unless we recognize that many emotional states (and not just beliefs!) that constitute those symptoms are warranted by the circumstances they are responsive to. I argue that there is a failure to distinguish between PTSD symptoms that are warranted emotional responses to trauma and those that are not. This results in us focusing our attention on “fixing” the agent internally, but not on fixing the world. It is only by centering questions of warrant that we will be able to understand and expose the relationship between agents’ internal mental states and their oppression. But we also need to ask when someone’s emotional response is unwarranted by their experience (as in the case of someone who develops PTSD after a non-traumatic event). If we fail to do this—as, I claim, both our mental healthcare and the broader social world fail to do—we treat warranted and unwarranted emotions as on a par. This undermines the epistemic judgment of the agent who has warranted PTSD symptoms, resulting in her failing to trust her evaluation of whether her emotional response to her own trauma is warranted by that trauma, and thus failing to recognize her own oppression.
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Notes
I don’t deny that we ought to treat PTSD as a mental disorder, nor that there are both normative and descriptive issues at stake in doing so. (Thus this might be construed as a “weak normativist”, not “strong normativist” (Szasz. 1961; Foucault, 1964) critique.) However, as we will see, my argument does point towards overhaul at both the conceptual (we must conceive of it as a disorder grounded in the world/environment) and diagnostic (we must distinguish between similar symptoms that are agentially vs. environmentally grounded) levels.
See also Scrutton (2015a).
There are important differences between warranted emotions and beliefs (e.g. warrant of directed emotional states is (on my view) not unique, e.g., two people can appropriately grieve the death of a friend with distinct sets of emotional reactions, whereas I am neutral about uniqueness for justification).
I don’t claim that what is warranted is fixed, or fully fixed, by mind-and-language-independent facts. Indeed, I believe that our social practices and ideology contribute to not just the strength of our norms about warrant and desirability, but also their shape.
D’Arms and Jacobson (2000) distinguish between what is fitting to feel and what is right or wrong to feel (granting, e.g., that Taylor (1975) might be correct that anger is always wrong (morally) to feel, if it is wrong to feel so “concerned with what is due to one” (Taylor, 1975, 402), but that the further claim that anger is never warranted is wrong). I agree that warrant has little (directly) to do with what is morally right, just as what we should believe on the basis of our evidence has little to do with what is morally right, but if one takes the belief-emotion analogy seriously here, this issue is about whether an analogue of moral encroachment is true for warrant.
I don’t mean to be ruling out that we construct these facts somehow—but they are not individually subjective.
See e.g. Kendell and Jablensky (2003), Andreasen (2007), who point to an intentional decision in the construction of the DSM to focus on reliability over validity. Also see Frances and Widiger (2012), Scrutton (2015b). Scrutton claims that folk-psychiatry concepts tend to be more essentialist, whereas professional-psychiatry concepts tend to be more pragmatic (15). Murphy (2005) critiques the DSM for using something like folk-theoretic, “common sense” ideas about the mental rather than being more scientific, and advocates a focus on causal mechanism. Tabb (2015) sharpens the issue by pointing out that it is actually the assumption that “operationalized criteria for diagnosing clinical types will also successfully pick out populations about which relevant biomedical facts can be discovered” (2015, 1048) that is the real issue here.
Frances and Widiger (2012), make claims about the epistemology and method of the DSM that seem to support Pickard’s claim.
In particularly oppressive contexts, things are more complicated: warrant and desirability norms both systematically conflict, and are systematically enforced, thus putting the oppressed in a double bind. Fully elaborating this is a project for a different paper. (See Srinivasan, 2018 for related argument, and Hirji, 2021 for an account of double binds that fits with this claim.).
See Haslam (2016).
This is, of course, contentious: our inductive learning should arguably rationally be better adaptive to shifts in circumstances. But given that, e.g., victims of abuse are likely to be re-abused, it’s at least unclear exactly what the new circumstance warrants.
Meek Mill’s comments apply here as everywhere—if Mare were not a middle class white woman she would be treated quite differently.
For a critique of the view that, e.g., emotions like grief are “healing processes”, see Marušić 2022, 3.4.
Marušić is partly drawing on Moller (2007), who motivates a similar tension in discussing “resilient” grief.
I focus on Marušić’s discussion of grief because it most closely connects to my argument here, but it’s important to note that there is much disagreement both about what grief is and what role it plays in our lives. (And I don’t intend to be appealing to authority here.) See, among others, e.g. Cholbi (2022), Garland (2021, ch. 5) for grief’s connection to the shaping of identity/self; Atkins (2022) for the relationship between grief and intimacy with the self; Ratcliffe, Richardson, and Millar (2022) on a distinct account of grief’s object; Olberding (2007) on grief in the Zhuangzi/the importance of the capacity for sorrow; Gustafson (1989) on grief as a combination of belief (in the loss) and unsatisfiable desire (that it not be the case); and Price (2010) on grief involving two distinct forms of sadness.
Again, this isn’t an anti-therapeutic or anti-psychiatric treatment paper; the harm that PTSD causes to the agent and those around her are real and serious.
James Fritz (2021) makes a similar point about anxiety: because anxiety is overwhelmingly both fitting and imprudent, “for almost any actual person, it’s impossible to have an overall emotional state that meets the standards of both fitting emotion and prudent emotion.” Michael Cholbi (2017) makes a similar point about grief, and Marušić presents a similar puzzle about grief (2018, 2022) and our response to injustice (2020). Srinivasan (2018) points to a more systematic tension for the oppressed.
Such accounts of wellbeing are relevant to the broader project, if we are looking to ameliorate by conceptually engineering—one way to rectify the way in which desirability trumps warrant norms is by shifting our concept of desirability to one of warrant-including well-being. (This is not my favored solution).
Ruth Whippman (2017) gives an account of the United States’ “happiness industrial complex” and the positive psychology movement, which explains why happiness (and, in particular, happiness that we achieve precisely by being in unwarranted positive mental states—by making peace with any problematic circumstances we are in) is so central to our shared social concept of desirability. Horwitz and Wakefield (2007) provide an extended account of the ways in which fitting/warranted sadness (and other negative emotions) are treated as clinical depression, and the problems this presents.
Instead, insofar as this paper contains a concrete recommendation for mental healthcare providers (which is not my primary goal), it is primarily at the therapeutic level: recognize and mark the distinction between warranted and unwarranted emotions. Perhaps an intermediary suggestion can also be made: distinguish diagnostically between (partly) warranted PTSD and unwarranted PTSD.
Arpaly, who makes similar comments, also points out that this kind of thing can be taken to undermine the way in which we take our own lives and projects to be meaningful (for example, if the artist is told that his “state of inspiration is actually… hypomania, and that hypomania is a symptom of a disease” he may be “insulted or devastated” (2005, 290), though she argues that it is a mistake for us to respond this way.
Abramson (2014) gives an account of gaslighting that is useful here, though it is unclear whether Therapist is guilty of gaslighting—something more complex is happening here. (Therapist is in the grip of a theory on which his speech is both true and helpful.) Dandelet (2021) gives a more extensive account of self-gaslighting.
Others have discussed epistemic injustice in the psychiatric context, but not in this way. Scrutton (2017) discusses a distinct but related question about epistemic injustice and mental health care; Carel and Kidd (2020) apply Medina’s (2012) ideas about predicaments and epistemic injustice to make a related argument about epistemic injustice and illness more generally. Crighton et al. (2017) give an analysis of epistemic injustice in psychiatric contexts, but again, their cases, and focus, are distinct from mine—though might result in a similar threat to an agent’s metaepistemic attitudes (e.g. failure to trust a true and justified belief of a psychiatric patient; treatment of someone’s religious beliefs and rituals as delusional or psychotic).
Hirji (forthcoming) uses Miller’s case to motivate an account of “outrage anger” and its function—(in part) to prevent victims from empathizing with their abusers. She also makes some interesting observations about fittingness that I am sympathetic to, e.g.: “outrage anger might not just be a fitting response to the way the world is, it might be the agent’s only real path to trusting or really knowing what the world is like.” (p. 15)—and this is so even if outrage anger is not “productive” in other ways. Trauma responses like PTSD may be somewhat analogous here.
Two notes: first, I don’t suggest that we should do this; that would be to lose sight of the importance of desirability for individuals and their well-being. Second, mental health care comes closer to getting this right in “trauma-informed care”. Trauma-informed care is supposed to “shift focus from “what’s wrong with you?” to “what happened to you”?”.This sounds it shifts attention away from the idea that an agent is internally defective and instead focusing on the wrong of what happened to her. But if we still treat what counts as traumatic as deeply subjective, the problems I raise stand.
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Acknowledgements
Thanks for written comments and/or extensive discussion to Clayre Attisani, Mark Balaguer, Rebecca Chan, Katrina Elliott, Kim Frost, Samia Hesni, Sukaina Hirji, Jonathan Jacobs, Paul Katsafanas, Jaira Koh, Ned Markosian, Berislav Marušić, Daniel Méndez, Alisha Patel, Karl Schafer, Joel Silvestri, Tony Smith, and Eliška Wichterlová, and anonymous referees. Thanks for discussion with my wonderful colleagues at BU, audiences at the 2021 Pacific APA and the 2019 Rocky Mountain Ethics Congress, and to Pamela Hieronymi and her Fall 2021 Rationality and Action seminar students at UCLA. Thanks for encouragement from August Gorman, Jennifer Morton, and Sarah Paul. This paper was born out of (many iterations of) my Introduction to Philosophy course, and couldn’t have been written without the hundreds of young philosophers. I learned from therein.
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McSweeney, M. Maladjustment. Philos Stud 180, 843–869 (2023). https://doi.org/10.1007/s11098-022-01844-z
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DOI: https://doi.org/10.1007/s11098-022-01844-z