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