Phil Hutchinson

This paper sets out a practical, interview-free protocol for studying how stigma, inequalities, and restrictive practices are done in women’s mental health, learning-disability, and autism services, with a particular focus on women detained in inpatient and other institutional settings. Building on Praxeological Analysis (PA) and Critical Praxeological Analysis (CPA), we specify data pathways for naturally occurring materials (clinical letters, triage logs, ward round notes, safeguarding records, complaint correspondence, public hearings/transcripts, and, where ethically approved, audio/video recordings of clinical interactions between people who use services and healthcare professionals), and a replicable analytic procedure keyed to linguistic/praxeological Gestalts. Rather than treating “stigma” as an attitude, attribute or variable, we investigate stigma in its sites of production, the situations in which discrimination, discreditation, degradation etc are done, experienced and witnessable. The protocol operationalizes what we call a praxeological respecification: a shift from traits to scenes and from beliefs and attitudes to practices, enabling research and quality improvement that directly addresses the levers through which inequalities are produced and maintained and which supports least-restrictive, trauma-informed, autism-informed and culturally competent inpatient care in line with current NHS culture-of-care standards.

This article examines the concepts of stigma and shame, their interrelationship, and their relevance to healthcare. It traces the intellectual genealogies of stigma and shame research, highlighting key debates and recent developments. The article argues for a praxeological approach to studying stigma and shame, focusing on how they are produced and made witnessable in interaction, rather than relying on theoretical abstractions. It explores the connections between stigma, shame, respect, and acknowledgement, emphasizing the importance of lived experience and interactional dynamics. The article presents a fictional stigma scenario to illustrate how stigma can be enacted unintentionally and experienced differently based on past encounters. It concludes by advocating for case studies and scenarios over theories to build a picture of the praxeological logic of stigma and shame. This approach aims to avoid depicting stigmatized individuals as passive victims and instead recognizes their agency in anticipating, resisting, and managing potential degradation.

This chapter explores the significant parallels between the later philosophy of Ludwig Wittgenstein, the philosophy of social science developed by Peter Winch, and the themes and orientations of ethnomethodology and conversation analysis (EM/CA). While EM/CA has its philosophical roots in phenomenology, particularly in the work of Alfred Schutz and Aron Gurwitsch—both formative influences on Harold Garfinkel—there are striking affinities with the Wittgensteinian tradition. The chapter outlines Wittgenstein’s later vision of philosophy as a practice of clarification aimed at dissolving conceptual confusion through attention to language-in-use and shared forms of life. It then turns to Winch’s The Idea of a Social Science, a work deeply indebted to Wittgenstein’s Philosophical Investigations, and reconstructs its seven central claims concerning action, meaning, rules, and understanding from the participant’s perspective. The chapter shows how these claims anticipate or parallel key concerns in EM/CA, including the irreducibly contextual character of meaning, the importance of members’ methods, and the reorientation of social inquiry away from causal explanation toward the explication of practical reasoning. Special attention is given to the Manchester School of Ethnomethodology, which explicitly integrated Wittgenstein and Winch into its analytic orientation. The chapter makes a case for renewed engagement with these philosophical resources within EM/CA.

This paper introduces Praxeological Analysis (PA), a new qualitative methodology for investigating psychological phenomena by examining their situated sense within interaction and talk. PA draws upon and develops ideas from three intellectual resources: (i) praxeology, (ii) gestalt psychology, and (iii) the method of grammatical investigation found in the investigative ordinary language philosophy of Ludwig Wittgenstein. We integrate these three resources through the concept of linguistic gestalts, which serves as the foundation for PA. We argue that once psychological phenomena are respecified in terms of linguistic gestalts, the appropriate mode of investigation is what Wittgenstein termed grammatical. PA implements this mode of investigation by generating realizations through descriptions of actual, imagined, and fictionalized situations. The goal of such investigations is to explore the grammar—the practice-embedded rules for meaningful use—of psychological terms, as this reveals their real-world significance. In PA, we develop this insight into a structured methodology that qualitative researchers can systematically apply. By outlining the conceptual foundations of PA and demonstrating its methodological application, we position PA as a novel and transformative approach in qualitative research.

In this paper I focus on four varieties of shame absence. My hope is that re-flection on these varieties of shame-absence will go some way to giving us a more complete picture of the role that shame plays in our moral character and in discussions of atrocity. I note that the shame that emerges from an exposure to atrocity can be in part what leads us to identify the event as atro-cious. I progress to argue that when shame is absent, this absence can serve to blind us to the atrocity that is before us and that is ours to work to prevent. Feeling shame is part of seeing the atrocity for what it is in an appropriate emotionally-engaged manner. It is thus a vital part of being human, and its absence in certain cases is an all-too-human failure of humanity.

Throughout his career, Wes Sharrock has, following in the footsteps of Ludwig Wittgenstein, Peter Winch and Harold Garfinkel, sought to argue against accounts of the identity of an action which are the products of a social theory, a specific methodology or what Garfinkel termed formal analysis. In contrast, much of contemporary social science and social theory is grounded in a belief that ordinary or competent members of societies are unreliable authorities on the identity of their own and others’ actions because they are subject to systems of sociological refraction. The idea being that ordinary members of society are systematically misled as to the identity of their actions and those of their peers because they—or their perceptions of actions—are subject to the refractive properties of (for example) ideology, or folk theories of action, and so on. In this paper, I subject to analysis this core commitment of much social science and social theory.

Bioethics seems preoccupied with establishing, debating, promoting and sometimes debunking principles. While these tasks trade on the status of the word ‘principle’ in our ordinary language, scant attention is paid to the way principles operate in language. In this paper, we explore how principles relate to rules and practices so as to better understand their logic. We argue that principles gain their sense and power from the practices which give them sense. While general principles can be, and are, establishable in abstraction from specific practices, as they are in principlist bioethics, such principles are impotent as moral guides to action. We show that the purchase any principle has as a moral guide to action emerges from its indexical properties as a principle which has sense in a specific practice. The meaning of any principle is internal to the practice and context in which it is invoked and, therefore, principles are not kinds of master rule which dictate moral judgement in new contexts but rather chameleon-like rules which change with the contexture in which they are invoked.

Philosophical debates about how best to explain emotion or placebo are debates about how best to characterise and explain the distinctive form of human responsiveness to the world that is the object of interest for each of those domains of inquiry. In emotion research, the cognitive theory of emotion faces several intractable problems. I discuss two of these: the problem of epistemic deficit and the problem of recalcitrant emotions. Cognitive explanations in Placebo Studies, such as response-expectancy and belief-based explanations, also face the problem of epistemic deficit in addition to the problem of logically self-destructive true belief. While such considerations might motivate a retreat to affect, this brings its own problems. I argue that it is a particular version of cognitivism, representational cognitivism (Rep-Cog), that generates the paradoxes we encounter in emotion and placebo research. I propose that turning to nonrepresentational accounts of cognition will dissolve these paradoxes. As I move toward conclusion, I propose drawing on the ethnomethodological tradition to respecify human responsiveness to loci of significance in the lifeworld by undertaking ethnographies of members’ own situated methods for making intelligible and accountable their attitudinal and nonattitudinal responsiveness to loci of significance in their environment.

In this paper, I discuss stigma, understood as a category which includes acknowledged, enacted degradation, discreditation and discrimination. My discussion begins with an analysis of HIV stigma, as discussed in a social media post on Twitter. I then analyse a fictionalized clinical stigma scenario. These two analyses are undertaken to highlight aspects of the conceptual anatomy and interactional dynamics of stigma and by extension shame. Brief social media declarations and short, fictionalized clinical interactions are rich with information which helps us understand how stigma—degradation, discreditation and discrimination—is operationalized in interaction.

In this paper we introduce Critical Praxeological Analysis (CPA). CPA respecifies critical studies and research by operationalising insights from gestalt psychology and, in particular, the praxeological and linguistic gestalts identified by Harold Garfinkel and Ludwig Wittgenstein. CPA offers a framework for analysing the in-situ production, maintenance, challenging, repair and overcoming of norms and structures. Using naturally occurring data, as well as fictional and imagined examples, CPA examines the meanings that situations have for the participants who constitute them. The paper provides brief praxeological analyses, which draw upon themes from Frantz Fanon’s work to illustrate CPA in practice. We conclude by inviting others to apply CPA to themes drawn from the critical studies literature, in the hope that such analyses will deepen our understanding of how norms and structures are produced, maintained, challenged, repaired and overcome in interaction.

Since its foundation in 2010, the annual philosophy thematic edition of this journal has been a forum for authors from a wide range of disciplines and backgrounds, enabling contributors to raise questions of an urgent and fundamental nature regarding the most pressing problems facing the delivery and organization of healthcare. Authors have successfully exposed and challenged underlying assumptions that framed professional and policy discourse in diverse areas, generating productive and insightful dialogue regarding the relationship between evidence, value, clinical research and practice. These lively debates continue in this thematic edition, which includes a special section on stigma, shame and respect in healthcare. Authors address the problems with identifying and overcoming stigma in the clinic, interactional, structural and phenomenological accounts of stigma and the ‘stigma-shame nexus’. Papers examine the lived experience of discreditation, discrimination and degradation in a range of contexts, from the labour room to mental healthcare and the treatment of ‘deviancy’ and ‘looked-after children’. Authors raise challenging questions about the development of our uses of language in the context of care, and the relationship between stigma, disrespect and important analyses of power asymmetry and epistemic injustice. The relationship between respect, autonomy and personhood is explored with reference to contributions from an important conference series, which includes analyses of shame in the context of medically unexplained illness, humour, humiliation and obstetric violence.