Andrew Molas

I offer a preliminary examination on the importance of narrative for helping to overcome the issue of stigma surrounding mental illness, specifically schizophrenia. I maintain that engaging with first-person accounts of schizophrenia allows caregivers, and the broader general public, to better understand the phenomenological lived experiences of persons living with this mental health challenge and to better understand the experience of dealing with stigma. In doing so, I maintain that both caregivers and the public can begin developing more accepting views of schizophrenia and begin to support those who need it the most

I discuss Young’s “asymmetrical reciprocity” and apply it to an ethics of mental health care. Due to its emphasis on engaging with others through respectful dialogue in an inclusive manner, asymmetrical reciprocity serves as an appropriate framework for guiding caregivers to interact with their patients and to understand them in a morally responsible and appropriate manner. In Section 1, I define empathy and explain its benefits in the context of mental health care. In Section 2, I discuss two potential problems surrounding empathy: the difficulty of perspectivetaking and “compassion fatigue.” In Section 3, I argue that these issues can be resolved if examined through the lens of an ethics of care. Reciprocal relationships between patients and caregivers are an important element in the development of an ethics of care. In Section 4, I introduce two models of reciprocity that can be applied to a health care context: Benhabib’s symmetrical reciprocity and Young’s asymmetrical reciprocity. In Section 5, I demonstrate how asymmetrical reciprocity cultivates empathy and, in Section 6 and Section 7, I show how it overcomes the objections of empathy and improves therapeutic relationships.

In Ecological Thinking, Lorraine Code argues that advocacy “often makes knowledge possible” and without it “certain kinds of knowing are impossible.” By acknowledging the value of subjectivity and testimony in knowledge creation, I argue that ecological thinking serves as an appropriate framework for engagement with individuals who are living with mental illnesses. Contrasted with the dominant Anglo-American epistemologies that involve excessive degrees of mastery and control (with the tendency to silence the voices of Others), I argue that ecological thinking facilitates healthy advocacy practices precisely because of its inclusivity and receptivity towards different perspectives in knowledge creation.

I argue that the right to mental health should be viewed as a universal human right and that the United Nations Convention on the Rights of Persons with Disabilities (CRPD), as an international standard, protects it because it places a positive duty on states to actively promote the mental well-being of its citizens for the purpose of preserving their dignity and allowing them to flourish. I begin by discussing the discrimination that persons with psychiatric disabilities experience, including the systemic barriers and lack of mental health resources which impact the quality of their lives. Because flourishing and dignity are interconnected, protecting the rights of persons with mental illnesses is important because the possession of good mental health provides a firm basis for securing other basic human rights. Consequently, I maintain that the main advantage of a human rights approach for securing the right to mental health is that human rights is the only source of law which is accepted without qualification. I then look at three objections against the CRPD and the idea of the universal right to mental health as a socio-economic entitlement. Finally, I demonstrate how the CRPD can overcome these criticisms and offer suggestions on how states can implement the CRPD into their domestic mental health legislation.

My paper explores Maria Lugones’ concept of “world travelling” and how we can use it for the purposes of engaging with people who have schizophrenia in order to reduce stigma. I argue that travelling to a schizophrenic person’s “world” can help us gain a better understanding of her situation and experiences and, as a result, I argue that the interpersonal interaction which world travelling facilitates can reduce the stigmatization associated with this mental illness. I argue that the effects of stigma are similar to Marilyn Frye’s notion of “arrogant perception” and arrogantly perceiving persons with mental illnesses prevents us from actively engaging with them and “loving them.” After looking at a few objections against the idea of implementing world travelling as a means of engaging persons with schizophrenia, specifically the problem of role taking and the limits of understanding another person’s subjective experiences, I conclude by arguing that world travelling is a useful anti-stigma strategy because it requires us to interact with the other person, and contact is the most effective way of overcoming stigma associated with mental illness.

This dissertation explores a phenomenological account of empathy and narrative-based medicine. Its objective is to offer a sustained critical discussion of the benefits of a phenomenological account of empathy and narrative-based medicine for understanding the experiences of persons diagnosed with schizophrenia, improving therapeutic relationships, minimizing the stigma of mental illness, and supporting people with schizophrenia in their recovery. Part one of this dissertation critically examines the nature of empathy and highlights the challenges that impede our ability to understand the experiences of persons with schizophrenia. Schizophrenia has historically been viewed as a condition which defies empathic understanding. This view, endorsed by Karl Jaspers, has been influential in shaping current depictions of schizophrenia in Anglo-American medical literature and informing how clinicians interact with those who are diagnosed with this condition. The dissertation makes the argument that Jaspers' approach is limited and sets the theoretical basis for a more robust account of empathy in the conceptualization of relations with persons with schizophrenia. Part two of this dissertation defends a phenomenological account of empathy, developed by Edith Stein, and presents it as an alternative to simulation theories of empathy. Simulation theories of empathy involve using one's own cognitive resources to replicate the experiences and mental states of others by imagining being in their situation. But one problem with this approach is that it runs the risk of co-opting their experiences and substituting our own, which is morally problematic. In response, Stein's theory offers a solution by recognizing that empathy involves appreciating someones experiences as it is for them and thus it avoids the assimilation of the experiences of others. Part three of this dissertation explores applications of Stein's theory of empathy and examines narrative-based medicine as a model of therapy. The narratives of persons with schizophrenia offer crucial insight into their lived experience of illness. By engaging with the lived experiences and narratives of others, caregivers can learn improved ways of understanding and supporting people diagnosed with schizophrenia as they restore a sense of self that has been harmed due to the effects of stigma that portray mental illness negatively.

RésuméJe défends que la théorie de l'empathie d'Edith Stein représente une solution de remplacement aux théories de l'empathie fondées sur la simulation. Les théories simulationnistes impliquent l'utilisation de ses propres ressources cognitives pour reproduire les états mentaux des autres en imaginant être dans leur situation. Je soutiens que cette compréhension de l'empathie est problématique dans le contexte des soins de santé mentale, car elle peut conduire à la cooptation et à l'assimilation des expériences d'une autre personne. En réponse, je soutiens que la théorie de Stein est préférable parce qu'elle implique l'appréciation des expériences de l'autre telles qu'elles sont pour lui, et que cette explication alternative de l'empathie évite l'assimilation des expériences des autres.

This paper explores the nature of the legal doctrine of informed consent, particularly, in relation to the legitimacy of surrogacy contracts. By focusing on the Baby M case, it examines Lori B. Andrews’ argument that the doctrine of informed consent should apply to surrogacy contracts since, like other medical procedures, a woman’s consent to becoming a surrogate mother necessitates her awareness of the potential risks so that she can make an informed, conscientious decision. Andrews feels that surrogacy contracts should be upheld legally—contrary to the New Jersey Supreme Court’s ruling in February 1988—since the kind of consent involved is sufficiently similar to the consent involved in other medical procedures.