Jodie Louise Russell

An oft misattributed piece of folk-wisdom goes: “Insanity is doing the same thing, over and over again, but expecting different results.” In many cases, we don’t just do things repeatedly but think over the same topics repeatedly. People who ruminate are not often diagnosed as insane—most of us ruminate at some point in our lives—but it is a common behaviour underlying both depression and anxiety :504, 2000). If rumination is something we all do at some time, what is it about ruminative thought that makes it ‘sticky’ and difficult to stop for the worst sufferers? In order to answer this question, I will present a plausible account of how ruminative behaviour becomes entrenched to the point where sufferers of anxiety and depression simply cannot make meaning from the world except in terms of the kinds of behaviours, actions and thoughts they have become reliant on. I develop my account from Barrett’s theory of constructed emotion using the work of Merleau-Ponty, ProQuest Ebook Central, 2012. https://ebookcentral.proquest.com/lib/ed/detail.action?docID=1433878. Accessed 29 Dec 2020) in order to bridge the gap between the explicit thought we experience—an important part of the lived experience of rumination. To conclude, I will apply my account to Wu and Dunning’s :25–35, 2018; Hypocognitive mind: How lack of conceptual knowledge confines what people see and remember, 2019. https://doi.org/10.31234/osf.io/29ryz) theory of hypocognition to further illuminate the particular cognitive qualities that can be experienced by ruminators, i.e. a prohibited access to particular emotion concepts.

In recent years, autopoietic enactivism has been used to address persistent conceptual problems in psychiatry, such as the problem of demarcating disorder, that other models thus far have failed to overcome. There appear to be three main enactive accounts of psychopathology with subtle, although not incompatible, differences: Maiesecharacterizes disorder as distinct disruptions in autonomy and agency; Nielsen characterizes disorder as behaviors that relevantly conflict with the functional norms of an individual; De Haan emphasizes patterns of disordered sense-making, that are transformed through the existential dimension. Given that these accounts are intended to provide not only an ontologically richer account of psychopathology but also reduce the stigma experienced by individuals with mental disorders by accounting for lived experience, a critical analysis of these approaches is needed. I will provide a problematization of enactive accounts of mental disorder, showing that this particular framework does not, as it stands, necessarily reduce the harm and suffering experienced by individuals with mental disorder because of its ontological openness; enactivism leaves much to be interpreted and applied by the clinician (or patient) such that practical and ethical problems in its use arise.

In this thesis I develop an account of how processes of social understanding are implicated in experiences of mental disorder, critiquing the lack of examination of this phenomena along the way. First, I demonstrate how disorder concepts, as developed and deployed by psychiatric institutions, have the effect of shaping the cognition of individuals with psychopathology through setting expectations. Such expectation-setting can be harmful in some cases, I argue, and can perpetuate epistemic injustices. Having developed this view, I criticise enactive accounts of mental disorder for failing to consider how such terms like ‘dysfunction’ are open to interpretation and can come embedded with normative expectations. Enactive accounts consequently run the risk of perpetuating injustices in their account of the sociality of mental disorder. Similar concerns arise when we consider the attachment of enactivism to the medical model, I argue. But by adapting enactivism to consider other experiences of disorder, such as those described as ‘madness’, enactive psychiatry may genuinely provide ethical groundwork for a better conception of disordered experience. Then, I consider a further concern with a distinctly medicalised conception of mental disorder from the perspective of self-illness ambiguity, arguing that self-illness ambiguities appear to form a special class of ambiguities due to their proximity to disorder concepts which mark them as appropriate targets for therapeutic treatment. However, I argue further that we should be critical of the idea that self-illness ambiguities necessitate disambiguation, as, in cases where self and illness are demarcated, individuals may still experience distress because simply having a mental disorder can be socially alienating. The medicalised focus in self-illness ambiguity, and the explicit need from the medical perspective to disambiguate it, might then exacerbate the distress someone experiences in mental disorder. Moreover, drawing on Mad Studies, I suggest that one might not need a coherent self-narrative to live well. Because of this, one may not need to adopt a medicalised view of the self in the case of selfillness ambiguity. In order to support this analysis, I provide a phenomenological account of language and argue that the very thoughts implicated in mental disorder shape the individual’s perception of the world due to the way that language foregrounds particular aspects of our world. This demands a critical examination of the language adopted and used by both clinicians and disordered individuals. I thus conclude with some thoughts on how to approach research and developing understanding of mental disorder given that we, as people, are always implicated in this process and therefore socialisation of some kind will always be taking place.