Zsuzsanna Chappell

Many worry about the over-medicalisation of mental illness, and some even argue that we should abandon the term mental illness altogether. Yet, this is a commonly used term in popular discourse, in policy making, and in research. In this paper I argue that if we distinguish between disease, illness, and sickness (where illness refers to the first-personal, subjective experience of the sufferer), then the concept of mental illness is a useful way of understanding a type of human experience, inasmuch as the term is (i) apt or accurate, (ii) a useful hermeneutical resource for interpreting and communicating experience, and (iii) can be a good way for at least some of us to establish a liveable personal identity within our culture.

In this paper, we argue that there are reasons to believe that an implicit bias for normalcy influences what are considered medically necessary treatments in psychiatry. First, we outline two prima facie reasons to suspect that this is the case. A bias for ‘the normal’ is already documented in disability studies; it is reasonable to suspect that it affects psychiatry too, since psychiatric patients, like disabled people, are often perceived as ‘weird’ by others. Secondly, psychiatry's explicitly endorsed values of well-being and function are hard to measure directly, which is why we see simpler box-ticking conceptions of recovery used in large research studies. This need not be problematic, but might lead to researchers and clinicians focusing too much on treatments that promote easy-to-measure proxies for recovery, instead of what actually matters to psychiatric patients themselves. Next, we provide examples of treatments and treatment decisions within two areas – self-injury and psychosis – which are hard to explain unless we assume that an implicit and harmful normalcy bias is at work. We conclude with some suggestions for clinicians and future research.

Enactivism has much to offer to moral, social and political philosophy through giving a new perspective on existing ethical problems and improving our understanding of morally ambiguous behaviours. I illustrate this through the case of self-injury, a common problematic behaviour which has so far received little philosophical attention. My aim in this paper has been to use ideas from enactivism in order to explore self-injury without assuming a priori that it is morally or socially wrong under all circumstances, seeking to establish a less implicitly value-laden analysis. Enactivism can help us in making this behaviour more intelligible and contextualising it through examining the relations of individual embodied action and social practices with the help of enactivist theories of habits and affordances.

In spite of the global diffusion of democracy and a general commitment to democratic values, there is a widespread alienation from the political process in advanced democracies. Deliberative democracy has received much attention in recent years as a possible solution to this malaise. Its promise of a more engaged and collective form of politics has drawn the interest of policy makers and political philosophers – generating new avenues of thought in contemporary democratic theory as well as heated debates about its utility in practice. This book provides an ideal starting point in understanding the core concepts of deliberative democracy. It is the first text to offer a systematic introduction to the theories and debates in the field and to combine this with a detailed critique of both the theory and the practice of deliberative democracy. It examines the core values of deliberative democrats and evaluates the implementation of deliberative practices at the local, national and global level – considering, along the way, how far it is possible to introduce meaningful deliberative reform in existing democracies. Giving readers a state-of-the-art account of the field, this book addresses fundamental questions about deliberative democracy and also charts the future directions for contemporary democratic thought.

Democracy is usually justified either on intrinsic or instrumental, particularly epistemic, grounds. Intrinsic justifications stress the values inherent in the democratic process itself, whereas epistemic ones stress that it results in good outcomes. This article examines whether epistemic justifications for deliberative democracy are superior to intrinsic ones. The Condorcet jury theorem is the most common epistemic justification of democracy. I argue that it is not appropriate for deliberative democracy. Yet deliberative democrats often explicitly state that the process will favour the best argument. This can only be the case if deliberation improves the overall competence of the group and of the individuals that constitute it. I analyse when deliberation will increase competences and when it will not do so and find that individual competences will not reliably increase as a result of deliberation. In order for deliberative democracy to be epistemically more effective than representative democracy, strong procedural assumptions need to be made and deliberative democracy needs to be justified based on a combination of epistemic and intrinsic elements.