Priestley PhD Scholarship in Youth Mental Health: Personhood, Epistemic injustice, and the Clinical Encounter in Early Psychosis

Supervisors: Professor Matthew Broome (UoB), Professor Lisa Bortolotti (IUoB), Professor Barnaby Nelson (Orygen and University of Melbourne)

The project aims to examine different dimensions of the encounter between mental health clinicians and young people with psychosis. The project’s fundamental assumption is that both participants in the encounter are autonomous persons. The project research questions are: (i) How is someone’s sense of autonomy and personhood affected by a diagnosis of psychosis? (ii) How does the diagnosis impact on the therapeutic relationship?

There are three dimensions to the project: (a) a clinical dimension (e.g., what conception of the self is most conducive to positive clinical outcomes; how might disturbances in minimal self-hood in early psychosis impact on this); (b) an empirical dimension (e.g., what factors influence one’s conceptions of the self and the other in the clinical encounter; what effects alterations to the minimal self have); (c) a philosophical and ethical dimension (e.g., how should one see the self and the other in the clinical encounter to maintain reciprocal trust and respect?).

Goal 1: Develop an empirical and conceptual analysis of personhood in the context of mental disorder. The project will analyse how one’s sense of oneself as an autonomous person may be challenged by a diagnosis of psychosis, given what we know about mental disorders neuroscientifically and phenomenologically. Psychosis may affect a person by features inherent to the illness, but also by features such as medication, detention under the Mental Health Act, isolation, and stigma.

Goal 2: Develop an understanding of the threats to autonomy and personhood in the clinical encounter. According to some studies, people feel that the therapeutic relationship is compromised by coercion and by clinicians’ reliance on scientific knowledge (1). The neuroscientific perspective has an important role in current understandings of psychosis, but does it limit person-level approaches, leading clinicians to prioritise the vocabulary of neurochemistry and neuroimaging at the expense of a person-level vocabulary? Does the clinical encounter impact upon phenomenological changes to the minimal self, either positively or negatively? Does the perceived relationship between mental illness and responsibility for action (2,3) impact on the clinical encounter?

Goal 3: Explore the risks of Epistemic and Autonomous Agency Injustice compromising the success of the therapeutic relationship. The concept of Epistemic Injustice (4-6), whereby an individual’s status as a knower is undermined by non-epistemic factors, will be used to explore relationships where one person has her authority as a knower challenged by a psychiatric diagnosis. This concept will be expanded into the notion of Autonomous Agency Injustice, where the presence of mental disorder per se undermines an individual’s perceived autonomy as an agent. Epistemic and Autonomous Agency Injustice reduce the likelihood of a positive therapeutic relationship.

Methodologies to be used:

Different methodologies will be used, including philosophical analysis of the impact of mental disorder on personhood and autonomy; phenomenological interviews and measures; collection of qualitative data concerning the clinical encounter, with a focus on self-conceptions and conceptions of the other. Furthermore, there will be a reflection on clinical practice and its relation to neuroscience, based on a careful consideration of the phenomenology of illness.

Training Opportunities and Inter-disciplinary environment:

The student will be based at the Institute for Mental Health (IMH) at the University of Birmingham, and Orygen in Melbourne, and will train in conceptual analysis, qualitative research methods, phenomenological interviewing, and psychopathology. At Orygen, the student will collect data in a second clinical service, train in phenomenological tools and assessment of self-disturbance, and assess potential impacts on minimal self-disturbance in the clinical encounter. At the IMH, the student will work with different disciplines, participate in research seminars, and receive postgraduate training via the Graduate School.