compounded vulnerabilities in social institutions: vulnerabilities as kinds

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Compounded Vulnerabilities in Social Institutions: Vulnerabilities as Kinds. Laura Guidry-Grimes, Georgetown University Elizabeth Victor, USF & Georgetown University Diotima Conference, 2011. Introduction. Vulnerabilities Rejection of Kantian isolated ‘ willers ’ account - PowerPoint PPT Presentation

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Compounded Vulnerabilities in Social Institutions: Vulnerabilities as Kinds

Compounded Vulnerabilities in Social Institutions: Vulnerabilities as KindsLaura Guidry-Grimes, Georgetown UniversityElizabeth Victor, USF & Georgetown University

Diotima Conference, 2011

LGG1IntroductionVulnerabilitiesRejection of Kantian isolated willers accountReflect the various ways in which we are dependent on others for effective agencyVulnerability: Our definitionMorally problematic disadvantaged placement of an individual within the context of social practicesClarifying who is the vulnerableContext and the impact of situationsOverlapping factors Vulnerabilities as kinds

LGG2Compounded Vulnerabilities: A ConceptSides of Compounded Vulnerabilities

Agent-side factorsLuna (2009)Widen scope of applicability & still keep sufficiently narrow definition of vulnerability

Institution-side factorsShift analysis to social practices and systematic disadvantageFunction of labels in the context of vulnerabilityEKV3Outline of PresentationMedical labels as interactive kindsWhere and when interactive kinds arise

Diagnostic categories creation of barriersLimiting capacity toward well-being

Firmer grasp on the interaction of medical practice and other social institutions

PMDD as an example of an interactive kind that can compound vulnerabilities

LGG4Medical Labels & Interactive KindsHacking on interactive kindsDistinguishing interactive kinds from indifferent kindsThe problem with causal mappingBiological determinants vs. social determinatesWhy interactive kinds?Better modeling of relationships by looking at the looping effects between variablesBetter starting point for measures & remedy developmentAnother safety mechanism against perpetuating oppressions

EKV5Methods for Modeling

Medical-Biological ModelSocial Construction Model

Interactive Kind Model

EKV6PMDD as an Interactive KindChoosing between models for PMDDMedical-biological modelSocial constructionist modelRejecting mutual exclusivity of the modelsDifficulty in teasing the two apartWhy we wouldnt want to if we couldWhat interactive modeling has to offerDifferent ways of understandingDifferent ways of respondingRecognition of how social groups can be rendered vulnerable upon diagnosisEKVmention pg 1 of handout7Defining VulnerabilityVulnerability as a flexible termAccommodate particularities & circumstantial detailsWhen is a person vulnerable?When in a position which threatens the holistic person as an agent for developing and achieving the most fundamental dimensions of well-beingSources of vulnerabilityInternal variablesExternal variablesNarrowing the definitionDistinguishing from susceptibility or loss whatsoever

LGG8Vulnerabilities & Well-BeingThe holistic personPowers & Faden (2006) & dimensions of well-beingSufficient level of functioning along all dimensions necessary for decent minimumAll of equal moral importanceNecessary for human flourishingHealthPersonal securityReasoningRespectAttachmentSelf-determinationLGG9Vulnerability, Well-Being , and LabelsIntersecting of dimensionsMedical labels can cut across categories

Vulnerability as too broad or abstract?Problems with non-ideal theoriesFlexibility at the expense of narrowness?

Avoiding blanket labelsEssential/fixed traits do not threatenVulnerability enters withPerceptions of other within the context of normative social practices

EKV10Ways to Interpret VulnerabilityDistinguishing vulnerability from susceptibilityAll humans are vulnerable, but only certain people at specific times are susceptible (Kottow 2003)Feature of humanityIn our close social relationships, acknowledgement of human frailty is essential for emotional closeness & empathic engagement (Carse 2006)Forced vulnerability as a social illDistinguishing our definition from Kottow & CarseAs the result ofSystematic disadvantageAsymmetric power relations

LGG11Compounded VulnerabilitiesWhen do they happen?When systemic or institutional conditions intersect in a manner that creates additional barriers to the agent's ability to develop or achieve wellness of beingParticular susceptibility of historically marginalized populationsTools to identify when and how different kinds of vulnerabilities intersect to give rise to compounded vulnerabilitiesCompounded vulnerabilities as layers of vulnerability EKV12Mental Illness, labels, and compounded vulnerabilitiesWhen diagnostic categories target historically marginalized and disadvantaged populationsStigma of mental illness

Building of an institutional barrierReinforcement of stereotypes & biasesEffects of psychological oppressionDouble effect of compounding vulnerabilities Bolsters marginalization and adds difficulties for attaining sufficient level of well-being

LGG13PMDD & Compounded VulnerabilityControversial medical labelsDesignate specific population as an essential feature of the diagnostic criteriaNot explicit in this regard, but de facto apply to a specific population in their diagnostic practicesPMDD as an institutional barrierPerpetuated stereotype of menstruating womenContinues history of womens pathologizationCompromised legal standingCompromised medical autonomyDenied career opportunitiesInternalized stigma

LGG14ConclusionsInteractive kinds as a conceptual toolBetter evaluate how labels are reflective of biological determinantsHow social determinants inform the interpretation of biological factors

Mitigating harm Through understanding how vulnerabilities intersect Who is susceptibleHarms and barriers confronted by targeted groupsEKV-mention Social Positioning Impact Statement on pg 2-3 of handout15RecommendationsNOT suggesting radical changesAwareness is the first step inRethinking classificationsRethinking research interventionsRethinking treatments at the institutional levelRecognizing the role of the clinician in enhancing patient autonomy through the presentation of materials Incorporate contextually rich diagnostic toolsNarrative-focused structured interviews when patient presents symptoms or seeks treatmentProvide fuller context & nuanced detailsExplain what symptoms mean to the individualExplain condition-significant distinctionsCommunicate life circumstances

LGG16Questions?Diversity of conceptsHow can they be bridged?Historically marginalized populationsWho are they?Effects of psychiatric labelingCheck out our website: http://engage.bioethics.georgetown.edu/mentalillnessEKV-discussion points based on IJFAB reviews will appear with click17