The author will discuss how we should look for a good model for the practice of expertise-by-experience in mental health care by looking at relevant research from the philosophy of mind and the philosophy of science. The lecture will be held online (via Zoom) on September 19 at 11 a.m. CEST, Grand Hall of IDN.
Experiential knowledge and expertise-by-experience are increasingly common in mental health care. On the one hand, many people share the intuition that having experienced something firsthand indeed puts one in a unique epistemic perspective. On the other hand, practical problems have emerged with the implementation of experiential knowledge and expertise-by-experience because professionals and other stakeholders in mental health care worry that experiential knowledge is, simply put, ‘vague’.
In philosophy, there are various fields of research that seem directly relevant to clarifying experiential knowledge, but, somewhat surprisingly, these have been largely overlooked by the practical movement of expertise-by-experience in mental health care. In this talk, I will present some recent research that shows the relevance of some of these hitherto neglected debates and fields of research (e.g. philosophy of mind and philosophy of science). On the one hand, I will summarize some criticisms that may be derived from these fields, targeting the idea of experiential knowledge. On the other hand, I will outline a more ‘positive’ alternative model that may form a basis for the practice of expertise-by-experience.
Dr. Roy Dings is a postdoctoral researcher at Radboud University Nijmegen (the Netherlands), where he also obtained his PhD in 2020. Previously, he was a visiting researcher at the University of Memphis (USA) and a postdoctoral researcher at Ruhr University Bochum (Germany). His research targets the intersection of philosophy, psychiatry and psychology. More specifically, his research focuses on (1) self-illness ambiguity, i.e. how the relation between a person and their illness is experienced and/or conceptualized; (2) experiential knowledge in mental health care; (3) the interplay of reflective self-understanding and unreflective agency.
This is the fourth lecture in the “Philosophy and Psychiatry” seminar series organized by the Center for Philosophy at the Institute of Social Sciences.
I’m honored and I have a pleasure to host today our first International guest at this seminar for philosophy and Psychiatry and this is um Dr Roy dings and he’s the currently a post do Post doctor researcher at the rod bound his university where he obtained his PhD in 2020 before that he was
A he was a p he was a post doctoral researcher at the University of menis and B University as I recall so his research is mostly the intersection of philosophy psychology and Psychiatry and he works on things like U self illness ambiguity and experiential knowledge in the mental health care this is something
That we will talk about that you will talk about today um and different other topics so Roy take it away uh your time okay thank you yes thanks also for the invitation to uh to present my research here um so yeah so the the topic is in the title is
Quite broad so it’s lift experience knowledge and expertise in mental health care and I think the the sort of central term that I will be talking about is the idea of experiential knowledge so that’s the idea that people who have experienced for instance depression or Autism firsthand that those people have a unique
EP uh perspective namely that they have something like experiential knowledge and that that can be put to use in mental health care so the problem basically or the the main reason why I’m interested in this topic from a philosopical perspective is because there have been a lot of worries about the concept of
Experiential knowledge uh being very simply put sorry now everything is okay okay sure um so the worry is that this top this concept is relatively vague and so this is actually also what you see in some recent review articles right so here on the left uh by cro and colleagues who CL
Who say that although the concept of experiential expertise is relatively new the absence of theoretical and conceptual Clarity has led to poor understanding and miscommunication among researchers Health practitioners and policy makers um and helloing colleagues go even a step further you could say say um when they claim that despite popular and
Institutional success the concept of experential knowledge remains Loosely defined with the result of weakening its euristic scope and Paving the way for its co-modification the term experiential knowledge as it is currently used is a polymus catchall concept that applies to Myriad definitions in the scientific literature the concept is rarely defined explicitly
Or solely evoked in a broad and imprecise way as knowledge derived from patient experiences so my evaluation of this this trend um and so I’m from the Netherlands and here uh the it you know it really is a trend in the sense that um almost all mental Healthcare institutions
Employ experential experts uh they are a central aspect of policy making for instance um so it’s it’s it’s a very common thing the these days and it’s increasingly common as well but the worry here seems to be that like I said there is a kind of intuition that if you’ve experienced mental illness
Firsthand uh that that offers uh knowledge however it seems that we’re kind of stuck on this level of intuitions right and that’s also what I take these quotes on the screen to show that you know it’s it’s a it’s an interesting and fascinating concept but in itself it’s quite vague
In the sense that it kind of sticks to this intuition but nothing beyond that and I think that what I’m trying to do as a philosopher is I’m trying to um explain a little bit more about what experential knowledge might be and so the interesting thing I think is that
Um this is I mean this is this is a bit problematic but I think many philosophers have fallen prey to this as well in the sense that philosophers almost by definition are people who would be very careful in the concepts that they use but I feel like philosphers actually have failed to
Elaborate on what they mean by experential knowledge um so for instance there has been a lot of research on epistemic Injustice in Psychiatry um many of which is written by philosophers and of course I don’t have room here to discuss all of this research in detail but I just want to
Pinpoint that um the concept of epistemic Injustice holds that someone is not taken seriously as a knower as someone who possesses knowledge and I feel that um when it comes to the Contex with mental health care an open question still is What patients or former patients what type of
Knowledge they actually have and presumably it is something like experiential knowledge but again as the earlier quotes show that is not very precise that is still on the levels of just intuitions and I feel that this is something that has to be addressed so at this point I should make
A very important disclaimer which is that we can distinguish between let’s say an epistemic and a more political ethical motivation for including former service users so why would Mental Health Care employ people who have have experienced let’s say depression and have recovered from that so the political ethical motivation is
Something along the lines of um you know um the famous slogan nothing about us without us for instance illustrates this idea that if you make policy for a specific population then you need to include that Pol that population in the making of policy for instance as well now the epistemic mod ation of
Course is the idea that including them adds something in terms of knowledge that they have a unique form of knowledge that nobody else is able to access and so including former service users strengthens our epistemic um investigation of mental illness and treatments Etc now we can also make an analogous
Distinction between the function that these service users have in mental health care so some of the contributions of people who call themselves experts by experience some contributions could be labeled epistemic and other could be labeled as non-epistemic so the epistemic contributions would be contributions in which a claim to
Knowledge is being made so if you say that you know policy should be like this rather than that then you make a claim of knowledge and if you say that uh with individual uh peer support or uh recovery support for instance if you say that you know
Uh taking taking a certain hobby or uh uh U um you know saying something about the role of social uh uh contexts in recovery that’s anep again that’s an epistemic contribution because you’re making a claim of knowledge you’re claiming to know that something works better than something else now a lot of the
Contributions that service users make are actually nonepistemic contributions so whe they’re not making a claim to knowledge so the prime examples here are that they serve as a role model or that they provide hope that they are empowering to fellow patients Etc so they’re not making any claims to knowledge they’re just offering
Hope and now the point that I want to make make is that even if we would conclude that there actually is not any epistemic contribution that they have so even if hypothetically speaking experiential knowledge turns to be something that doesn’t really exist then still it would be worthwhile
To include former service users in mental health care if only for the non-epistemic contributions which in themselves are already extremely valuable that being said I do think think that there is a unique epistemic contribution so I do think that there is something like experiential knowledge that you can only gain by experience and
That is difficult to access or impossible even to access for other people uh but this hasn’t been elaborated yet but I will at the end of this talk so what I want to do in the rest of this uh this presentation is basically two things to uh nutshell summaries if
You will um so what I’ll be presenting is is quite dense um so feel free to ask me about any of these topics in the in the Q&A and we can discuss further so the two nutshells pertain to what I would call the negative project or the project of explicating what is
Wrong with current views on experiential knowledge and expertise in other words if you look at current research on experiential knowledge what is problematic about it from a philosophical perspective and this is something that I’ve been doing these past couple of years so there’s already some published work on this uh if you’re
Interested in it I will add the references in the in the slides and also feel free to contact me afterwards to uh if you cannot access the the the papers yourself and after that I will turn to what what you could call the positive project so actually developing an
Account of experiential knowledge and expertise that is conceptually epistemologically and phenomenologically sound now this is still a work in Pro progress so it’s a paper that I’m still writing uh but it’s not finished so uh you know I would I would U appreciate feedback on this as well
Okay so starting with the the so-called negative project so the first question that we can ask is if we have something like experiential knowledge then what kind of experience would form the basis for that what kind of experience is at stake when we talk about experiential knowledge and surprisingly this type of
Question really hasn’t been asked by people who work in on this topic right so they kind of just assume that experience is something that is given right that is simple homogeneous that it makes you know that everyone understands what this means Etc and of course from a philosophical point perspective We can
Question that because it experience is much more complex and Het genius than we might assume so in one paper that I wrote with sarif tein published in philosophical psychology we have this kind of thought experiment that we uh uh that is based on an analogy with this famous thought experiment by Frank
Jackson so Frank Jackson in his knowledge argument asks us to imagine a woman marry who is he uh visualized here so Mary grows up in a black and white room and uh so she can only see different Shades of Gray uh and then during her life she
Becomes an expert on color vision so she learns everything there is to know about color vision right so she knows exactly what kind of wavelength of light you know the way that it enters the retina the way that it’s processed in the brain the way that it leads to an experience
That people would l label as red for instance and then the the main point in the thought experiment is that when she leaves the black and white room whether they she then learns something new because the idea was that she has learned everything that is to learn from
You know books and science Etc and then does she learn something new when she leaves the black and white room and for the first time she sees red the color red herself and then this has sparked a really ridiculous amount of philosophical work and most of
That seems to uh Converge on the idea that she does learn something new namely what it is like to experience red so she already knew uh all facts about perceiving the color red but now she has learned what it is like to experience the color red
And so in the paper we make this analogy with um I think we call her Sarah so imagine Sarah who is a scientist and a clinician who is an expert on depression so she knows everything about the genetic underpinnings of depression she knows exactly what the role of
Development and social pressures is she knows exactly what kind of treatments work etc and then again you know at some point she herself becomes depressed and now the question is has she learned something new and again I think that a lot of people would agree that you learn
Something new uh and if you would ask them what that is then people might say something along the lines of that she has now learned what it is like to be depressed now the thing is that um this what it is likeness is something that philosophers have tended to see as a
Unique element of experience which they would call phenomenal experience and so in this paper with uh tein we investigated well is experiential knowledge something that has to do with phenomenal experience or maybe something else and we conclude that you know it it’s basically not clear so some work seems to be about
Phenomenal experience but then other work on experiential knowledge seems to be about a more common everyday type of experience you know like when you would say I have a lot of experience teaching then you probably don’t mean the kind of phenomenal experience of teaching but something more
Colloquial and then what we say in the paper is that you know either way there’s problems so if it’s the phenomenal aspects of experience that are at stake then there’s problems and if it’s not the phenomenal aspects of experience then there’s problems as well so here I want to just briefly
Mention two of those problems uh one is reification so reification is the tendency to uh to assume that there is a thing an entity underlying uh Concepts and and everyday words so the reason why this is relevant is because a lot of the uh you know the field of experiential knowledge is based
On things like DSM classifications so people would say I have experential knowledge with respect to autism or I have experential knowledge with respect to depression but the point is that you cannot experience depression and you cannot experience autism and this sounds a bit odd but the point here is that autism and depression
By themselves are categories or classifications so the things that you experience are the symptoms right which form the basis for the diagnosis of the classification and now if we acknowledge that then something interesting happens because even though not everyone has a diagnosis of autism and not everyone has
A diagnosis of depression most people would have experienced some of the individual symptoms right so in the case of depression One symptom is uh disruptions in your eating and sleeping cycle and most people have experienced that um pervasive sadness I mean most people even in the context of grief have
Experienced that same for autism so even though not everyone has an diagnosis of autism uh most people have experienced um things like uh struggles with social uh contexts most people have experienced being overwhelmed by stimuli Etc so even though we don’t want to say that this would mean that everyone has
Experiential knowledge with respect to autism we do think that it hints at a much more gradual uh idea of experential knowledge as what as how it is commonly assumed so the the the second Point here or well it’s actually the third on the list has to do with diversity and
Heterogeneity so the point here is fairly simple namely people are diverse and illnesses are diverse as well right so given that uh diagnosis are based on clusters of symptoms there is different combinations possible so you could have 10 people who are all diagnosed with depression but who have very different
Experiences um so to just give a simple example it’s probably different the experience of autism is probably different for a young male compared to an old female for instance and it’s probably also different for someone in the United States compared to someone in Japan so
The idea here is that it’s not that they all have the same experience so experiential knowledge of depression for instance doesn’t really make sense because 10 people who are depressed have 10 very different experiences and the point here is that this heterogeneity is typically not acknowledged in the way that people
Think about experiential knowledge so the another thing that I want to highlight because it’s very fascinating from a philosophical perspective is the fact that the field of experiential knowledge focuses both on narrative as well as on embodiment but those two seem to be at odds with one another so the point here
Is that if you want to become an expert by experience then one of the main requirements here is that you create a narrative a self-narrative about the Journey of recovery that you’ve undergone you have to sort of make connections between let’s say the moment that you diagnosed up until the moment
Where you truly felt recovered Etc you have to make connections to something like your early uh early development the role that your friends and family played for instance um but on the other hand there is a lot of EMP on embodiment so embodiment mainly plays a
Role in the sense that uh it’s typically seen as something that is crucial to lived experience so what it is like for someone to be depressed is inextricable from the way that their body feels during their depression but the point here is that creating a narrative of that abstracts away from
It so embodiment seems to be crucial to making it such that the person who has the experience is also the person who creates experiential knowledge but then the focus on narrative seems to be intention with that because if you put it into language then the knowledge that you possess switches
From something that is embodied to something that is linguistically mediated and that can be as such easily transferred a second problem here is of course the fact that narration by definition includes uh various processes of reconstruction both in experience and in memory so narrating an experience means selecting certain parts of the experience
Emphasizing certain points leaving uh leaving out certain elements of the experience Etc in other words A Narrative of your depression or a narrative of your process of recovery is very likely to not actually reflect the experience of depression or the experience of recovery it’s a narrative it’s a
Reconstruction so this too puts puts pressure on the idea that that the experience itself is really crucial for someone to have experiential knowledge okay so moving on to the last bit of the negative project so to speak uh is questions about knowledge and again it’s it’s really fascinating to me
Why these types of questions are not asked more often so what sort of knowledge is experiential knowledge and who who possesses that knowledge so if you look at the literature you see that I mean I would say maybe 70% of the research just doesn’t really say anything about this and then the
Remaining 30% has a sort of generic answer so they say experiential knowledge is tcid knowledge or it’s practical knowledge but the point is that that’s that should be the starting point for investigating experiential knowledge it shouldn’t be the end point right identifying it as practic iCal knowledge is not very
Informative so the interesting development that has happened in recent years and that’s why I added this figure here is the idea that experiential knowledge is something that of course starts with an individual so someone experiences a psychosis or or has bipolar disease and then recovers from that and then you know uh
Creates a narrative of that reflects on that but then if that person shares their experience with other people who may have also experienced autism or who has also been mentally ill then the exchange of that knowledge strengthens it and so over time you get something that people would call Collective experiential knowledge or
Deep experiential knowledge where through this process of sharing and collectivizing you would see certain patterns right so you would see well all of these people who have struggled with depression they all have this and this and this for instance and then you have a kind of knowledge that is no longer
Idiosyncratic but it’s more General now the main worry here I’m I’m not sure to what extent this is obvious but the main worry here is how this differs from qualitative research so if you look at social science but also for instance uh phenomenology so I take the the work of Matthew redl here
As an example what they do is to large extent the same thing right so they ask a significant amount of people I think actually in this study by Matthew R it was uh via an internet questionnaire where people could submit their experiences and what they do is they
They collect a lot of experiences and then they try to find patterns in those experiences now the main difference of course is that people like R Cliff or social scientists more generally have certain methods that they use they’re trained in doing this they’re trained in avoiding bias
Etc whereas if you would just have lay people so people who don’t have any training and doing research if you have them you know sharing these stories and trying to find patterns in them I think it’s very more likely that you um that you encounter biases or other kinds of methodological
Obstacles okay so all of that was negative right so that was sort of criticizing contemporary ideas and and research in uh the field of experential knowledge so what I want to do in the remainder of this talk and so this is just going to be a few
Slides is to say something about what I think experiential knowledge is so in other words I’m going to try to say something about how I think um what I think is a is a worthwhile conceptualization of this idea of experential knowledge in a way that it safeguards the fact that someone with
Experience does have a unique EP contribution but also in a way that it kind of Sid steps some of the worries that I’ve outlined in the previous slides so I think the core of of this idea that I have is that we should construe experential knowledge as a form of
Responsiveness and responsiveness is a very interesting notion because it’s at the same time extremely trivial but it’s also super important in our everyday agency and the way that we think and act and feel so let me say a little bit more about that so it’s trivial in the sense that
It really has to do with this very basic way in which we experience the world so if you’re responsive to something that means that you notice it that you feel something so someone with a particular style of responsiveness experiences some things is relevant others is irrelevant some things is Meaningful others are as
Non-meaningful um being responsive means processing information in a certain way being affected by the world in a certain way and it very much mimics the phenomenological idea of a life world so the crucial thing here is that it changes through experience right so in everyday life the um the the
Experiences that we have change what we are responsive to so if I’m hungry then I’m responsive to food but if I’ve already eaten then this responsiveness to food decreases right so a sandwich that I see is very respons you know I’m very responsive to a sandwich if I’m
Hungry but I really don’t care about sandwiches if I’m already full um so that’s a trivial bit but this also works for the more substantial experiences of let’s say depression uh or psychosis so in the thought experiment that I mentioned earlier about someone who is an expert on depression and then
Becomes depressed herself what does this person learn well the thing is that I’m not sure if it’s best construed as knowledge but I would construe this in terms of a change in her responsiveness so because she has experienced depression she has now become responsive to different things in
The world or she has um the existing responsiveness that she already had has started to become more subtle uh the meaning that she Associates with things is different Etc so there’s two other elements that I want to highlight one is that um pertains to the role of language so actually I think that
Language really hinges on this notion of responsiveness so imagine that there’s three people who are having a discussion on hallucinations or uh let’s say uh having an an LSD trip um now two out of three have taken LSD and have experienced such an LSD trip themselves and the third person
Hasn’t now what you’ll see is that the two people who have experienced an LSD trip are able to communicate about this quite easily whereas the third person doesn’t really know what they’re talking about right um this is maybe again this this goes not only for these kind of clinical
Cases but also for everyday cases right so uh I’m not sure if who in the audience has children but if you if if you have a group of people and some of them have children and others don’t then the people who have children are able to communicate about the difficulties of
Having children quite easily whereas the people who don’t have children you know they try to sort of um make sense of that by using analogous experiences but they usually fail to a certain extent now I think that the reason why that communication Works in some cases but not in others so the
Reason why it works in cases when people have similar experiences is because those experiences have changed their responsiveness so if you talk about an LSD trip then it’s very likely that you’re using kind of metaphorical language and the only re the only way in which you’re able to
Convey the the stuff that you’re trying to convey with that metaphor is if the other person is appropriately responsive to that metaphor right so the metaphor only works if the people who you’re talking to are responsive to that metaphor and the point is that people who have had the similar experience are
Responsive and people without the experience are not now another point that I want to add to this is that it’s also thoroughly embodied so this idea of responsiveness also has to do with being responsive um in a bodily way so your body responds to the stuff in the environment for
Instance and I’ve in previous work I’ve tried to cat that out in terms of affordances so I’m not sure if everyone is familiar with this idea but uh the the the rough sketch is that affordances are possibilities for action in the environment so a chair affords sitting on for instance and standing on
An extended hand affords shaking and so the idea is that what happens in mental illness is that your perception of affordances changes and one crucial element within your perception of affordances is your responsiveness to those affordances so this picture that I have here with the with the various graphs is
From a study by sonican and colleagues who investigated the impact of a certain Neurosurgical treatment on mental illness so the idea of this graph is that each bar that you see represents an action possibility and in a normal non-pathological case uh so hopefully that goes for most of us the way that
You would experience the world around you the way that you’re responsive to the possibilities for Action around you is quite diverse right some things are attractive others are not some things are um sort of uh very uh proximal others are more distal Etc and so what happens in the case of depression is
That people are not responsive to any action possibility and what happens in OCD is that they’re only responsive to a very specific action possibility for instance okay so this is the last slide so one of the main points that I made previously is this idea that experiences are diverse right
So um people so I said like um what it is like for someone to experience autism is probably different for for a 20-year-old man compared to a 30 year old woman uh same for someone from a western culture compared to someone from a non-western culture Etc but I’ve also said in the previous
Slide that all experiences affect your responsiveness so everyone has a particular responsiveness profile if you will now what people who work as experiential experts and mental healthare do I think is best captured by something that I would like to call attuned responsiveness so what you have to do is
To be responsive to someone else’s responsiveness that’s basically what tement here means and one of the main ways of cashing this out is Again by using this idea from Matthew redcliffe who in a 2012 paper wrote about what he calls radical empathy so the question he poses is whether we can
Understand really grasp the way that someone with mental illness experiences the world and according to redcliff we can so he says that the way that we experience the world has to do with experiences of significance right kind of in line with the stuff that I’ve been saying about responsiveness
Um so the world as we experience it is a world where some things are relevant others are not not some things are significant others are not Etc and for most people you know we have a shared world the way that you and I experien the world is probably shared to
A large extent but the point is that in the case of someone with mental illness we need to bracket some of that shared world right so we cannot take for granted that someone else experiences the same kinds of significance that I experience in other words we have to
Bracket the fact that someone else might not not be responsive in the same way as I am to the world and so red says that this not only goes for uh trying to understand someone else uh with a mental illness but also when you engage with someone from a
Completely different culture right they will also probably not be responsive to the same things you are and then they also gives the example of children and that’s why I have this picture here so this is a picture of me and my daughter doing the dishes
And so the idea is that if you if you’re doing the dishes then as an adult you know that there might be like knives in the water right so sharp things so the way that you’re responsive to the water is in a certain way you know that you shouldn’t put your hands
In the water too quickly you have to kind of you know uh put them in the water gently and then uh uh calmly pick up one of of the knives in the water for instance in order for it to be washed now my daughter who is 2 years
Old on this picture she probably doesn’t know about the fact that there is knives in the water that they’re sharp that you can cut yourself with them Etc so as a father I’m trying to attune my responsiveness to hers she is not responsive to the knives in an
Appropriate way um so I have to sort of try to experience the world through her eyes so to speak I have to make sure that uh her way of experiencing the world is compatible in a way that she’s not able to Hur herself right so I might
Take out the knives out of the water before I hel let her help um I might warn her and say you know you can help me but you can only help by uh I don’t know um um putting putting the the stuff that we’ve already already washed away
Instead of putting your hands in the water Etc there’s a different way of catching this out which is in terms of what uh phenomenologists would call pre- understanding so so the idea is quite similar namely that even if there is some element of experience where you differ which is probably the case when
It comes to mental illness right so someone with a psychosis or history of psychosis has a radically different way of experience the world compared to someone who doesn’t experience psychosis at the same time however there is an enormous amount of experience that is shared right so let’s say that
They’re both uh I mean they’re both embodied in roughly the same way and even if it’s a man versus a woman there are differences there but there’s also an enormous overlap I mean we both have to breathe in order to survive we both have to eat in order to survive
Etc it’s very likely that you both grw up in the same kind of culture you might be roughly the same age and so the idea is that all of those things create a kind of Common Ground a common form of responsiveness that you can build on in this process of
Atunement so I think this atunement this being able to adapt your own responsib to someone else’s is really a crucial skill for someone who works as an experiential expert and I would even say that this is the main skill that would have to be trained for someone who is um
Engaged in a process of becoming an experiential expert okay so thank you for your attention um if you want to get in touch about this stuff please don’t hesitate so I’m trying to set up a network of people who work on this or related topics and and have them exchange ideas
Um I’ve listed some paper don’t mind hesitate to get in touch uh and I’m looking forward to any questions that you might have okay right thank you this is wonderful um I will take the questions from people here at the Institute or anyone who’s online so please do ask
Anything or any clarifications if you need so we we have a question here from the one of our guests at The Institute Stefan he’s a psychiatrist so I think he’ll have a very practical questions but also very interesting theoretical question uh thank you very much for really excellent and thought
Provoking talk so as Yano says I’m a practitioner with interest rela to these issues and I have several questions that pertain mostly to the negative part of your talk so and maybe I missed some things so please correct me um so at one point you said how
Um we can uh if we base ourselves our our experience on symptoms of depression and not on the category of depression so then we can even if people who are not depressed we some times we have these overlapping experiences and we can uh experientially see what it’s like for
Someone to be depressed if I understood you correctly so I’m wondering how would you um defend this argument with regards to uh the phenomenological literature and first person reports which say that in depression there is something in depressive mood specifically there is something something which is qualitatively different than sadness
Which we see as a regular part of life so this is the first question do you want me to ask several of them or take this one um I think I would prefer to uh to address them one by one if that’s okay with you yeah of course um
So that’s a very interesting question um thanks so I think I think there’s different answers to this so the first answer would be to say that let’s say a fullblown depression so someone who is actually diagnosed with depression they have a significant amount of symptoms right so it’s not
Only the disruption of the sleeping and eating cycle it’s not only the feelings of Shame it’s not only the perace of sadness but it’s all of that in combination for a significant period of time so one way so one way to answer your question would be to say well what
The phenomenologists are investigating is precisely that so if you have experienced all of those symptoms in combination for a significant period of time that’s what makes it unique uh but again I would hold that you know so the claim I think would still be the same namely that even though that doesn’t
Mean that someone who has experienced a lot of experiences of Shame or you know uh disruptions in in the way that they eat that doesn’t mean that they know what it is like to be depressed but it does open the door for the dialogue about uh their experiences because the
Thing is that I’ve often seen also in a in in a personal context so I have a a brother-in-law with autism right so he would say you don’t know what it’s like so you cannot say anything about this and I think that’s just that’s not true
I mean all of us have experiences where we struggle with things and I think it’s better to use those as a way of having a meaningful discussion instead of saying well but I you know I’m in this unique position and you cannot in any way access that so there is no discussion
Possible um now that being said I do think that there is also the more cont versal option of answering your question in terms of um so you asked me like that I should prove or that I would have to defend why those phenomenologists come up with this idea that there is a
Unquality and a part of me wants to say well maybe you should be the other way around right so um so maybe as as a little bit of self-disclosure so I’ve also struggled with depression myself and I’m still not sure whether there was really something qualitatively different than earlier
Episodes in my life where I also struggled with things I mean obviously it was much more intense and it was much more related to different elements of my life but I’m not yeah I mean yeah so it could be that I I I wasn’t sufficiently depressed so to speak and that the
People who were discussed in those philological reports are uh you know more severe cases that could be um so yeah I’m I’m not sure but the point that I want to make here today in this talk is only to say that I think it’s much more useful to think of
Experiential knowledge as something that is more gradual rather than something that is an All or Nothing phenomenon uh because it help it it helps us to create a more meaningful dialogue between people because it provides Common Ground yeah it’s a great answer thank you very much so I also wanted to ask
You you also said in the negative part um that um experience is somehow more important than the narrative if I understood you correctly and U or at least that it it um I’m wondering why do you think that is because uh as we uh and I might be wrong with this but
Psychotherapy usually works on the narrative and this is a demonstrated uh treatment option so basically for people who have for example depression or anxiety disorder or any other let’s say DSM diagnosis usually the procedure is such that um it’s important which specific experience you have but maybe less
Important than what your narrative is about so do you have any comments on that why would the narrative be let’s say second hand to to the so I think the the point here is that um so the thing is that gives rise to a dilemma and the Dilemma is something
That I hope to have of resolved by means of the positive account but the Dilemma is this if you put a lot of emphasis on narrative that means that you put a lot of emphasis on something that you can put into words that you can exchange with other people so then the question
Is well why then should the person who has had the experience be the person who worked as an expert by experience why not have a researcher collect all of those narratives and find the patterns and I think that this this this you know is SL was an open question
Because the experience is meant to safeguard the role of the person who’s had the experience obviously and I think with the emphasis on narrative you kind of put that into you know it becomes problematic because a narrative can be conveyed and an embodied experience cannot now I hope my account of sort of
Positive account of responsiveness shows what kind of attempts to resolve that tension namely that a narrative can only be conveyed appropriately right so to people who are responsive in the right way and again those are people who have had the experience so um so if Matthew Ratcliffe
Tries to collect all of the pattern all of the accounts all of the testimonies of people with depression and tries to find patterns in those then um the reason why he might be less successful or less less good at doing that than someone who has himself struggled with depression is because
Matthew Radcliffe approaches those testimonies more or less objectively with his own responsiveness which is not necessarily the kind of responsiveness that is most optimal there and to be honest I’m not sure I actually think that Matthew has also struggled with depression so the the example might not
Work in that respect um and actually that that allows me to make a sort of follow-up point which is that um I’ve I’ve talked about people with exponential knowledge and for instance researchers or clinicians as being opposite but of course I think there’s enormous value in the fact that people
Who work in mental health care themselves often also have had experiences of either mental illness or they might have had family members or relatives with mental illness and you know by those experiences also learn a lot that they can use in practice and often times they already do use that in
Practice uh and here in the Netherlands this is something that uh clinicians in training are also educated in so how can you um use experiences that you’ve had yourself in in a functional manner in a way that it actually benefits the treatment or the uh the relationship with the patient for instance
Yeah thank you very much and just a quick follow up to that uh relating to practitioners people who work work with people other people in mental Healthcare who themselves have lived experience so would you say that it’s always a good thing for someone who works with other
People to have the experience of this notion of the Wounded healer that it’s always a benefit and if you do agree would you say that then we should have like policies which connect people who have had lived experience and who are practitioners that they should work with other people
For example a psychiatrist or a psychologist who is depressed who who had depression at some point in his life should always work with other people who have had similar experiences um so I would definitely not want to make any general claims so wouldn’t want to say that you know all
Of them would have to do that or that it’s always better or something like that I would refrain from any of those claims I do think it’s worthwhile to explore what benefits it could have and so what we see in the Netherlands is that um that professions in let’s say the
Lower part of the treatment hierarchy so nurses and social workers they are more often um motivated to use their own experience whereas psychologists and psychiatrists are more hesitant in doing that and it I mean there is there’s are obviously reasons for why why it’s good
To be hesitant in some cases right so um it seems that there has to be a sort of good division of labor in in any treatment so um the the kind of knowledge that is used by a psychiatrist sorry um uh is you know sometimes it’s just medical knowledge that they use
Other times it’s more clinical or kind of scientific knowledge and now the question is whether they could also sometimes rely on experiential knowledge and I think that the answer is yes they might sometimes use that but being able to do it well is really a skill so I
Wouldn’t want any like novel clinician someone who just started working as clinician I would say you know don’t rely on your own experiences too much but someone who has years of experience they might be in a better position to uh to find a balance in in doing that yeah thank you very
Much okay thank you stepan um there is a question from the one of the people from the chat so I’ll just read it to you so Lily Clark said or has a couple of questions um here it is if language restricts transference of experience uh narrative construction
That is how do we avoid the similar in accessing experiential knowledge as a responsiveness question and we can answer it right away yeah so there the the answer would be in terms of um um so so let’s say optimal communication between two people where the message that the one person
Wants to send across to the other person by means of language is transferred in a way that it really kind of hits the Mark um relies on both of those people being responsive to the words that they use in the right way so I mean the kind of trivial
Example would be that if someone would tell me something uh and uh tell me something in Japanese and I don’t speak Japanese that would mean that I have no idea what those what that person is talking about however if I learn Japanese then basically learning Japanese means becoming responsive to those words
In a way that I can make sense of them um now that’s of course learning a completely different language but you could say that within any given language you can also have certain subtleties that you can develop so uh becoming subtle becoming sensitive or responsive to the words that someone uses to
Explain their own situation um this is something that that uh that is helpful as well and this could be done by other ways but I think the most uh I the best way of doing it is just to have the same kind of experience so I’ve never been to
Belgrade so if someone tries to explain to me how beautiful the city is ETC then you know you can you can tell me about some famous Square for instance but I’ve never been there so I wouldn’t really know um what what to do with with that linguistic formulation
Now if I would actually go to Belgrade and experience the city itself then that changes the way that I’ve become responsive to descriptions of the city um and in that way I can I think you can avoid this restriction that language usually offers so this this is
Really similar to the answer that I gave to one of the previous questions right so um um being um being responsive in the right way basically means that um yeah sorry I’m I think my answer is going in circles now so I I I hope the point
Is okay so I see a followup to that question yeah there’s a followup and there’s another question from Lily so okay your answer was great that’s that’s good um yeah so I think so the crucial bit here is uh and again I mean um so in
The negative part of the talk I was mainly emphasizing how um how the existing work on experiential knowledge is sort of missing the Mark at some points and one of the ways that it’s missing the Mark is that it emphasizes both embodiment and narrative where uh but but in a way that it
Doesn’t offer a a solution to how those might be interconnected now I personally think in line with maloon that they are very much interconnected so I’ve also published on the relation between embodiment and narrative um so my own view is indeed that this this embodied uh the role of embodiment plays a
Crucial role in that as well um and then the other question was are affordances accessible through or dictated by narrative is narrative form of attuned responsiveness so here too I mean this is really like right up my alley in terms of the stuff that I’ve worked on so I’ve I’ve written a paper
On Um on why narrative is not only this kind of abstract story that you tell right so if I create a self narrative it’s not just something that I tell to people when I’m at a when I’m at a party and someone tells me asks me who I am or
Something uh the narrative that I create is actually concrete it connects to Everyday goals that I have it connects to the way that I interact with objects in my environment um so I I actually use this term which I call narrative self-programming which I say that um developing your narrative means making
Yourself responsive to certain affordances rather than others um so yeah I if if you’re interested in this I would say read read the paper um there’s a lot more I can say about this but I don’t want to take up too much time on this okay thank you we have another
Question here from one of the guys from The Institute um thank you very much for your um brilliant presentation my name ischenko I’m a visiting scholar here in the University of Belgrade and um as a a philosopher of uh science um of philosopher of medicine I have a
Plentitude of uh questions but I would like uh to stop on um to the most general questions the first one is uh about uh your your general conceptual project do you understand uh you correctly that you trying first uh to understand uh what is uh experimental knowledge is uh through the sort
Experiment like uh Mary uh sort experiment and then apply it uh to the specific field to dep in Psychiatry or uh probably you have a more uh modest and more practical oriented project uh just to to see which Health Care decisions uh can be altered can be changed through the inclusion uh
Of people with um experimental knowledge in their decision- making process that is a first um thanks so I think it’s it’s it’s a bit of both to be honest so um in the end I’m I’m most interested in the kind of practical questions right so if you have an expert by experience who
Is part of an interdisciplinary team in healthcare and the let’s say the psychologist says we should do a and the expert by experience says no we should do B then how can we resolve those kind of conflicts given that they rely on completely different knowledge that’s that that’s what I find really
Interesting now the way to Target that I mean I’ve been basically trying to approach this from different angles and one of them is viia the more abstract philosophical literature on um right so with with Frank Jackson’s knowledge argument the mar the scientist idea for instance I mean that that
Original thought experiment is not at all aiming at mental health care right it’s it’s ontological questions about physicalism I mean it couldn’t be further away from from practical questions but I think it targets the same kind of intuition right namely that you learn something by experiencing it
And I think that there is value in looking at what philosophers have written about the the type the type of cases that um are present in in the discussion on physicalism but I don’t think that it’ll lead us all the way so to speak precisely because it’s actually
About something else so what I want find really fascinating is that this discussion on physicalism I mean there’s I would say it’s it’s mostly influenced by this thought experiment experiment of Mary the scientist but it’s of course about a very specific experience namely perceiving a color now
Interestingly uh a few years before that there was a paper by Thomas Nagel which is also very famous called what it is like to be a b and I think that is you know that should be mandatory reading for everyone who engages in the field of experiential knowledge because it really
Tackles not not a simple experience like color perception but you know a way of being right what is it like to be a bat uh and he actually also mentions like um that it doesn’t his point doesn’t only go for what he calls exotic cases like
Being a bat but also for more typical cases of you know what is it like to be blind for instance uh and I think he doesn’t talk about Mental Illness but I think it would go the same way like what is it like to experience psychosis what
Is it like to be depressed and I think that Nagle makes a lot of very interesting points in that paper which directly touch upon questions of Mental Health Care um but I mean as you might know that the paper by Nagle is not meant is really a starting point of a
Discussion so he doesn’t provide that many solutions so to speak uh and again in the field of experiential knowledge there you know it’s also an ongoing discussion so there’s also not that many solutions present either um but yeah I do think that there is there is a lot of
Value in seeking out these also classical texts uh but we have to be careful to not fall in the philosopher trap and only talk about the kind of abstract stuff because eventually it has to also be translated to clinical practice and to healthcare and you know
Um to see how it works in in concrete settings uh yes uh thank you and I have one more uh question it is uh about uh clarification the relation between uh empathy and responsiveness you know that um empathy is a crucial uh concept for uh phology of mental health conditions
And uh Matthew redcliff also uh deal with uh different uh approach uh towards empathy and uh does the change uh does the difference look like uh the amount of active efforts to in inter for interpretation uh the particular uh experience uh or it is um a separate there is a separate
Difference between these uh two concepts um so I think this is one of those points where I would have to say that this is still work in progress so I favor the more general term of responsiveness because I think it it it highlights the really uh basic and like I said even
Trivial element that is at stake here um so empathy is I think a little bit of more loaded term and more used in specifically contexts of understanding other people where I think that responsiveness also has to do with you know being responsive to objects in the world for
Instance um that being said I do think that in you know fleshing out this idea of responsiveness it’s definitely worthwhile to use the research on uh empathy as I’ve done only a little bit here as well with with the work of of Matthew Radcliffe um I think there’s actually a bunch of of
Interesting uh Fields I mean so one one thing for instance has to do with imagination so is it possible to imagine what it is like to be depressed or to have autism if you don’t have those experiences yourself I think again that really touches on something crucial namely that
Many people would have the intuition that you cannot fully grasp it because something is by definition missing then but that that again reinforces the point of well what what is it that is missing and and is there a way of even if we cannot fully grasp it can you sort of uh
Approximate that that type of experience um so I’m looking into various Fields including kind of social cognition uh empathy phenomenology uh but also stuff on imagination and uh and other fields to kind of um elucidate this idea of experential knowledge so I’m I’m I’ve been working on this for a
Couple of years already but I feel like there is still so much to be done and so much more Avenues to be pursued um so um yeah I I I really like working on this on this topic and I hope that I can still do so in the in the next couple of
Years thank you thank you we have another question from one was here uh hi thank you for this interesting lecture uh so my question uh Ares from one from a pical perspective uh so do you think um can we connect experiential knowledge with some core ideas of which
Epistemology uh in my opinion it seems that this subjective perspective uh can be uh helpful in understanding um experience from a first person um from yeah from from a from third person um so do you think that we can connect this and is this something that can be helpful or
Not um thanks I’m I’m not entirely sure if I if I get the question could you could you maybe repeat the the central part of the question uh so can we connect the main ideas of virtu epistemology so should we include um this um subjective uh um demands in the
Classical theory of knowledge and is this something that is helpful in our understanding of experiential knowledge of a concept okay um so actually this this two is something that I’m still kind of contemplating so I think that there it has really been the development in in recent years if you look at epistemology
That there is an increasing emphasis on what people would call the situatedness of knowledge so this idea that there is a view from nowhere that you can have fully objective knowledge that is not tainted in any way by the people who obtain that knowledge that is something that is increasingly being left behind
Behind uh and I think for good reason now the sort of um opposite extreme of that would be to say that it’s all relative and you get this kind of postmodern view that uh you know knowledge is always just in the eye of the beholder so to
Speak um and I think both of those extremes are best avoided but where exactly we should end up is I think very difficult um I do think that one important remark here is to say that I do think that there is a difference between science strictly speaking and
Clinical practice so what people mean by objective subjective in science I don’t think it you know we can translate that oneon-one to objective and subjective in clinical practice precisely because in clinical practice we are always by definition working with for instance you know testimony by by a client by patient um and
So like so imagine that you have to decide on a course of treatment it’s it’s almost impossible to objectively say what the best course of treatment is so objectivity in clinical practice is typically much more a kind of interactive process with different in puts some people have a scientific
Background some people have a medical background Etc uh but there’s also the input from from the patient or from someone with experiential knowledge and then in that process you kind of come to the conclusion of well you know this is the best treatment option for instance
Uh and that’s not objective in a strict scientific sense but it’s the kind of you know most useful kind of objectivity that there is I think in in clinical practice okay thank you do we have any other questions from people here or online I don’t see any questions in the
Chat perhaps I could ask something um this is again more um as all philosophers do more of a commment than a question type of a question uh it’s clarificatory uh so what you’re saying in your account is that um you try to find you’re looking for Attunement between ading between fields
Of affordances of a person with a certain disorder and a psychiatrist therapist or whatever being the person that tries to understand the other person’s uh different kind of experiences so you’re are talking in this terms of this in terms of um skilled intentionality terminology for example you have affordance SYM every
Person individually has a certain field of of affordances to which it is responsive and you want to attune the responsiveness of one person to the other so find a common shared ground experientially and the real um value of um someone who has different experience is to show how that that experience is
Uh stands out from the shared experience between other people is that so and I’m getting it Right I I think that’s that’s more or less uh what I’m saying um I am a bit hesitant though about as you might actually know about using the skilled intentionality framework for this um because I think that it precisely the stuff that is so the thing that is probably most at stake
In this process of Attunement is um responsiveness to something like meaning so what do you know what do taking medication mean for someone and that you know for someone who never had to take medication that’s very difficult to understand but for people who do have to take medication that’s much more
Easier now the point is that the skill intentionality framework is very good at explaining or helping to understand other elements of responsiveness except for the meaningful part so I would say that that’s actually one of its its main weaknesses and I’ve I’ve published elsewhere about why I think that that
Means that the skill intentionality framework is limited in its application to clinical cont contexts precisely because it um it’s more useful in precisely those elements that are typically shared right so people have roughly the same body with roughly the same skills uh roughly the same cultural background Etc that’s all the stuff that
People share but the thing that is different when it comes to people with or without mental illness is usually much more related to things like uh meaning and that’s precisely what the skill intens framework uh is lacking yes I recall the paper there meaningful of but what what would the um meaning be
Exactly in this kind of context experientially um where is meaning being situated at what level experiential like pre reflective reflector or so on how to um what’s the difference here yeah what would be the meaning that is different with the patient or with the psychiatrist or
So yeah so um so there so for instance there has been um so let me give two examples one one is a kind of non pathological context and I think it’s also one of the examples that I use in the paper on meaningful affordances so let’s say that two people get their
Driver’s license and you ask what does this mean for you and one person says well now I’m allowed to drive a car and you know U that means that I can go places and the other person says now that I have my driver’s license this
Means that I can take better care of my family so the meaning is radically different and that’s also the way that they experience it in terms of emotions so the Practical fact that you’re able to drive somewhere is for most people not very strongly associated with any
Kind of emotion but being able to provide for your family is a very emotional uh Affair so in the paper i s a study on on emotional experiences and I use this example that is actually taken from that study um to show that the meaning of one affordance in this
Case the driver’s license uh varies significantly across across different people in the case of uh of of mental healthare I would say something along the lines of uh like the example I just gave about medication so what does medication mean um so a lot of people
That I’ve talked to about this issue is that the the step from you know taking medication for the first time is an enormously big step because it means that they that they have to uh acknowledge that they are now a person who has to take medication and I mean again this this
This is interesting because people who who are not sort of familiar with this they will say well you know what’s what’s what’s bad about that whereas people who have experienced this this step of having to take medication know that it’s really a big step because it affects all of your identity and your
Self-image it really creates you have to sort of rewrite the idea of who you are because you apparently need um um like uh uh how do you say that like a sort of biological addition to your own uh biological system in order to function appropriately so the kind of
Meaning that this little pill that you’re supposed to take has is really enormous um and I mean on a on sort of very simple level what does a a pill of medication afford well it affords picking up up and it affords putting in your mouth but
Obviously that’s not at all what is at stake what it affords is a radical disruption of your identity and that is the way that they experience it okay that’s an excellent answer um I wanted to just discuss a bit this kind of example of autism because we give several examples of depression
Schizophrenia and so psychosis of changing of experiences and how one comes to be driven to um examine their changes in in their field of affordances in their the whole change of responsiveness to certain affordances but perhaps in the case of something like autism this kind of disorder which
Is the lifelong disorder you have you have it from birth to death and there’s no specific change that comes into one’s life and now you become Autistic or something like that so I’m not say saying that that is kind of a problematic for this whole framework but what is the difference between that
And something like depression you have like a normal State and then you become depressed or something different um how does one quiz artist become uh an expert by experience because other people tell them that they’re autistic something like that because there is this kind of a social uh element to someone becoming an
Expert by experience whereas in other disorders it is the person themselves that sees the change and kind of examines it in self- reference and so on MH um um so I think that Um so I think it’s important to stress that this idea of responsiveness to some extent is not normative at all right so responsiveness just kind of results from your experience now this idea of Attunement is normative so it suggests that there is a good way at you know an
Optimal way of changing your responsiveness for instance uh and I think you’re right right to point out that there is a difference here between um more episodic forms of illness um which which could be psychosis for instance or more chronic or developmental uh things like autism or
Uh this also goes for certain somatic illnesses for instance uh and one of the differences seems to be that if you have a certain like sudden onset of depression then that means that you have kind of a baseline that you can compare yourself to right so you have yourself
Before the depression and you have yourself after the Depression so to speak um and that Baseline can be something that you use in you know uh contemplating your own responsiveness and in this process of Attunement and as you say in the case of autism that doesn’t really seem to work
Because you already have it um so I think that to some extent this isn’t necessarily a problem I think that it may be a case where it even actually goes the other way around right so a lot of people with Autism they find out that they have
Autism because they find out that other people apparently experience the world differently from them right so they can be surprised that other people um you know are fine with sort of sudden Flex ible changes whereas they find it very difficult um so it’s it it’s almost like
A radical empathy in the other in the other direction so to speak right so neurotypical people trying to understand neurodiverse people that’s that’s one step but the other way around is again also uh uh also requires work so to speak um I think so what I said about the
Normativity of this process of atunement I think there the difficulty is that it’s very problematic to speak about this in very general terms so what is good atunement or how should this process work well that kind of depends on like what you’re doing right so I gave the example of attuning to my
Two-year-old daughter for instance that’s relatively concrete we can discuss like how that Attunement should proceed and uh what you could do in in facilitating that but if you talk about Attunement in the case of autism um I think it it really has to do with what it is that you’re trying to do
So I think it’s different if you ask someone with lived experience in autism to assist someone else who is uh recovering from autism for instance or who is going uh through some difficult moments that will be different than asking that person to you know provide input for like policymaking which is a
Much more abstract uh thing that they would have to contribute to and which arguably requires less Attunement for instance um I’m not entirely sure if if I really answered the the core of your question but feel free to to follow up on that no that’s okay it wasn’t much of
A question just to discuss this kind of a different case within the framework so but yes it’s a good answer thank you uh do we have any more questions uh I I don’t see any so thank you again for accepting the invitation for even the lecture at our seminar hopefully we’ll
See again here um hopefully all the questions were useful for you and your work later on so definitely so thanks thanks for for having me and thanks for all the wonderful wonderful questions thank you see you