Hello, I’m Shelley Tremain and I’d like to welcome you to the ninetieth installment of Dialogues on Disability, the series of interviews that I am conducting with disabled philosophers and post to BIOPOLITICAL PHILOSOPHY on the third Wednesday of each month. The series is designed to provide a public venue for discussion with disabled philosophers about a range of topics, including their philosophical work on disability; the place of philosophy of disability vis-à-vis the discipline and profession; their experiences of institutional discrimination and exclusion, as well as personal and structural gaslighting in philosophy in particular and in academia more generally; resistance to ableism, racism, sexism, and other apparatuses of power; accessibility; and anti-oppressive pedagogy.
The land on which I sit to conduct these interviews is the traditional ancestral territory of the Haudenosaunee and Anishnaabeg, covered by the Upper Canada Treaties and directly adjacent to Haldimand Treaty territory. As a settler, I offer these interviews with respect for and in solidarity with Indigenous peoples of Turtle Island and other colonized settler states who, for thousands of years, have held sacred the land, water, and air, as well as their inhabitants and who, for centuries, have protected them from the ravages of colonialism and expropriation.
My guest today is Abigail Gosselin. Abigail is a professor in the philosophy department at Regis University in Denver, Colorado. She is the author of Global Poverty and Individual Responsibility (Lexington, 2009), Humanizing Mental Illness: Enhancing Agency through Social Interaction (McGill-Queen’s University Press, 2021), and Mental Patient: Psychiatric Ethics from a Patient’s Perspective (MIT Press, 2022), writing on many topics in social philosophy, including mental illness stigma, medicalization of mental disorders, philosophizing from experience, and human rights and poverty. She keeps busy with her husband and two teenage daughters and, when she has the time, she likes to run, walk, and read.
[Description of photo below: a smiling Abigail, who has glasses and curly hair, stands holding one of her furry grey rabbit friends in her arms. Leaves on a tree can be seen through a large window in the background of the shot.]
Welcome to Dialogues on Disability, Abigail! Abigail, you did your Ph.D. at University of Colorado at Boulder where you studied with Alison Jaggar. Please tell us what led you to do graduate work in philosophy and, ultimately, become a professional philosopher.
When I was in college, I enjoyed my philosophy classes immensely and was especially interested in classical authors like Plato and Kant, as well as philosophical examinations of contemporary issues, especially feminism. I decided to apply to graduate school in philosophy to see where that might take me. Alison Jaggar was one of my favourite feminist philosophers; so, I applied to the University of Colorado at Boulder to work with her.
Graduate school was emotionally very difficult for many reasons. Graduate-level philosophy was much more competitive and aggressive than undergraduate work; and I did not feel cut out for it. During my time in graduate school, I was diagnosed with bipolar disorder. I suffered from manic, depressive, and mixed episodes for years, which complicated my experience in graduate school. Nevertheless, the graduate-school environment was also intellectually stimulating and enriching. I thought that even if I did not get a professional job, and regardless of how hard graduate school was, it was intrinsically rewarding and worth the time and energy. Alison had a way of bringing people together; and a group of students who all worked with her formed a support group to help us get through the trials of graduate-level philosophy together. This support was critical to my success in graduate school and my ability to cope with my psychiatric problems.
I have always been driven by questions in ethics and political philosophy about how to be good people, live worthwhile lives, and create conditions of justice living together in society. My interests can be summarized with the Jesuit question, “How ought we to live?” Regis University, a Jesuit Catholic university in Denver, where I have worked for 16 years, uses this question to guide and direct what we do in the university. The question guides and frames all of my classes too, as well as my research. Generally speaking, this question basically summarizes my interest in philosophy: how ought we to live, given the empirical constraints that we are under?
My courses and my research examine questions like: How ought we to live, given the constraints we have on our agency, both the necessary, unavoidable constraints we have by virtue of being human, and the socially contingent constraints put upon us by society? How can we build a supportive community with others that allows each individual to flourish? How should we cope with the environmental and political crises that we are in? In my research, I am especially interested in understanding how people with mental illness can still have agency, autonomy, and general functioning and flourishing, despite the major constraints of their illness, as well as how they can work on recovery.
I do philosophy because I think that philosophy provides a helpful and deep way to think about social issues that impact our lives. I am not interested in the kind of philosophy that involves either proving arguments premise by premise or thinking through science-fiction-y thought experiments. Philosophy is at its best when it explores people’s real-life experience in a way that both illuminates and complicates that experience.
At The University of Colorado, you wrote your dissertation on individual responsibility and global poverty. You subsequently shifted your research endeavours to focus on mental distress, the nature of diagnostic categories, and philosophy of psychiatry. Please describe this research, what motivated you to engage in it, and its relation to your previous work in feminist philosophy and global justice.
In graduate school, as you said, I wrote my dissertation on individual responsibility for global poverty; I rewrote my dissertation into a book, Global Poverty and Individual Responsibility, that was published by Lexington in 2009. Soon afterward, I switched my research focus to look at issues related to mental illness. I had long been interested in questions about free will, agency, and responsibility, and I now wanted to write in these areas. As I explored philosophy of psychiatry, I became interested in questions about the nature of diagnostic categories of mental disorders. I was especially interested in the history and construction of the category of schizophrenia. In college, I had a job working as a supportive living specialist with, in their homes, adults who had schizophrenia. I was very interested in understanding how people who had such a disabling illness could nonetheless live meaningful lives. Moreover, my background in feminist philosophy led me to question how schizophrenia is constituted and framed, as well as to wonder about the extent to which schizophrenia is natural versus constructed.
Worried that mental disorders are too often naturalized, my interest in feminist philosophy and global justice led me to write papers on injustices in the medicalization of mental disorders. I used the non-ideal theory espoused by Jaggar to argue that people’s lived experiences with mental illness often shows that mental illness experience is fundamentally social and has to be examined as a social phenomenon that can be addressed adequately only with social change. Medicalization of mental disorders often obscures the social factors involved with mental illness, causing people who have mental illness to experience various injustices in their mental illness experience and treatment.
This work on medical injustices led me to examine stigma of mental illness more closely. I began working on some papers and a book–Humanizing Mental Illness: Enhancing Agency through Social Interaction–that analyzed how mental illness and stigma create constraints on the agency of people with mental illness. My papers examined stigma from a social epistemology standpoint, while my book explored ways that we in society can interact with people with mental illness in order to enhance their agency. I argued that we need to interact intentionally with people who have mental illness, especially severe mental illness, by embodying various moral and epistemic virtues that enable the people with whom we are interacting to have more agency.
Abigail, your forthcoming book, which is entitled, Mental Patient: Psychiatric Ethics from a Patient’s Perspective, will be published by MIT Press this Fall. Please give us a preview of the central arguments of the book, why you wrote it, and what you hope it achieves.
In 2017, while I was still working on the book about enhancing agency of people with mental illness, I had a psychotic break and struggled with psychosis for about two years, sometimes with suicidal depression, and sometimes without a mood shift. During this time, I was often in a cognitive fog and could barely hear anything outside the noise in my head. I lost my ability to think clearly and had trouble reading, following plot lines in movies, and even tracking basic conversations. Engrossed in and distracted by strange physical sensations, I interpreted songs and objects as sending me messages, and I developed some fantastical beliefs (delusions). After several months of being psychotic and suicidal–hearing a voice telling me to kill myself–I was hospitalized for psychotic depression, and I began taking antipsychotic medications. Later, when my depression receded and I was still struggling with psychosis, I was diagnosed with psychotic disorder, not otherwise specified.
It took some time to find the right combination of medications to help me. First, I tried ziprasidone (an antipsychotic), which helped some, but I still suffered from suicidal depression; when I took a high enough dose of mirtazapine (an antidepressant), the depression lifted but psychosis remained. At this point, I had lost my mind so completely that teaching was torturous; I could not fulfill all my duties as department chair, and I thought I would have to go on short-term disability. But then, I added risperidone (another antipsychotic) to my medication regimen, which was a life-changer and life-saver. For the first time in over two years, I finally felt “normal,” and I could think more clearly. Ever since I went on the risperidone three years ago, I have been well. These three years make up the longest period of wellness that I have had in my adult life.
My experience with medications completely changed the way that I saw the world and the way I was able to think. This experience led me to adopt a medicalized view of my illness. I came to believe that, for at least some cases of psychiatric disability, the disability is objectively harmful–causing problems in how a person relates to the world and interacts with others–when a person does not have the same sense of shared reality that others have, is biologically caused, and is best understood and treated from a medical standpoint. Earlier, I had written papers criticizing the medicalization of mental disorders; and now I was defending it! I guess that I would amend my take on medicalization to say that medicalization can be harmful in some circumstances, especially when it leads to injustices; yet it can also be helpful in other circumstances, as when it enables treatment, provides hermeneutical resources, provides access to social and material resources, and enables social support. As with most things, a nuanced approach is necessary.
My experience with the medicalization of my psychotic disorder was not wholly positive. In particular, I struggled with how I was positioned as a mental patient receiving mental healthcare treatment, experiencing certain harms and injustices as a result. After participating in some intensive treatments–hospitalization and an intensive outpatient program (IOP)–I realized that I had a lot to say about the nature of my treatment. So I started writing a book about psychiatric ethics from a patient’s perspective.
At first, I was just exploring various themes in philosophy of psychiatry literature, as well as in relevant literatures in nursing (voice-hearing simulations), medicine (forcible injection, forcible treatment, and medication nonadherence), and psychology (stigma in the profession and the nature of hallucinations). The first draft of my book was kind of all over the place as I saw myself as a commentator on all these themes. After getting reviews from MIT Press, I rewrote the manuscript completely to focus on various issues in psychiatric ethics related to mental illness treatment, including autonomy/paterna- lism, coercive treatment, medicalization of mental disorders, trust and empathy in the therapeutic relationship, epistemic justice, narratives about mental disorders, and choices in medication adherence. This draft, titled Mental Patient: Psychiatric Ethics from a Patient’s Perspective, got accepted by MIT Press and, as you indicated, will be in print this Fall.
The main thesis of the book is that, in some cases of psychosis, psychosis takes over a person’s will, impeding their autonomy and agency, making it so that they act in ways that further their psychosis rather than try to overcome it. This cycle keeps people in a state of perpetual illness and makes it hard for people to willingly engage in treatment, including taking their medication as prescribed. I argue that paternalistic interventions that increase a person’s overall autonomy by helping them to adopt a health-oriented disposition and care for themselves are justified; however, these interventions should be done in the context of a therapeutic relationship that involves empathy, trust, and epistemic humility/curiosity. In such a relationship, mental-health professionals need to encourage patients to develop greater self-understanding through constructing narratives of their experience and to make informed choices for themselves about their own treatment. In this way, mental-health professionals can avoid committing epistemic injustices and other forms of oppression, to which patients are often easily prone because of the way that they are positioned as patients receiving mental-healthcare treatment. Mental-health professionals play a crucial role in enabling psychiatric patients to increase their autonomy and agency, but only if they act intentionally in ways that promote this enhancement.
This book is what I wish that I could have given my treatment providers when I was receiving treatment for psychosis. I wrote this book, in part, because I wanted a way to express what they did that was helpful and what they should have done to be more efficacious. My hope is that the book will be read not only by philosophers, but also by clinicians in the mental-health field.
Abigail, the Dialogues on Disability series aims to (among other things) throw into relief the forms of epistemic oppression that disabled philosophers in particular and disabled people in general confront. As a disabled philosopher who has been institutionalized, has received psychiatric diagnoses, and routinely takes medication, what sorts of epistemic injustice have you experienced within philosophy, the university, and beyond?
One aspect of being mentally ill and receiving mental healthcare treatment that was very hard for me to deal with was how utterly vulnerable that it made me. My illness made me lose many of the capacities that are required to be a competent professor and professional; and I felt very much like I could not do my job anymore. When I was a patient receiving mental-healthcare treatment, I felt reduced to my identity as a mental patient. My whole experience was tied up with being sick and receiving treatment. All my clinicians knew me only as a sick person; they did not see the side of me that was trying to function at work. I embodied what Talcott Parsons called the “sick role,” making me vulnerable in many ways, including vulnerable to a loss of privacy and vulnerable to the dictates of my clinicians.
One of the most humbling experiences that I had occurred when I was in the hospital. Nursing students passed through daily doing their clinicals. I was relieved that none were Regis students, at least not while I was there. Yet even though they were not my own students, they were students nonetheless now in a position of authority over me. Most of the nursing students felt shy and awkward and avoided the patients; however, a few did interact with us. On my second or third day in the hospital, one student was brave enough to initiate a conversation with me. When I told her that I was a professor at Regis, I could tell that she was not sure whether to believe me because I might be psychotic and delusional. After all, I was on the ward that housed the psychotic patients. As I talked more about being at Regis, however, I could see her relax as she realized that I knew what I was talking about, that I was expressing a truth, not a delusion. The whole experience was surreal for me. There, while I was doubted and questioned, I had none of the epistemic power, authority, and credibility that I normally have in my day-to-day life as a professor; instead, the nursing student, like the staff, had all the power, authority, and credibility. The epistemic terrain was entirely on their terms, and I held no power within it. I felt like I was nothing but a sick person. I felt a tremendous loss.
After hospitalization, I participated in an IOP for a few weeks in the Spring and then again later in the Fall. IOP met for 3 hours a day; I attended 3 times a week on days that I didn’t teach. Half of the class was a lesson on topics related to distress tolerance and mindfulness; the other half of it was group therapy. At IOP, I was a sick person with my head on the table, too depressed to sit up; then I would go to work to hold office hours; while the next day, I taught. It was surreal leading these two lives: one as a barely competent professor and the other as a skilled mental patient. For many months, I had two entirely distinct identities, which I had difficulty bridging. Inside, I knew that the “real” me was the sick me, while the professor me was acting out a part that felt foreign and undeserved.
In my role as a professor, I experienced a peculiar form of epistemic injustice, where I was granted a professional credibility that I did not feel that I deserved and denied a first-person credibility that I identified with more. My personal experience was one of great vulnerability and suffering, where I identified more with the oppressed and vulnerable people that I taught about in my ethics and social philosophy classes than with my students and colleagues. My students and colleagues were studying the nature of vulnerability and oppression that some people experience, acting as impartial observers trying to gain an objective understanding of such conditions. As a professor, I was positioned as someone studying these people. Yet I was also one of these people who was being studied! And there were few opportunities to acknowledge that I was positioned this way. I had to act like an impartial observer studying the vulnerability and oppression of people situated as such, without acknowledging that this vulnerability and oppression was my experience too. I felt alienated from my experience and like an imposter as a professor because I was unable to bridge this gap between professional credibility and first-person credibility.
As a result of this alienation and imposter feeling, I try to share my story where it seems relevant. In my “Philosophy of Mental Health” and “Drugs and Society” classes, I share with my students my experiences with bipolar and psychotic disorders and my experiences with taking psychiatric medication. Doing so helps me bridge my personal perspective based on my experience with my professional perspective as one who studies these issues, as well as affirms my first-person credibility alongside my professional credibility. For students, this discussion of my personal experiences makes what we talk about seem more real and relevant; for colleagues, this personal narrative makes my professional perspective seem less abstract, less theoretical, and more grounded in reality.
In a recent post on BIOPOLITICAL PHILOSOPHY, I pointed out that the now ubiquitous term accessibility has been commodified and tends to conceal the purposes for which it was initially intended: desegregation. Since Dialogues on Disability began in 2015, it has aimed to desegregate philosophy. What, in your view, are the salient issues with respect to desegregation for disabled philosophers who experience mental distress, hear voices, have visions, and so on?
Segregation for disabled philosophers who experience psychiatric difficulties mainly consists of silencing. In order to be considered professionally credible as philosophers, we have to be positioned as impartial observers of the phenomena that we are studying. This positioning requires that we “prove” our credibility by appearing to not have a personal connection to the phenomena that we are studying and that we talk and write about it as impartially and objectively as anyone else. These tacit demands lead us to silence ourselves regarding our personal experience and basically hide this aspect of ourselves so that we can pass as credible professionals.
Desegregation requires that we create spaces in our professional lives to be able to disclose and talk about our personal connection to the phenomena that we study. Having firsthand experience and perspective does not—and should not appear to—conflict with having professional credibility. If anything, first-person credibility should enhance professional credibility by grounding people’s theoretical observations in people’s real-life experience, giving these observations more authority, legitimacy, and relevance. Currently, we worry that such disclosure indicates a bias that limits the depth of knowledge that a person’s study can provide. Instead, we should see such disclosure as increasing knowledge by providing multiple perspectives on the phenomena studied. We should welcome people to disclose and talk about their personal connection to the phenomena that they study so that we can have a richer and deeper understanding of it.
There is less stigma talking about mental illness than there used to be. When I was a graduate student in the early 2000s, having a mental illness was still something that one did not talk about publicly, certainly not within the profession. Ever since Peter Railton talked about his experiences with depression at the Central APA in 2015, more and more people in the philosophy profession are talking about mental illness experience. The field of philosophy of psychiatry has exploded in recent years. Philosophers who write in this area still tend not to disclose personal experience with the subject matter; however, I believe that this reluctance is slowly changing.
In addition to ceasing the silencing that often occurs with mental illness experience, desegregation of psychiatric disability also involves increasing accessibility as traditionally understood. But accessibility issues for people with mental illness are tricky. It’s usually not as simple as changing the light source or seating arrangements. People with mental illness often struggle with things like thinking clearly (a true hazard for the philosophy profession), time management, expectations around workload, and social anxiety and other types of anxiety. Having a supervisor that one can trust and with whom one can have serious conversations is important. When my psychosis was active and I was not able to fulfill all my duties as department chair, I had to negotiate with my supervisor about what work that I could give up—what that meant, however, is that my coworkers had to do more work to pick up the slack. I felt very bad about needing this kind of accommodation.
Another area where I—and many others—struggle is travel to conferences. I do not mind, and even enjoy, reading and talking about my work. But the actual travel is incredibly stressful and anxiety-producing. As more conferences develop online options, like Zoom presentations, this adjustment will help people like me who have difficulty with travel. More than once, I have felt as if I would have to give up the research aspect of my job because traveling is so difficult. I’m trying not to give it up. Having local conference options and online options helps a lot.
The flexibility of the academic life is extremely helpful for people with mental disorders. If I have an unproductive period, I can make up for it with a more productive period later. Having to be “on” when I’m in the classroom or in meetings usually occurs for only a few hours a day, so I can often channel my energy for that time block; having hours in the workday when I do not have to be “on” all the time, can just relax, and work on my computer or do grading, is very helpful. We could do better with accessibility issues, especially in terms of enabling more accessible conference participation; but we are fortunate to be in a profession that has a lot of flexibility built into the workweek.
Abigail, how would you like to end this interview? Would you like to say anything more about something that we’ve discussed? Is there anything that you would like to talk about that we haven’t touched upon? Do you want to recommend any articles or other materials related to something you’ve mentioned in this interview?
The book I am finishing–Mental Health Resilience: The Social Context of Coping with Mental Illness–examines what kind of resilience is needed for people with mental illness to be able to cope with their illness. I argue that resilience has a necessarily social context that is often overlooked. To be resilient, one must have a community that can provide support, resources, and opportunities needed for resilience. Inner resources such as strength, courage, perseverance, creativity, hope, a positive attitude, and problem-solving skills are essential aspects of resilience; but, so are external resources such as sufficient support from others, the meeting of one’s basic needs, access to mental health treatment and medical care, as well as that one not be subject to injustices. We develop inner resources through our interactions with others, we garner support from the people who interact with us in our daily lives, and we acquire external resources and opportunities from our society.
For someone with severe mental illness, I am lucky to have a lot of privilege, including: advanced education, a professional job as a college professor, and a family of my own. This privilege has enabled me to recover from episodes of mental illness more easily. People who have their basic needs met and who are not subject to various injustices and harms are better able to develop and exercise the resilience that is needed for recovery.
As I indicated above, I often feel as if I straddle two worlds: one as a professor and the other as a mentally sick person who needs mental-healthcare treatment. When I approach my research and my teaching through a hybrid identity as both a professional philosopher and a person with a psychiatric disability, I can bridge these two worlds and let each one of them inform the other. I believe this hybrid identity makes both my research and my teaching more meaningful and relevant as a result.
A lot of exciting work is being done at present in the field of philosophy of psychiatry. I encourage readers to explore it. Many philosophers in this field are doing their part to destigmatize mental illness and desegregate psychiatric disability. I expect that we will see even more progress in these areas in the future.
Abigail, thank you so much for this very interesting interview and, in particular, for telling us what to expect from your forthcoming book. I suspect that your remarks will play a significant role in the increasing destigmatization of psychiatrized philosophers.
Readers/listeners are invited to use the Comments section below to respond to Abigail Gosselin’s remarks, ask questions, and so on. Comments will be moderated. As always, although signed comments are preferred, anonymous comments may be permitted.
The entire Dialogues on Disability series is archived on BIOPOLITICAL PHILOSOPHY here.
From April 2015 to May 2021, I coordinated, edited, and produced the Dialogues on Disability series without any institutional or other financial support. A Patreon account now supports the series, enabling me to continue to create it. You can add your support for these vital interviews with disabled philosophers at the Dialogues on Disability Patreon account page here.
Please join me here again on Wednesday, October 19th for the ninety-first installment of the Dialogues on Disability series and, indeed, on every third Wednesday of the months ahead. I have a fabulous line-up of interviews planned. If you would like to nominate someone to be interviewed (self-nominations are welcomed), please feel free to write me at firstname.lastname@example.org. I prioritize diversity with respect to disability, class, race, gender, institutional status, nationality, culture, age, and sexuality in my selection of interviewees and my scheduling of interviews.