Challenges to Wellbeing – Prof Lisa Bortolotti

Challenges to Wellbeing: The Experience of Loneliness and Epistemic Injustice in the Clinical Encounter
By Lisa Bortolotti and Valeria Motta

The Workshop originated from a multi-disciplinary conversation about wellbeing and happiness. This conversation brought together academics from across the University, practitioners, and campaigners. The workshop was hosted by Lisa Bortolotti and Sophie Stammers for project PERFECT, and co-organised and funded by the Institute of Advanced Studies (IAS). It was held at the Centre for Professional Development (CPD) in the Medical School on the 22nd of November 2017.

The workshop was divided in three sessions. Session one was dedicated to Themes from Project PERFECT, session two was on the experience of loneliness, and section three was more interactive, inviting people to discuss specific issues.

In session one, Kathy Puddifoot and Alex Miller Tate started with a discussion of Epistemic Injustice.

Kathy explained that epistemic injustice happens when people are wronged in their capacity as knowers and thus treated unfairly in these processes of knowledge exchange. In testimonial injustice specific stereotypes determine the lack of credibility given to people from some groups. In hermeneutical injustice the resources people need to understand and articulate their own experiences are denied to them. For instance, people might not have the concepts of sexual harassment or postnatal depression, and thus they cannot describe their experiences with those terms. In testimonial silencing an audience fails to identify the person as a knower or the person comes to believe that her testimony will be misinterpreted so she decides not to speak.

Alex talked about how issues of epistemic injustice emerge in the psychiatric encounter. He explained that the literature has noticed that service users are particularly vulnerable to testimonial injustice in their interactions with medical staff due to the fact that medical professionals enjoy undue credibility inflation. This derives from global prejudices about the mentally ill and specific prejudices about people with specific diagnoses. Alex argued that stigma and prejudice extend beyond individual interactions in the psychiatric encounter, and should be thought in terms of social structure, for instance reflecting on what we identify as socially accepted markers of credibility (such as good personal hygiene). Alex also argued that service users might lack access to the kinds of epistemic resources that are necessary to make sense of their experience.

Valeria Motta gave the third talk on the experience of loneliness and solitude. Loneliness has pervasive effects on our mental and physical health and interventions have been proposed to create opportunities for social interaction, to correct deficits in social skills, to enhance social support, and to address maladaptive cognition. Valeria pointed out that there is a conceptual distinction between social isolation and loneliness. Loneliness has been defined as a painful subjective emotional state which happens when there is discrepancy between desired and achieved patterns of social interaction. Social isolation, on the other hand,  involves a subjective state but also the objective fact that there is lack of social contact. Even when this conceptual distinction is acknowledged, the strategies used in the studies predominantly target social isolation and not necessarily loneliness. Giving people opportunities to interact may not address their own specific subjective experiences of loneliness. She also looked at how loneliness differs from solitude. Solitude protects us against the potential dangers of over-stimulation, enhancing freedom, creativity, spirituality and even intimacy.

In session two of the workshop, on the experience of loneliness, we had three talks.

Kimberley Brownlee looked at children who may feel unseen and unheard. She started from a situation narrated in Ian McEwan’s The Children Act. In the story there is a boy who has leukaemia and needs a life-saving blood transfusion. But he and his family are members of Jehova’s Witnesses. The protagonist Judge May decides to order the transfusion. The transfusion results in the boy feeling violated while his parents are in joyful tears because they have stayed true to their beliefs. The boy feels disorientated and alienated by his own family behaviour. Brownlee raised the question of whether the judge had wronged the boy as a knower of his own mind and faith, when she ordered the transfusion. When is it an injustice to ignore a child? This prompted some other questions concerning loneliness in children. What weight should we give to children self-reporting? If they lack the concepts to describe specific experiences, should we give them those concepts? It seems problematic to give a child a concept that could potentially define them when the concept prevents the child from acting freely. On the other hand, a concept could be useful. For instance, the concept of bullying may help children understand their experiences when they are at school.

Next, Kellie Payne and Jolie Goodman talked about their experiences in campaigning and devising interventions to combat loneliness.

Kellie’s Campaign to End Loneliness is 7 years old and the focus mainly on loneliness in old age. Loneliness is more pronounced during transitions in life such as bereavement, illness, disability, and retirement. According to the data, there are about 1.2 million people (roughly 10% of the population) who are chronically lonely living in the UK. Kellie added that this is set to increase as the population of older people grows. Kellie spoke about the campaign’s successes and challenges. The campaign was successful in making the case that loneliness impacts on health, and has already gained 10,000 active supporters. In the collaboration with the Jo Cox Commission on loneliness one of the main challenges is knowing which interventions work, but evaluating data from projects such as Age UK can help filling this gap. Kellie is keen on starting to engage with businesses in local areas and also with the public. The campaign promotes fighting the stigma around loneliness so people can start talking about their own experience openly and realise that this is something that happens to everyone.

Jolie presented the amazing results of the work of the Standing Together Project that she leads for the Mental Health Foundation and Housing & Care 21, a UK housing organisation providing social housing and support to people in later life, including people with dementia. The Standing Together project facilitates self-help groups in extra care or retirement housing schemes to improve the emotional health and community connections of older people. The groups are for tenants who are experiencing memory loss, mental health issues, learning disabilities, and experience significant loneliness.

The last session was dedicated to discussing in groups the themes emerging from the earlier presentations and to planning further collaboration on epistemic injustice and loneliness. Videos of the talks can be found following this link. Valeria Motta and Lisa Bortolotti also authored a recent Birmingham Perspective on the theme of loneliness, asking whether we should think of it as a pathology.