Laura GuidryGrimes Georgetown University Elizabeth Victor USF amp Georgetown University FEMMSS Conference 2012 Introduction Vulnerabilities Rejection of Kantian isolated willers account ID: 532450
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Slide1
Compounded Vulnerabilities in Social Institutions: Vulnerabilities as Kinds
Laura Guidry-Grimes, Georgetown University
Elizabeth Victor, USF & Georgetown University
FEMMSS Conference, 2012Slide2
IntroductionVulnerabilitiesRejection of Kantian isolated ‘willers
’ account
Reflect the various ways in which we are
dependent on others for effective agencyVulnerability: Our definitionMorally problematic disadvantaged placement of an individual within the context of social practicesClarifying who is ‘the vulnerable’Context and the impact of situationsOverlapping factors Vulnerabilities as kindsSlide3
Compounded Vulnerabilities: A ConceptSides of Compounded VulnerabilitiesAgent-side factorsLuna (2009)
Widen scope of applicability & still keep sufficiently narrow definition of vulnerability
Institution-side factors
Shift analysis to social practices and systematic disadvantageFunction of labels in the context of vulnerabilitySlide4
Medical Labels & Interactive KindsHacking on interactive kindsDistinguishing interactive kinds from indifferent kinds
The problem with causal mapping
Biological determinants vs. social determinates
Why interactive kinds?Better modeling of relationships by looking at the looping effects between variablesBetter starting point for measures & remedy developmentAnother safety mechanism against perpetuating oppressionsSlide5
PMDD as an Interactive KindChoosing between models for PMDDMedical-biological model
Social constructionist model
Rejecting mutual exclusivity of the models
Difficulty in teasing the two apartWhy we wouldn’t want to if we couldWhat interactive modeling has to offerDifferent ways of understandingDifferent ways of respondingRecognition of how social groups can be rendered vulnerable upon diagnosisSlide6
Defining VulnerabilityVulnerability as a flexible termAccommodate particularities & circumstantial detailsWhen is a person vulnerable?
When in a position which threatens the holistic person as an agent for developing and achieving the most fundamental dimensions of well-being
Sources of vulnerability
Internal variablesExternal variablesNarrowing the definitionDistinguishing from susceptibility or loss whatsoeverSlide7
Vulnerabilities & Well-BeingThe holistic personPowers &
Faden
(2006) & dimensions of well-being
Sufficient level of functioning along all dimensions necessary for decent minimumAll of equal moral importanceNecessary for human flourishingHealthPersonal securityReasoningRespectAttachmentSelf-determinationSlide8
Vulnerability, Well-Being , and LabelsIntersecting of dimensionsMedical labels can cut across categories
Vulnerability as too broad or abstract?
Problems with non-ideal theories
Flexibility at the expense of narrowness?Avoiding blanket labelsEssential/fixed traits do not threatenVulnerability enters withPerceptions of other within the context of normative social practices Slide9
Compounded VulnerabilitiesWhen do they happen?When systemic or institutional conditions intersect in a manner that creates additional barriers to the agent's ability to develop or achieve wellness of beingParticular susceptibility of historically marginalized populations
Tools to identify when
and
how different kinds of vulnerabilities intersect to give rise to compounded vulnerabilitiesCompounded vulnerabilities as layers of vulnerability Slide10
PMDD & Compounded VulnerabilityControversial medical labelsDesignate specific population as an essential feature of the diagnostic criteria
Not explicit in this regard, but
de facto
apply to a specific population in their diagnostic practicesPMDD as an institutional barrierPerpetuated stereotype of ‘menstruating women’Continues history of women’s pathologizationCompromised legal standingCompromised medical autonomy
Denied career opportunities
Internalized stigmaSlide11
ConclusionsInteractive kinds as a conceptual toolBetter evaluate how labels are reflective of biological determinantsHow social determinants inform the interpretation of biological factors
Mitigating harm
Through understanding how vulnerabilities intersect
Who is susceptibleHarms and barriers confronted by targeted groupsSlide12
RecommendationsNOT suggesting radical changesAwareness is the first step in
Rethinking classifications
Rethinking research interventions
Rethinking treatments at the institutional levelRecognizing the role of the clinician in enhancing patient autonomy through the presentation of materials Incorporate contextually rich diagnostic toolsNarrative-focused structured interviews when patient presents symptoms or seeks treatmentProvide fuller context & nuanced detailsExplain what symptoms mean to the individualExplain condition-significant distinctionsCommunicate life circumstances