Laura Guidry-Grimes, Georgetown University
Elizabeth Victor, USF & Georgetown University
Diotima Conference, 2011
 Vulnerabilities


Rejection of Kantian isolated ‘willers’ account
Reflect the various ways in which we are
dependent on others for effective agency
 Vulnerability:

Morally problematic disadvantaged placement of
an individual within the context of social
practices
 Clarifying


Our definition
who is ‘the vulnerable’
Context and the impact of situations
Overlapping factors
Vulnerabilities as
kinds
 Sides

Agent-side factors



of Compounded Vulnerabilities
Luna (2009)
Widen scope of applicability & still keep sufficiently
narrow definition of vulnerability
Institution-side factors


Shift analysis to social practices and systematic
disadvantage
Function of labels in the context of vulnerability
 Medical

labels as interactive kinds
Where and when interactive kinds arise
 Diagnostic
barriers

categories
creation of
Limiting capacity toward well-being
 Firmer
grasp on the interaction of medical
practice and other social institutions
 PMDD
as an example of an interactive kind
that can compound vulnerabilities
 Hacking

Distinguishing interactive kinds from indifferent kinds
 The



problem with causal mapping
Biological determinants vs. social determinates
 Why

on interactive kinds
interactive kinds?
Better modeling of relationships by looking at the
looping effects between variables
Better starting point for measures & remedy
development
Another safety mechanism against perpetuating
oppressions
 Interactive
Medical-Biological
Social
Construction
Kind Model
Model
Model
 Choosing


Medical-biological model
Social constructionist model
 Rejecting




mutual exclusivity of the models
Difficulty in teasing the two apart
Why we wouldn’t want to if we could
 What

between models for PMDD
interactive modeling has to offer
Different ways of understanding
Different ways of responding
Recognition of how social groups can be rendered
vulnerable upon diagnosis

Vulnerability as a flexible term


When is a person vulnerable?


Accommodate particularities & circumstantial details
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 variables
 External variables


Narrowing the definition

Distinguishing from susceptibility or loss whatsoever
 The



holistic person
Powers & Faden (2006) & dimensions of well-being
Sufficient level of functioning along all dimensions
necessary for decent minimum
All of equal moral importance
 Necessary






for human flourishing
Health
Personal security
Reasoning
Respect
Attachment
Self-determination
 Intersecting

of dimensions
Medical labels can cut across categories
 Vulnerability

Problems with non-ideal theories

Flexibility at the expense of narrowness?
 Avoiding


as too broad or abstract?
blanket labels
Essential/fixed traits do not threaten
Vulnerability enters with

Perceptions of other within the context of normative
social practices
 Distinguishing

All humans are vulnerable, but only certain people at
specific times are susceptible (Kottow 2003)
 Feature


of humanity
In our close social relationships, acknowledgement
of human frailty is essential for emotional
closeness & empathic engagement (Carse 2006)
 Forced

vulnerability from susceptibility
vulnerability as a social ill
Distinguishing our definition from Kottow & Carse
As the result of


Systematic disadvantage
Asymmetric power relations
 When

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 being

Particular susceptibility of historically marginalized
populations
 Tools
to identify when and how different
kinds of vulnerabilities intersect to give rise
to compounded vulnerabilities

Compounded vulnerabilities as layers of
vulnerability
 When
diagnostic categories target historically
marginalized and disadvantaged populations

Stigma of mental illness
 Building

Reinforcement of stereotypes & biases



of an institutional barrier
Effects of psychological oppression
Double effect of compounding vulnerabilities
Bolsters marginalization and adds difficulties for
attaining sufficient level of well-being
 Controversial


Designate 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 practices
 PMDD






medical labels
as an institutional barrier
Perpetuated stereotype of ‘menstruating women’
Continues history of women’s pathologization
Compromised legal standing
Compromised medical autonomy
Denied career opportunities
Internalized stigma
 Interactive


Better evaluate how labels are reflective of
biological determinants
How social determinants inform the
interpretation of biological factors
 Mitigating

kinds as a conceptual tool
harm
Through understanding how vulnerabilities
intersect


Who is susceptible
Harms and barriers confronted by targeted groups

NOT suggesting radical changes

Awareness is the first step in





Rethinking classifications
Rethinking research interventions
Rethinking treatments at the institutional level
Recognizing the role of the clinician in enhancing patient
autonomy through the presentation of materials
Incorporate contextually rich diagnostic tools

Narrative-focused structured interviews when patient
presents symptoms or seeks treatment




Provide fuller context & nuanced details
Explain what symptoms mean to the individual
Explain condition-significant distinctions
Communicate life circumstances
 Diversity

of concepts
How can they be bridged?
 Historically

marginalized populations
Who are they?
 Effects
of psychiatric labeling