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Chapter 5 assesses harms that people with mental illness experience that are related to how their self is constituted. These include harms of de-individuation and mis-identification, but also, as this chapter focuses on, harms of social exclusion and dehumanization that result from status loss and moral distancing. Dehumanization occurs through both being reduced to a stereotyped trait and being viewed as lesser compared to others. Having a sense of belonging and being accepted as an equal member of a moral/epistemic/social community are important parts of being viewed as and viewing oneself as a full human being; these are also critical for developing and exercising autonomous agency as well as for well-being and flourishing. People with mental illness are often excluded from these communities as a result of public stigma, diminishing their autonomy and well-being. This chapter shows how dehumanization, social exclusion, and belonging uncertainty threaten belongingness and autonomy.
This chapter revisits the question of Renaissance individualism by focusing on the writings of two early propagators of the Italian Renaissance: Petrarch and Boccaccio. Through an analysis of their literary dialogues with central medieval authorities and institutions, it argues that both authors develop a highly personal, earthbound conception of a relational self. In their engagements with figures such as Augustine (for Petrarch) and Dante (for Boccaccio), they challenge traditional structures of order and meaning, questioning their relevance to contemporary experience and thereby opening a space for an individualism that may be described as “modern.” The chapter also demonstrates that these dialogues are not purely agonistic or triumphant, but reveal the costs and contradictions of this emerging individualism – whether in its lack of metaphysical grounding or its destabilizing effects on the social fabric. Rather than simply discarding old authorities, Petrarch and Boccaccio’s representations of the self often seek to reconcile the old with the new, individualism with tradition, and self with others, anticipating Charles Taylor’s emphasis on the relational nature of the self.
Conventional psychiatric services are not always acceptable to indigenous communities and people.
Objectives
We used qualitative methodology to explore a successful collaboration of psychiatrists and addiction medicine specialists with indigenous communities in Maine, USA, in North America, comparing these results to previously unsuccessful collaborations. We wanted to delineate what leads to success.
Methods
We used constant comparative, iterative methodology within a constructivist, grounded theory approach to generate differences to discuss.
Results
Successful strategies address the highly relational approach to defining the self of the indigenous communities, a collectivist mindset in which the needs of the group can supersede the needs of the individual, a reliance upon stories for transmission of knowledge and culture, and a commitment to a biopsychosocial and spiritual approach, which, in North America, is often symbolized by the metaphor of the Four Cardinal Directions. Successful psychiatrists working in these communities needed to share more personal details than what they are usually accustomed to provide. They acknowledged local culture and spirituality and worked with traditional knowledge holders to create collaborative approaches. As part of this, the use of a narrative approach worked best in which the psychiatrist worked within the stories and beliefs of the community which required taking the time in dialogue to learn those stories and beliefs.
Conclusions
We addressed the challenges of consulting to tribal-based treatment programs, of modifying usual counseling techniques such as motivational interviewing to an indigenous population. We propose that these sorts of participatory-action-based approaches go far to improve service delivery to indigenous people and reduce health disparities.
This chapter explores the concept of the relational self. It contrasts it with the traditional understanding of the indivdiualised self. It argues that the model of the relational self captures the sense that our identity, language and ways of understanding the world come from our relationships. It explores how the law has been based on an individualised self through, for example, emphasising autonomy. It argues that the law should adopt a relational understanding of the self.
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