Oppressive Double Binds

S. Hirji

Ethics, Vol 131, 4.

July 2021

Abstract

I give an account of the structure of “oppressive double binds,” the double binds that exist in virtue of oppression. I explain how these double binds both are a product of and serve to reinforce oppressive structures. The central feature of double binds, I argue, is that an agent’s own prudential good is bound up with their ability to resist oppression; double binds are choice situations where no matter what an agent does, they become a mechanism in their own oppression. A consequence is that double binds constrain an individual’s agency while leaving various dimensions of their autonomy fully intact.

In the concluding remarks

To sum up: I have had three overarching goals of this article. The first has been to vindicate Frye’s point that once we properly understand the structure of double binds, we see how they differ from ordinary restrictions on an individual’s options and how they serve to immobilize and reduce members of certain groups. As Frye insists, understanding this difference between mechanisms of oppression and ordinary restrictions on our options is a crucial part of identifying and challenging oppressive structures. The second goal has been to develop and refine the concept of a double bind so that it can be useful in theorizing about oppression. I have argued that double binds are choice situations in which a member of an oppressed group is forced to choose between cooperating with and resisting some oppressive norm, and because of the way their own prudential good is bound up with their ability to resist oppression, they end up to some degree reinforcing their own oppression no matter what they do. The third goal has been to better understand what I call “imperfect choices”—choices where, no matter what an agent does, they undermine the very interest at stake in their choice. I have argued that “imperfect choices” constrain an individual’s agency while leaving various dimensions of their autonomy fully intact.

The information is here.

Docs Decry ‘Moral Injury’ From Financial Pressures Of Health Care

Melissa Bailey
Kaiser Health News
Originally published 4 Feb 20

Here are two excerpts:

But “the real priority is speed and money and not our patients’ care,” Corl said. “That makes it tough for doctors who know they could be doing better for their patients.”

Dean said people often frame burnout as a personal failing. Doctors get the message: “If you did more yoga, if you ate more salmon salad, if you went for a longer run, it would help.” But, she argued, burnout is a symptom of deeper systemic problems beyond clinicians’ control.

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“The health system is not set up to help patients. It’s set up to make money,” he said.

The best way to approach this problem, he said, is to help future generations of doctors understand “how decisions made at the systems level impact how we care about patients” — so they can “stand up for what’s right.”

Whether these experiences amount to moral injury is open for discussion.

Cynda Rushton, a nurse and professor of clinical ethics at Johns Hopkins University, who has studied the related notion of “moral distress” for 25 years, said there isn’t a base of research, as there is for moral distress, to measure moral injury among clinicians.

But “what both of these terms signify,” Rushton said, “is a sense of suffering that clinicians are experiencing in their roles now, in ways that they haven’t in the past.”

Dean grew interested in moral injury from personal experience: After a decade of treating patients as a psychiatrist, she stopped because of financial pressures. She said she wanted to treat her patients in longer visits, offering both psychotherapy and medication management, but that became more difficult. Insurers would rather pay her for only a 15-minute session to manage medications and let a lower-paid therapist handle the therapy.

The info is here.