Thursday 18 April 2013

Summary of Sen, A. (1993) ‘Capability and wellbeing’

This is the brisk summary I made of the reading for this week’s Mental Health Reading Group at UCLan, digging back to try to understand the recovery model after reading the Kim Hopper paper last time.

1 Introduction
Capability = the alternative things a person is able to do: an ability to achieve various valuable ‘functionings’ as a part of living.
Contrasts with, eg.,
Personal utility: such as happiness or desire satisfaction.
Opulence: wealth
Negative freedoms
Equality of resources
This paper is supposed to be a clearer account of the whole approach.

2 Functionings, capabilities and values
Functionings = the various things a person manages to do. Some are basic / animal (being nourished). Others more complex (self-respect). But variation in value attached to the latter. Hence the whole approach owes an account of which functionings (and hence capabilities as ability to function) matter.

3 Value objects and evaluative spaces
Despite this, it is useful to say what is valued (in this case capabilities and functionings) even prior to ranking them. This already contrasts with other approaches (eg welfarism) and does not attach intrinsic value to the means of living. Though freedom will play a role.

4 Capability and freedom
The freedom live different kinds of life is reflected in a person’s set of capabilities. Should freedom be assessed independently of what a subject values (ie the range of things to value from which she can choose)? No: assessment of freedom depends on what one can choose between. (Also adding bad extra options does not increase freedom.)

5 Value purposes and distinct exercises
How to assess capabilities? In accord with a subject’s wellbeing? Or their broader ‘agency’ goals (which may not just be there wellbeing) ie all that they have reason to aim at? Their achievements in either, or their freedoms? Fourfold matrix. Re state intervention, wellbeing, rather than agency gaols may be more important. For adults, freedom may be more relevant to the state than achievement.

6 Wellbeing, agency and living standards
Wellbeing achievement: concerns intrinsic functionings (so doing good may be a source of wellbeing by affecting the person’s own being). Vary from basic to complex. A subject’s being is constituted by their functionings. Agency achievement is broader (and also broader than the person’s own functioning). Living standard is narrower.

7 Why capability not achievement?
Functioning achievement is a point (a vector?) of all the distinction functionings. Capability is a set of points that could be selected. If related, why pick latter?
1) May be interested in wellbeing freedom.
2) Freedom itself may be important for wellbeing achievement. (So removing even only the less valued alternatives may reduce wellbeing.) A ‘refined’ account of actual functioning may also take account of freedom (eg fasting <> starving).

8 Basic capability and poverty
Basic capabilities are abilities to satisfy basic functionings and addresses a problem with equality of commodities such as food (given eg different metabolisms). No clear correlation between income and basic capabilities. Also income not desired intrinsically. But locally and derivatively basic incomes can be defined.

9 Midfare, functionings and capability
Cohen: capability combines 2 elements: ability to do basic things but also ‘midfare’ ie states of a subject produced by goods which explains the values of utility levels eg. state of nutrition rather than food supply. Midfare <> capability.
Sen: midfare = functionings not capability. Capability is then the better measure (cf section 7) because of the connection to freedom in even achieving wellbeing.

10 The Aristotelian connections and contrasts
Nussbaum: Aristotle’s politics of dustribution of goods starts with the question of the function of man and a life lived as a set of activities. Cf capabilities.
But: for Aristotle, there is only one list of functionings that constitute human good. Not incompatible with but not implied by Sen’s view. Though commodity requirements vary between cultures, the valued capabilities vary less but Sen is reluctant to commit to an objectivist picture of human nature.

11 Incompleteness and substance
Capabilities approach is a gappy general framework and allows different weights to attach to functionings and hence capabilities. So why leave it like this? Aim is agreement on framework before seeking agreement on specific values (or... on the metaphysics of value). But even so, it has different consequences from rivals (eg valuing utility, or primary goods intrinsically).

Aside from some details of the account – such as how and why freedom could appear at two levels: a ground level functioning as part of well-being achievement but also at a higher level as a set of capabilities – discussion mainly focused on some issues Sen leaves open. For a recovery approach to mental healthcare, should the focus be well being or agency goals (all the things a subject can wish for)? And to what extent should we, and can we, expect agreement on what basic capabilities should be? Like the discussion of Hopper, this suggested a tension between a patient-centred approach stressing patient autonomy and a paternalistic account attempting to articulate what should count towards wellbeing.

PS: I first begin to include Sen in writing here.