From 2023-2029, I am a co-investigator on the Wellcome-funded project Epistemic Injustice in Health Care (EPIC).
Please email me additions or corrections! Last updated 22/4/24.
General overviews and introductions to epistemic injustice
General work on epistemic injustice, healthcare, and illness
Epistemic injustice and somatic illness
Epistemic injustice, psychiatry, and mental health.
Epistemic injustice and disabilities
Barnes, Elizabeth, The Minority Body: A Theory of Disability (Oxford: Oxford University Press, 2017), ch.6, 'Disability Pride'.
This book argues that disability is primarily a social phenomenon, 'a way of being a minority, a way of facing social oppression, but not a way of being inherently or intrinsically worse off'. Chapter six explore the vulnerability of disabled persons to forms of hermeneutical injustice.
Berenstain, Nora, 'Epistemic exploitation', Ergo 3 (2016): 569-590.
Epistemic exploitation occurs when privileged persons compel marginalized persons to educate them about the nature of their oppression. I argue that epistemic exploitation is marked by unrecognized, uncompensated, emotionally taxing, coerced epistemic labor. The coercive and exploitative aspects of the phenomenon are exemplified by the unpaid nature of the educational labor and its associated opportunity costs, the double bind that marginalized persons must navigate when faced with the demand to educate, and the need for additional labor created by the default skepticism of the privileged. I explore the connections between epistemic exploitation and the two varieties of epistemic injustice that Fricker (2007) identifies, testimonial and hermeneutical injustice. I situate epistemic exploitation within Dotson’s (2012; 2014) framework of epistemic oppression, and I address the role that epistemic exploitation plays in maintaining active ignorance and upholding dominant epistemic frameworks.
Berenstein, Nora, 'White feminist gaslighting', Hypatia, forthcoming.
Structural gaslighting arises when conceptual work functions to obscure the non-accidental connections between structures of oppression and the patterns of harm they produce and license. This paper examines the role that structural gaslighting plays in white feminist methodology and epistemology using Fricker’s (2007) discussion of hermeneutical injustice as an illustration. Fricker’s work produces structural gaslighting through several methods: i) the outright denial of the role that structural oppression plays in producing interpretive harm, ii) the use of single-axis conceptual resources to understand intersectional oppression, and iii) the failure to recognize the legacy of women of color’s epistemic resistance work surrounding the issue of sexual harassment in the workplace. I argue that Fricker’s whitewashed discussion of epistemic resistance to sexual harassment in the United States is a form of structural gaslighting that fails to treat women of color as knowers and exemplifies the strategic forgetting that is a central methodological tactic of white feminism.
Bhakuni, Himani and Seye Abimbola, 'Epistemic Injustice in Academic Global Health', The Lancet Global Health 9.10 (2021): E1465-E1470.
This Viewpoint calls attention to the pervasive wrongs related to knowledge production, use, and circulation in global health, many of which are taken for granted. We argue that common practices in academic global health (eg, authorship practices, research partnerships, academic writing, editorial practices, sensemaking practices, and the choice of audience or research framing, questions, and methods) are peppered with epistemic wrongs that lead to or exacerbate epistemic injustice. We describe two forms of epistemic wrongs, credibility deficit and interpretive marginalisation, which stem from structural exclusion of marginalised producers and recipients of knowledge. We then illustrate these forms of epistemic wrongs using examples of common practices in academic global health, and show how these wrongs are linked to the pose (or positionality) and the gaze (or audience) of producers of knowledge. The epistemic injustice framework shown in this Viewpoint can help to surface, detect, communicate, make sense of, avoid, and potentially undo unfair knowledge practices in global health that are inflicted upon people in their capacity as knowers, and as producers and recipients of knowledge, owing to structural prejudices in the processes involved in knowledge production, use, and circulation in global health.
Blease, Charlotte, Liz Salmi, Hanife Rexhepi, Maria Hägglund, Catherine M DesRoches, 'Patients, Clinicians, and Open Notes: Information Blocking as a Case of Epistemic Injustice', Journal of Medical Ethics (2021), doi:10.1136/medethics-2021-107275.
In many countries, including patients are legally entitled to request copies of their clinical notes. However, this process remains time-consuming and burdensome, and it remains unclear how much of the medical record must be made available. Online access to notes offers a way to overcome these challenges and in around 10 countries worldwide, via secure web-based portals, many patients are now able to read at least some of the narrative reports written by clinicians (’open notes’). However, even in countries that have implemented the practice many clinicians have resisted the idea remaining doubtful of the value of opening notes, and anticipating patients will be confused or anxious by what they read. Against this scepticism, a growing body of qualitative and quantitative research reveals that patients derive multiple benefits from reading their notes. We address the contrasting perceptions of this practice innovation, and claim that the divergent views of patients and clinicians can be explained as a case of epistemic injustice. Using a range of evidence, we argue that patients are vulnerable to (oftentimes, non-intentional) epistemic injustice. Nonetheless, we conclude that the marginalisation of patients’ access to their health information exemplifies a form of epistemic exclusion, one with practical and ethical consequences including for patient safety.
Boer, Marjolein Lotte, 'Epistemic in/justice in patient participation. A discourse analysis of the Dutch ME/CFS Health Council advisory process', Sociology of Health & Illness, DOI: 10.1111/1467-9566.13301.
In healthcare settings, patient participation is increasingly adopted as a possible remedy to ill people suffering from ‘epistemic injustices’ – that is to their unfair harming as knowers. In exploring and interpreting patient participation discourses within the 2013–2018 Dutch Myalgic Encephalomyelitis (ME)/Chronic Fatigue Syndrome (CFS) Health Council advisory process, this paper assesses the epistemological emancipatory value of this participatory practice. It reveals that in the analysed case, patient representatives predominantly offer biomedical knowledge about ME/CFS. They frame this condition as primarily somatic, and accordingly, perceive appropriate diagnostic criteria, research avenues and treatment options as quantifiable, objectifiable and explicitly non‐psychogenic. This paper argues that such a dominant biomedical patient participatory practice is ambiguous in terms of its ability to correct epistemic injustices towards ill people. Biomedicalized patient participation may enhance people's credibility and their ability to make sense of their illness, but it may also undermine their valid position within participatory practices as well as lead to (sustaining) biased and reductive ideas about who ill people are and what kind of knowledge they hold. The final section of this paper offers a brief reflection on how to navigate such biomedicalized participatory practices in order to attain more emancipatory ones.
Bueter, Anke, 'Epistemic Injustice and Psychiatric Classification', Philosophy of Science, forthcoming.
This paper supports calls for an increased integration of patients into taxonomic decision- making in psychiatry by arguing that their exclusion constitutes a special kind of epistemic injustice: Pre-emptive testimonial injustice, which precludes the opportunity for testimony due to a wrongly presumed irrelevance or lack of expertise. Here, this presumption is misguided for two reasons: (1) the role of values in psychiatric classification and (2) the potential function of first-person knowledge as a corrective means against implicitly value- laden, inaccurate, or incomplete diagnostic criteria sets. This kind of epistemic injustice leads to preventable epistemic losses in psychiatric classification, diagnosis, and treatment.
Bueter, Anke, 'Diagnostic Overshadowing in Psychiatric-Somatic Comorbidity: A Case for Structural Testimonial Injustice', Erkenntnis, DOI: 10.1007/s10670-021-00396-8, forthcoming.People with mental illnesses have higher prevalence and mortality rates with regard to common somatic diseases and causes of death, such as cardio-vascular conditions or cancer. One factor contributing to this excess morbidity and mortality is the sub-standard level of physical healthcare offered to the mentally ill. In particular, they are often subject to diagnostic overshadowing: a tendency to attribute physical symptoms to a pre-existing diagnosis of mental illness. This might be seen as an unfortunate instance of epistemic bad luck, where particular features of a group of patients make a timely and correct diagnosis unlikely. While this can explain some cases of diagnostic overshadowing, I argue that in other cases, epistemic injustice is involved. Analyzing the case of diagnostic overshadowing, I distinguish two kinds of testimonial injustice. For one, there are classic cases of transactional testimonial injustice resulting from prejudices against the mentally ill. In addition, there are cases of structural testimonial injustice resulting from features of health care systems. To overcome diagnostic overshadowing, remedies on the individual as well as structural level are thus needed.
Byrne, Eleanor, Striking the balance with epistemic injustice in healthcare: the case of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis
Medicine, Health Care and Philosophy, 2020
Miranda Fricker's influential concept of epistemic injustice (2007) has recently seen application to many areas of interest, with an increasing body of healthcare research using the concept of epistemic injustice in order to develop both general frameworks and accounts of specific medical conditions and patient groups. This paper illuminates tensions that arise between taking steps to protect against committing epistemic injustice in healthcare, and taking steps to understand the complexity of one's predicament and treat it accordingly. Work on epistemic injustice is therefore at risk of obfuscating legitimate and potentially fruitful inquiry. This paper uses Chronic Fatigue Syndrome/Myalgic Encephalomyelitis as a case study, but I suggest that the key problems identified could apply to other cases within healthcare, such as Medically Unexplained Illnesses, Functional Neurological Disorders and Psychiatric Disorders. Future work on epistemic injustice in healthcare must recognise and attend to this tension to protect against unsatisfactory attempts to correct epistemic injustice.
Blease, Charlotte, Havi Carel, Keith Geraghty, ‘Epistemic injustice in healthcare encounters: Evidence from chronic fatigue syndrome’, Journal of Medical Ethics 43 (2016): 549-557.
This paper surveys the state of knowledge and attitudes about this illness and proposes that epistemic concerns about the testimonial credibility of patients can be articulated using Miranda Fricker's concept of epistemic injustice. Patients with CFS/ME often experience suspicion by healthcare professionals, and many patients vocally oppose the effectiveness, and the conceptualisation, of their illness as psychologically treatable. We address the intersection of these issues and healthcare ethics, and claim that this state of affairs can be explained as a case of epistemic injustice (2007). We find evidence that healthcare consultations are fora where patients with CFS/ME may be particularly vulnerable to epistemic injustice. We argue that the (often unintentional) marginalisation of many patients is a professional failure that may lead to further ethical and practical consequences both for progressive research into CFS/ME, and for ethical care and delivery of current treatments among individuals suffering from this debilitating illness. {abstract slightly edited for brevity}
Bortolotti, Lisa and Sophie Stammers, 'Overcoming injustice in mental health: Is there a role for philosophy?', The Mental Elf blog, October 2018.
A commentary on Kurs and Grinshpoon 2018.
Buchman, Daniel Z., Anita Ho, and Daniel S. Goldberg, 'Investigating Trust, Expertise, and Epistemic Injustice in Chronic Pain', Journal of Bioethical Inquiry 14.1 (2017): 31-42. (Symposium: Public Trust in Expert Knowledge)
Trust is central to the therapeutic relationship, but the epistemic asymmetries between the expert healthcare provider and the patient make the patient, the trustor, vulnerable to the provider, the trustee. The narratives of pain sufferers provide helpful insights into the experience of pain at the juncture of trust, expert knowledge, and the therapeutic relationship. While stories of pain sufferers having their testimonies dismissed are well documented, pain sufferers continue to experience their testimonies as being epistemically downgraded. This kind of epistemic injustice has received limited treatment in bioethics. In this paper, we examine how a climate of distrust in pain management may facilitate what Fricker calls epistemic injustice. We critically interrogate the processes through which pain sufferers are vulnerable to specific kinds of epistemic injustice, such as testimonial injustice. We also examine how healthcare institutions and practices privilege some kinds of evidence and ways of knowing while excluding certain patient testimonies from epistemic consideration. We argue that providers ought to avoid epistemic injustice in pain management by striving toward epistemic humility. Epistemic humility, as a form of epistemic justice, may be the kind disposition required to correct the harmful prejudices that may arise through testimonial exchange in chronic pain management.
Byrne, Eleanor Alexandra, 'Striking the balance with epistemic injustice in healthcare: the case of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis', Medicine, Health Care and Philosophy, 2020.
This paper illuminates tensions that arise between taking steps to protect against committing epistemic injustice in healthcare, and taking steps to understand the complexity of one’s predicament and treat it accordingly. Work on epistemic injustice is therefore at risk of obfuscating legitimate and potentially fruitful inquiry. This paper uses Chronic Fatigue Syndrome/Myalgic Encephalomyelitis as a case study, but I suggest that the key problems identified could apply to other cases within healthcare, such as those classed as Medically Unexplained Illnesses, Functional Neurological Disorders and Psychiatric Disorders. Future work on epistemic injustice in healthcare must recognise and attend to this tension to protect against unsatisfactory attempts to correct epistemic injustice.
Carel, Havi and Gita Györffy, ‘Seen but not heard: Children and epistemic injustice’, The Lancet 384 (9950) (2014): 1256-1257.
How do we listen to children? How do we decide whether we believe a story relayed to us by a child? We don't often reflect on our listening practices, which can rely on unrecognised presuppositions. This issue is particularly important when listening to patients: how do we decide what level of credibility to assign to testimonies and interpretations offered by children? We suggest that a philosophical framework can encourage reflection on this important, yet neglected, topic.
Carel, Havi and Ian James Kidd, ‘Epistemic injustice in healthcare: A philosophical analysis’, Medicine, Healthcare and Philosophy 17(4) (2014): 529-40.
In this paper we argue that ill persons can experience epistemic injustice in the sense articulated by Miranda Fricker (2007). Ill persons can suffer testimonial injustice through the presumptive attribution of characteristics like cognitive unreliability and emotional instability that downgrade the credibility of their testimonies. Ill persons can also suffer hermeneutical injustice because many aspects of the experience of illness are difficult to understand and communicate and this often owes to gaps in collective hermeneutical resources. We then argue that epistemic injustice arises in part owing to the epistemic privilege enjoyed by the practitioners and institutions of contemporary healthcare services – the former owing to their training, expertise, and third-person psychology, and the latter owing to their implicit privileging of certain styles of articulating and evidencing testimonies in ways that marginalise ill persons. We suggest that a phenomenological toolkit may be part of an effort to ameliorate epistemic injustice. Keywords epistemic injustice, illness, patient experience, phenomenology, patient toolkit
Carel, Havi and Ian James Kidd, ‘Epistemic Injustice in Medicine and Healthcare’, in Ian James Kidd, José Medina, and Gaile Pohlhaus (eds.) The Routledge Handbook to Epistemic Injustice (London: Routledge: 2017), 755-777.
This chapter explores the relation of epistemic injustice to medicine and healthcare as they arise from epistemic asymmetries and differential power relations. Healthcare systems rely on complex structures of epistemic norms and expectations, both implicit and explicit, that create knowledge asymmetries—for instance, privileging the knowledge derived from medical training and theory, rather than that potentially rooted in patient experience, which effectively limiting epistemic authority to healthcare practitioners
Carver, L., Morley, S., & Taylor, P. (2016) 'Voices of deficit: Mental health, criminal victimisation and epistemic injustice', Illness, Crisis and Loss 25(1). doi: 10.1177/1054137316675715
This paper explores the experience of those with mental and emotional distress as a victim of crime. The interconnectedness of matters of identity created though the application of a diagnosis of illness/disorder is addressed as is the crisis of criminal victimisation. This is achieved via an exploration of contemporary concerns surrounding victims of crime with experience of mental and emotional distress, including the (further) loss of voice and agency when interfacing with agencies of the State.
Catala, Amandine, 'Metaepistemic injustice and intellectual disability: A pluralist account of epistemic agency', Ethical Theory and Moral Practice 25(5) (2020): 755-776.
The literature on epistemic injustice currently displays a logocentric or propositional bias that excludes people with intellectual disabilities from the scope of epistemic agency and the demands of epistemic justice. This paper develops an account of epistemic agency and injustice that is inclusive of both people with and people without intellectual disabilities. I begin by specifying the hitherto undertheorized notion of epistemic agency. I develop a broader, pluralist account of epistemic agency, which relies on a conception of knowledge that accounts not only for propositional knowing, but also for other types of knowing that have been largely neglected in debates on epistemic injustice and agency. Based on this pluralist account of epistemic agency, I then show that people with intellectual disabilities qualify as epistemic agents and therefore as subjects of epistemic justice. Finally, I argue that this pluralist account of epistemic agency pushes us to revisit the current conception of epistemic injustice and to expand its taxonomy in two important ways.
Catala, Amandine, Luc Faucher, and Pierre Poirer, 'Autism, epistemic injustice, and epistemic disablement: a relational account of epistemic agency', Synthese, 2021.
The contrast between third- and first-personal accounts of the experiences of autistic persons has much to teach us about epistemic injustice and epistemic agency. This paper argues that bringing about greater epistemic justice for autistic people requires developing a relational account of epistemic agency. We begin by systematically identifying the many types of epistemic injustice autistic people face, specifically with regard to general assumptions regarding autistic people’s sociability or lack thereof, and by locating the source of these epistemic injustices in neuronormativity and neurotypical ignorance. We then argue that this systematic identification pushes us to construe epistemic agency as resulting from a fundamentally relational and dynamic process between an individual, others around them, and their social, cultural, or institutional environment, rather than as a fixed and inherent property of individuals. Finally, we show how our relational account of epistemic agency allows us to introduce the novel concepts of epistemic disablement and epistemic enablement. We argue that these two concepts allow us to more accurately track the mechanisms that undermine or facilitate epistemic agency, and thereby to better understand how epistemic injustice arises and to design more effective interventions to foster greater epistemic justice for autistic people.
Crichton, Paul, Havi Carel, and Ian James Kidd, ‘Epistemic injustice in psychiatry’, BJ Psych Bulletin, forthcoming.
Epistemic injustice is a harm done to a person in their capacity as an epistemic subject (a knower, a reasoner, a questioner) by undermining her capacity to engage in epistemic practices such as giving knowledge to others (testifying) or making sense of one’s experiences (interpreting). It has been argued that those who suffer from medical conditions are more vulnerable to epistemic injustice than the healthy. This paper claims that people with mental disorders are even more vulnerable to epistemic injustice than those with somatic illnesses. Two kinds of contributory factors for epistemic injustice in psychiatric patients are outlined: global and specific. Some suggestions are made to counteract the effects of these contributory factors, for instance we suggest that physicians should participate in groups where the subjective experience of patients is explored, and learn to become more aware of their own unconscious prejudices towards psychiatric patients.
Critchley, Harry, 'Epistemic Injustice and Medical Neglect in Ontario Jails: The Case of Pregnant Women' in Ben Sherman and Stacey Goguen (eds.) Overcoming Epistemic Injustice: Social and Psychological Perspectives (New York: Rowman and Littlefield, 2019), 237-251.
Cupples, Laura M., 'Disability, epistemic harms, and the quality-adjusted life year', International Journal of Feminist Approaches to Bioethics 13.1 (2020): 45-62.
Health economists use a conceptual tool called the quality-adjusted life year (QALY) in resource allocation decisions. Despite claims that the values of disabled people are distorted by adaptive preference, I argue that their testimony is in fact more reliable than that of nondisabled third parties. Epistemic injustice in this context harms disabled people and people with chronic illnesses. It also prevents us from challenging the current hegemonic and ableist formulation of the problem of just resource allocation. Community-based participatory research that gives disabled people greater agency in the research process would allow the reframing of the research problem.
Doan, Michael, 'Resisting structural epistemic injustice', Feminist Philosophy Quarterly 4.4 (2018).
What form must a theory of epistemic injustice take in order to successfully illuminate the epistemic dimensions of struggles that are primarily political? How can such struggles be understood as involving collective struggles for epistemic recognition and self-determination that seek to improve practices of knowledge production and make lives more liveable? In this paper, I argue that currently dominant, Fricker-inspired approaches to theorizing epistemic wrongs and remedies make it difficult, if not impossible, to understand the epistemic dimensions of historic and ongoing political struggles. Recent work in the theory of recognition— particularly the work of critical, feminist, and decolonial theorists—can help to identify and correct the shortcomings of these approaches. I offer a critical appraisal of recent conversation concerning epistemic injustice, focusing on three characteristics of Frickerian frameworks that obscure the epistemic dimensions of political struggles. I propose that a theory of epistemic injustice can better illuminate the epistemic dimensions of such struggles by acknowledging and centering the agency of victims in abusive epistemic relations, by conceptualizing the harms and wrongs of epistemic injustice relationally, and by explaining epistemic injustice as rooted in the oppressive and dysfunctional epistemic norms undergirding actual communities and institutions
Dohmen, Josh, ‘“A little of her language”: Epistemic injustice and mental disability’, Res Philosophica 93(4) (2016): 669-691.
In this essay, I argue that certain injustices faced by mentally disabled persons are epistemic injustices by drawing upon epistemic injustice literature, especially as it is developed by Miranda Fricker. First, I explain the terminology and arguments developed by Fricker, Gaile Pohlhaus, Jr., and Kristie Dotson that are useful in theorizing epistemic injustices against mentally disabled people. Second, I consider some specific cases of epistemic injustice to which mentally disabled persons are subject. Third, I turn to a discussion of severely mentally disabled persons who, because they are unable to share information or develop interpretations of shared social experiences, may fall outside Fricker’s discussion of epistemic injustice. Fourth and finally, following arguments given by Kristie Dotson and Christopher Hookway, I define and explain a type of epistemic injustice: intimate hermeneutical injustice that I believe supplements other discussions of epistemic injustice.
Dotson, Kristie, 'In search of Tanzania: Are effective epistemic practices sufficient for just epistemic practices?', Southern Journal of Philosophy 46 (2008): 52-64.
Argues that epistemic injustice may remain untouched in the reformed model of healthcare administration in Tanzania discussed by Lorraine Code in her paper 'Advocacy, negotiation, and the politics of unknowing'.
Dotson, Kristie, 'Tracking epistemic violence, tracking practices of silencing', Hypatia 26.2 (2011):" 236-257.
Too often, identifying practices of silencing is a seemingly impossible exercise. Here I claim that attempting to give a conceptual reading of the epistemic violence present when silencing occurs can help distinguish the different ways members of oppressed groups are silenced with respect to testimony. I offer an account of epistemic violence as the failure, owing to pernicious ignorance, of hearers to meet the vulnerabilities of speakers in linguistic exchanges. Ultimately, I illustrate that by focusing on the ways in which hearers fail to meet speaker dependency in a linguistic exchange, efforts can be made to demarcate the different types of silencing people face when attempting to testify from oppressed positions in society.
Dotson, Kristie, 'Conceptualizing epistemic oppression', Social Epistemology 28.2 (2014) : 115-138.
Epistemic oppression refers to persistent epistemic exclusion that hinders one’s contribution to knowledge production. The tendency to shy away from using the term “epistemic oppression” may follow from an assumption that epistemic forms of oppression are generally reducible to social and political forms of oppression. While I agree that many exclusions that compromise one’s ability to contribute to the production of knowledge can be reducible to social and political forms of oppression, there still exists distinctly irreducible forms of epistemic oppression. In this paper, I claim that a major point of distinction between reducible and irreducible epistemic oppression is the major source of difficulty one faces in addressing each kind of oppression, i.e. epistemic power or features of epistemological systems. Distinguishing between reducible and irreducible forms of epistemic oppression can offer a better understanding of what is at stake in deploying the term and when such deployment is apt.
Falbo, Arianna, 'Hermeneutical Injustice: Distortion and Conceptual Aptness', Hypatia 37 (2022): 343-363.
According to a dominant view, hermeneutical injustice results from a hermeneutical gap: one lacks the conceptual tools needed to make sense of, or to communicate, impor- tant social experiences, where this lack is a result of an injustice in the background social methods used to determine hermeneutical resources. I argue that this approach is incom- plete. It fails to capture an important species of hermeneutical injustice which doesn’t result from a lack of hermeneutical resources, but from the overabundance of distorting and oppressive concepts which function to crowd-out, defeat, or pre-empt the application of a more accurate hermeneutical resource.
Fraser, Rachel, ‘Against authenticity’, talk given at Munich, October 2016
In her book, Transformative Experience, ‘[L.A.] Paul endorses an ideal of authenticity: as well as being rational, she says, our choices should make sense to us from our own ‘first personal points of view’. I argue for some important connections between social power and ideals of authenticity, with a particular focus on the connections between ideals of authenticity and hermeneutic injustice.
Freeman, Lauren, ‘Confronting diminished epistemic privilege and epistemic injustice in pregnancy by challenging a ‘panoptics of the womb’’, Journal of Medicine and Philosophy 40.1 (2015): 44-68.
This paper demonstrates how the problematic kinds of epistemic power that physicians have can diminish the epistemic privilege that pregnant women have over their bodies and can put them in a state of epistemic powerlessness. This result, I argue, constitutes an epistemic injustice for many pregnant women. A reconsideration of how we understand and care for pregnant women and of the physician-patient relationship can provide us with a valuable context and starting point for helping to alleviate the knowledge/power problems that are symptomatic of the current system and structure of medicine. I suggest that we can begin to confront this kind of injustice if medicine adopts a more phenomenological understanding of bodies and if physicians and patients – in this case, pregnant women – become what I call ‘epistemic peers’.
Freeman, Lauren and Heather Stewart, 'Microaggressions in Clinical Medicine', Kennedy Institute of Ethics Journal 28 (4): 411-449.
This paper proposes a victim-centered account of microaggressions within the context of clinical medicine. In so doing, it argues that microaggres- sions can undermine physician–patient relationships, preclude relationships of trust, and therefore compromise the kind and quality of care that patients deserve. Ultimately, by focusing on the experiences of victims of microaggressions, the paper demonstrates how harmful microaggressions in clinical medical contexts can be, and thus provides strong reasons why healthcare providers ought to know about them and actively work to avoid committing them.
Freeman, Lauren and Heather Stewart, 'Epistemic Microaggressions and Epistemic Injustices in Clinical Medicine' in Ben Sherman and Stacey Goguen (eds.) Overcoming Epistemic Injustice: Social and Psychological Perspectives (New York: Rowman and Littlefield, 2019).
Freeman, Lauren and Heather Stewart, 'The Problem of Recognition, Erasure, and Epistemic Injustice in Medicine: Harms to Transgender and Gender Non-Binary Patients -Why We Should Be Worried' in Paul Giladi & Nicola McMillan (eds.), Recognition Theory and Epistemic Injustice (London: Routledge, 2021).
This paper considers the structural, institutional, social, and individual barriers that prevent transgender and gender non-binary patients from receiving good medical care. Many of these barriers stem from two forms of erasure that have been outlined by Bauer et al. (2009). “Informational erasure” refers to a lack of knowledge on the part of health care providers regarding trans people, trans experiences, and trans health, and the assumption that such knowledge does not exist. “Institutional erasure” refers to the absence of policies that accommodate trans identities or trans bodies, including the lack of knowledge that such policies are even necessary. Each form of erasure, we argue, results in a failure to recognise and respect trans and non-binary patients and to treat them as full epistemic agents. Drawing on these two forms of erasure, our chapter aims to make sense of the resulting epistemic and other injustices and harms that result for trans and non-binary patients within the context of health care by understanding them as stemming from this double failure to be recognised. While our discussion foregrounds the epistemic dimensions of the harms that result, we also discuss some of the related psychological and health-related consequences of the mistreatment of trans and non-binary patients. Ultimately, our hope is that this paper helps to motivate a shift in thinking about the importance of trans health and health care on both the institutional and individual level.
Gallagher, Siun, John Miles Little, and Claire Hooker, 'Testimonial Injustice: Discounting Women's Voices in Health Care Priority Settings', Journal of Medical Ethics 47.11 (2021): 744-747.
Testimonial injustice occurs when bias against the credibility of certain social identities results in discounting of their contributions to deliberations. In this analysis, we describe testimonial injustice against women and how it figures in macroallocation procedure. We show how it harms women as deliberators, undermines the objective of inclusivity in macroallocation and affects the justice of resource distributions. We suggest that remedial action is warranted in order to limit the effects of testimonial injustice in this context, especially on marginalised and disadvantaged groups, and propose three areas for action, whose implementation might feasibly be achieved by those immediately involved in macroallocation.
Gunaratnam, Yasmin, ‘Illness Narratives, Meaning Making, and Epistemic Injustice in Research at the End of Life’, in Christoph Rehmann-Sutter, Heike Gudat, and Kathrin Ohnsorge (eds.), The Patient’s Wish to Die: Research, Ethics, and Palliative Care (University Press Scholarship, 2015).
This chapter is about narrative approaches to end-of-life wishes. Following an initial discussion of last wishes and plans as affected by cultural differences, pain, and the biochemistry of advanced disease, the chapter covers three main areas. First, it provides a general flavour of the narrative dimensions of illness and care through key themes from the literature on illness narratives. Second, it turns to definitions and distinctions that have been drawn between the terms ‘narrative’ and ‘story’, focusing upon speech act theory as one approach to understanding the complex relationships between what is said, its meaning, and effects. Finally, the chapter draw upon ideas from the palliative care concept of ‘total pain’ to highlight the limits of empathic understanding in situations of suffering and the importance of recognizing how narrative research with dying people can affect the researcher.
Harcourt, Edward, 'Epistemic injustice, children and mental illness', Journal of Medical Ethics, forthcoming, DOI 10.1136/medethics-2021-107329
The concept of epistemic (specifically testimonial) injustice is the latest philosophical tool with which to try to theorise what goes wrong when mental health service users are not listened to by clinicians, and what goes right when they are. Is the tool adequate to the task? It is argued that, to be applicable at all, the concept needs some adjustment so that being disbelieved as a result of prejudice is one of a family of alternative necessary conditions for its application, rather than a necessary condition all on its own. It is then argued that even once adjusted in this way, the concept does not fit well in the area where the biggest efforts have been made to apply it so far, namely the highly sensitive case of adult patients suffering from delusions. Indeed it does not serve the interests of service users struggling for recognition to try to apply it in this context, because there is so much more to being listened to than simply being believed. However, the concept is found to apply smoothly in many cases where the service users are children, for example, in relation to children’s testimony on the efficacy of treatment. It is suggested that further research would demonstrate the usefulness of the concept in adult cases of a similar kind.
Harris, Olivia, Carina Andrews, Matthew R. Broome, Claudia Kustner, and Pamela Jacobsen, 'Epistemic Injustice amongst Clinical and Non-clinical Voice-hearers: A Qualitative Thematic Analysis Study', British Journal of Clinical Psychology 61.4 (2022): 947-963.
Research has suggested people who hear voices may be at risk of epistemic injustice. This is a form of discrimination whereby someone is unfairly judged to be an unreliable knower (testimonial injustice) or is unable to contribute to, and therefore access, concepts that make sense of their experience within mainstream society (hermeneutical injustice). Voice-hearing occurs both in people who are mental health service users and in the general population (clinical and non-clinical voice-hearers, respectively). The degree of distress and impairment associated with voices has been shown to relate to how individuals make sense of their experiences and how others respond to their identity as a voice-hearer. The aim of this study was to explore people's experiences of epistemic injustice in relation to voice-hearing and to understand how these may differ between clinical and non-clinical voice-hearers.
Hassall, Richard, 'Sense-making and Hermeneutical Injustice Following a Psychiatric Diagnosis', Journal of Evaluation and Clinical Practice (2024), forthcoming.onlinelibrary.wiley.com/doi/10.1111/jep.13971
When one is seriously ill, the diagnosis given can generate questions about what it means and how to make sense of it. This is particularly the case for psychiatric diagnoses which can convey a biomedical narrative of the sufferer's condition. Making sense of one's diagnosis in such cases can involve changing one's self-narrative in such a way as to incorporate the belief that one has developed a disease with an unknown cause. I argue that those receiving a psychiatric diagnosis may consequently be vulnerable to epistemic injustice. In particular, this includes hermeneutical injustice, where individuals lack the ability to understand or articulate their experiences in ways that make sense to them, due to their hermeneutical resources being marginalised by the dominant narrative in a medicalized environment.
Ho, Anita, 'Trusting Experts and Epistemic Humility in Disability', International Journal of Feminist Approaches to Bioethics 4.2 (2011): 102-123.
It is generally accepted that the therapeutic relationship between professionals and patients is one of trust. Nonetheless, some patient groups carry certain social vulnerabilities that can be exacerbated when they extend trust to health-care professionals. In exploring the epistemic and ethical implications of expert status, this paper examines how calls to trust may increase epistemic oppression and perpetuate the vulnerability of people with impairments. It critically evaluates the processes through which epistemic communities are formed or determined, and examines the institutional structure and power relations that contribute to or sustain such self-affirming ideological communities. It also argues for a two-way collaborative approach between professionals and people with impairments that recognizes the role of local knowledge in enhancing professionals' own understanding of their theoretical framework and promoting responsive practices and policies
Hutchison, Katrina, 'Epistemic Injustice in Careers: Insights from a Study with Women Surgeons' in Ben Sherman and Stacey Goguen (eds.) Overcoming Epistemic Injustice: Social and Psychological Perspectives (New York: Rowman and Littlefield, 2019), 183-199.
Isham, Louise, Caroline Bradbury-Jones and Alistair Hewison, 'Female family carers' experience of violent, abusive, or harmful behaviour by the older person for whom they care: A case of epistemic injustice?', Sociology of Health & Illness 42.1 (2020).
Family carers affected by violent, abusive or harmful behaviour by the older person for whom they care face social and epistemic challenges in developing and sharing knowledge about their experiences. These difficulties have contributed to a situation in which there is a paucity of evidence and public discourse about how we understand violence and harm instigated by people who have care needs or are ‘vulnerable’. This paper reports the findings of a qualitative study that involved 12 in‐depth interviews with female carers affected by violence, abuse or harm. The study was informed theoretically by Miranda Fricker's concept of epistemic injustice which was used as a framework for analysis. There were two principal findings: (1) Carers were sensitive to anticipatory stigma and loss of moral autonomy. As a result, they self‐censured what they shared and, at times, were met with subtle but powerful processes of silencing. (2) Carers had limited linguistic and conceptual resources to explain the emotional and social aspects of the harm they experienced, exacerbated by implicit social norms about the ‘private’ and gendered nature of familial care. To conclude, we discuss the implications of these findings for sociological research and health and social care practice.
Jackson, Jake, 'Patronizing Depression: Epistemic Injustice, Stigmatizing Attitudes, and the Need for Empathy', Journalof Social Philosophy 48.3 (2017): 359-376. (Special issue: Reshaping the Polis: Toward a Political Conception of Disability).
Jackson, Jake, 'Phenomenological Psychopathology and America’s Social Life-World', Giovanni Stanghellini, et al (eds.) The Oxford Handbook of Phenomenological Psychopathology (Oxford: Oxford University Press, 2019), 987-1003.
This chapter addresses how the lack of consensus and constant debates regarding the existence of mental illness along with inaccessibility of mental healthcare in the United States leaves individuals with mental disorders "epistemically adrift" - a state of being overwhelmed by too much information that is interrelated with hermeneutical injustice.
Jongsma, Karin, Elisabeth Spaeth, and Silke Schickten, 'Epistemic injustice in dementia and autism patient organisations: An empirical analysis', AJOB Empirical Bioethics 8.4 (2017): 28-30.
Patient organizations (POs) represent patient collectives in health care policy. The inclusion of people with a ‘neuro-psychiatric’ condition poses a particular challenge for the organizational processes and political representation of such collectives. In recent years, new POs (POs of) have been established in the field of autism spectrum disorder and dementia that advocate a different agenda and have a different organizational structure than traditional POs (POs for). The divide between these two types of POs indicates a different standpoint with regard to who should be included on an organizational level, which voices are accepted and who should represent these voices on the political level. The inclusion and exclusion of voices needs to be normatively justified in order to be regarded legitimate representation of such a collective. With the help of Miranda Fricker's theory of epistemic injustice, we scrutinize whether and, if so, which types of epistemic injustices (wrongdoings to a person as a knower) can be found within POs' practices and the political field in which they operate. Our in-depth analysis indicates that persistent stereotypes hamper the inclusion of affected members both within POs and on the health political level (abstract edited for brevity).
Kidd, Ian James, José Medina, and Gaile Pohlhaus (eds.) The Routledge Handbook to Epistemic Injustice(London: Routledge: 2017).
Part one contains chapters exploring the core concepts of epistemic injustice. Part five contains chapters with applied case studies of epistemic injustice in medicine and healthcare (by Carel and Kidd) and mental illness (Tasia Scrutton). Several other chapters will be of interest to those interested in epistemic injustice and illness—for instance, there are chapters on intersectionality, Foucault, and so on.
Kidd, Ian James and Havi Carel, ‘Epistemic injustice and illness’, Journal of Applied Philosophy 33.2 (2016): 172-190. (Special issue: Applied Epistemology, edited by David Coady and Miranda Fricker)
This paper analyses the phenomenon of epistemic injustice within contemporary healthcare. We begin by detailing the persistent complaints patients make about their testimonial frustration and hermeneutical marginalization, and the negative impact this has on their care. We offer an epistemic analysis of this problem using Miranda Fricker’s account of epistemic injustice. We detail two types of epistemic injustice, testimonial and hermeneutical, and identify the negative stereotypes and structural features of modern healthcare practices that generate them. We claim that these stereotypes and structural features render ill persons especially vulnerable to these two types of epistemic injustice. We end by proposing five avenues for further work on epistemic injustice in healthcare.
Kidd, Ian James and Havi Carel, 'Naturalism, Healthcare Practice, and Epistemic Injustice’, Royal Institute of Philosophy Supplement 84 (2018): 1-23.
Ill persons suffer from a variety of epistemically-inflected harms and wrongs. Many of these are interpretable as specific forms of what we dub pathocentric epistemic injustices, these being ones that target and track ill persons. We sketch the general forms of pathocentric testimonial and hermeneutical injustice, each of which are pervasive within the experiences of ill persons during their encounters in healthcare contexts and the social world. What’s epistemically unjust might not be only agents, communities and institutions, but the theoretical conceptions of health that structure our responses to illness. Thus, we suggest that although such pathocentric epistemic injustices have a variety of interpersonal and structural causes, they are also sustained by a deeper naturalistic conception of the nature of illness.
Kidd, Ian James and Havi Carel, 'Pathocentric Hermeneutical Injustice and Conceptions of Health', Benjamin R. Sherman and Stacey Goguin (eds.), Overcoming Epistemic Injustice: Social and Psychological Perspectives, edited by (New York: Rowman and Littlefield, 2019).
In this paper, we make an effort to contribute to that work by arguing for an expanded conception of the bearers of the vice of epistemic injustice. We argue that certain theoretical conceptions of health, particularly those described as ‘biomedical’ or ‘naturalistic’, are viciously epistemically unjust. Obviously, our claim that abstract, non-agential objects can be bearers of virtues and vices sounds counterintuitive, at best, and a category mistake, at worse. We therefore draw on some recent work in vice epistemology to identity three ways that abstract objects – such as theoretical conceptions – can be legitimately described as epistemically vicious. Although only two of these apply to theoretical conceptions of health, this is enough to justify our main claim that amelioration of pathocentric epistemic injustice must go all the way down – to the conceptions of health that inform and shape the ways that people talk and think about illness and ill persons. If this is right, then it seems robust reform of individuals, social systems, and institutions would not be enough to secure epistemic justice.
Kidd, Ian James and Havi Carel, ‘The Predicament of Patients’, co-authored with Havi Carel, Royal Institute of Philosophy Supplement 89 (2021): 65-84.
In this paper we propose that our understanding of pathocentric epistemic injustices can be enriched if they are theorised in terms of predicaments. These are the wider socially scaffolded structures of epistemic challenges, dangers, needs, and threats ex- perienced by ill persons due to their particular emplacement within material, social, and epistemic structures. In previous work we have described certain aspects of these predicaments, such as pathocentric epistemic injustices and pathophobia. A wider systematic perspective is needed to integrate these and other concepts. By thinking predicamentally, we can better understand the interrelated social, epistemic, and practical obstacles experienced by ill persons and connect the many concepts avail- able for theorising them (microaggessions, epistemic injustices, and so on).
Kidd, Ian James, Lucienne Spencer, and Havi Carel, 'Epistemic Injustice in Psychiatric Research and Practice', Philosophical Psychology (2023) https://doi.org/10.1080/09515089.2022.2156333.
This paper offers an overview of the philosophical work on epistemic injustices as it relates to psychiatry. After describing the development of epistemic injustice studies, we survey the existing literature on its application to psychiatry. We describe how the concept of epistemic injustice has been taken up into a range of debates in philosophy of psychiatry, including the nature of psychiatric conditions, psychiatric practices and research, and ameliorative projects. The final section of the paper indicates future directions for philosophical research of epistemic injustices and psychiatry, concerning neurocognitive disorders, identity prejudices in psychiatric illness, concepts of epistemic privilege in psychiatry, and the prospects for combining phenomenological psychopathology and epistemic justice. We argue that much remains to be done in the conceptualization of these epistemic injustices and suggest that this future work should be multidisciplinary in character and sensitive to the phenomenology of psychiatric conditions.
Kious, Brent M., Benjamin R. Lewis, and Scott Y.H. Kim, 'Epistemic injustice and the psychiatrist', Psychological Medicine 53, 1–5. https://doi.org/ 10.1017/S0033291722003804.
Psychiatrists depend on their patients for clinical information and are obligated to regard them as trustworthy, except in special circumstances. Nevertheless, some critics of psychiatry have argued that psychiatrists frequently perpetrate epistemic injustice against patients. Epistemic injustice is a moral wrong that involves unfairly discriminating against a person with respect to their ability to know things because of personal characteristics like gender or psychiatric diagnosis. We review the concept of epistemic injustice and several claims that psychiatric practice is epistemically unjust. While acknowledging the risk of epistemic injustice in psychiatry and other medical fields, we argue that most concerns that psychiatric practice is epistemically unjust are unfounded. The concept of epistemic injustice does not add significantly to existing standards of good clinical practice, and that it could produce changes in practice that would be deleterious. Psychiatrists should resist calls for changes to clinical practice based on this type of criticism.
Kurs, Rena and Alexander Grinshpoon, ‘Vulnerability of individuals with mental disorders to epistemic injustice in both clinical and social domains’, Ethics & Behaviour 28.4 (2018): 336-346.
Many individuals who have mental disorders often report negative experiences of a distinctively epistemic sort, such as not being listened to, not being taken seriously, or not being considered credible because of their psychiatric conditions. In an attempt to articulate and interpret these reports we present Fricker’s concepts of epistemic injustice (Fricker, 2007, p. 1) and then focus on testimonial injustice and hermeneutic injustice as it applies to individuals with mental disorders. The clinical impact of these concepts on quality of care is discussed. Within the clinical domain, we contrast epistemic injustice with epistemic privilege and authority. We then argue that testimonial and hermeneutic injustices also affect individuals with mental disorders not only when communicating with their caregivers but also in the social context as they attempt to reintegrate into the general society and assume responsibilities as productive citizens. Following the trend of the movement of mental health care to the community, the testimonies of people with mental disorders should not be restricted to issues involving their own personal mental states.
Kyratsous, Michaelis and Sanati, Abdi (2015) ‘Epistemic Injustice in Assessment of Delusions’, Journal of Evaluation in Clinical Practice 21.3: 479–485.
We will use the concept of epistemic injustice to explore the role of stereotypes and prejudice in the identification of delusions. We will discuss cases where patients are suffering from testimonial injustice by virtue of having a mental disorder that is so often associated with attributions of irrationality, bizarreness and incomprehensibility. Two vignettes will be presented to show that this is often the case in clinical practice. We will discuss relevant issues around the epistemology of the delusions. We think that in order to challenge the testimonial injustice, there needs to be an awareness of its possibility and thus recognition of the role of certain stereotypes in assessing these mental states. Challenging the stigma against mentally ill and adopting a holistic view of delusions can help tackle the prejudice that pre-empt the testimonial injustice.
Kyratsous, Michalis and Abdi Sanati, ‘Epistemic injustice and responsibility in borderline personality disorder’, Journal of Evaluation in Clinical Practice. DOI: 10.1111/jep.12609
Miranda Fricker's concept of epistemic injustice has been quite a novel idea in epistemology. The application of the concept in the context of mental health is less explored. Here, we aim to apply the concept of epistemic injustice in attributing responsibility to patients with borderline personality disorder. We will focus on patients suffering from borderline personality disorder. We provide a case vignette to show a tendency in the professionals in holding these patients responsible for their action when it can be argued otherwise. We argue that prejudice against the patient with borderline personality disorder where the person is seen as manipulative plays a significant role in the process of epistemic injustice. The suggested manipulative nature of patients with borderline personality disorder leads to professionals to ascribe agency and knowledge where it is not due.
Lakeman, Richard, ‘Epistemic injustice and the mental health service user’, International Journal of Mental Health Nursing 19 (2010): 151-153.
LeBlanc, Stephanie and Elizabeth Anne Kinsella, 'Toward epistemic justice: A critically reflexive examination of 'sanism' and implications for knowledge generation', Studies in Social Justice 10.1 (2016): 59-78.
The dominance of medicalized “psy” discourses in the West has marginalized alternative perspectives and analyses of madness, resulting in the under-inclusion (or exclusion) from mainstream discourse of the firsthand experiences and perspectives of those who identify as Mad. We argue that this marginalization of firsthand knowledge(s) demands closer critical scrutiny, particularly through the use of critical reflexivity. This paper draws on Fricker’s concept of epistemic injustice, whereby a person is wronged in his or her capacity as a knower, as a useful framework for interrogating the subjugation of Mad knowledge(s). Also examined is the problem of 'sanism', a deeply embedded system of discrimination and oppression, as an underlying component of epistemic injustice. Sanism assumes a pathological view of madness, which can be attributed to what Rimke has termed psychocentrism: the notion that pathologies are rooted in the mind and/or body of the individual, rather than the product of social structures, relations, and problems. (abstract edited for brevity)
Lee, Eunjung, A Ka Tat Tsang, Marion Bogo, Marjorie Johnstone, Jessica Herschman, Monique Ryan , 'Honoring the voice of the client in clinical social work practice: Negotiating with epistemic injustice', Social Work 1.64.1 (2019): 29-40.
Epistemic injustice occurs when therapists implicitly and explicitly impose professional and institutional power onto clients. When clients have a diagnosis of schizophrenia, this very fact further complicates and highlights the power disparity within the helping relationship. Inspired by the work of critical philosopher Miranda Fricker on epistemic injustice, and using critical theories of language and knowledge, this article analyzes audiotaped session transcripts between a client with a history of psychosis and a social worker in an outpatient mental health agency. Findings illustrate two main discursive interactional patterns in everyday clinical social work encounters: (1) how the therapist's utterances claim disciplinary power and construct the client's testimony in alignment with an institutional agenda, while pre-empting the client's lived experience; and (2) how the client, though actively resisting, is managed to perform the identity of being a mentally ill person. The authors close with suggestions of how to avoid these mishaps and work toward epistemic justice in mental health practice.
McKinnon, Rachel, 'Epistemic injustice', Philosophy Compass 11.8 (2016): 437-446.
A survey of recent work on, and new developments in, the study of epistemic injustice that both expand and critique the expansion of the concept.
Merrick, Teri, ‘From ‘intersex’ to ‘DSD’: A case of epistemic injustice’, Synthese DOI: 10.1007/s11229-017-1327-x
The 2005 International Consensus Conference on Intersex resulted in a substantive revision of the lexicon and guidelines for treating intersex conditions. The speed with which the new treatment protocol has been adopted by healthcare practitioners and providers is considered unprecedented. However, a number of intersex people and advocacy groups have complained that the recommended revisions are inadequately informed by the testimony of intersex people. In this paper, I argue that such complaints are valid and that, despite the conference conveners stated intention, the revisions perpetuate the epistemic injustice long endured by intersex people. By analyzing the Consensus Conference and its results as a failed attempt to redress the epistemic marginalization of intersex patients and advocacy groups, I am able to identify lingering institutional hurdles to cultivating the virtue of epistemic justice in biomedical practice.
Miller Tate AJ, 'Contributory injustice in psychiatry', Journal of Medical Ethics 45 (2019): 97-100.
I explain the notion of contributory injustice, a kind of epistemic injustice, and argue that it occurs within psychiatric services, affecting (at least) those who hear voices. I argue that individual effort on the part of clinicians to avoid perpetrating this injustice is an insufficient response to the problem; mitigating the injustice will require open and meaningful dialogue between clinicians and service user organisations, as well as individuals. I suggest that clinicians must become familiar with and take seriously concepts and frameworks for understanding mental distress developed in service user communities, such as Hearing Voices Network, and by individual service users. This is especially necessary when these concepts and frameworks explicitly conflict with medical or technical understandings of users’ experiences. I defend this proposal against three objections.
Miškulin, Inka (2015), 'Epistemic Justice as a Virtue in Hermeneutic Psychotherapy', Snježana Prijić-Samaržija and Inka Miškulin (eds.), Epistemic Justice: Epistemic Virtue and the Philosophy of Psychiatry, Philosophical Inquiries, 35/2: 307-322.
In the first part of this article we will attempt to briefly explain the value turn and outline the basic aspects of virtue epistemology, underlining the diversity of epistemic attitudes associated with this approach and their positive impact on expanding epistemological horizons. The second part will be focused on the virtues of epistemic responsibility and epistemic justice as particularly appropriate for evaluating social cognitive processes such as, for example, testimony and general communication/conversation. In the third section we will show how the psychiatric and psychotherapeutic communicative act can be more efficiently analyzed and evaluated from the perspective of epistemic justice, than from the traditional epistemic approach based on a monist concept of truth. The fourth and fifth section synthesize the discussion by introducing the concept of hermeneutic psychotherapy as a therapeutically and epistemically favorable framework for evaluating communicative acts in psychotherapy.
Miškulin, Inka (2017), 'Psychotherapist’s epistemic responsibility', Kairos 11/1: 23-43.
http://www.kairos.skzp.org/index.php/revija/article/view/358
Given that the epistemic asymmetry inherent in the relationship of a therapist and their client favours the therapist, as shown by numerous examples, the psychotherapist is obliged to approach the client in an epistemically responsible and empirically adequate manner. This requires sensitivity to the evidence, understood as healthy scepticism to- wards the scientific foundations of the concept of mental disorders and psychotherapeu- tic theories, as well as critical reflexion upon their own theoretical presuppositions and prejudices.
Newbigging, Karen and Julie Ridley (2018), 'Epistemic struggles: The role of advocacy in promoting epistemic justice and Trights in mental health', Social Science & Medicine 219: 36–44.
Advocacy for people using health and social care services is widely promoted but its theoretical foundation is under-developed and its impact poorly conceptualised. This paper explores the liberatory potential of independent advocacy, using Fricker's concept of ‘epistemic injustice’ as a framework. The concept of epistemic injustice provides a valuable theoretical basis for understanding the worth of advocacy in addressing testimonial injustice as well as its relative weakness in overcoming hermeneutical injustice. The challenge of independent advocacy to the dominant discourse within mental health is considered and questions raised about the place of advocacy in modern democratic mental health systems.
O'Donovan, Orla and Deirdre Madden, 'Why do medical professional regulators dismiss most complaints from members of the public? Regulatory illiteracy, epistemic injustice, and symbolic power', Journal of Bioethical Inquiry 15,3 (2018):469-478.
Drawing on an analysis of complaint files that we conducted for the Irish Medical Council (Madden and O'Donovan 2015), this paper offers three possible explanations for the gap between the ubiquity of official commitments to taking patients' complaints seriously and medical professional regulators' dismissal-as not warranting an inquiry-of the vast majority of complaints submitted by members of the public. One explanation points to the "regulatory illiteracy" of many complainants, where the remit and threshold of seriousness of regulators is poorly understood by the general public. Another points to possible processes of "institutional epistemic injustice" (Fricker 2007; Anderson 2012) that unjustly undermine the credibility of certain complainants, such as those with low levels of formal education. A third explanation highlights the marginalization of the general public from "symbolic power" (Bourdieu 1989) to define what matters in medical professional regulation. The paper is offered in a spirit of ideas in progress and raising questions rather than definitive insights into the regulatory process.
Peled, Yael, 'Language barriers and epistemic injustice in healthcare', Bioethics 32.6 (2018): 360-367.
Contemporary realities of global population movement increasingly bring to the fore the challenge of quality and equitable health provision across language barriers. While this linguistic challenge is not unique to immigration contexts and is likewise shared by health systems responding to the needs of aboriginal peoples and other historical linguistic minorities, the expanding multilingual landscape of receiving societies renders this challenge even more critical, owing to limited or even non‐existing familiarity of modern and often monolingual health systems with the particular needs of new linguistic minorities. The centrality of language to health beliefs, attitudes, practices, cultural scripts, and conceptual frameworks emphasizes its pivotal role in the healthcare process, and consequently in the adverse effects of treatment that is language‐insensitive and unaware. Such an attitude on the part of medical authorities risks considerable epistemic injustice in the form of a (mis)judgement of patients’ intelligence, credibility, and rationality based on the language that they speak and the manner in which they speak it, consequently impacting the quality and equity of care provided. This danger, I argue, may be effectively countered by fostering among the participants in the healthcare process a sense of epistemic humility through greater metalinguistic awareness. Outlining a range of operative steps that can be used to facilitate this. I argue that the reality of language barriers in the healthcare process, while not entirely eliminable, may nevertheless be successfully addressed, in order to mitigate the challenge of quality and equitable healthcare provision in multilingual societies.
Peña-Guzmán, David M. Peña-Guzmán and Joel Michael Reynolds, 'The harm of ableism: Medical error and epistemic injustice', Kennedy Institute of Ethics Journal 29.3 (2019):205-242.
This paper argues that epistemic errors rooted in group- or identity- based biases, especially those pertaining to disability, are undertheorized in the literature on medical error. After sketching dominant taxonomies of medical error, we turn to the field of social epistemology to understand the role that epistemic schemas play in contributing to medical errors that disproportionately affect patients from marginalized social groups. We examine the effects of this unequal distribution through a detailed case study of ableism. There are four primary mechanisms through which the epistemic schema of ableism distorts communication between nondisabled physicians and disabled patients: testimonial injustice, epistemic overconfidence, epistemic erasure, and epistemic derailing. Measures against epistemic injustices in general and against schema-based medical errors in particular are ultimately issues of justice that must be better addressed at all levels of health care practice.
Pitts, Andrea J., 'Carceral Medicine and Prison Abolition: Trust and Truth-telling in Correctional Healthcare' in Ben Sherman and Stacey Goguen (eds.) Overcoming Epistemic Injustice: Social and Psychological Perspectives (New York: Rowman and Littlefield, 2019), 221-236.
Pohlhaus, Gaile, 'Relational knowing and epistemic injustice: Toward a theory of willful hermeneutical ignorance', Hypatia 27.4 (2012) :715-735.
I distinguish between two senses in which feminists have argued that the knower is social: 1. situated or socially positioned and 2. interdependent. I argue that these two aspects of the knower work in cooperation with each other in a way that can produce willful hermeneutical ignorance, a type of epistemic injustice absent from Miranda Fricker's Epistemic Injustice. Analyzing the limitations of Fricker's analysis of the trial of Tom Robinson in Harper Lee's To Kill a Mockingbird with attention to the way in which situatedness and interdependence work in tandem, I develop an understanding of willful hermeneutical ignorance, which occurs when dominantly situated knowers refuse to acknowledge epistemic tools developed from the experienced world of those situated marginally. Such refusals allow dominantly situated knowers to misunderstand, misinterpret, and/or ignore whole parts of the world.
Pohlhaus, G., Jr., 'Discerning the primary harm in cases of testimonial injustice', Social Epistemology 28.2 (2014): 99–114. https://doi.org/10.1080/02691728.2013.782581
This article examines the primary epistemic harm of testimonial injustice, or, as defined by Miranda Fricker, the injustice of perceiving another epistemic agent as less credible due to an identity prejudice. My analysis shows that (1) testimonial injustice does not render its victim to an object-like status and (2) testimonial injustice necessarily treats its victim as a subject, albeit a truncated subject. I demonstrate that the primary harm of testimonial injustice is more aptly described in terms of a subject/other relation, or a relation that circumscribes the subjectivity of its victim within the confines of the perpetrator’s subjectivity.
Reiheld, Alison, ‘‘Patient complains of…’ How medicalization mediates power and justice’, International Journal of Feminist Approaches to Bioethics 3(1) (2010): 72-98.
The process of medicalization has been analyzed in the medical humanities with disapprobation, with much emphasis placed on its ability to reinforce existing social power structures to ill effect. While true, this is an incomplete picture of medicalization. I argue that medicalization can both reinforce and disrupt existing social hierarchies within the clinic and outside of it, to ill or good effect. We must attend to how this takes place locally and globally lest we misunderstand how medicalization mediates power and justice. I provide concrete examples of how this occurs by considering dysesthesia ethiopsis, autism, chronic fatigue syndrome, depression, and HIV/AIDS.
Reiheld, Alison, ‘What you don’t know can hurt you: Epistemic injustice and conceptually impoverished health promotion’, talk given at the IAB World Congress of Bioethics, 13 June 2016.
This paper considers a particular kind of wrong within medicine and health promotion: epistemic injustice and its harms. My case study is obesity conceived of as a public health concern. However, the analytic framework I deploy may prove useful in ethically assessing many health promotion campaigns. Individuals—both doctors and patients—are often provided with an impoverished set of conceptual tools for making sense of health and health behaviors, a set of tools that can lead to inappropriate individualization of responsibility and to unproductive attitudes towards health and which behaviors are health promoting. This is the case with obesity.
Reiheld, Alison, ‘I can hardly credit it: Epistemic injustice and the practice of medicine’, talk given at the Society for Analytical Feminism, 18 September 2016.
In this paper, I document serious issues with physician's doubt of patient testimony specifically with respect to patients who are members of stigmatized groups. I use the framework of epistemic injustice to diagnose these physician-patient interactions. Only once we both perceive and understand these interactions as unjust can we repair the physician-patient relationship and deliver better patient care for members of stigmatized groups.
Reynolds, Joel Michael, 'What if there's something wrong with her?” How biomedical technologies contribute to epistemic injustice in healthcare', Southern Journal of Philosophy 58.1 (2020):161-185.
While there is a steadily growing literature on epistemic injustice in healthcare, there are few discussions of the role that biomedical technologies play in harming patients in their capacity as knowers. Through an analysis of newborn and pediatric genetic and genomic sequencing technologies (GSTs), I argue that biomedical technologies can lead to epistemic injustice through two primary pathways: epistemic capture and value partitioning. I close by discussing the larger ethical and political context of critical analyses of GSTs and their broader implications for just and equitable healthcare delivery.
Ritunnano, Rosa (2022) ‘Overcoming Hermeneutical Injustice in Mental Health: A Role for Critical Phenomenology’, Journal of the British Society for Phenomenology 53.3: 243-260.
The significance of critical phenomenology for psychiatric praxis has yet to be expounded. In this paper, I argue that the adoption of a critical phenomenological stance can remedy localised instances of hermeneutical injustice, which may arise in the encounter between clinicians and patients with psychosis. In this context, what is communicated is often deemed to lack meaning or to be difficult to understand. While a degree of un-shareability is inherent to subjective life, I argue that issues of unintelligibility can be addressed by shifting from individualistic conceptions of understanding to an interactionist view. This takes into account the contextual, historical and relational background within which meaning is co-constituted. I conclude by providing a corrective for hermeneutical injustice, which entails a specific attentiveness towards the person’s subjectivity, a careful sensitivity to contingent meaning-generating structures, and a degree of hermeneutical flexibility as an attitude of openness towards alternative horizons of possibility.
Samaržija, H., & Cerovac, I. (2021) 'The institutional preconditions of epistemic justice', Social Epistemology 35(6) (2021): 621–635. https://doi.org/10.1080/02691728.2021.1919238
This paper proposes four comprehensive institutional measures for countering epistemic injustice. Institutional epistemic justice demands that, first, all groups enjoy fair and equal access to education and the opportunity to acquire the socially recognized markers of credibility. Second, epistemic justice requires that marginalized groups have access to the relevant public platforms, such as politics and journalism, for voicing their social perspectives. Third, fair access to public positions can aid vulnerable groups in attaining rewarding careers, publicly affirming their epistemic resources, and rupturing the cycle of epistemic disadvantage. As our fourth and final measure, we propose institutional mechanisms for eliminating identity markers from formal epistemic exchanges.
Scrutton, Anastasia Philippa, ‘Epistemic Injustice and Mental Illness’, in Ian James Kidd, José Medina, and Gaile Pohlhaus (eds.) The Routledge Handbook to Epistemic Injustice (London: Routledge: 2017), in press.
The first part of this chapter looks at epistemic injustices that can take place in the context of psychiatric diagnosis and treatment. I argue people diagnosed with mental illnesses are often stereotyped in such a way as to deflate their credibility, and that the authoritative and even exclusive status accorded to third-person, medical perspectives on experiences of mental illness leads to hermeneutical marginalization and silencing. The second part of the chapter takes as its starting-point the idea that epistemic injustice can be countered by a recognition of the ways in which the marginalized person is in fact epistemically privileged. I argue that recognising the ways in which people diagnosed with mental illnesses have access to distinctive and/or unique forms of knowledge can correct our testimonial sensibilities and provide us with new hermeneutical resources, and is therefore a route to epistemic justice. I explore ways in which this might be the case in relation to experiences of mental illness, focusing on two kinds of knowledge: knowledge of what the experience is like, and knowledge of what is good for the person. I conclude with some implications for clinical practice and more general ethical behaviour.
Scully, Jackie Leach, 'From “She would say that, wouldn't she?” to “does she take sugar?” Epistemic injustice and disability', International Journal of Feminist Approaches to Bioethics 11.1 (2018): 106-124.
Epistemic injustice is the idea that social power ensures that the knowledge of some groups is excluded from the collective epistemic resources. In this paper, I argue that there are distinctive features of disabled life that, because they shape the processes through which knowledge is gathered, evaluated, judged, and disseminated, also influence the ways in which epistemic injustice is experienced by disabled people. These features include the ascription of a global epistemic incapacity to people affected by impairment. Against a background of contemporary political shifts and biotechnology innovation, the implications of epistemic injustice for disabled people are serious.
Scully, Jackie Leach, 'Epistemic Exclusion, Injustice, and Disability', in David T. Wasserman and Adam Cureton (eds.), The Oxford Handbook of Philosophy and Disability (Oxford: Oxford University Press, 2018).
This chapter examines the ways in which disabled people are subject to epistemic injustice. It starts by introducing how social epistemology models the creation of shared knowledge and then uses feminist epistemology to highlight the role of social and political power in producing epistemic privilege, exclusion, and oppression. The well-known concepts of testimonial and hermeneutic epistemic injustice are discussed in relation to disability, showing how these forms of injustice are frequently experienced within the lives of disabled people. In particular, disabled experience has features that distinguish it from the experiences of sexism and racism most commonly used as illustrations of epistemic injustice. The chapter ends by arguing that the potential for epistemic injustice poses unprecedented risks for disabled people in the current context, which could be minimized by recognizing that ignorance about disabled lives is not inevitable, but something that can and should be challenged.
Shabot, Sara Cohen, '"You are not qualified--leave it to us": Obstretic violence as testimonial injustice', Human Studies, DOI: 10.1007/s10746-021-09596-1
This paper addresses epistemic aspects of the phenomenon of obstetric violence—which has been described as a kind of gender violence—mainly from the perspective of recent theories on epistemic injustice. I argue that what is behind the dismissal of women’s voices in labor is mainly how the birthing subject, in general, is conceived. Thus, I develop a link between the phenomenon of testimonial injustice in labor and the marked irrationality that is seen as a core characteristic of birthing subjects: an irrationality that appears to be always at odds with the kind of knowledge that is, wrongly, privileged within medicalized childbirth. I use Miranda Fricker’s analysis to argue that a central part of obstetric violence involves laboring women being “wrongfully undermined specifically in their capacity as knowers” (2007: 9): they are disbelieved in the labor room because of a double prejudice, one deriving simply from their condition as women, the second involving the kind of knowledge that many women find useful in the process of birthing. Women in labor thus suffer from both systematic and incidental kinds of testimonial injustice.
Spandler, Helen and Meg Allen, 'Contesting the psychiatric framing of ME/CFS', Social Theory & Health 16.2 (2018): 127-141.
ME/CFS is a medically contested illness and its understanding, framing and treatment has been the subject of heated debate. This paper examines why framing the condition as a psychiatric issue—what we refer to as ‘psychiatrisation’—has been so heavily contested by patients and activists. We argue that this contestation is not simply about stigmatising mental health conditions, as some have suggested, but relates to how people diagnosed with mental illness are treated in society, psychiatry and the law. We highlight the potentially harmful consequences of psychiatrisation which can lead to people’s experiential knowledge being discredited.
Spencer, Lucienne, 'Epistemic injustice and loneliness in late-stage dementia', video of a public philosophy talk at the University of Birmingham, 18 May 2022.
This paper argues that Fricker's concept of a 'testimonial sensibility' should be expanded into a 'communicative sensibility', to accommodate the range of non-verbal communicative capacities of human beings - like looks, gestures, and so on - which are especially salient to those with diminished verbal capacities. An overly narrow focus on verbal testimonies to the exclusion of wider communicative capacities is, itself, a form of epistemic injustice.
Spencer, Lucienne (2022) 'Epistemic Injustice in Late-Stage Dementia: A Case for Non-Verbal Testimonial Injustice', Social Epistemology 37.1: 62-79.
The literature on epistemic injustice has thus far confined the concept of testimonial injustice to speech expressions such as inquiring, discussing, deliberating, and, above all, telling. I propose that it is time to broaden the horizons of testimonial injustice to include a wider range of expressions. Controversially, the form of communication I have in mind is non-verbal expression. Non-verbal expression is a vital, though often overlooked, form of communication, particularly for people who have certain neurocognitive disorders. Dependency upon non-verbal expression is a common feature of some forms of neurocognitive disorders such as ‘intellectual disabilities’, autism and late-stage dementia. According to the narrow definition of testimonial injustice currently championed in the literature, people who express non-verbally are exempt from testimonial injustice. However, when we consider cases where meaningful communications from non-verbal people are dismissed or ignored in virtue of identity prejudice, there seems to be a distinct testimonial harm at play. Using late-stage dementia as a case study, I argue that the definition of testimonial injustice should be expanded to include all communicative practices, whether verbal or non-verbal, to encompass the epistemic harms inflicted upon some of the most marginalised in our society.
Spencer, Lucienne, 'Hermeneutical Injustice and Unworlding in Psychopathology', Philosophical Psychopathology, forthcoming, open access.
The rich literature in phenomenological psychopathology regards the communicative difficulties accompanying psychiatric illness as a product ofunworlding: the experience of a drastic change in one’s habitual field of experience. This paper argues that the relationship between speech expression and unworlding in psychiatric illness is more complex than previously assumed. Not only does unworlding cause a breakdown in speech expression, but a breakdown in speech expression can perpetuate, and even exacerbate, the experience of unworlding characteristic of psychiatric illness. In other words, I identify a two-way relationship between unworlding and the communication breakdown in psychiatric illness. Merleau-Ponty’s phenomenology of speech expression is drawn upon to demonstrate how hermeneutical injustice in psychiatric healthcare can elicit unworlding for the person with a psychiatric illness.
Spencer, Lucienne and Havi Carel (2021) ’'Isn’t Everyone a Little OCD?’: The Epistemic Harms of Wrongful Depathologisation’, Philosophy of Medicine 2.1, forthcoming.
This article develops the concept of wrongful depathologization, in which a psychiatric disorder is simultaneously stigmatized (because of sanist attitudes towards mental illness) and trivialized (as it is not considered a “proper” illness). We use OCD as a case study to argue that cumulatively these two effects generate a profound epistemic injustice to OCD sufferers, and possibly to those with other mental disorders. We show that even seemingly positive stereotypes attached to mental disorders give rise to both testimonial injustice and wilful hermeneutical ignorance. We thus expose an insidious form of epistemic harm that has been overlooked in the literature.
Todd, T. (2021). “Epistemic injustice” in the administration of mental health legislation. Psychosis, 13(1), 85–88. https://doi.org/10.1080/17522439.2020.1853204
Young, J. A., Lind, C., Orange, J. B., & Savundranayagam, M. Y., 'Expanding current understandings of epistemic injustice and dementia: Learning from stigma theory', Journal of Aging Studies 48 (2019) 76–84. https://doi.org/10.1016/j.jaging.2019.01.003
We describe how theoretical models of stigma align with the current model of epistemic injustice through a consideration of the concepts of ‘stereotype’, ‘prejudice’ and ‘discrimination’, shared by the two models. We draw on current understandings of dementia-related stigma to expand understandings of the epistemic injustice faced by persons with dementia. We discuss how these insights may inform the development of mechanisms to uphold the basic human right to speak, to be heard, and to be believed for persons with dementia.
Weidmann-Hügle, T., & Monteverde, J. B. S. (2022) 'Clinical ethics consultation in chronic illness: Challenging epistemic injustice through epistemic modesty'. HEC Forum : An Interdisciplinary Journal on Hospitals’ Ethical and Legal Issues, in press. https://doi.org/10.1007/s10730-022-09494-8 link.springer.com/article/10.1007/s10730-022-09494-8
In this paper, we present a theoretical reflection on the underlying biomedical model of disease, how it shaped clinical practices and patterns of ethical deliberation within these practices, and the repercussions it has on clinical ethics consultations for patients with chronic illness. Not fully considering the sources of personal knowledge and expertise may lead to epistemic injustice within an ethical deliberation logic narrowly relying on a biomedical model of disease. In caring “for” and collaboratively “with” this patient population, we answer the threat of epistemic injustice with epistemic modesty and humility.
Please email me additions or corrections! Last updated 22/4/24.
General overviews and introductions to epistemic injustice
- For surveys of recent work on epistemic injustice, see McKinnon (2016). Kidd, Medina, and Pohlhaus (2017) has chapters on many different concepts, methodologies, frameworks, and applied case studies.
- For criticisms of Fricker's conception of epistemic injustice, see Berenstain (forthcoming).
- On structural epistemic injustice, see Doan (2018).
- On testimonial injustice, see Pohlhaus, Jr. (2014).
- On epistemic justice, see Samaržija and Cerovac (2021).
- On hermeneutical injustice as involving presences, as well as absences, of hermeneutical resources, see Falbo (2022).
- On wilful hermeneutical injustice, see Pohlhaus Jr. (2014).
- On epistemic exploitation, see Berenstain (2016).
- On epistemic oppression, see Dotson (2014).
- On epistemic violence, see Dotson (2011).
General work on epistemic injustice, healthcare, and illness
- On epistemic injustice and clinical ethics, see Weidmann-Hügle and Monteverde (2022)
- On epistemic injustice and illness (pathocentric epistemic injustices), see Carel and Kidd (2014) and (2017) and Kidd and Carel (2016).
- On global health in relation to epistemic injustice, see Bhakuni and Abimbola (2021).
- On pathocentric epistemic injustice and wider aspects of the life-world of ill persons, see Kidd and Carel (2021).
- On the structural and regulatory dimensions of epistemic injustice in healthcare, see O'Donovan and Madden (2018).
- On testimonial injustice and women, see Gallagher, Miles Little, and Hooker 2020.
- On pathocentric hermeneutical injustice, see Kidd and Carel (2019).
- On conceptions of health and illness, see Kidd and Carel (2018).
- On epistemic microagressions and illness, see Freeman and Stewart (2018) and (2019).
- On healthcare, prisons, and 'carcereal medicine', see Critchley (2019) and Pitts (2019).
- On epistemic injustice and the professional practice and careers of women surgeons, see Hutchinson (2019).
- On language barriers in globalised healthcare, see Peled (2018).
- On epistemic justice in healthcare, Dotson (2008).
- On transgender and non-binary persons, see Freeman and Stewart (2021).
- On clinical notes and 'information blocking', see Blease et al 2021.
Epistemic injustice and somatic illness
- On epistemic injustice and somatic illness:
- On CFS/ME see Blease, Carel, and Geraghty (2016), Boer (forthcoming), Byrne (forthcoming), and Spandler and Allen (forthcoming).
- On chronic pain, see Buchman, Ho,and Goldberg (2017).
- On CFS/ME see Blease, Carel, and Geraghty (2016), Boer (forthcoming), Byrne (forthcoming), and Spandler and Allen (forthcoming).
- On male breast cancer, see Younas (2020).
- On geriatric care nursing, see Isham, Bradbury-Jones, and Hewison (2019).
- On obstetric violence and testimonial injustice, see Shabot (forthcoming).
Epistemic injustice, psychiatry, and mental health.
- On epistemic injustice and psychiatry and psychiatric illness, see Crichton, Carel, and Kidd (2017), Kidd, Spencer, and Carel (2023), Kurs and Grinshpoon (2018), Lakeman (2010), LeBlanc, and Kinsella (2016), Miller (2019), and Scrutton (2017).
- On autism, see Catala et al (2021).
- On borderline personality disorder, see Kyratsous and Sanati (forthcoming).
- On epistemic injustice, mental disorder, and criminal victimisation, see Carver, Morley and Taylor (2016).
- On dementia, see Young, Lind, Orange, and Savundranayagam (2019) and Spencer (2022).
- On depression, see Jackson (2017).
- On delusions, see Kyratsous and Sanati (2015).
- On dementia, see Spencer (2022).
- On advocacy and mental health, see Bortolotti and Stammers (2018) and Newbigging and Ridley (2018) and Todd (2021).
- On child mental health, see Harcourt (forthcoming).
- On OCD, see Spencer and Carel (forthcoming).
- On phenomenology, see Ritunnano (2022).
- On psychiatric diagnosis, see Hassall (2024).
- On psychosis, see Todd (2021).
- On psychopathology, see Spencer (2023).
- On patient organisations (dementia and autism), see Jongsma, Spaeth, and Schicktanz (2017).
- On psychotherapy, see Miškulin (2015) and (2017) and Weiste, Voutilainen, and Peräkylä (2016).
- On therapy and clinical social work, see Lee et al (2019).
- On structural and cultural dimensions, focused on the US, see Jackson (2019).
- On epistemic assumetries in psychiatry, see Miškulin (2017).
- On testimonial injustices and psychiatry, see Beuter (2021).
- On voice-hearing, see Harris et al.
- For a sceptical perspective, see Kious et al (2022).
Epistemic injustice and disabilities
- On epistemic injustice and disability, see Barnes (2017, ch.6), Ho (2011), and Scully (2018a) and (2018b).
- On ableism, see Peña-Guzmán and Reynolds (2019).
- On mental disability, see Dohmen (2016).
- On cognitive impairment, see Yi Li (2016).
- On intellectual disability and metaepistemic injustice, see Catala (2020).
- On the epistemic injustices inherent in the quality-adjusted life years (QALYs) system, see Cupples (2020).
Barnes, Elizabeth, The Minority Body: A Theory of Disability (Oxford: Oxford University Press, 2017), ch.6, 'Disability Pride'.
This book argues that disability is primarily a social phenomenon, 'a way of being a minority, a way of facing social oppression, but not a way of being inherently or intrinsically worse off'. Chapter six explore the vulnerability of disabled persons to forms of hermeneutical injustice.
Berenstain, Nora, 'Epistemic exploitation', Ergo 3 (2016): 569-590.
Epistemic exploitation occurs when privileged persons compel marginalized persons to educate them about the nature of their oppression. I argue that epistemic exploitation is marked by unrecognized, uncompensated, emotionally taxing, coerced epistemic labor. The coercive and exploitative aspects of the phenomenon are exemplified by the unpaid nature of the educational labor and its associated opportunity costs, the double bind that marginalized persons must navigate when faced with the demand to educate, and the need for additional labor created by the default skepticism of the privileged. I explore the connections between epistemic exploitation and the two varieties of epistemic injustice that Fricker (2007) identifies, testimonial and hermeneutical injustice. I situate epistemic exploitation within Dotson’s (2012; 2014) framework of epistemic oppression, and I address the role that epistemic exploitation plays in maintaining active ignorance and upholding dominant epistemic frameworks.
Berenstein, Nora, 'White feminist gaslighting', Hypatia, forthcoming.
Structural gaslighting arises when conceptual work functions to obscure the non-accidental connections between structures of oppression and the patterns of harm they produce and license. This paper examines the role that structural gaslighting plays in white feminist methodology and epistemology using Fricker’s (2007) discussion of hermeneutical injustice as an illustration. Fricker’s work produces structural gaslighting through several methods: i) the outright denial of the role that structural oppression plays in producing interpretive harm, ii) the use of single-axis conceptual resources to understand intersectional oppression, and iii) the failure to recognize the legacy of women of color’s epistemic resistance work surrounding the issue of sexual harassment in the workplace. I argue that Fricker’s whitewashed discussion of epistemic resistance to sexual harassment in the United States is a form of structural gaslighting that fails to treat women of color as knowers and exemplifies the strategic forgetting that is a central methodological tactic of white feminism.
Bhakuni, Himani and Seye Abimbola, 'Epistemic Injustice in Academic Global Health', The Lancet Global Health 9.10 (2021): E1465-E1470.
This Viewpoint calls attention to the pervasive wrongs related to knowledge production, use, and circulation in global health, many of which are taken for granted. We argue that common practices in academic global health (eg, authorship practices, research partnerships, academic writing, editorial practices, sensemaking practices, and the choice of audience or research framing, questions, and methods) are peppered with epistemic wrongs that lead to or exacerbate epistemic injustice. We describe two forms of epistemic wrongs, credibility deficit and interpretive marginalisation, which stem from structural exclusion of marginalised producers and recipients of knowledge. We then illustrate these forms of epistemic wrongs using examples of common practices in academic global health, and show how these wrongs are linked to the pose (or positionality) and the gaze (or audience) of producers of knowledge. The epistemic injustice framework shown in this Viewpoint can help to surface, detect, communicate, make sense of, avoid, and potentially undo unfair knowledge practices in global health that are inflicted upon people in their capacity as knowers, and as producers and recipients of knowledge, owing to structural prejudices in the processes involved in knowledge production, use, and circulation in global health.
Blease, Charlotte, Liz Salmi, Hanife Rexhepi, Maria Hägglund, Catherine M DesRoches, 'Patients, Clinicians, and Open Notes: Information Blocking as a Case of Epistemic Injustice', Journal of Medical Ethics (2021), doi:10.1136/medethics-2021-107275.
In many countries, including patients are legally entitled to request copies of their clinical notes. However, this process remains time-consuming and burdensome, and it remains unclear how much of the medical record must be made available. Online access to notes offers a way to overcome these challenges and in around 10 countries worldwide, via secure web-based portals, many patients are now able to read at least some of the narrative reports written by clinicians (’open notes’). However, even in countries that have implemented the practice many clinicians have resisted the idea remaining doubtful of the value of opening notes, and anticipating patients will be confused or anxious by what they read. Against this scepticism, a growing body of qualitative and quantitative research reveals that patients derive multiple benefits from reading their notes. We address the contrasting perceptions of this practice innovation, and claim that the divergent views of patients and clinicians can be explained as a case of epistemic injustice. Using a range of evidence, we argue that patients are vulnerable to (oftentimes, non-intentional) epistemic injustice. Nonetheless, we conclude that the marginalisation of patients’ access to their health information exemplifies a form of epistemic exclusion, one with practical and ethical consequences including for patient safety.
Boer, Marjolein Lotte, 'Epistemic in/justice in patient participation. A discourse analysis of the Dutch ME/CFS Health Council advisory process', Sociology of Health & Illness, DOI: 10.1111/1467-9566.13301.
In healthcare settings, patient participation is increasingly adopted as a possible remedy to ill people suffering from ‘epistemic injustices’ – that is to their unfair harming as knowers. In exploring and interpreting patient participation discourses within the 2013–2018 Dutch Myalgic Encephalomyelitis (ME)/Chronic Fatigue Syndrome (CFS) Health Council advisory process, this paper assesses the epistemological emancipatory value of this participatory practice. It reveals that in the analysed case, patient representatives predominantly offer biomedical knowledge about ME/CFS. They frame this condition as primarily somatic, and accordingly, perceive appropriate diagnostic criteria, research avenues and treatment options as quantifiable, objectifiable and explicitly non‐psychogenic. This paper argues that such a dominant biomedical patient participatory practice is ambiguous in terms of its ability to correct epistemic injustices towards ill people. Biomedicalized patient participation may enhance people's credibility and their ability to make sense of their illness, but it may also undermine their valid position within participatory practices as well as lead to (sustaining) biased and reductive ideas about who ill people are and what kind of knowledge they hold. The final section of this paper offers a brief reflection on how to navigate such biomedicalized participatory practices in order to attain more emancipatory ones.
Bueter, Anke, 'Epistemic Injustice and Psychiatric Classification', Philosophy of Science, forthcoming.
This paper supports calls for an increased integration of patients into taxonomic decision- making in psychiatry by arguing that their exclusion constitutes a special kind of epistemic injustice: Pre-emptive testimonial injustice, which precludes the opportunity for testimony due to a wrongly presumed irrelevance or lack of expertise. Here, this presumption is misguided for two reasons: (1) the role of values in psychiatric classification and (2) the potential function of first-person knowledge as a corrective means against implicitly value- laden, inaccurate, or incomplete diagnostic criteria sets. This kind of epistemic injustice leads to preventable epistemic losses in psychiatric classification, diagnosis, and treatment.
Bueter, Anke, 'Diagnostic Overshadowing in Psychiatric-Somatic Comorbidity: A Case for Structural Testimonial Injustice', Erkenntnis, DOI: 10.1007/s10670-021-00396-8, forthcoming.People with mental illnesses have higher prevalence and mortality rates with regard to common somatic diseases and causes of death, such as cardio-vascular conditions or cancer. One factor contributing to this excess morbidity and mortality is the sub-standard level of physical healthcare offered to the mentally ill. In particular, they are often subject to diagnostic overshadowing: a tendency to attribute physical symptoms to a pre-existing diagnosis of mental illness. This might be seen as an unfortunate instance of epistemic bad luck, where particular features of a group of patients make a timely and correct diagnosis unlikely. While this can explain some cases of diagnostic overshadowing, I argue that in other cases, epistemic injustice is involved. Analyzing the case of diagnostic overshadowing, I distinguish two kinds of testimonial injustice. For one, there are classic cases of transactional testimonial injustice resulting from prejudices against the mentally ill. In addition, there are cases of structural testimonial injustice resulting from features of health care systems. To overcome diagnostic overshadowing, remedies on the individual as well as structural level are thus needed.
Byrne, Eleanor, Striking the balance with epistemic injustice in healthcare: the case of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis
Medicine, Health Care and Philosophy, 2020
Miranda Fricker's influential concept of epistemic injustice (2007) has recently seen application to many areas of interest, with an increasing body of healthcare research using the concept of epistemic injustice in order to develop both general frameworks and accounts of specific medical conditions and patient groups. This paper illuminates tensions that arise between taking steps to protect against committing epistemic injustice in healthcare, and taking steps to understand the complexity of one's predicament and treat it accordingly. Work on epistemic injustice is therefore at risk of obfuscating legitimate and potentially fruitful inquiry. This paper uses Chronic Fatigue Syndrome/Myalgic Encephalomyelitis as a case study, but I suggest that the key problems identified could apply to other cases within healthcare, such as Medically Unexplained Illnesses, Functional Neurological Disorders and Psychiatric Disorders. Future work on epistemic injustice in healthcare must recognise and attend to this tension to protect against unsatisfactory attempts to correct epistemic injustice.
Blease, Charlotte, Havi Carel, Keith Geraghty, ‘Epistemic injustice in healthcare encounters: Evidence from chronic fatigue syndrome’, Journal of Medical Ethics 43 (2016): 549-557.
This paper surveys the state of knowledge and attitudes about this illness and proposes that epistemic concerns about the testimonial credibility of patients can be articulated using Miranda Fricker's concept of epistemic injustice. Patients with CFS/ME often experience suspicion by healthcare professionals, and many patients vocally oppose the effectiveness, and the conceptualisation, of their illness as psychologically treatable. We address the intersection of these issues and healthcare ethics, and claim that this state of affairs can be explained as a case of epistemic injustice (2007). We find evidence that healthcare consultations are fora where patients with CFS/ME may be particularly vulnerable to epistemic injustice. We argue that the (often unintentional) marginalisation of many patients is a professional failure that may lead to further ethical and practical consequences both for progressive research into CFS/ME, and for ethical care and delivery of current treatments among individuals suffering from this debilitating illness. {abstract slightly edited for brevity}
Bortolotti, Lisa and Sophie Stammers, 'Overcoming injustice in mental health: Is there a role for philosophy?', The Mental Elf blog, October 2018.
A commentary on Kurs and Grinshpoon 2018.
Buchman, Daniel Z., Anita Ho, and Daniel S. Goldberg, 'Investigating Trust, Expertise, and Epistemic Injustice in Chronic Pain', Journal of Bioethical Inquiry 14.1 (2017): 31-42. (Symposium: Public Trust in Expert Knowledge)
Trust is central to the therapeutic relationship, but the epistemic asymmetries between the expert healthcare provider and the patient make the patient, the trustor, vulnerable to the provider, the trustee. The narratives of pain sufferers provide helpful insights into the experience of pain at the juncture of trust, expert knowledge, and the therapeutic relationship. While stories of pain sufferers having their testimonies dismissed are well documented, pain sufferers continue to experience their testimonies as being epistemically downgraded. This kind of epistemic injustice has received limited treatment in bioethics. In this paper, we examine how a climate of distrust in pain management may facilitate what Fricker calls epistemic injustice. We critically interrogate the processes through which pain sufferers are vulnerable to specific kinds of epistemic injustice, such as testimonial injustice. We also examine how healthcare institutions and practices privilege some kinds of evidence and ways of knowing while excluding certain patient testimonies from epistemic consideration. We argue that providers ought to avoid epistemic injustice in pain management by striving toward epistemic humility. Epistemic humility, as a form of epistemic justice, may be the kind disposition required to correct the harmful prejudices that may arise through testimonial exchange in chronic pain management.
Byrne, Eleanor Alexandra, 'Striking the balance with epistemic injustice in healthcare: the case of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis', Medicine, Health Care and Philosophy, 2020.
This paper illuminates tensions that arise between taking steps to protect against committing epistemic injustice in healthcare, and taking steps to understand the complexity of one’s predicament and treat it accordingly. Work on epistemic injustice is therefore at risk of obfuscating legitimate and potentially fruitful inquiry. This paper uses Chronic Fatigue Syndrome/Myalgic Encephalomyelitis as a case study, but I suggest that the key problems identified could apply to other cases within healthcare, such as those classed as Medically Unexplained Illnesses, Functional Neurological Disorders and Psychiatric Disorders. Future work on epistemic injustice in healthcare must recognise and attend to this tension to protect against unsatisfactory attempts to correct epistemic injustice.
Carel, Havi and Gita Györffy, ‘Seen but not heard: Children and epistemic injustice’, The Lancet 384 (9950) (2014): 1256-1257.
How do we listen to children? How do we decide whether we believe a story relayed to us by a child? We don't often reflect on our listening practices, which can rely on unrecognised presuppositions. This issue is particularly important when listening to patients: how do we decide what level of credibility to assign to testimonies and interpretations offered by children? We suggest that a philosophical framework can encourage reflection on this important, yet neglected, topic.
- This paper can be read profitably alongside Michael D. Burroughs and Deborah Tollefson, 'Learning to listen: Epistemic injustice and the child', Episteme 13.3 (2016): 359-377.
Carel, Havi and Ian James Kidd, ‘Epistemic injustice in healthcare: A philosophical analysis’, Medicine, Healthcare and Philosophy 17(4) (2014): 529-40.
In this paper we argue that ill persons can experience epistemic injustice in the sense articulated by Miranda Fricker (2007). Ill persons can suffer testimonial injustice through the presumptive attribution of characteristics like cognitive unreliability and emotional instability that downgrade the credibility of their testimonies. Ill persons can also suffer hermeneutical injustice because many aspects of the experience of illness are difficult to understand and communicate and this often owes to gaps in collective hermeneutical resources. We then argue that epistemic injustice arises in part owing to the epistemic privilege enjoyed by the practitioners and institutions of contemporary healthcare services – the former owing to their training, expertise, and third-person psychology, and the latter owing to their implicit privileging of certain styles of articulating and evidencing testimonies in ways that marginalise ill persons. We suggest that a phenomenological toolkit may be part of an effort to ameliorate epistemic injustice. Keywords epistemic injustice, illness, patient experience, phenomenology, patient toolkit
Carel, Havi and Ian James Kidd, ‘Epistemic Injustice in Medicine and Healthcare’, in Ian James Kidd, José Medina, and Gaile Pohlhaus (eds.) The Routledge Handbook to Epistemic Injustice (London: Routledge: 2017), 755-777.
This chapter explores the relation of epistemic injustice to medicine and healthcare as they arise from epistemic asymmetries and differential power relations. Healthcare systems rely on complex structures of epistemic norms and expectations, both implicit and explicit, that create knowledge asymmetries—for instance, privileging the knowledge derived from medical training and theory, rather than that potentially rooted in patient experience, which effectively limiting epistemic authority to healthcare practitioners
Carver, L., Morley, S., & Taylor, P. (2016) 'Voices of deficit: Mental health, criminal victimisation and epistemic injustice', Illness, Crisis and Loss 25(1). doi: 10.1177/1054137316675715
This paper explores the experience of those with mental and emotional distress as a victim of crime. The interconnectedness of matters of identity created though the application of a diagnosis of illness/disorder is addressed as is the crisis of criminal victimisation. This is achieved via an exploration of contemporary concerns surrounding victims of crime with experience of mental and emotional distress, including the (further) loss of voice and agency when interfacing with agencies of the State.
Catala, Amandine, 'Metaepistemic injustice and intellectual disability: A pluralist account of epistemic agency', Ethical Theory and Moral Practice 25(5) (2020): 755-776.
The literature on epistemic injustice currently displays a logocentric or propositional bias that excludes people with intellectual disabilities from the scope of epistemic agency and the demands of epistemic justice. This paper develops an account of epistemic agency and injustice that is inclusive of both people with and people without intellectual disabilities. I begin by specifying the hitherto undertheorized notion of epistemic agency. I develop a broader, pluralist account of epistemic agency, which relies on a conception of knowledge that accounts not only for propositional knowing, but also for other types of knowing that have been largely neglected in debates on epistemic injustice and agency. Based on this pluralist account of epistemic agency, I then show that people with intellectual disabilities qualify as epistemic agents and therefore as subjects of epistemic justice. Finally, I argue that this pluralist account of epistemic agency pushes us to revisit the current conception of epistemic injustice and to expand its taxonomy in two important ways.
Catala, Amandine, Luc Faucher, and Pierre Poirer, 'Autism, epistemic injustice, and epistemic disablement: a relational account of epistemic agency', Synthese, 2021.
The contrast between third- and first-personal accounts of the experiences of autistic persons has much to teach us about epistemic injustice and epistemic agency. This paper argues that bringing about greater epistemic justice for autistic people requires developing a relational account of epistemic agency. We begin by systematically identifying the many types of epistemic injustice autistic people face, specifically with regard to general assumptions regarding autistic people’s sociability or lack thereof, and by locating the source of these epistemic injustices in neuronormativity and neurotypical ignorance. We then argue that this systematic identification pushes us to construe epistemic agency as resulting from a fundamentally relational and dynamic process between an individual, others around them, and their social, cultural, or institutional environment, rather than as a fixed and inherent property of individuals. Finally, we show how our relational account of epistemic agency allows us to introduce the novel concepts of epistemic disablement and epistemic enablement. We argue that these two concepts allow us to more accurately track the mechanisms that undermine or facilitate epistemic agency, and thereby to better understand how epistemic injustice arises and to design more effective interventions to foster greater epistemic justice for autistic people.
Crichton, Paul, Havi Carel, and Ian James Kidd, ‘Epistemic injustice in psychiatry’, BJ Psych Bulletin, forthcoming.
Epistemic injustice is a harm done to a person in their capacity as an epistemic subject (a knower, a reasoner, a questioner) by undermining her capacity to engage in epistemic practices such as giving knowledge to others (testifying) or making sense of one’s experiences (interpreting). It has been argued that those who suffer from medical conditions are more vulnerable to epistemic injustice than the healthy. This paper claims that people with mental disorders are even more vulnerable to epistemic injustice than those with somatic illnesses. Two kinds of contributory factors for epistemic injustice in psychiatric patients are outlined: global and specific. Some suggestions are made to counteract the effects of these contributory factors, for instance we suggest that physicians should participate in groups where the subjective experience of patients is explored, and learn to become more aware of their own unconscious prejudices towards psychiatric patients.
- A brief critical reply is Manhal M. Zarroug, Dieneke Hubbeling, Robert Bertram, 'Epistemic injustice or safety first?', BJ Psych Bulletin, DOI: 10.1192/pb.41.1.56a Published 1 February 2017
Critchley, Harry, 'Epistemic Injustice and Medical Neglect in Ontario Jails: The Case of Pregnant Women' in Ben Sherman and Stacey Goguen (eds.) Overcoming Epistemic Injustice: Social and Psychological Perspectives (New York: Rowman and Littlefield, 2019), 237-251.
Cupples, Laura M., 'Disability, epistemic harms, and the quality-adjusted life year', International Journal of Feminist Approaches to Bioethics 13.1 (2020): 45-62.
Health economists use a conceptual tool called the quality-adjusted life year (QALY) in resource allocation decisions. Despite claims that the values of disabled people are distorted by adaptive preference, I argue that their testimony is in fact more reliable than that of nondisabled third parties. Epistemic injustice in this context harms disabled people and people with chronic illnesses. It also prevents us from challenging the current hegemonic and ableist formulation of the problem of just resource allocation. Community-based participatory research that gives disabled people greater agency in the research process would allow the reframing of the research problem.
Doan, Michael, 'Resisting structural epistemic injustice', Feminist Philosophy Quarterly 4.4 (2018).
What form must a theory of epistemic injustice take in order to successfully illuminate the epistemic dimensions of struggles that are primarily political? How can such struggles be understood as involving collective struggles for epistemic recognition and self-determination that seek to improve practices of knowledge production and make lives more liveable? In this paper, I argue that currently dominant, Fricker-inspired approaches to theorizing epistemic wrongs and remedies make it difficult, if not impossible, to understand the epistemic dimensions of historic and ongoing political struggles. Recent work in the theory of recognition— particularly the work of critical, feminist, and decolonial theorists—can help to identify and correct the shortcomings of these approaches. I offer a critical appraisal of recent conversation concerning epistemic injustice, focusing on three characteristics of Frickerian frameworks that obscure the epistemic dimensions of political struggles. I propose that a theory of epistemic injustice can better illuminate the epistemic dimensions of such struggles by acknowledging and centering the agency of victims in abusive epistemic relations, by conceptualizing the harms and wrongs of epistemic injustice relationally, and by explaining epistemic injustice as rooted in the oppressive and dysfunctional epistemic norms undergirding actual communities and institutions
Dohmen, Josh, ‘“A little of her language”: Epistemic injustice and mental disability’, Res Philosophica 93(4) (2016): 669-691.
In this essay, I argue that certain injustices faced by mentally disabled persons are epistemic injustices by drawing upon epistemic injustice literature, especially as it is developed by Miranda Fricker. First, I explain the terminology and arguments developed by Fricker, Gaile Pohlhaus, Jr., and Kristie Dotson that are useful in theorizing epistemic injustices against mentally disabled people. Second, I consider some specific cases of epistemic injustice to which mentally disabled persons are subject. Third, I turn to a discussion of severely mentally disabled persons who, because they are unable to share information or develop interpretations of shared social experiences, may fall outside Fricker’s discussion of epistemic injustice. Fourth and finally, following arguments given by Kristie Dotson and Christopher Hookway, I define and explain a type of epistemic injustice: intimate hermeneutical injustice that I believe supplements other discussions of epistemic injustice.
Dotson, Kristie, 'In search of Tanzania: Are effective epistemic practices sufficient for just epistemic practices?', Southern Journal of Philosophy 46 (2008): 52-64.
Argues that epistemic injustice may remain untouched in the reformed model of healthcare administration in Tanzania discussed by Lorraine Code in her paper 'Advocacy, negotiation, and the politics of unknowing'.
Dotson, Kristie, 'Tracking epistemic violence, tracking practices of silencing', Hypatia 26.2 (2011):" 236-257.
Too often, identifying practices of silencing is a seemingly impossible exercise. Here I claim that attempting to give a conceptual reading of the epistemic violence present when silencing occurs can help distinguish the different ways members of oppressed groups are silenced with respect to testimony. I offer an account of epistemic violence as the failure, owing to pernicious ignorance, of hearers to meet the vulnerabilities of speakers in linguistic exchanges. Ultimately, I illustrate that by focusing on the ways in which hearers fail to meet speaker dependency in a linguistic exchange, efforts can be made to demarcate the different types of silencing people face when attempting to testify from oppressed positions in society.
Dotson, Kristie, 'Conceptualizing epistemic oppression', Social Epistemology 28.2 (2014) : 115-138.
Epistemic oppression refers to persistent epistemic exclusion that hinders one’s contribution to knowledge production. The tendency to shy away from using the term “epistemic oppression” may follow from an assumption that epistemic forms of oppression are generally reducible to social and political forms of oppression. While I agree that many exclusions that compromise one’s ability to contribute to the production of knowledge can be reducible to social and political forms of oppression, there still exists distinctly irreducible forms of epistemic oppression. In this paper, I claim that a major point of distinction between reducible and irreducible epistemic oppression is the major source of difficulty one faces in addressing each kind of oppression, i.e. epistemic power or features of epistemological systems. Distinguishing between reducible and irreducible forms of epistemic oppression can offer a better understanding of what is at stake in deploying the term and when such deployment is apt.
Falbo, Arianna, 'Hermeneutical Injustice: Distortion and Conceptual Aptness', Hypatia 37 (2022): 343-363.
According to a dominant view, hermeneutical injustice results from a hermeneutical gap: one lacks the conceptual tools needed to make sense of, or to communicate, impor- tant social experiences, where this lack is a result of an injustice in the background social methods used to determine hermeneutical resources. I argue that this approach is incom- plete. It fails to capture an important species of hermeneutical injustice which doesn’t result from a lack of hermeneutical resources, but from the overabundance of distorting and oppressive concepts which function to crowd-out, defeat, or pre-empt the application of a more accurate hermeneutical resource.
Fraser, Rachel, ‘Against authenticity’, talk given at Munich, October 2016
In her book, Transformative Experience, ‘[L.A.] Paul endorses an ideal of authenticity: as well as being rational, she says, our choices should make sense to us from our own ‘first personal points of view’. I argue for some important connections between social power and ideals of authenticity, with a particular focus on the connections between ideals of authenticity and hermeneutic injustice.
Freeman, Lauren, ‘Confronting diminished epistemic privilege and epistemic injustice in pregnancy by challenging a ‘panoptics of the womb’’, Journal of Medicine and Philosophy 40.1 (2015): 44-68.
This paper demonstrates how the problematic kinds of epistemic power that physicians have can diminish the epistemic privilege that pregnant women have over their bodies and can put them in a state of epistemic powerlessness. This result, I argue, constitutes an epistemic injustice for many pregnant women. A reconsideration of how we understand and care for pregnant women and of the physician-patient relationship can provide us with a valuable context and starting point for helping to alleviate the knowledge/power problems that are symptomatic of the current system and structure of medicine. I suggest that we can begin to confront this kind of injustice if medicine adopts a more phenomenological understanding of bodies and if physicians and patients – in this case, pregnant women – become what I call ‘epistemic peers’.
Freeman, Lauren and Heather Stewart, 'Microaggressions in Clinical Medicine', Kennedy Institute of Ethics Journal 28 (4): 411-449.
This paper proposes a victim-centered account of microaggressions within the context of clinical medicine. In so doing, it argues that microaggres- sions can undermine physician–patient relationships, preclude relationships of trust, and therefore compromise the kind and quality of care that patients deserve. Ultimately, by focusing on the experiences of victims of microaggressions, the paper demonstrates how harmful microaggressions in clinical medical contexts can be, and thus provides strong reasons why healthcare providers ought to know about them and actively work to avoid committing them.
Freeman, Lauren and Heather Stewart, 'Epistemic Microaggressions and Epistemic Injustices in Clinical Medicine' in Ben Sherman and Stacey Goguen (eds.) Overcoming Epistemic Injustice: Social and Psychological Perspectives (New York: Rowman and Littlefield, 2019).
Freeman, Lauren and Heather Stewart, 'The Problem of Recognition, Erasure, and Epistemic Injustice in Medicine: Harms to Transgender and Gender Non-Binary Patients -Why We Should Be Worried' in Paul Giladi & Nicola McMillan (eds.), Recognition Theory and Epistemic Injustice (London: Routledge, 2021).
This paper considers the structural, institutional, social, and individual barriers that prevent transgender and gender non-binary patients from receiving good medical care. Many of these barriers stem from two forms of erasure that have been outlined by Bauer et al. (2009). “Informational erasure” refers to a lack of knowledge on the part of health care providers regarding trans people, trans experiences, and trans health, and the assumption that such knowledge does not exist. “Institutional erasure” refers to the absence of policies that accommodate trans identities or trans bodies, including the lack of knowledge that such policies are even necessary. Each form of erasure, we argue, results in a failure to recognise and respect trans and non-binary patients and to treat them as full epistemic agents. Drawing on these two forms of erasure, our chapter aims to make sense of the resulting epistemic and other injustices and harms that result for trans and non-binary patients within the context of health care by understanding them as stemming from this double failure to be recognised. While our discussion foregrounds the epistemic dimensions of the harms that result, we also discuss some of the related psychological and health-related consequences of the mistreatment of trans and non-binary patients. Ultimately, our hope is that this paper helps to motivate a shift in thinking about the importance of trans health and health care on both the institutional and individual level.
Gallagher, Siun, John Miles Little, and Claire Hooker, 'Testimonial Injustice: Discounting Women's Voices in Health Care Priority Settings', Journal of Medical Ethics 47.11 (2021): 744-747.
Testimonial injustice occurs when bias against the credibility of certain social identities results in discounting of their contributions to deliberations. In this analysis, we describe testimonial injustice against women and how it figures in macroallocation procedure. We show how it harms women as deliberators, undermines the objective of inclusivity in macroallocation and affects the justice of resource distributions. We suggest that remedial action is warranted in order to limit the effects of testimonial injustice in this context, especially on marginalised and disadvantaged groups, and propose three areas for action, whose implementation might feasibly be achieved by those immediately involved in macroallocation.
Gunaratnam, Yasmin, ‘Illness Narratives, Meaning Making, and Epistemic Injustice in Research at the End of Life’, in Christoph Rehmann-Sutter, Heike Gudat, and Kathrin Ohnsorge (eds.), The Patient’s Wish to Die: Research, Ethics, and Palliative Care (University Press Scholarship, 2015).
This chapter is about narrative approaches to end-of-life wishes. Following an initial discussion of last wishes and plans as affected by cultural differences, pain, and the biochemistry of advanced disease, the chapter covers three main areas. First, it provides a general flavour of the narrative dimensions of illness and care through key themes from the literature on illness narratives. Second, it turns to definitions and distinctions that have been drawn between the terms ‘narrative’ and ‘story’, focusing upon speech act theory as one approach to understanding the complex relationships between what is said, its meaning, and effects. Finally, the chapter draw upon ideas from the palliative care concept of ‘total pain’ to highlight the limits of empathic understanding in situations of suffering and the importance of recognizing how narrative research with dying people can affect the researcher.
Harcourt, Edward, 'Epistemic injustice, children and mental illness', Journal of Medical Ethics, forthcoming, DOI 10.1136/medethics-2021-107329
The concept of epistemic (specifically testimonial) injustice is the latest philosophical tool with which to try to theorise what goes wrong when mental health service users are not listened to by clinicians, and what goes right when they are. Is the tool adequate to the task? It is argued that, to be applicable at all, the concept needs some adjustment so that being disbelieved as a result of prejudice is one of a family of alternative necessary conditions for its application, rather than a necessary condition all on its own. It is then argued that even once adjusted in this way, the concept does not fit well in the area where the biggest efforts have been made to apply it so far, namely the highly sensitive case of adult patients suffering from delusions. Indeed it does not serve the interests of service users struggling for recognition to try to apply it in this context, because there is so much more to being listened to than simply being believed. However, the concept is found to apply smoothly in many cases where the service users are children, for example, in relation to children’s testimony on the efficacy of treatment. It is suggested that further research would demonstrate the usefulness of the concept in adult cases of a similar kind.
Harris, Olivia, Carina Andrews, Matthew R. Broome, Claudia Kustner, and Pamela Jacobsen, 'Epistemic Injustice amongst Clinical and Non-clinical Voice-hearers: A Qualitative Thematic Analysis Study', British Journal of Clinical Psychology 61.4 (2022): 947-963.
Research has suggested people who hear voices may be at risk of epistemic injustice. This is a form of discrimination whereby someone is unfairly judged to be an unreliable knower (testimonial injustice) or is unable to contribute to, and therefore access, concepts that make sense of their experience within mainstream society (hermeneutical injustice). Voice-hearing occurs both in people who are mental health service users and in the general population (clinical and non-clinical voice-hearers, respectively). The degree of distress and impairment associated with voices has been shown to relate to how individuals make sense of their experiences and how others respond to their identity as a voice-hearer. The aim of this study was to explore people's experiences of epistemic injustice in relation to voice-hearing and to understand how these may differ between clinical and non-clinical voice-hearers.
Hassall, Richard, 'Sense-making and Hermeneutical Injustice Following a Psychiatric Diagnosis', Journal of Evaluation and Clinical Practice (2024), forthcoming.onlinelibrary.wiley.com/doi/10.1111/jep.13971
When one is seriously ill, the diagnosis given can generate questions about what it means and how to make sense of it. This is particularly the case for psychiatric diagnoses which can convey a biomedical narrative of the sufferer's condition. Making sense of one's diagnosis in such cases can involve changing one's self-narrative in such a way as to incorporate the belief that one has developed a disease with an unknown cause. I argue that those receiving a psychiatric diagnosis may consequently be vulnerable to epistemic injustice. In particular, this includes hermeneutical injustice, where individuals lack the ability to understand or articulate their experiences in ways that make sense to them, due to their hermeneutical resources being marginalised by the dominant narrative in a medicalized environment.
Ho, Anita, 'Trusting Experts and Epistemic Humility in Disability', International Journal of Feminist Approaches to Bioethics 4.2 (2011): 102-123.
It is generally accepted that the therapeutic relationship between professionals and patients is one of trust. Nonetheless, some patient groups carry certain social vulnerabilities that can be exacerbated when they extend trust to health-care professionals. In exploring the epistemic and ethical implications of expert status, this paper examines how calls to trust may increase epistemic oppression and perpetuate the vulnerability of people with impairments. It critically evaluates the processes through which epistemic communities are formed or determined, and examines the institutional structure and power relations that contribute to or sustain such self-affirming ideological communities. It also argues for a two-way collaborative approach between professionals and people with impairments that recognizes the role of local knowledge in enhancing professionals' own understanding of their theoretical framework and promoting responsive practices and policies
Hutchison, Katrina, 'Epistemic Injustice in Careers: Insights from a Study with Women Surgeons' in Ben Sherman and Stacey Goguen (eds.) Overcoming Epistemic Injustice: Social and Psychological Perspectives (New York: Rowman and Littlefield, 2019), 183-199.
Isham, Louise, Caroline Bradbury-Jones and Alistair Hewison, 'Female family carers' experience of violent, abusive, or harmful behaviour by the older person for whom they care: A case of epistemic injustice?', Sociology of Health & Illness 42.1 (2020).
Family carers affected by violent, abusive or harmful behaviour by the older person for whom they care face social and epistemic challenges in developing and sharing knowledge about their experiences. These difficulties have contributed to a situation in which there is a paucity of evidence and public discourse about how we understand violence and harm instigated by people who have care needs or are ‘vulnerable’. This paper reports the findings of a qualitative study that involved 12 in‐depth interviews with female carers affected by violence, abuse or harm. The study was informed theoretically by Miranda Fricker's concept of epistemic injustice which was used as a framework for analysis. There were two principal findings: (1) Carers were sensitive to anticipatory stigma and loss of moral autonomy. As a result, they self‐censured what they shared and, at times, were met with subtle but powerful processes of silencing. (2) Carers had limited linguistic and conceptual resources to explain the emotional and social aspects of the harm they experienced, exacerbated by implicit social norms about the ‘private’ and gendered nature of familial care. To conclude, we discuss the implications of these findings for sociological research and health and social care practice.
Jackson, Jake, 'Patronizing Depression: Epistemic Injustice, Stigmatizing Attitudes, and the Need for Empathy', Journalof Social Philosophy 48.3 (2017): 359-376. (Special issue: Reshaping the Polis: Toward a Political Conception of Disability).
Jackson, Jake, 'Phenomenological Psychopathology and America’s Social Life-World', Giovanni Stanghellini, et al (eds.) The Oxford Handbook of Phenomenological Psychopathology (Oxford: Oxford University Press, 2019), 987-1003.
This chapter addresses how the lack of consensus and constant debates regarding the existence of mental illness along with inaccessibility of mental healthcare in the United States leaves individuals with mental disorders "epistemically adrift" - a state of being overwhelmed by too much information that is interrelated with hermeneutical injustice.
Jongsma, Karin, Elisabeth Spaeth, and Silke Schickten, 'Epistemic injustice in dementia and autism patient organisations: An empirical analysis', AJOB Empirical Bioethics 8.4 (2017): 28-30.
Patient organizations (POs) represent patient collectives in health care policy. The inclusion of people with a ‘neuro-psychiatric’ condition poses a particular challenge for the organizational processes and political representation of such collectives. In recent years, new POs (POs of) have been established in the field of autism spectrum disorder and dementia that advocate a different agenda and have a different organizational structure than traditional POs (POs for). The divide between these two types of POs indicates a different standpoint with regard to who should be included on an organizational level, which voices are accepted and who should represent these voices on the political level. The inclusion and exclusion of voices needs to be normatively justified in order to be regarded legitimate representation of such a collective. With the help of Miranda Fricker's theory of epistemic injustice, we scrutinize whether and, if so, which types of epistemic injustices (wrongdoings to a person as a knower) can be found within POs' practices and the political field in which they operate. Our in-depth analysis indicates that persistent stereotypes hamper the inclusion of affected members both within POs and on the health political level (abstract edited for brevity).
Kidd, Ian James, José Medina, and Gaile Pohlhaus (eds.) The Routledge Handbook to Epistemic Injustice(London: Routledge: 2017).
Part one contains chapters exploring the core concepts of epistemic injustice. Part five contains chapters with applied case studies of epistemic injustice in medicine and healthcare (by Carel and Kidd) and mental illness (Tasia Scrutton). Several other chapters will be of interest to those interested in epistemic injustice and illness—for instance, there are chapters on intersectionality, Foucault, and so on.
Kidd, Ian James and Havi Carel, ‘Epistemic injustice and illness’, Journal of Applied Philosophy 33.2 (2016): 172-190. (Special issue: Applied Epistemology, edited by David Coady and Miranda Fricker)
This paper analyses the phenomenon of epistemic injustice within contemporary healthcare. We begin by detailing the persistent complaints patients make about their testimonial frustration and hermeneutical marginalization, and the negative impact this has on their care. We offer an epistemic analysis of this problem using Miranda Fricker’s account of epistemic injustice. We detail two types of epistemic injustice, testimonial and hermeneutical, and identify the negative stereotypes and structural features of modern healthcare practices that generate them. We claim that these stereotypes and structural features render ill persons especially vulnerable to these two types of epistemic injustice. We end by proposing five avenues for further work on epistemic injustice in healthcare.
Kidd, Ian James and Havi Carel, 'Naturalism, Healthcare Practice, and Epistemic Injustice’, Royal Institute of Philosophy Supplement 84 (2018): 1-23.
Ill persons suffer from a variety of epistemically-inflected harms and wrongs. Many of these are interpretable as specific forms of what we dub pathocentric epistemic injustices, these being ones that target and track ill persons. We sketch the general forms of pathocentric testimonial and hermeneutical injustice, each of which are pervasive within the experiences of ill persons during their encounters in healthcare contexts and the social world. What’s epistemically unjust might not be only agents, communities and institutions, but the theoretical conceptions of health that structure our responses to illness. Thus, we suggest that although such pathocentric epistemic injustices have a variety of interpersonal and structural causes, they are also sustained by a deeper naturalistic conception of the nature of illness.
Kidd, Ian James and Havi Carel, 'Pathocentric Hermeneutical Injustice and Conceptions of Health', Benjamin R. Sherman and Stacey Goguin (eds.), Overcoming Epistemic Injustice: Social and Psychological Perspectives, edited by (New York: Rowman and Littlefield, 2019).
In this paper, we make an effort to contribute to that work by arguing for an expanded conception of the bearers of the vice of epistemic injustice. We argue that certain theoretical conceptions of health, particularly those described as ‘biomedical’ or ‘naturalistic’, are viciously epistemically unjust. Obviously, our claim that abstract, non-agential objects can be bearers of virtues and vices sounds counterintuitive, at best, and a category mistake, at worse. We therefore draw on some recent work in vice epistemology to identity three ways that abstract objects – such as theoretical conceptions – can be legitimately described as epistemically vicious. Although only two of these apply to theoretical conceptions of health, this is enough to justify our main claim that amelioration of pathocentric epistemic injustice must go all the way down – to the conceptions of health that inform and shape the ways that people talk and think about illness and ill persons. If this is right, then it seems robust reform of individuals, social systems, and institutions would not be enough to secure epistemic justice.
Kidd, Ian James and Havi Carel, ‘The Predicament of Patients’, co-authored with Havi Carel, Royal Institute of Philosophy Supplement 89 (2021): 65-84.
In this paper we propose that our understanding of pathocentric epistemic injustices can be enriched if they are theorised in terms of predicaments. These are the wider socially scaffolded structures of epistemic challenges, dangers, needs, and threats ex- perienced by ill persons due to their particular emplacement within material, social, and epistemic structures. In previous work we have described certain aspects of these predicaments, such as pathocentric epistemic injustices and pathophobia. A wider systematic perspective is needed to integrate these and other concepts. By thinking predicamentally, we can better understand the interrelated social, epistemic, and practical obstacles experienced by ill persons and connect the many concepts avail- able for theorising them (microaggessions, epistemic injustices, and so on).
Kidd, Ian James, Lucienne Spencer, and Havi Carel, 'Epistemic Injustice in Psychiatric Research and Practice', Philosophical Psychology (2023) https://doi.org/10.1080/09515089.2022.2156333.
This paper offers an overview of the philosophical work on epistemic injustices as it relates to psychiatry. After describing the development of epistemic injustice studies, we survey the existing literature on its application to psychiatry. We describe how the concept of epistemic injustice has been taken up into a range of debates in philosophy of psychiatry, including the nature of psychiatric conditions, psychiatric practices and research, and ameliorative projects. The final section of the paper indicates future directions for philosophical research of epistemic injustices and psychiatry, concerning neurocognitive disorders, identity prejudices in psychiatric illness, concepts of epistemic privilege in psychiatry, and the prospects for combining phenomenological psychopathology and epistemic justice. We argue that much remains to be done in the conceptualization of these epistemic injustices and suggest that this future work should be multidisciplinary in character and sensitive to the phenomenology of psychiatric conditions.
Kious, Brent M., Benjamin R. Lewis, and Scott Y.H. Kim, 'Epistemic injustice and the psychiatrist', Psychological Medicine 53, 1–5. https://doi.org/ 10.1017/S0033291722003804.
Psychiatrists depend on their patients for clinical information and are obligated to regard them as trustworthy, except in special circumstances. Nevertheless, some critics of psychiatry have argued that psychiatrists frequently perpetrate epistemic injustice against patients. Epistemic injustice is a moral wrong that involves unfairly discriminating against a person with respect to their ability to know things because of personal characteristics like gender or psychiatric diagnosis. We review the concept of epistemic injustice and several claims that psychiatric practice is epistemically unjust. While acknowledging the risk of epistemic injustice in psychiatry and other medical fields, we argue that most concerns that psychiatric practice is epistemically unjust are unfounded. The concept of epistemic injustice does not add significantly to existing standards of good clinical practice, and that it could produce changes in practice that would be deleterious. Psychiatrists should resist calls for changes to clinical practice based on this type of criticism.
Kurs, Rena and Alexander Grinshpoon, ‘Vulnerability of individuals with mental disorders to epistemic injustice in both clinical and social domains’, Ethics & Behaviour 28.4 (2018): 336-346.
Many individuals who have mental disorders often report negative experiences of a distinctively epistemic sort, such as not being listened to, not being taken seriously, or not being considered credible because of their psychiatric conditions. In an attempt to articulate and interpret these reports we present Fricker’s concepts of epistemic injustice (Fricker, 2007, p. 1) and then focus on testimonial injustice and hermeneutic injustice as it applies to individuals with mental disorders. The clinical impact of these concepts on quality of care is discussed. Within the clinical domain, we contrast epistemic injustice with epistemic privilege and authority. We then argue that testimonial and hermeneutic injustices also affect individuals with mental disorders not only when communicating with their caregivers but also in the social context as they attempt to reintegrate into the general society and assume responsibilities as productive citizens. Following the trend of the movement of mental health care to the community, the testimonies of people with mental disorders should not be restricted to issues involving their own personal mental states.
Kyratsous, Michaelis and Sanati, Abdi (2015) ‘Epistemic Injustice in Assessment of Delusions’, Journal of Evaluation in Clinical Practice 21.3: 479–485.
We will use the concept of epistemic injustice to explore the role of stereotypes and prejudice in the identification of delusions. We will discuss cases where patients are suffering from testimonial injustice by virtue of having a mental disorder that is so often associated with attributions of irrationality, bizarreness and incomprehensibility. Two vignettes will be presented to show that this is often the case in clinical practice. We will discuss relevant issues around the epistemology of the delusions. We think that in order to challenge the testimonial injustice, there needs to be an awareness of its possibility and thus recognition of the role of certain stereotypes in assessing these mental states. Challenging the stigma against mentally ill and adopting a holistic view of delusions can help tackle the prejudice that pre-empt the testimonial injustice.
Kyratsous, Michalis and Abdi Sanati, ‘Epistemic injustice and responsibility in borderline personality disorder’, Journal of Evaluation in Clinical Practice. DOI: 10.1111/jep.12609
Miranda Fricker's concept of epistemic injustice has been quite a novel idea in epistemology. The application of the concept in the context of mental health is less explored. Here, we aim to apply the concept of epistemic injustice in attributing responsibility to patients with borderline personality disorder. We will focus on patients suffering from borderline personality disorder. We provide a case vignette to show a tendency in the professionals in holding these patients responsible for their action when it can be argued otherwise. We argue that prejudice against the patient with borderline personality disorder where the person is seen as manipulative plays a significant role in the process of epistemic injustice. The suggested manipulative nature of patients with borderline personality disorder leads to professionals to ascribe agency and knowledge where it is not due.
Lakeman, Richard, ‘Epistemic injustice and the mental health service user’, International Journal of Mental Health Nursing 19 (2010): 151-153.
LeBlanc, Stephanie and Elizabeth Anne Kinsella, 'Toward epistemic justice: A critically reflexive examination of 'sanism' and implications for knowledge generation', Studies in Social Justice 10.1 (2016): 59-78.
The dominance of medicalized “psy” discourses in the West has marginalized alternative perspectives and analyses of madness, resulting in the under-inclusion (or exclusion) from mainstream discourse of the firsthand experiences and perspectives of those who identify as Mad. We argue that this marginalization of firsthand knowledge(s) demands closer critical scrutiny, particularly through the use of critical reflexivity. This paper draws on Fricker’s concept of epistemic injustice, whereby a person is wronged in his or her capacity as a knower, as a useful framework for interrogating the subjugation of Mad knowledge(s). Also examined is the problem of 'sanism', a deeply embedded system of discrimination and oppression, as an underlying component of epistemic injustice. Sanism assumes a pathological view of madness, which can be attributed to what Rimke has termed psychocentrism: the notion that pathologies are rooted in the mind and/or body of the individual, rather than the product of social structures, relations, and problems. (abstract edited for brevity)
Lee, Eunjung, A Ka Tat Tsang, Marion Bogo, Marjorie Johnstone, Jessica Herschman, Monique Ryan , 'Honoring the voice of the client in clinical social work practice: Negotiating with epistemic injustice', Social Work 1.64.1 (2019): 29-40.
Epistemic injustice occurs when therapists implicitly and explicitly impose professional and institutional power onto clients. When clients have a diagnosis of schizophrenia, this very fact further complicates and highlights the power disparity within the helping relationship. Inspired by the work of critical philosopher Miranda Fricker on epistemic injustice, and using critical theories of language and knowledge, this article analyzes audiotaped session transcripts between a client with a history of psychosis and a social worker in an outpatient mental health agency. Findings illustrate two main discursive interactional patterns in everyday clinical social work encounters: (1) how the therapist's utterances claim disciplinary power and construct the client's testimony in alignment with an institutional agenda, while pre-empting the client's lived experience; and (2) how the client, though actively resisting, is managed to perform the identity of being a mentally ill person. The authors close with suggestions of how to avoid these mishaps and work toward epistemic justice in mental health practice.
McKinnon, Rachel, 'Epistemic injustice', Philosophy Compass 11.8 (2016): 437-446.
A survey of recent work on, and new developments in, the study of epistemic injustice that both expand and critique the expansion of the concept.
Merrick, Teri, ‘From ‘intersex’ to ‘DSD’: A case of epistemic injustice’, Synthese DOI: 10.1007/s11229-017-1327-x
The 2005 International Consensus Conference on Intersex resulted in a substantive revision of the lexicon and guidelines for treating intersex conditions. The speed with which the new treatment protocol has been adopted by healthcare practitioners and providers is considered unprecedented. However, a number of intersex people and advocacy groups have complained that the recommended revisions are inadequately informed by the testimony of intersex people. In this paper, I argue that such complaints are valid and that, despite the conference conveners stated intention, the revisions perpetuate the epistemic injustice long endured by intersex people. By analyzing the Consensus Conference and its results as a failed attempt to redress the epistemic marginalization of intersex patients and advocacy groups, I am able to identify lingering institutional hurdles to cultivating the virtue of epistemic justice in biomedical practice.
Miller Tate AJ, 'Contributory injustice in psychiatry', Journal of Medical Ethics 45 (2019): 97-100.
I explain the notion of contributory injustice, a kind of epistemic injustice, and argue that it occurs within psychiatric services, affecting (at least) those who hear voices. I argue that individual effort on the part of clinicians to avoid perpetrating this injustice is an insufficient response to the problem; mitigating the injustice will require open and meaningful dialogue between clinicians and service user organisations, as well as individuals. I suggest that clinicians must become familiar with and take seriously concepts and frameworks for understanding mental distress developed in service user communities, such as Hearing Voices Network, and by individual service users. This is especially necessary when these concepts and frameworks explicitly conflict with medical or technical understandings of users’ experiences. I defend this proposal against three objections.
Miškulin, Inka (2015), 'Epistemic Justice as a Virtue in Hermeneutic Psychotherapy', Snježana Prijić-Samaržija and Inka Miškulin (eds.), Epistemic Justice: Epistemic Virtue and the Philosophy of Psychiatry, Philosophical Inquiries, 35/2: 307-322.
In the first part of this article we will attempt to briefly explain the value turn and outline the basic aspects of virtue epistemology, underlining the diversity of epistemic attitudes associated with this approach and their positive impact on expanding epistemological horizons. The second part will be focused on the virtues of epistemic responsibility and epistemic justice as particularly appropriate for evaluating social cognitive processes such as, for example, testimony and general communication/conversation. In the third section we will show how the psychiatric and psychotherapeutic communicative act can be more efficiently analyzed and evaluated from the perspective of epistemic justice, than from the traditional epistemic approach based on a monist concept of truth. The fourth and fifth section synthesize the discussion by introducing the concept of hermeneutic psychotherapy as a therapeutically and epistemically favorable framework for evaluating communicative acts in psychotherapy.
Miškulin, Inka (2017), 'Psychotherapist’s epistemic responsibility', Kairos 11/1: 23-43.
http://www.kairos.skzp.org/index.php/revija/article/view/358
Given that the epistemic asymmetry inherent in the relationship of a therapist and their client favours the therapist, as shown by numerous examples, the psychotherapist is obliged to approach the client in an epistemically responsible and empirically adequate manner. This requires sensitivity to the evidence, understood as healthy scepticism to- wards the scientific foundations of the concept of mental disorders and psychotherapeu- tic theories, as well as critical reflexion upon their own theoretical presuppositions and prejudices.
Newbigging, Karen and Julie Ridley (2018), 'Epistemic struggles: The role of advocacy in promoting epistemic justice and Trights in mental health', Social Science & Medicine 219: 36–44.
Advocacy for people using health and social care services is widely promoted but its theoretical foundation is under-developed and its impact poorly conceptualised. This paper explores the liberatory potential of independent advocacy, using Fricker's concept of ‘epistemic injustice’ as a framework. The concept of epistemic injustice provides a valuable theoretical basis for understanding the worth of advocacy in addressing testimonial injustice as well as its relative weakness in overcoming hermeneutical injustice. The challenge of independent advocacy to the dominant discourse within mental health is considered and questions raised about the place of advocacy in modern democratic mental health systems.
O'Donovan, Orla and Deirdre Madden, 'Why do medical professional regulators dismiss most complaints from members of the public? Regulatory illiteracy, epistemic injustice, and symbolic power', Journal of Bioethical Inquiry 15,3 (2018):469-478.
Drawing on an analysis of complaint files that we conducted for the Irish Medical Council (Madden and O'Donovan 2015), this paper offers three possible explanations for the gap between the ubiquity of official commitments to taking patients' complaints seriously and medical professional regulators' dismissal-as not warranting an inquiry-of the vast majority of complaints submitted by members of the public. One explanation points to the "regulatory illiteracy" of many complainants, where the remit and threshold of seriousness of regulators is poorly understood by the general public. Another points to possible processes of "institutional epistemic injustice" (Fricker 2007; Anderson 2012) that unjustly undermine the credibility of certain complainants, such as those with low levels of formal education. A third explanation highlights the marginalization of the general public from "symbolic power" (Bourdieu 1989) to define what matters in medical professional regulation. The paper is offered in a spirit of ideas in progress and raising questions rather than definitive insights into the regulatory process.
Peled, Yael, 'Language barriers and epistemic injustice in healthcare', Bioethics 32.6 (2018): 360-367.
Contemporary realities of global population movement increasingly bring to the fore the challenge of quality and equitable health provision across language barriers. While this linguistic challenge is not unique to immigration contexts and is likewise shared by health systems responding to the needs of aboriginal peoples and other historical linguistic minorities, the expanding multilingual landscape of receiving societies renders this challenge even more critical, owing to limited or even non‐existing familiarity of modern and often monolingual health systems with the particular needs of new linguistic minorities. The centrality of language to health beliefs, attitudes, practices, cultural scripts, and conceptual frameworks emphasizes its pivotal role in the healthcare process, and consequently in the adverse effects of treatment that is language‐insensitive and unaware. Such an attitude on the part of medical authorities risks considerable epistemic injustice in the form of a (mis)judgement of patients’ intelligence, credibility, and rationality based on the language that they speak and the manner in which they speak it, consequently impacting the quality and equity of care provided. This danger, I argue, may be effectively countered by fostering among the participants in the healthcare process a sense of epistemic humility through greater metalinguistic awareness. Outlining a range of operative steps that can be used to facilitate this. I argue that the reality of language barriers in the healthcare process, while not entirely eliminable, may nevertheless be successfully addressed, in order to mitigate the challenge of quality and equitable healthcare provision in multilingual societies.
Peña-Guzmán, David M. Peña-Guzmán and Joel Michael Reynolds, 'The harm of ableism: Medical error and epistemic injustice', Kennedy Institute of Ethics Journal 29.3 (2019):205-242.
This paper argues that epistemic errors rooted in group- or identity- based biases, especially those pertaining to disability, are undertheorized in the literature on medical error. After sketching dominant taxonomies of medical error, we turn to the field of social epistemology to understand the role that epistemic schemas play in contributing to medical errors that disproportionately affect patients from marginalized social groups. We examine the effects of this unequal distribution through a detailed case study of ableism. There are four primary mechanisms through which the epistemic schema of ableism distorts communication between nondisabled physicians and disabled patients: testimonial injustice, epistemic overconfidence, epistemic erasure, and epistemic derailing. Measures against epistemic injustices in general and against schema-based medical errors in particular are ultimately issues of justice that must be better addressed at all levels of health care practice.
Pitts, Andrea J., 'Carceral Medicine and Prison Abolition: Trust and Truth-telling in Correctional Healthcare' in Ben Sherman and Stacey Goguen (eds.) Overcoming Epistemic Injustice: Social and Psychological Perspectives (New York: Rowman and Littlefield, 2019), 221-236.
Pohlhaus, Gaile, 'Relational knowing and epistemic injustice: Toward a theory of willful hermeneutical ignorance', Hypatia 27.4 (2012) :715-735.
I distinguish between two senses in which feminists have argued that the knower is social: 1. situated or socially positioned and 2. interdependent. I argue that these two aspects of the knower work in cooperation with each other in a way that can produce willful hermeneutical ignorance, a type of epistemic injustice absent from Miranda Fricker's Epistemic Injustice. Analyzing the limitations of Fricker's analysis of the trial of Tom Robinson in Harper Lee's To Kill a Mockingbird with attention to the way in which situatedness and interdependence work in tandem, I develop an understanding of willful hermeneutical ignorance, which occurs when dominantly situated knowers refuse to acknowledge epistemic tools developed from the experienced world of those situated marginally. Such refusals allow dominantly situated knowers to misunderstand, misinterpret, and/or ignore whole parts of the world.
Pohlhaus, G., Jr., 'Discerning the primary harm in cases of testimonial injustice', Social Epistemology 28.2 (2014): 99–114. https://doi.org/10.1080/02691728.2013.782581
This article examines the primary epistemic harm of testimonial injustice, or, as defined by Miranda Fricker, the injustice of perceiving another epistemic agent as less credible due to an identity prejudice. My analysis shows that (1) testimonial injustice does not render its victim to an object-like status and (2) testimonial injustice necessarily treats its victim as a subject, albeit a truncated subject. I demonstrate that the primary harm of testimonial injustice is more aptly described in terms of a subject/other relation, or a relation that circumscribes the subjectivity of its victim within the confines of the perpetrator’s subjectivity.
Reiheld, Alison, ‘‘Patient complains of…’ How medicalization mediates power and justice’, International Journal of Feminist Approaches to Bioethics 3(1) (2010): 72-98.
The process of medicalization has been analyzed in the medical humanities with disapprobation, with much emphasis placed on its ability to reinforce existing social power structures to ill effect. While true, this is an incomplete picture of medicalization. I argue that medicalization can both reinforce and disrupt existing social hierarchies within the clinic and outside of it, to ill or good effect. We must attend to how this takes place locally and globally lest we misunderstand how medicalization mediates power and justice. I provide concrete examples of how this occurs by considering dysesthesia ethiopsis, autism, chronic fatigue syndrome, depression, and HIV/AIDS.
Reiheld, Alison, ‘What you don’t know can hurt you: Epistemic injustice and conceptually impoverished health promotion’, talk given at the IAB World Congress of Bioethics, 13 June 2016.
This paper considers a particular kind of wrong within medicine and health promotion: epistemic injustice and its harms. My case study is obesity conceived of as a public health concern. However, the analytic framework I deploy may prove useful in ethically assessing many health promotion campaigns. Individuals—both doctors and patients—are often provided with an impoverished set of conceptual tools for making sense of health and health behaviors, a set of tools that can lead to inappropriate individualization of responsibility and to unproductive attitudes towards health and which behaviors are health promoting. This is the case with obesity.
Reiheld, Alison, ‘I can hardly credit it: Epistemic injustice and the practice of medicine’, talk given at the Society for Analytical Feminism, 18 September 2016.
In this paper, I document serious issues with physician's doubt of patient testimony specifically with respect to patients who are members of stigmatized groups. I use the framework of epistemic injustice to diagnose these physician-patient interactions. Only once we both perceive and understand these interactions as unjust can we repair the physician-patient relationship and deliver better patient care for members of stigmatized groups.
Reynolds, Joel Michael, 'What if there's something wrong with her?” How biomedical technologies contribute to epistemic injustice in healthcare', Southern Journal of Philosophy 58.1 (2020):161-185.
While there is a steadily growing literature on epistemic injustice in healthcare, there are few discussions of the role that biomedical technologies play in harming patients in their capacity as knowers. Through an analysis of newborn and pediatric genetic and genomic sequencing technologies (GSTs), I argue that biomedical technologies can lead to epistemic injustice through two primary pathways: epistemic capture and value partitioning. I close by discussing the larger ethical and political context of critical analyses of GSTs and their broader implications for just and equitable healthcare delivery.
Ritunnano, Rosa (2022) ‘Overcoming Hermeneutical Injustice in Mental Health: A Role for Critical Phenomenology’, Journal of the British Society for Phenomenology 53.3: 243-260.
The significance of critical phenomenology for psychiatric praxis has yet to be expounded. In this paper, I argue that the adoption of a critical phenomenological stance can remedy localised instances of hermeneutical injustice, which may arise in the encounter between clinicians and patients with psychosis. In this context, what is communicated is often deemed to lack meaning or to be difficult to understand. While a degree of un-shareability is inherent to subjective life, I argue that issues of unintelligibility can be addressed by shifting from individualistic conceptions of understanding to an interactionist view. This takes into account the contextual, historical and relational background within which meaning is co-constituted. I conclude by providing a corrective for hermeneutical injustice, which entails a specific attentiveness towards the person’s subjectivity, a careful sensitivity to contingent meaning-generating structures, and a degree of hermeneutical flexibility as an attitude of openness towards alternative horizons of possibility.
Samaržija, H., & Cerovac, I. (2021) 'The institutional preconditions of epistemic justice', Social Epistemology 35(6) (2021): 621–635. https://doi.org/10.1080/02691728.2021.1919238
This paper proposes four comprehensive institutional measures for countering epistemic injustice. Institutional epistemic justice demands that, first, all groups enjoy fair and equal access to education and the opportunity to acquire the socially recognized markers of credibility. Second, epistemic justice requires that marginalized groups have access to the relevant public platforms, such as politics and journalism, for voicing their social perspectives. Third, fair access to public positions can aid vulnerable groups in attaining rewarding careers, publicly affirming their epistemic resources, and rupturing the cycle of epistemic disadvantage. As our fourth and final measure, we propose institutional mechanisms for eliminating identity markers from formal epistemic exchanges.
Scrutton, Anastasia Philippa, ‘Epistemic Injustice and Mental Illness’, in Ian James Kidd, José Medina, and Gaile Pohlhaus (eds.) The Routledge Handbook to Epistemic Injustice (London: Routledge: 2017), in press.
The first part of this chapter looks at epistemic injustices that can take place in the context of psychiatric diagnosis and treatment. I argue people diagnosed with mental illnesses are often stereotyped in such a way as to deflate their credibility, and that the authoritative and even exclusive status accorded to third-person, medical perspectives on experiences of mental illness leads to hermeneutical marginalization and silencing. The second part of the chapter takes as its starting-point the idea that epistemic injustice can be countered by a recognition of the ways in which the marginalized person is in fact epistemically privileged. I argue that recognising the ways in which people diagnosed with mental illnesses have access to distinctive and/or unique forms of knowledge can correct our testimonial sensibilities and provide us with new hermeneutical resources, and is therefore a route to epistemic justice. I explore ways in which this might be the case in relation to experiences of mental illness, focusing on two kinds of knowledge: knowledge of what the experience is like, and knowledge of what is good for the person. I conclude with some implications for clinical practice and more general ethical behaviour.
Scully, Jackie Leach, 'From “She would say that, wouldn't she?” to “does she take sugar?” Epistemic injustice and disability', International Journal of Feminist Approaches to Bioethics 11.1 (2018): 106-124.
Epistemic injustice is the idea that social power ensures that the knowledge of some groups is excluded from the collective epistemic resources. In this paper, I argue that there are distinctive features of disabled life that, because they shape the processes through which knowledge is gathered, evaluated, judged, and disseminated, also influence the ways in which epistemic injustice is experienced by disabled people. These features include the ascription of a global epistemic incapacity to people affected by impairment. Against a background of contemporary political shifts and biotechnology innovation, the implications of epistemic injustice for disabled people are serious.
Scully, Jackie Leach, 'Epistemic Exclusion, Injustice, and Disability', in David T. Wasserman and Adam Cureton (eds.), The Oxford Handbook of Philosophy and Disability (Oxford: Oxford University Press, 2018).
This chapter examines the ways in which disabled people are subject to epistemic injustice. It starts by introducing how social epistemology models the creation of shared knowledge and then uses feminist epistemology to highlight the role of social and political power in producing epistemic privilege, exclusion, and oppression. The well-known concepts of testimonial and hermeneutic epistemic injustice are discussed in relation to disability, showing how these forms of injustice are frequently experienced within the lives of disabled people. In particular, disabled experience has features that distinguish it from the experiences of sexism and racism most commonly used as illustrations of epistemic injustice. The chapter ends by arguing that the potential for epistemic injustice poses unprecedented risks for disabled people in the current context, which could be minimized by recognizing that ignorance about disabled lives is not inevitable, but something that can and should be challenged.
Shabot, Sara Cohen, '"You are not qualified--leave it to us": Obstretic violence as testimonial injustice', Human Studies, DOI: 10.1007/s10746-021-09596-1
This paper addresses epistemic aspects of the phenomenon of obstetric violence—which has been described as a kind of gender violence—mainly from the perspective of recent theories on epistemic injustice. I argue that what is behind the dismissal of women’s voices in labor is mainly how the birthing subject, in general, is conceived. Thus, I develop a link between the phenomenon of testimonial injustice in labor and the marked irrationality that is seen as a core characteristic of birthing subjects: an irrationality that appears to be always at odds with the kind of knowledge that is, wrongly, privileged within medicalized childbirth. I use Miranda Fricker’s analysis to argue that a central part of obstetric violence involves laboring women being “wrongfully undermined specifically in their capacity as knowers” (2007: 9): they are disbelieved in the labor room because of a double prejudice, one deriving simply from their condition as women, the second involving the kind of knowledge that many women find useful in the process of birthing. Women in labor thus suffer from both systematic and incidental kinds of testimonial injustice.
Spandler, Helen and Meg Allen, 'Contesting the psychiatric framing of ME/CFS', Social Theory & Health 16.2 (2018): 127-141.
ME/CFS is a medically contested illness and its understanding, framing and treatment has been the subject of heated debate. This paper examines why framing the condition as a psychiatric issue—what we refer to as ‘psychiatrisation’—has been so heavily contested by patients and activists. We argue that this contestation is not simply about stigmatising mental health conditions, as some have suggested, but relates to how people diagnosed with mental illness are treated in society, psychiatry and the law. We highlight the potentially harmful consequences of psychiatrisation which can lead to people’s experiential knowledge being discredited.
Spencer, Lucienne, 'Epistemic injustice and loneliness in late-stage dementia', video of a public philosophy talk at the University of Birmingham, 18 May 2022.
This paper argues that Fricker's concept of a 'testimonial sensibility' should be expanded into a 'communicative sensibility', to accommodate the range of non-verbal communicative capacities of human beings - like looks, gestures, and so on - which are especially salient to those with diminished verbal capacities. An overly narrow focus on verbal testimonies to the exclusion of wider communicative capacities is, itself, a form of epistemic injustice.
Spencer, Lucienne (2022) 'Epistemic Injustice in Late-Stage Dementia: A Case for Non-Verbal Testimonial Injustice', Social Epistemology 37.1: 62-79.
The literature on epistemic injustice has thus far confined the concept of testimonial injustice to speech expressions such as inquiring, discussing, deliberating, and, above all, telling. I propose that it is time to broaden the horizons of testimonial injustice to include a wider range of expressions. Controversially, the form of communication I have in mind is non-verbal expression. Non-verbal expression is a vital, though often overlooked, form of communication, particularly for people who have certain neurocognitive disorders. Dependency upon non-verbal expression is a common feature of some forms of neurocognitive disorders such as ‘intellectual disabilities’, autism and late-stage dementia. According to the narrow definition of testimonial injustice currently championed in the literature, people who express non-verbally are exempt from testimonial injustice. However, when we consider cases where meaningful communications from non-verbal people are dismissed or ignored in virtue of identity prejudice, there seems to be a distinct testimonial harm at play. Using late-stage dementia as a case study, I argue that the definition of testimonial injustice should be expanded to include all communicative practices, whether verbal or non-verbal, to encompass the epistemic harms inflicted upon some of the most marginalised in our society.
Spencer, Lucienne, 'Hermeneutical Injustice and Unworlding in Psychopathology', Philosophical Psychopathology, forthcoming, open access.
The rich literature in phenomenological psychopathology regards the communicative difficulties accompanying psychiatric illness as a product ofunworlding: the experience of a drastic change in one’s habitual field of experience. This paper argues that the relationship between speech expression and unworlding in psychiatric illness is more complex than previously assumed. Not only does unworlding cause a breakdown in speech expression, but a breakdown in speech expression can perpetuate, and even exacerbate, the experience of unworlding characteristic of psychiatric illness. In other words, I identify a two-way relationship between unworlding and the communication breakdown in psychiatric illness. Merleau-Ponty’s phenomenology of speech expression is drawn upon to demonstrate how hermeneutical injustice in psychiatric healthcare can elicit unworlding for the person with a psychiatric illness.
Spencer, Lucienne and Havi Carel (2021) ’'Isn’t Everyone a Little OCD?’: The Epistemic Harms of Wrongful Depathologisation’, Philosophy of Medicine 2.1, forthcoming.
This article develops the concept of wrongful depathologization, in which a psychiatric disorder is simultaneously stigmatized (because of sanist attitudes towards mental illness) and trivialized (as it is not considered a “proper” illness). We use OCD as a case study to argue that cumulatively these two effects generate a profound epistemic injustice to OCD sufferers, and possibly to those with other mental disorders. We show that even seemingly positive stereotypes attached to mental disorders give rise to both testimonial injustice and wilful hermeneutical ignorance. We thus expose an insidious form of epistemic harm that has been overlooked in the literature.
Todd, T. (2021). “Epistemic injustice” in the administration of mental health legislation. Psychosis, 13(1), 85–88. https://doi.org/10.1080/17522439.2020.1853204
Young, J. A., Lind, C., Orange, J. B., & Savundranayagam, M. Y., 'Expanding current understandings of epistemic injustice and dementia: Learning from stigma theory', Journal of Aging Studies 48 (2019) 76–84. https://doi.org/10.1016/j.jaging.2019.01.003
We describe how theoretical models of stigma align with the current model of epistemic injustice through a consideration of the concepts of ‘stereotype’, ‘prejudice’ and ‘discrimination’, shared by the two models. We draw on current understandings of dementia-related stigma to expand understandings of the epistemic injustice faced by persons with dementia. We discuss how these insights may inform the development of mechanisms to uphold the basic human right to speak, to be heard, and to be believed for persons with dementia.
Weidmann-Hügle, T., & Monteverde, J. B. S. (2022) 'Clinical ethics consultation in chronic illness: Challenging epistemic injustice through epistemic modesty'. HEC Forum : An Interdisciplinary Journal on Hospitals’ Ethical and Legal Issues, in press. https://doi.org/10.1007/s10730-022-09494-8 link.springer.com/article/10.1007/s10730-022-09494-8
In this paper, we present a theoretical reflection on the underlying biomedical model of disease, how it shaped clinical practices and patterns of ethical deliberation within these practices, and the repercussions it has on clinical ethics consultations for patients with chronic illness. Not fully considering the sources of personal knowledge and expertise may lead to epistemic injustice within an ethical deliberation logic narrowly relying on a biomedical model of disease. In caring “for” and collaboratively “with” this patient population, we answer the threat of epistemic injustice with epistemic modesty and humility.