Delusions are one of the most elusive concepts in psychiatry. There have been several theories on the nature and definition of delusions. Jaspers described them as entailing a total transformation of reality and considered primary delusions as un-understandable. When it comes to clinical practice, psychiatrists resort to criteria of falsity, incorrigibility, conviction and being out of keeping with the person's culture. All these criteria have been subject to various criticisms, some of which will be discussed in the paper. 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.

Aims and method In 1988, Lewis and Appleby demonstrated that psychiatrists hold negative attitudes towards patients with personality disorder. We assessed the attitudes of psychiatry trainees towards patients with borderline personality disorder and depression, expecting an improvement. 166 trainees were block randomised to receive one of four case vignettes that varied by diagnosis and ethnic group. We used Lewis and Appleby's original questionnaire and the Attitudes to Personality Disorder Questionnaire (APDQ).Results We received 76 responses. Lewis and Appleby's questionnaire showed more negative attitudes towards personality disorder than depression, with no significant patient ethnic group effects, and the APDQ also showed a (weak) trend towards more negative attitudes to personality disorder. In subgroup analysis, only in the White British patient group were there significantly more negative attitudes to personality disorder. Factor analysis showed significantly less sense of purpose when working with personality disorder.Clinical implications The perceived greater lack of purpose in working with personality disorder should be the target of clinical training and intervention. Targeted interventions that include training in managing personality disorder, supervision and practice in non-specialist, general psychiatry settings are important.

We consider how conceptions of the self and identity from the philosophical literature can help us to understand identity disturbance in borderline personality disorder (BPD). We present 3 philosophical approaches: connectedness, narrative, and agency. We show how these map on to 3 different ways in which the self can be temporally extended. The connectedness approach is dominant in philosophy, and the narrative approach has been used by psychiatry, but we argue that the lesser‐known agency approach provides a promising way to theorize some aspects of identity disturbance in BPD. It relates the 2 diagnostic criteria of identity disturbance and disinhibition and is consistent with evidence of memory deficits and altered self‐processing in BPD patients.

Miranda Fricker's concept of epistemic injustice has been quite a novel idea in epistemology. It brings something new to the fields of epistemology and ethics. Fricker draws our attention to a distinctive species of injustice, the epistemic injustice, in which someone is specifically wronged in his capacity as a knower. There has been a significant amount of work done in epistemic injustice, both in race and gender studies. 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. Attributing responsibility involves holding someone accountable for his presumed wrongdoings, making judgments on whether the agent has control on his action, on whether is aware of its consequences. It is generally agreed that in order to be morally responsible for an action the person should be worthy of praise or blame for it. Following Aristotle, we focus on epistemic condition in attribution of responsibility. We will discuss the role of epistemic injustice in assessment of epistemic condition of responsibility. We will show that we can misinterpret the agent's intentions because of the presence of systematic prejudices. 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.