Epistemic injustice amongst clinical and non‐clinical voice‐hearers: A qualitative thematic analysis study

Harris, Olivia; Andrews, Carina; Broome, Matthew R.; Kustner, Claudia; Jacobsen, Pamela

doi:10.1111/bjc.12368

Cited by 8 publications

(7 citation statements)

References 34 publications

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“…They sometimes feel they are treated disrespectfully (and sometimes are treated disrespectfully). They may even feel that they are victims of EI per se (Harris, Andrews, Broome, Kustner, & Jacobsen, 2022). It is also possible that, when EI does arise, it leads to real harms – misdiagnosis, inappropriate care, and distress, among others.…”

Section: The Risks Of Using Epistemic Injustice As a Tool For Psychia...mentioning

confidence: 99%

Epistemic injustice and the psychiatrist

2023

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Background 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. Methods We review the concept of epistemic injustice and several claims that psychiatric practice is epistemically unjust. Results 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. Conclusions 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.

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Section: The Risks Of Using Epistemic Injustice As a Tool For Psychia...mentioning

confidence: 99%

Epistemic injustice and the psychiatrist

2023

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“…Our proposal bears significant ethical implications for both research and practice in mental healthcare, where the alleged value-neutrality of operational epistemologies has often led to the dismissal of the perspectives of people who live with mental disorders. In the past, this has led to localised and structural forms of epistemic injustice ( Box 1 ) derived from differential power relations (e.g., patient/physician; participant/researcher; policymakers/communities) across healthcare research and services, where many have voiced feelings of being persistently ignored, dismissed or marginalised by health professionals (Carel and Kidd, 2017 ; Harris et al ., 2022 ; Ritunnano, 2022 ). While there is now (at least in high-income countries) a growing recognition of the importance of patient and public involvement within the field of mental health research and service improvement, it is still the case that meaningful participation of service-users and carers as active collaborators in the research process is not yet systematically sought (Montori et al ., 2013 ; Schünemann et al ., 2014 ; Zhang et al ., 2019 ).…”

Section: Introduction: Why Do We Need Phenomenology In Psychiatry?mentioning

confidence: 99%

Phenomenology as a resource for translational research in mental health: methodological trends, challenges and new directions

Ritunnano

Papola

Broome

et al. 2023

Epidemiol Psychiatr Sci

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This editorial reflects on current methodological trends in translational research in mental health. It aims to build a bridge between two fields that are frequently siloed off from each other: interventional research and phenomenologically informed research. Recent years have witnessed a revival of phenomenological approaches in mental health, often – but not only – as a means of connecting the subjective character of experience with neurobiological explanatory accounts of illness. Rich phenomenological knowledge accrued in schizophrenia, and wider psychosis research, has opened up new opportunities for improving prediction, early detection, diagnosis, prognostic stratification, treatment and ethics of care. Novel qualitative studies of delusions and hallucinations have challenged longstanding assumptions about their nature and meaning, uncovering highly complex subjective dimensions that are not adequately captured by quantitative methodologies. Interdisciplinary and participatory research efforts, informed by phenomenological insights, have prompted revisions of pre-established narratives of mental disorder dominated by a dysfunction framework and by researcher-centric outcome measures. Despite these recent advances, there has been relatively little effort to integrate and translate phenomenological insights across applied clinical research, with the goal of producing more meaningful, patient-valued results. It is our contention that phenomenological psychopathology – as the basic science of psychiatry – represents an important methodology for advancing evidence-based practices in mental health, and ultimately improving real-world outcomes. Setting this project into motion requires a greater emphasis on subjectivity and the structures of experience, more attention to the quality and patient-centredness of outcome measures, and the identification of treatment targets that matter most to patients.

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“…This might lead to knowledge produced by service users being questioned due to a credibility deficit and epistemic injustice (where someone is unfairly assumed to be an unreliable knower or is unable to add to, and therefore access, concepts that make sense of their experience within mainstream society) 13,14 can transpire. Also, ideological power, which operates when people's thoughts, beliefs and feelings are manipulated, ignored or disbelieved, and alternative interpretations are offered or imposed, 15 can occur 13,14 . This results in service users' voices not being acknowledged, listened to, or consulted and enhances the possibility of retraumatisation.…”

Section: Introductionmentioning

confidence: 99%

“…Also, service users often experience moderate to severe levels of emotional distress and mild cognitive impairment 12 . This might lead to knowledge produced by service users being questioned due to a credibility deficit and epistemic injustice (where someone is unfairly assumed to be an unreliable knower or is unable to add to, and therefore access, concepts that make sense of their experience within mainstream society) 13,14 can transpire. Also, ideological power, which operates when people's thoughts, beliefs and feelings are manipulated, ignored or disbelieved, and alternative interpretations are offered or imposed, 15 can occur 13,14 .…”

Section: Introductionmentioning

confidence: 99%

“…Also, ideological power, which operates when people's thoughts, beliefs and feelings are manipulated, ignored or disbelieved, and alternative interpretations are offered or imposed, 15 can occur. 13 , 14 This results in service users' voices not being acknowledged, listened to, or consulted and enhances the possibility of retraumatisation.…”

Section: Introductionmentioning

confidence: 99%

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What should inpatient psychological therapies be for? Qualitative views of service users on outcomes

Morgan,

Clarkson,

Hiscocks

et al. 2023

Health Expectations

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BackgroundThere is limited research on what, when and how outcomes should be measured in psychological therapy trials in acute mental health inpatient wards.ObjectivesThis study aimed to consider what outcomes service users think are important to measure.MethodsThis qualitative study explored the views of 14 participants, who had an inpatient admission within the last year, on outcomes of psychological therapies using semistructured interviews. Data were analysed using thematic analysis from a critical realist perspective with both inductive and deductive coding.ResultsThe 126 outcomes that were important to participants were mapped onto an established taxonomy of outcomes across different health areas and the socioecological framework to consider the wider context and help summarise the outcomes. Most of the outcomes were mapped to the intrapersonal and interpersonal level. In addition to the outcome mapping, three themes were constructed from the qualitative data: (1) I am not a problem I am a person, (2) Feeling cared for and loved, (3) What does getting better look like.ConclusionsOur results highlight the need for patient‐reported outcomes which are cocreated with service users, disseminating research and training on preventing dehumanising experiences, enhancing psychological safety and therapeutic relationships and improving access to psychological therapy.Patient or Public ContributionThe wider People with Personal Experience Involvement Committee at the University of Bath were consulted which included a focus group during the early planning stages. We also collaborated with a person with personal experience, at every stage of the research. This included developing our research question and aims, protocol, participant documents (e.g., information and debrief forms), advertisement and recruitment strategy, interview topic guide, the codes, the final themes and quotes and reviewing the manuscript. People with lived experience of being admitted to an acute mental health inpatient ward participated in our study.

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Epistemic injustice amongst clinical and non‐clinical voice‐hearers: A qualitative thematic analysis study

Cited by 8 publications

References 34 publications

Epistemic injustice and the psychiatrist

Epistemic injustice and the psychiatrist

Phenomenology as a resource for translational research in mental health: methodological trends, challenges and new directions

What should inpatient psychological therapies be for? Qualitative views of service users on outcomes

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