Epistemic Injustice and Psychiatric Classification

Abstract

This article 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: preemptive 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.

‘Isn’t Everyone a Little OCD?’ The Epistemic Harms of Wrongful Depathologization

“…By exposing the epistemic harm that arises from pathophobic stigmatization, the literature on epistemic injustice in psychiatry has already done much to amplify the voices of those with a mental disorder. This has cleared a path for greater epistemic sensitivity towards psychiatric patients' testimonial credibility and collaboration on interpretive frameworks (Bueter 2019;Kurs and Grinshpoon 2018;Sanati and Kyratsous 2015;LeBlanc and Kinsella 2016;Scrutton 2017).…”

“…We suggest that persons with OCD suffer wrongful depathologization when they are simultaneously stigmatized and trivialized. On the one hand, they may be seen as less reliable epistemic agents because they have a mental disorder, and hence are more vulnerable to epistemic injustice, as has been argued previously (Bueter 2019;Kurs and Grinshpoon 2018;Sanati and Kyratsous 2015;LeBlanc and Kinsella 2016;Scrutton 2017). On the other hand, the positive stereotypes associated with OCD trivialize the disorder.…”

“…Following terms such as "racism," "sexism," or "homophobia," Michael L. Perlin popularized the term "sanism" to draw attention to the discriminatory distinction between the "mad" and the "sane." 6 In the philosophy of psychiatry, scholars share the assumption that such pathophobic attitudes are the sole cause of epistemic injustice for those with psychiatric illness (Bueter 2019;Kurs and Grinshpoon 2018;Sanati and Kyratsous 2015;LeBlanc and Kinsella 2016;Scrutton 2017). Yet, the credibility deficit imposed upon sufferers of epistemic injustice cannot be sufficiently understood through negative identity prejudice.…”

Deep Uncertainties in the Criteria for Physician Aid-in-Dying for Psychiatric Patients

“…Of course, mental suffering stemming from nondiagnosable sources covers different types of suffering, such as emotional, existential, or spiritual, but the distinction between (diagnosable) psychical suffering and (nondiagnosable) mental suffering is also value loaded (Raus and Sterckx 2019). In particular, this is visible if we take into account the fact that current psychiatry tends to pathologize normal behaviors and promotes a biomedicalization of common problems in life that may result from the tremendous impact of the pharmaceutical industry on psychiatric research (Bueter 2019). Finally, the "existential" type of uncertainty is characteristic for all life-and-death medical decisions and stems from a need to weigh expected harms of existence that are full of suffering with the alleged "benefits" of dying earlier.…”

Distributive Epistemic Justice in Science

“…There is a growing body of research on discriminatory epistemic injustice in science. In addition to Heidi Grasswick's [2017] general account of the phenomenon, there are studies that examine it in the context of specific sciences and their applications, such as medicine and psychiatry, and proposals for remedying it (Carel and Kidd, 2014, Bueter, 2019, Crichton et al, 2017, Koskinen and Rolin, 2019. Distributive epistemic in/justice in science, however, remains under-theorized.…”