Epistemic injustice and responsibility in borderline personality disorder

Abstract

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.

Reasoning, evidence, and clinical decision‐making: The great debate moves forward

“…Reasoning about mental health has always provided significant challenges to the simple dichotomies embodied by the “modernism” Wieringa et al seek to challenge . Clinicians Michalis Kyratsous and Abdi Sanati apply Miranda Fricker's concept of a distinctively epistemic form of injustice—wronging persons in their capacity as knowers—to persons with borderline personality disorder (BPD) . Despite recognizing that pathology sometimes justifies epistemic disqualification, the authors use a case vignette to illustrate how valid consideration of persons as unreliable witnesses differs from disqualifying their epistemic status on the basis of negative stereotypes and prejudice.…”

“…5,7 Clinicians Michalis Kyratsous and Abdi Sanati apply Miranda Fricker's concept of a distinctively epistemic form of injustice-wronging persons in their capacity as knowers-to persons with borderline personality disorder (BPD). 19 Despite recognizing that pathology sometimes justifies epistemic disqualification, the authors use a case vignette to illustrate how valid consideration of persons as unreliable witnesses differs from disqualifying their epistemic status on the basis of negative stereotypes and prejudice. The problem of prejudice is suggested to be evident here to the extent that health professionals have been inclined to ascribe knowledge, agency, and moral responsibility for apparently manipulative behaviour to persons with BPD who lack these qualities.…”

“…Similar points could be made about the idea that we need to go "beyond" the cognitive to develop a broader notion of practical wisdom, with the revival of such "pre-modern" concepts as phronesis. 14,49 The idea of epistemic injustice is "predicated on a mutual entanglement between epistemology and ethics" 19 (as are the increasingly influential concepts of "epistemic virtue" and "epistemic vice" 85,86 ). The claim that, to develop a defensible conception of human health, we need to engage with the unapologetically value-laden concepts of "flourishing" or "eudaemonia," seems to be one shared by Deckers and his critics.…”

“…In this edition, we present an array of up‐to‐date analyses of the problems of reason in practice, addressing a diverse range of healthcare contexts and methods, considering policy decisions as well as specific instances of clinical reasoning . Contributors discuss the nature of practical wisdom, the relationship between reasoning, emotion, intuition, and evidence, and the sense in which EBM is (or is not) a “modern” scientific enterprise, in the light of considerations of the relationship between science, context, and culture .…”

“…Contributors discuss the nature of practical wisdom, the relationship between reasoning, emotion, intuition, and evidence, and the sense in which EBM is (or is not) a "modern" scientific enterprise, in the light of considerations of the relationship between science, context, and culture. [11][12][13][14][15][16][17][18] The edition includes important sections on mental health, where questions ranging from epistemic injustice to psychiatric nosology and validity are analysed [19][20][21][22] -discussions given both specificity and depth via a range of papers from a significant conference on how we conceptualize a number of psychiatric disorders. [23][24][25][26][27][28] There is also a significant section on causal reasoning, publishing papers delivered to a recent gathering of the CauseHealth collaboration.…”