Epistemic injustice and the psychiatrist

Abstract

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.

Correspondence

“…The analytical reasoning in some of the studies Kious et al (2023) have included in their review has inspired our analyses and resonates with our discoveries. In my view, these studies convincingly illustrate how psychiatric patients are particularly vulnerable to EI in their healthcare contacts and provide valuable guidance for addressing and overcoming EI in the psychiatric context.…”

“…Accordingly, while Kious et al (2023) propose that heeding calls to counter epistemic injustice in the psychiatric context entails risks, I suggest, on the contrary, that it is risky to dismiss the theory's value for practice on account of a partial review.…”

“…In a recent editorial, Kious, Lewis, and Kim (2023) review literature on epistemic injustice in psychiatry, concluding that practice adaptions in response to allegations of EI should be discouraged and may even be detrimental. They present excerpts from a handful of publications that, according to their authors, exemplify EI in psychiatrists' contacts with patients.…”

Epistemic justice is an essential component of good psychiatric care

“…In their editorial, Kious, Lewis, and Kim (2023) make the startling and provocative claim that psychiatrists should resist calls for changes to clinical practice based on critiques centered around the concept of epistemic injustice. While disagreeing with the authors on many points they raise, I welcome the opportunity it presents to clarify the relationship between epistemic justice and medical practice.…”

Epistemic justice is both a legitimate and an integral goal of psychiatry: a reply to Kious, Lewis and Kim (2023)

“…In a recent Editorial, Kious, Lewis, and Kim (2023) put forward the claim that psychiatrists should resist calls to integrate concerns about epistemic injustice into their practice as this concept not only fails to add significantly to the current professional standards but would also lead to deleterious clinical outcomes. We believe their claim is mistaken, as it arises from several misconceptions about both the nature of epistemic injustice and its clinical relevance.…”