Epistemic injustice in healthcare: a philosophial analysis

Abstract

General rightsThis document is made available in accordance with publisher policies. Please cite only the published version using the reference above. Full terms of use are available: http://www.bristol.ac.uk/pure/about/ebr-terms AbstractIn this paper we argue that ill persons can experience epistemic injustice in the sense articulated by Miranda Fricker (2007). Ill persons can suffer testimonial injustice through the presumptive attribution of characteristics like cognitive unreliability and emotional instability that downgrade the credibility of their testimonies. Ill persons can also suffer hermeneutical injustice because many aspects of the experience of illness are difficult to understand and communicate and this often owes to gaps in collective hermeneutical resources. We then argue that epistemic injustice arises in part owing to the epistemic privilege enjoyed by the practitioners and institutions of contemporary healthcare services -the former owing to their training, expertise, and third-person psychology, and the latter owing to their implicit privileging of certain styles of articulating and evidencing testimonies in ways that marginalise ill persons. We suggest that a phenomenological toolkit may be part of an effort to ameliorate epistemic injustice.

Toward Epistemic Justice: A Critically Reflexive Examination of ‘Sanism’ and Implications for Knowledge Generation

“…Alternatively, hermeneutical injustice occurs when groups of people are wronged in their capacities as subjects of social understanding through structural prejudices which impact the production of (and access to) interpretive resources needed to make sense of their social experiences (Fricker, 2007;Medina, 2012). Although Fricker's terminology is seldom used among Mad scholars and activists, the experience of testimonial injustice is all too familiar, and is an important concept to consider as it describes a serious threat to the citizenship and humanity of Mad persons (Callard, 2014;Carel & Kidd, 2014;Russo & Beresford, 2015;Thachuk, 2011). The Mad community has focused even less attention on the notion of hermeneutical injustice, which perhaps suggests that the detection of hermeneutical injustice is more difficult (Fricker, 2007;Medina, 2012).…”

“…Oppressed social groups may be hermeneutically marginalized to the extent that they must interpret their social experiences, "through a glass, darkly, with at best ill fitting meanings to draw on in the effort to render them intelligible" to others, and in some cases, to themselves (Fricker, 2007, p. 148;Medina, 2012). Members of the Mad community may be particularly vulnerable to this form of epistemic injustice due to the elusive nature of madness (which makes it difficult to understand and communicate), resulting in their marginalization as contributors to the collective hermeneutical resource (Carel, 2013;Carel & Kidd, 2014).…”

“…The marginalization of Mad persons' knowledges may be due to a hermeneutical lacuna, resulting in a paucity of language or concepts available to discuss experiences of injustice (Carel & Kidd, 2014;Geekie, 2004;Fricker, 2007). Some persons may find that their experiences of madness, or its related injustices, cannot be communicated in "any direct, propositional manner, and so are only shareable with persons with whom one shares a standpoint or a sense of solidarity" (Carel & Kidd, 2014, p. 530;Geekie, 2004).…”

“…In this way the hearer is aware that the speaker's relative unintelligibility to her is perhaps a function of "a collective hermeneutical impoverishment, and [she] can adjust or suspend [her] credibility judgment accordingly" (Ficker, 2007, p. 7). Furthermore, a critically reflexive hearer can acknowledge that while to her a speaker's testimony is seemingly unintelligible due to the speaker's hermeneutically disadvantaged position, to another hearer the speaker may be communicating manifestly important knowledge (Carel & Kidd, 2014;Fricker, 2007). Hearers can move toward hermeneutical justice by seeking, including, listening, and being open to speakers' interpretations, and viewing these as important contributors to knowledge generation (Carel & Kidd, 2014;Fricker, 2007).…”

Can jinn be a tonic? The therapeutic value of spirit-related beliefs, practices and experiences

“…As I have ar ued elsewhere, the former a lows both for the recognition that distress and suffering are (a l other things being equal) experiences we should seek to eradicate and/or a leviate where possi le, while balancing this with the idea that life can be lived we l even when the elimination of suffering is not possi le (Scrutton, 2013(Scrutton, , 2015(Scrutton, , 2016. Thus, distress does seem like a sensi le way for psychiatric literature to chara erise pathology -though there is perhaps also the need to re-balance this with a place for positive meaning when the elimination of suffering altogether is not possi le (see Carel, 2013).…”