Medicalization and epistemic injustice

Abstract

Many critics of medicalization (the process by which phenomena become candidates for medical definition, explanation and treatment) express concern that the process privileges individualised, biologically grounded interpretations of medicalized phenomena, inhibiting understanding and communication of aspects of those phenomena that are less relevant to their biomedical modelling. I suggest that this line of critique views medicalization as a hermeneutical injustice--a form of epistemic injustice that prevents people having the hermeneutical resources available to interpret and communicate significant areas of their experience. Interpreting the critiques in this fashion shows they frequently fail because they: neglect the ways in which medicalization may not obscure, but rather illuminate, individuals' experiences; and neglect the testimony of those experiencing first-hand medicalized problems, thus may be guilty of perpetrating testimonial injustice. However, I suggest that such arguments are valuable insofar as they highlight the unwarranted epistemic privilege frequently afforded to medical institutions and medicalized models of phenomena, and a consequent need for greater epistemic humility on the part of health workers and researchers.

The Legitimacy of User Knowledge in Decision-Making Processes in Mental Health Care: An Analysis of Epistemic Injustice

“…Certainly, service users in the present study reported how medicalized descriptions were often incorrect or incomplete and how they may obscure and distort our understandings of experiences and conditions. It should be noted, however, that some comments resonated with the point made by Wardrope [31] who asserts how criticism of such descriptions may indeed silence the voices of some service users ''for whom medicalization may prove to illuminate, not cloud, experience-and rather than undermining their ability to cope … affords them with strategies by which to do so.'' (p. 352).…”

Mistaking the Map for the Territory: What Society Does With Medicine Comment on "Medicalisation and Overdiagnosis: What Society Does to Medicine"

“…Some of them invoke concepts that do not demonstrably correspond to any particular entity in their domain of interest (eg, some thermodynamic potentials),while others make deliberate distortions to properties of the object of interest (modelling a pendant as an ideal pendulum, or the world as mapped in the Mercator projection), or even (as with Bohr’s and Rutherford’s models of the atom) directly contradict the theories in which they are grounded. 3 The way components of models are delineated and their interactions described has as much to do with the purposes for which a given phenomenon is being modelled, as with the nature of the phenomenon itself. These models have nonetheless served as central components of the image of the world presented by their respective sciences, because they usefully serve the purposes of scientific inquiry in their respective domains.…”

Contesting the psychiatric framing of ME/CFS

“…concept of 'epistemic injustice' to illness experience(Kidd and Carel 2016;Wardrope 2015), including ME/CFS(Blease et al 2016) and also 'mental illness'(Liegghio 2013;Crichton 2016). Epistemic injustice refers to the systematic discrediting of oppressed people's knowledge claims about their own experience.…”