THE CASE STUDIES

This case study explores the relationship between loneliness and epistemic injustice as a historically contingent and embedded thing. It begins from the proposition that the conceptualisation, measurement, and framing of loneliness as a social, medical, and public health problem has rested – and continues to rest – on a series of unjust epistemic exercises and exchanges, and that these are consequently open to historical excavation, interrogation, and critique. It deepens, therefore, injunctions to critically attend to the institutions, practices, and systems of knowledge and expertise which structure experiences of epistemic injustice in the present. 

Tacking between historical and philosophical registers, the project brings literatures on epistemic injustice into conversation with critical loneliness studies and the history of medicine. Theorising loneliness and epistemic injustice in complex interconnection, it will identify sites and processes of particular contention, and demonstrate how they constrain possibilities for epistemic justice and care. These will include a history of loneliness scales and their afterlives in research and practice, threaded around a critique of measurement as a practice of epistemic extraction and containment; and interdisciplinary work on the depoliticisation of loneliness as a source of epistemic harm. 

Michael Bresalier’s case study examines the development, implementation and impacts of ‘selective' tuberculosis (BCG) vaccination programmes for migrant, immigrant and ethnic minority populations coming to or living within Britain since the 1960s. Selective vaccination primarily targets infants (0-12 months) and children (6-16 years old) at risk of contracting tuberculosis as a result of either familial ties with countries with a high incidence of the disease or by virtue of living in areas in the United Kingdom with similarly high rates of infection. While selective vaccination formally replaced ‘universal’ vaccination in 2005, its conceptual, practical and policy roots have a long history, which can be traced to changing public health and medical discourses on im/migration, ethnicity, and the epidemiology of tuberculosis.  Through a combination of archival, policy and oral history research, the study will trace how, and with what consequences, selective vaccination has been framed, understood, and experienced by medical practitioners, vaccine service providers, and parents, children, and communities in selected locales in the UK. In developing a long-term perspective on the ways in which uncertainties and perceived or identified injustices associated with selective tuberculosis vaccination have been negotiated and addressed, the study aims to better understand the roots and nature of the broader phenomenon of vaccine hesitancy. 

This case study examines silence and epistemic injustice (EI) in bipolar disorder.

We often assume that silence in the context of healthcare is a bad thing and we should always strive to break it. This assumption is particularly common in scholarship on epistemic injustice healthcare. This case study critically examines this assumption and implications. Drawing on first-person accounts of adults with bipolar disorder, it asks: What meanings and value does silence have to individuals with bipolar? How do psychiatric concepts affects how those people are able to keep and break silence? How should EI theory be revised in light of a more nuanced understanding of silence?

Broome with partners Larkin (Aston University) and McCabe (City University) together with a young people advisory group will conduct a case study on young people who access services with psychotic symptoms for the first time. This population is often attributed negative characteristics (e.g. ‘attention seeking’) and seen as unable to accurately represent reality. As a result, healthcare practitioners may dismiss the young person’s reports of their experience; and undermine the young person’s feeling that they are capable, efficacious, and in control. The study will consist of 10 qualitative interviews focusing on the young person’s experience of clinical encounter. Participants will be asked to reflect on their medical consultations to achieve a better understanding of the interpersonal dynamics of epistemic injustice, in a context where the person’s age and the nature of the illness contribute to stigmatisation

Bortolotti with partners Grassi and Belvederi Murri from the University of Ferrara will conduct a case study on people who are diagnosed with a serious illness late in life. This population has an increased risk of epistemic injustice: the elderly person’s interests and preferences are often dismissed due to their age and their limited opportunities for a full recovery. Healthcare practitioners may fail to elicit the patient’s preferences; undermine the patient’s feeling that they can participate in decisions about their healthcare; reduce the patient to an illness rather than a person whose views and goals are important. The study will consist of 10 qualitative interviews focusing on patients’ experience of the clinical encounter, exploring situations in which they felt that they were not listened to, and decisions were made without them. Participants will be asked to reflect on their medical consultations to improve understanding of the interpersonal dynamics of EI, in a context where both the person’s age and the nature of the illness contribute to exclusion.

Bortolotti with partners Lalumera and Chattat from University of Bologna will conduct a case study on people diagnosed with dementia (esp. mild dementia). This population has an increased risk of epistemic injustice because when the patient receives a diagnosis of dementia, the stigma associated with the diagnosis increases the risk that the healthcare practitioner does not listen to the patient;  stops including the patient in shared decision making; and objectifies the patient by considering only the illness and not the wider context, which compromises the choice of the best treatment. The study will consist of 10 qualitative interviews focusing on people with dementia, exploring situations in which they felt dismissed, objectified, and excluded from decision-making.