Epic Seminar series: all available online

24.03.25

Epistemic Injustice and Psychiatric Diagnosis: Who Gets to Be Believed?  

  Few topics in mental health spark more controversy than psychiatric diagnosis. From ward rounds to social media and the broadsheet press, debates are often heated, polarising, and destructive. Yet these discussions frequently treat all psychiatric diagnoses as if they function the same way—but they do not. Diagnoses like depression often confer credibility, opening doors to care and support. Others, like schizophrenia and borderline personality disorder, are far more likely to strip patients of epistemic agency, determining whose voices are heard and whose suffering is dismissed. Even within the same diagnosis, experiences diverge: for some, a label provides meaning and empowerment; for others, it is an act of epistemic violence. Efforts to challenge psychiatric categorisation, however, risk slipping into accusations of false consciousness, where those who do not accept or reject their diagnosis in the 'correct' way are framed as simply mistaken. I argue that epistemic injustice provides a crucial framework for navigating this complexity, allowing us to critique diagnosis while respecting the varied meanings patients ascribe to their diagnoses. By centering patient epistemic agency, we can develop more just approaches to future psychiatric nosologies.

27.01.25

Title: Woman Alone: Carmita Wood's archival fragments and the emotions of epistemic injustice

In the summer of 1975, the inaugural issue of the feminist journal Labor Pains carried a brief article, ‘Woman Alone’, written by a victim - and co-articulator - of sexual harassment, Carmita Wood. Harassed by a professor of Nuclear Physics, Boyce McDaniel, at Cornell University, Wood had turned to feminist scholars and activists in Cornell’s Human Studies department to help her make sense of what she had experienced; not (or not exclusively) to herself, but in her ongoing attempts to provide evidence that she had left her post at the university for good reason. The work they did together resulted in the formation of a campaigning organisation, Working Women United (WWU), with Labor Pains as its organ, and the contribution of a new composite term, sexual harassment, to stake out a particular set of behaviours and experiences which had been hitherto difficult to formally name.  For many if not most scholars of epistemic injustice (and a smaller number of scholars of sexual harassment and second-wave feminism), Wood’s story is at least partially familiar, forming a central spur of Miranda Fricker’s famous 2007 analysis of hermeneutic injustice. Amid sustained and ongoing discussions over what Wood ‘knew’ about her experience, however, there has been far less attention paid to what she said – and how she felt – at the time. In ‘Woman Alone’, and in a speak-out on sexual harassment attended by hundreds, Wood (and her fellow speakers) made sense of their experiences – and the epistemic problems of understanding and speaking about them – through the interconnecting prisms of aloneness and shame. I take their emphasis on the emotional barriers to epistemic action as a prompt for a consideration of the emotions that attend experiences of epistemic injustice, re-centring them as primary mechanisms rather than secondary harms.

25.11.24

Epistemic Pedantry in the Dementia Context

Imagine the following scenario: A person with dementia tells a care worker that a certain loved one visited them yesterday. The care worker replies that the resident is mistaken and that this particular loved one has passed away.

Imagine a second scenario: A person with dementia starts wishing everyone a merry Christmas, and sings Christmas songs. A family member informs the person with dementia that it is not Christmas.

Through this talk, I explore the epistemic harm of contradicting false beliefs in the context of dementia. Drawing on Kant, I attempt to capture this epistemic harm through a distinct form of epistemic injustice which I call 'epistemic pedantry': where a person’s epistemic status is unnecessarily undermined in pursuit of a trivial truth.

30.09.24

Title:   

What is the characteristic wrong of testimonial injustice? 

My aim in this paper is to identify the wrong that is done in all cases of testimonial injustice, if there is one. Miranda Fricker (2007) proposes one account of this distinctive wrong, and Gaile Pohlhaus Jr. (2014) offers another. I think neither works. Nor does an account based on giving due respect to the testifier’s epistemic competence. Nor does an account based on exposing the testifier to substantial risk of harm. Rachel Fraser (2023) describes a further account, and the proposal I favour is a slight amendment of this.

Epistemic injustice and epistemic responsibility in evidence-informed policymaking during crises

20.05.24

Complex and interrelated crises define today’s policy space and pose particular challenges for deploying science to support evidence-informed policymaking (EIPM). Pandemics, climate change, natural catastrophes or energy crises demand science-based solutions, but also expose our inability to locate, discriminate, understand, and respond to incomplete and contested evidence. The reification of scientific knowledge and expertise as the antidote to uncertainty obscures the challenges of deciding what needs to be asked, and ‘which’ or ‘whose’ science ought to provide the answers when contestation and disagreements emerge. This highlights the inevitability of ignorance in crisis policymaking, created by the exclusion - but also inclusion- of voices, facts and values from the decision-making processes.

In this talk, I will use examples from the past COVID-19 pandemic to show how scientific expertise was selectively and narrowly mobilised to respond to the crisis, thus creating a form of systemic ignorance that shaped public policy. Following the work of Elizabeth Anderson, I argue that explaining why expertise is so narrowly conceived and mobilised requires us to consider science’s structural epistemic injustices. I will finish by sketching an account of epistemic responsibilities that may allow epistemic communities to widen the range of voices contributing to the policy process despite the inherently exclusionary nature of expertise.  Taking epistemic responsibility seriously can help address the root causes of epistemic injustices in EIPM and pave the way for more inclusive and deliberative forms of crisis governance better equipped to deal with uncertainty.

Epistemic Microaggressions and Epistemic Harm in Medicine

29.04.24

Drawing on her recently published book, Microaggressions in Medicine (Oxford 2024), this talk will provide an overview and analysis of epistemic microaggressions in medical contexts. Epistemic microaggressions result in epistemic harm to recipients. Focusing on cases of patients who are members of marginalized groups, the presentation will demonstrate how epistemic microaggressions can lead to a variety of serious short- and long-term harms to patients and therefore ought to be avoided by healthcare professionals. Special attention will be paid to the moral significance of epistemic microaggressions in medical contexts.

Epistemic Injustices and Mental Ill-Health

04.03.24

I will talk us through some types of epistemic injustice, principally: ‘testimonial injustice’, ‘pre-emptive testimonial injustice’, and ‘hermeneutical injustice’ which I defined in earlier work; and ‘testimonial smothering’ as defined by Kristie Dotson. I’ll explain these phenomena largely by way of examples from a memoir of mental ill-health written by the British actor David Harewood, Maybe I Don’t belong Here: A Memoir of Race, Identity, Breakdown and Recovery (2021). His personal story explores how experiences of racism, growing up in Britain in the seventies and as a young man in the eighties, sowed the seeds of personal fracture and psychological disconnect that later expressed themselves in psychosis.

I will also reflect that many psychiatrists and therapists effectively see their own work as including the amelioration of precisely these forms of epistemic injustice: aiming to create a therapeutic relationship in which credibility is not withheld, and shared intelligibility of experience is cultivated, with the result that the service-user may come to express themselves without needing to truncate or restyle what they want to say. This may be an impossible ideal, given that healthcare professionals must equally be diagnostically alert to fantasy, projection, and delusion, among other phenomena of epistemic disturbance, but impossible ideals can nonetheless be useful guiding ideals, playing a helpful informal self-regulatory role in one’s professional practice. If so, then perhaps the explicitly epistemic framing of this particular guiding ideal may make for a useful tool in the therapeutic toolbox?