Silence and epistemic injustice in bipolar disorder

Case study team

Dr Dan Degerman

Dr Alice Malpass

Case study aims

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 its 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?

Current and planned research

The primary data source for this case study is a series of interviews with 14 people of different genders and socioeconomic backgrounds who self-identify as having bipolar disorder.  The interview schedule was co-developed by Alice and Dan, and the study has received ethics approval from the University of Bristol. Analysis of the data is currently ongoing and the first of several publications based on the interviews is currently under review. The data has also had into Dan’s recently published monograph Silence in Mood Disorders: A Philosophical Investigation (Routledge). 

In addition to this, Dan is also working with the Common Sense policy group at Northumbria University on a quantitative survey study of epistemic injustice in healthcare and social inequality. 

Publications  

• Degerman, D. (2026) Silence in Mood Disorders: A Philosophical Investigation. London: Routledge. 
• Byrne, E.A., Carel, H., Cooper, F., Degerman, D., Monypenny, A., and Broome, M. (2026) A reply to “Fundamental issues in epistemic injustice in healthcare” by Nielsen, Nordgaard & Henriksen (2025). Medicine, Health Care and Philosophy (early online access)  
• Degerman, D. (2026) ‘What mental health campaigns get wrong about silence’. Psyche, 2 February. 
• Degerman, D., Carel, H., and Kidd, I. (forthcoming). ‘Silence in illness’. Royal Institute of Philosophy Supplement.  
• Degerman, D., (forthcoming). ‘The fear of fear in political theory’. In: Szanto, T., and Osler, L., (eds.) For, Against, Together: Antagonistic political emotions. Cambridge: Cambridge University Press.  
• Degerman, D., and Sul, J. R., (2025). ‘Lost in speech: Depressive rumination and the dynamics of inner silence’. Inquiry (early online access). 
• Degerman, D., (2025). ‘Silence as epistemic agency in mania’. Medicine, Health Care and Philosophy 28 (2), 247-259.  
• Degerman, D., (2025). ‘Silence, depression, and bodily doubt: Toward a phenomenology of silence in psychopathology’. Philosophical Psychology 38 (1), 126-149. 
•  Degerman, D., and Bellazzi, F., (2024). ‘Epistemic arguments for a democratic right to silence’, Philosophical Quarterly 74 (4), 1137-1158.  

Talks 

• Degerman, D., ‘A capacity to be silent’. Democracy of Silence Symposium, University of Oslo, Norway, 23-24 September 2026.
• Degerman, D., ‘Silence in mood disorders’. EPIC Seminar, Bristol, UK, 18 May 2026.
• Degerman, D., ‘Emotion extraction’. Affect and Emotions in Transitions, University of Manchester, UK, 27 March 2026.
• Degerman, D. ‘A philosophical introduction to silence’. Silence & Music, St George’s Bristol, UK, 16 March 2026. Available at: https://youtu.be/ZtbpSvhMVvE?si=T5AQJg3wSapA_uJq
• Degerman, D., ‘Mania and the capacity for silence’. Philosophy Research Seminar, Open University, Milton Keynes, UK, 16 September 2025.
• Degerman, D., ‘The medicalisation of silence’. 12th Philosophy of Medicine Roundtable, King’s College London, UK, 3 June 2025.
• Degerman, D., ‘The medicalisation of silence’. Southwest Philosophy Workshop, Swansea University, UK, 11 April 2025.
• Degerman, D., ‘The medicalisation of silence’. The Silence Studies Network Monthly Seminar, 19 March 2025.
• Degerman, D., Panelist on ‘Knowing patients: Emotions, silence and loneliness’. Spark 2024: A British Council Festival of Ideas. Hong Kong, 18 October 2024.
• Degerman, D., ‘Mania and the capacity for silence’. Centre for Health, Humanities and Science Research Seminar, University of Bristol, UK, 25 September 2024.
• Degerman, D., ‘Mania and the capacity for silenc’e. British Society for Phenomenology Annual Conference, Bristol, UK, 11-13 September 2024.
• Degerman, D., Panelist on ‘Patient Partnership Week 2024: Empowering patients as equal partners in care’. The Patients’ Association, 4 September 2024. Available at: https://www.youtube.com/watch?v=22j70IGDFvs
• Degerman, D., ‘Silence as epistemic agency in mania’. Continental Philosophy Seminar, Durham University, Durham, UK, 6 June 2024.