Silence and epistemic injustice in bipolar disorder

Case study team: Dr Dan Degerman and Dr Alice Malpass

Case study overview

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?

Data collection and analysis

The source of primary data for this case study is a series of interviews with people who have self-identified as having bipolar disorder. The first wave of interviews involved 14 people.

The interview schedule was co-developed by Alice and Dan, and the study has received ethics approval from the University of Bristol. Alice conducted the first wave of interviews in the spring of 2025, and been leading the preliminary analysis of the data.

As of September 2025, the team is currently authoring the first publication based on the interview data together members of the wider EPIC project.

Publications

Silence in illness. Forthcoming in the Royal Institute of Philosophy Supplement. Co-authored with Carel, H., and Kidd, I.

Silence as epistemic agency in mania. Medicine, Health Care and Philosophy (2025; early online access). Available at: https://doi.org/10.1007/s11019-025-10256-9/

Silence, depression, and bodily doubt: Toward a phenomenology of silence in psychopathology. Philosophical Psychology 38 (1) (2025), 126-149.

Epistemic arguments for a democratic right to silence, Philosophical Quarterly 74 (4) (2024), 1137-1158. Co-authored with Bellazzi, F.

Talks

Mania and the capacity for silence. Philosophy Research Seminar, Open University, Milton Keynes, UK, 16 September 2025.

The medicalisation of silence. 12th Philosophy of Medicine Roundtable, King’s College London, UK, 3 June 2025.

The medicalisation of silence. Southwest Philosophy Workshop, Swansea University, Swansea, UK, 11 April 2025.

The medicalisation of silence. The Silence Studies Network Monthly Seminar (online), 19 March 2025.

Panelist, Knowing patients: Emotions, silence and loneliness. Spark 2024: A British Council Festival of Ideas. Hong Kong, 18 October 2024.

Mania and the capacity for silence. Centre for Health, Humanities and Science Research Seminar, University of Bristol, UK, 25 September 2024.

Mania and the capacity for silence. British Society for Phenomenology Annual Conference, Bristol, UK, 11-13 September 2024.

Panelist, 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

Silence as epistemic agency in mania. Continental Philosophy Seminar, Durham University, Durham, UK, 6 June 2024.