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Epistemic injustice and its role in psychiatry

Interview with Lucienne Spencer

Lucienne Spencer is a Postdoctoral Researcher in Mental Health Ethics located within the Neuroscience, Ethics and Society (NEUROSEC) Team in the Department of Psychiatry at University of Oxford. Her research primarily focuses on phenomenology, epistemology, and the philosophy of psychiatry.

Her recent work explored marginalization experienced by psychiatric patients in contemporary society, in particular in her doctoral thesis she delves into the concept of epistemic injustice.  The concept of epistemic injustice was coined by Miranda Fricker in an influential book that was published in 2007 “Epistemic Injustice: Power and the Ethics of Knowing”: Fricker’s aim was to capture a particular kind of wrong that impacted people as “knowers” – those capable of acquiring knowledge, conveying it, and contributing to it. Fricker argues that epistemic injustice isn’t limited to situations where someone isn’t recognized as an epistemic subject. For example, if someone is known to be a habitual liar and therefore not believed, this doesn’t automatically constitute epistemic injustice. Instead, it occurs when disbelief or lack of serious consideration is rooted in what Fricker refers to as identity prejudice. If someone is not taken seriously due to reasons such as marginalized background, race, gender, or social class, this constitutes an instance of epistemic injustice. There are two key forms of epistemic injustice that Fricker highlights: 1) testimonial injustice, this can occur when somebody’s testimony isn’t taken seriously or it’s downgraded and 2) hermeneutical injustice, when an interpretive framework has got gaps where the experiences of certain marginalized groups ought to be. 

Epistemic injustice affects different groups of people such as ethnic minorities, women, and psychiatric patients. In Fricker’s book, the author’s focused particularly on extreme forms of hermeneutical injustice, such as epistemic silencing. According to Spencer, such concept has been insufficiently investigated so far, so she delved into this concept in order to look at what extreme forms of hermeneutical Injustice look like. Drawing inspiration from her interest in phenomenology, particularly with French philosopher Merleau-Ponty, Spencer felt that there was a particularly phenomenological impact that comes from extreme forms of hermeneutical injustice and the example she gives is, in her words: 

 “I asked readers to imagine a footballer who sees the ball and feels this pull towards the ball, these intentional threads as Merleau-Ponty would would call it, these threads are pulling him towards the ball and then he kicks the ball in one fluid action in one sort of pre-reflective action: when he sees the ball it has that kind of affordance, he sees it as a thing that needs to be kicked. Then I asked if the reader could imagine that the footballer had “Phantom Limb Syndrome” where you’ve lost one of your limbs, but you still experience it as existing sometimes, so you can still feel it, and I was saying that even without the limb the footballer would see the ball and still feel this urge towards the ball, urge towards kicking it. Imagine if they don’t have a leg nevertheless they feel the intentional threads pulling them towards the football: I was imagining that something similar to me happens in a case of extreme hermeneutical Injustice where you lack the words to explain your experience but you still have this urge to speech expression which I think is a very natural thing for human beings to have to try and put their experiences into words and when you lack that language you feel this intentional pull towards expression but there’s something missing almost in your body schema, you’re missing those essential hermeneutical resources and that is sort of the phenomenological impact of hermeneutical silencing.”

This kind of silencing can exacerbate some of the negative psychiatric experiences, as some patients are unable to put experiences into words. Spencer argues that this kind of silencing increases the sense of “unworlding” that is very common in psychiatric illness where one feels unmowed from the world, as if there was an unbridgeable distance between the body and the world. By looking at Merleau-Ponty’s phenomenology of speech expression, where he outlines how speech expression roots us humans into the world, Spencer argues that without speech expression there is this unmowing that can occur and negatively impact on people who suffer of psychiatric conditions.

In Spencer’s opinion, phenomenologically oriented care approaches can overcome this issue, as phenomenology can provide essential hermeneutical resources that can plug these gaps, also referred by Fricker as hermeneutical lacunas, where patients’ experiences ought to be. She also points out that current psychiatric approaches to research and classification offer a limited framework that, as stated previously, can cause a disconnection between one’s personal experience and clinical language, whereas phenomenological psychopathology is about meaning-making with the patient. In other words, she critiques the Diagnostic and Statistical Manual of Mental Disorders (DSM) as a limited framework that may further disconnect patients from their experiences, emphasizing the importance of meaningful narratives constructed with patients, rather than for them. From a phenomenological point of view, patients are hearing about their experiences in their own words and these narratives need to be meaningful first and foremost not to the clinician or the researcher, but to the patients themselves. By taking a phenomenological disposition – she concludes – one could finally achieve hermeneutical justice, allowing patients to reclaim their experiences and meanings within the clinical context.

Emiliana Mancuso

Laureata in medicina e chirurgia presso l’Università Vita-Salute San Raffaele di Milano. Specializzanda in psichiatria presso l’Università degli Studi della Campania “Luigi Vanvitelli”. Allieva della Scuola di Specializzazione in Psicoterapia Fenomenologico-Dinamica di Firenze. Si interessa della riflessione filosofica intorno alla psichiatria. Editor presso

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