Michael Bresalier on EPIC

Michael Bresalier is a lecturer in the history of medicine at the University of Swansea. He is also a member of EPIC and will contribute a case study on epistemic injustice in tuberculosis vaccination programmes.

Michael Bresalier

 

Hi Michael! What is your main research interest?

My research interest has been with the production, legitimisation, circulation, and consequences of biomedical knowledge of human and animal health and disease. Much of my work has been on infectious and zoonotic diseases (infections that move between human and non-human animals). 

My new book, Modern Flu (Palgrave 2023), traces the long process by which influenza was framed as a viral disease and how new virological ways of knowing influenza reshaped clinical, public health and popular approaches to the disease. 

A key concern of mine is with how disease categories vary and change, and how they are negotiated and incorporated into medical practices and experiences (broadly construed). I am especially interested with how agreement is formed in medicine at various levels, whose ideas and interests are included or excluded in the process, how medical knowledge is or is not shared, and the ways agreed disease concepts or definitions affect diagnoses, treatment, and access to healthcare resources. 

Why do you think it is important to study epistemic injustice in healthcare?

Although people working on the history, anthropology or sociology of medicine and health have used different terms and frameworks, forms of epistemic injustice have been a central concern for some time. Among other things, what such research has shown is that differentials in patients’ and sufferers' testimonies or the knowledge they possess to negotiate health or illness are socially determined and have shaped healthcare systems and health outcomes. 

But I think epistemic injustice is an important framework for gaining critical new insight into how power relations operate in healthcare and, most importantly to me, as way to think about what justice in healthcare might look like and what forms it might take. This kind of normative move is not something historians usually make. Collaborating on this project is a great opportunity to reflect on how historical perspectives can help address epistemic injustice and make healthcare more equitable. 

What are you working on right now?

I have been working on a couple of different projects that tie into EPIC. One is a study of ‘gift’ economies in global health and medicine, with particular focus on policy and practical arrangements that have developed to facilitate ‘sharing’ vaccines between high-, middle- and low-income countries. I am interested in how different actors and organisations conceive of gift-giving as fundamental (or not) to addressing global health inequalities, including epistemic inequalities (i.e., the sharing and exchange of knowledge in making or delivering essential vaccines). 

A related project examines the implementation and experience of ‘selective' tuberculosis vaccination programmes in the UK (and elsewhere), that have targeted ethnic minority communities from or connected with countries that have a high incidence of tuberculosis. The project will integrate archival research on TB vaccine policies and programmes with oral histories/ethnographic studies of medical practitioners, TB service providers, parents and children, among others, to examine how selective vaccination has been framed, understood and experienced by different groups. 

A key aim is to highlight how uncertainties about TB vaccination have been negotiated as way to better understand vaccine hesitancy, while another is to empirically test if and how epistemic injustice manifested in vaccination policies or programmes. This will be the focus of my EPIC case study, 'Negotiating Immunisation: Epistemic (in)justice in tuberculosis vaccination programmes’.

Silence

This post is by Dan Degerman, Leverhulme Early Career Research Fellow at the University of Bristol. Dan is soon to join project EPIC. 

Some members of team EPIC: Matthew Broome, Ian Kidd, 
Dan Degerman, Havi Carel, Kathleen Murphy-Hollies, and Fred Cooper.

Silence is an important phenomenon in mental health. But while philosophers have had much to say about the social silencing of people with psychiatric diagnoses, other ways in which silence can feature in psychopathology have been underexplored. In a recent workshop at the University of Bristol, generously funded by the Leverhulme Trust, we sought to begin to address this neglect by exploring the different faces of silence in psychopathology.

Ian Kidd opened the workshop with a talk that explored painful silences common in bereavement grief. In particular, he focused on four silences, each characterised by a loss of communicative possibilities that follows the death of a loved one. This included, for example, silence as the loss of the distinctive communicative style of the deceased and silence as the permanent absence of narrative closure. For the person subject to these silences, they are painful for three reasons, Ian explained. Firstly, these silences cannot be filled. Secondly, they involve the awareness that the ways of being in the world the relationship with the deceased made possible are now impossible. Thirdly, they involve the awareness that one can no longer be the same person that one was with the deceased.

Ian Kidd

The second speaker, Richard Stupart, drew on accounts of investigative journalists working in South Sudan to shed light on some of the mental dangers of being silent. He argued that journalists are at a heightened risk of moral injury, referring to the negative psychological impact a person experiences when they are unable to respond to a situation in what they consider a morally appropriate way. Journalists in conflict and crisis situations are particularly vulnerable to such injury because they often find themselves subject to structural pressures that may prevent them from communicating their knowledge about morally charged stories.

Richard Stupart

Inner speech in mental disorders was the subject of the next talk by Sam Wilkinson. He defended what he called a strong dialogical account of inner speech, which entails that all inner speech is directed at a recipient, namely, ourselves. This account also suggests, among other things, that inner speech plays a central role in shaping our identity. Sam then outlined some ways this account can help clarify the implications of inner speech and its absence in different mental disorders. For example, the strong dialogical account indicates that negative inner speech in anxiety and depression is not just an epiphenomenon of pre-existing a person’s feelings but that it can create a downward spiral of those feelings.

 

Sam Wilkinson

The fourth talk by Anna Bortolan examined experiences of silence in social anxiety. Drawing on some distinctions proposed in a recent paper on silence in mood disorders, Anna showed that these capture experiences described by people with social anxiety as well. She then went beyond that account to argue that a further two experiences of silence can be discerned in accounts of social anxiety. The first is characterised by a perceived inability to fill certain silences when one wants to do so, and the second is accompanied by a diminished sense of agency over how silences are filled.

Anna Bortolan

Finally, in my talk, I argued for the importance of attending to first-person experiences of silence in psychopathology through a case study drawn from accounts of depression. Using a phenomenological framework inspired by the work of Merleau-Ponty, I described an experience common in first-person accounts of depression that I termed empty silence. This is an unpleasant experience that involves a solicitation to speak and a breakdown in a person’s habitual relationship with words, which confronts them with their own outward and inner silence. I proceeded to argue that if lived repeatedly, it may give rise to bodily doubt in one’s ability to speak.

Dan Degerman

If you are interested in learning more about the talks, presentation materials from most of them can be found here. The talks were followed by wonderful discussions with the interdisciplinary audience that was in attendance in the room and online, and I want to extend heartfelt thanks to all those who participated.

The workshop was the capstone event for my Leverhulme Early Career Fellowship. However, it also served as an informal launch event for the EPIC project, with many of its team members in attendance, including Ian Kidd, Havi Carel, Matthew Broome, Fred Cooper, Kathleen Murphy-Hollies, and myself. The conversations and explorations that began during this workshop on silence and psychopathology will continue as part of the project, and if you are interested in contributing or participating in some way, please do get in touch.