In this post, Lea Nickel explores the potential and limitations of phenomenological psychopathology for better valuing the experiences of people diagnosed with mental health problems.
People who are suspected of having or have been diagnosed with a mental disorder are often stereotyped in ways that undermine their credibility. The concept of epistemic injustice is an important analytical tool for capturing these experiences. Testimonial injustice can manifest itself in the form of prejudiced overgeneralization of statements and behaviour. An example would be when all statements made by a person with delusions are seen as delusional, therefore, interpreted as part of the delusional belief system.
Another form of testimonial injustice is
“diagnostic overshadowing”, which describes the tendency to attribute physical
symptoms to a pre-existing diagnosis of a mental disorder. Hermeneutic
injustice is fuelled by the dominant status of the third-person biomedical
perspective on experiences and the excess credibility of psychiatric knowledge.
These forms of injustice not only hinder individual recovery but also
contribute to the structural discrimination of people with mental disorders. This
highlights the need for a more inclusive incorporation of the experiences of
those impacted.
I see phenomenological
psychopathology as a suitable starting point for this. Rooted in Husserl's
vision of phenomenology as a ‘rigorous science’ that strives for knowledge
without preconception, phenomenological psychopathology is focused on the
exploration of patients' first-person experiences. By actively bracketing assumptions and deep-rooted
prejudices and empowering patients to develop their own interpretative
frameworks, the factors contributing to epistemic injustice are reduced. In the following, however, I will examine one possible limitation of
phenomenological psychopathology with regard to improving epistemic injustice.
When we deal with epistemic injustice in the psychiatric context, identity biases that affect people because of their mental disorder are central. We call those sanistic prejudices. Sanism, like other “isms”, is based on deeply rooted social constructs and structures that aim to disadvantage or exclude certain groups, and thus contribute to the maintenance of social inequalities. However, forms of discrimination rarely occur in isolation. If a person is impacted by sexism, racism, classism, ageism, ableism, homophobia, or transphobia, then these oppressive mechanisms also operate in the context of mental disorders.
This can
only be captured by an intersectional approach, which leads us to a closer
inspection of the “phenomenological reduction” used in phenomenological
psychopathology. In general, this means questioning assumptions about the
person as well as their symptoms and possible diagnoses, in order to follow
Husserl’s call to get “to the things themselves”. This, however, can lead to certain dimensions of
experience, such as racialized and gendered experiences, being lost. As
a result, differences in experience due to the different situations of those
affected cannot be reflected. If the experiences of marginalized people are
taken as a basis for knowledge without reflection and without naming the
oppressive structures that produced these experiences, these very structures can
be re-naturalized. In the
context of phenomenological psychopathology, this could be countered through an
“intersectional unfolding” as proposed by Spencer (2024). Here, the various
social positionings and their effects can be addressed.
An interesting starting point for
this is the connection between rationality and femininity. Historically, the
feminine – and consequently women – have been pathologized as unstable,
hysterical, deceitful, and irrational. What such an intersectional unfolding
can look like is shown in Ruth Bankey's paper “La Donna è Mobile: Constructing
the irrational woman”. She shows, based on intensive conversations with women impacted by agoraphobia with panic
attacks, that their experience can be described as a fear of embodying the
hysterical image, characterized by excessive femininity, loss of control, and
potential “madness”. While
phenomenological reduction carries the risk of perpetuating a kind of ignorance
and thus upholding seemingly neutral conditions of experiences an intersectional
framework allows clinicians to recognize how overlapping identities shape
experiences of distress.
In general, the sexist ideas surrounding mental disorders make it difficult for marginalized people to understand their experiences beyond these discriminatory constructions. Thus, in order to fully analyse epistemic injustice in the psychiatric context, there must be an awareness of the intersections of different axes of discrimination. This addition would facilitate the capturing of different experiences and structures of meaning that arise from different social positions. Not only can phenomenological psychopathology be fruitful for combating epistemic injustice in the psychiatric context, the debate on epistemic injustice can be used to renew phenomenological psychopathology and make it more epistemically just.
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| Lea Nickel |
Lea Nickel is a PhD candidate in the Department of Medical Ethics and History of Medicine at the University Medical Center Göttingen, Germany. Her dissertation is focused on the influence of AI on doctor-patient communication. Her research interests lie in the fields of ethics of AI, empirical ethics and epistemic injustice. She is particularly keen on amplifying patients’ perspectives in the design, evaluation, and implementation of AI-based technologies in medicine.
