Epistemic injustice across disciplinary lines

This week, post-doc Fred Cooper reports from a GW4 residential on health inequalities and social justice.

For the last eight years, the GW4 Alliance – a consortium of universities in the south west of England and South Wales, consisting of Bath, Bristol, Cardiff, and Exeter – has run GW4 Crucible, a leadership development programme, which brings together future research leaders from across disciplines and institutions to explore how they can enhance their career through interdisciplinary collaboration. The programme has been running since 2017; with over 200 alumni, it runs over the course of four months, providing two in-person residential ‘labs’ and a series of online masterclasses.

Each cohort addresses a particular problem, an urgent challenge too complicated and embedded to be tackled by any singular form of expertise. For 2024, the focus of GW4 Crucible is ‘health inequalities and social justice’, and the methodologies of ‘radical interdisciplinarity’ necessary to approach them. My application to the programme emphasised my (at that point, barely started) research on epistemic injustice, and my interest in having conversations with people that historians don’t always get to meet; such as architects, engineers, scientists, and mathematicians. 

As a historian of medicine, and having worked for six years in an interdisciplinary health research centre, I began my post at EPIC with a sense that considerable numbers of researchers across disciplines are actively engaged with many of the themes and questions that animate the project, but without necessarily deploying the same kinds of language. 

Reading the profiles of my fellow ‘Cruciblees’, in anticipation of meeting them for a two-day residential in a hotel in the misty, rainy hills above Cardiff, nobody presented themselves as a philosopher; I was a rare representative, with a literary scholar, of the humanities in general. At a stage in my own work of trying to gauge the reach and purchase of literatures on epistemic injustice in the kinds of spaces that might usefully benefit from them, the structured and unstructured exchanges that Crucible offered felt like an opportunity to take a (wholly unrepresentative and unscientific) temperature. 

Over the course of the two days, discussions crystallised around six themes, developed in small groups with fluid memberships. While I couldn’t be part of every conversation, I stayed with the two subjects which seemed to show most promise for thinking on epistemic injustice across disciplines, occupied as they were with researcher positionality and lived experience, and the ethics and practice of meaningful inclusion in ‘PPI’ (patient and public involvement), here a cipher for participatory research more broadly. 

Although each of these concerns have their own distinct histories, they begin from a shared proposition immediately familiar to work on epistemic injustice in healthcare contexts; that the experience of being ill, and of becoming a patient, imparts knowledge which is 

• highly pertinent to collective and professional understandings of health, illness, disease, and medical systems; 
• impossible to otherwise come by; and 
• not easily formed, articulated, communicated, or formalised. 

Acknowledging the need for researchers to address, incorporate, and interpret lived experience, and to move towards programmes of work which are (genuinely) co-created or user-led, carries another tacit, latent acknowledgement; that the contexts and processes of health care and research as currently constituted reproduce a raft of epistemic harms, exclusions, injustices, and lacunae. Although different researchers work in different registers and are comfortable with (and able to advance) varying degrees of critique, even the most constructive, positive, ‘inclusive’ argument for greater attentiveness to experience implicitly and necessarily identifies a problem, which can only be fully understood in terms of respective epistemic power. 

Overwhelmingly, the interdisciplinary exchanges taking place in the Crucible spoke to the extensive common ground between researchers interested in problems of speaking and silence, shamed and ‘hidden’ illnesses and experiences, and how lived knowledge can be encouraged, supported, valued, and operationalised. 

The literature on epistemic injustice is, undeniably, extensive, prompting some researchers – including in past entries of this blog – to question its over-zealous application and its dilution or bland reproduction as an idea. These concerns come from very different perspectives and summations of worth, but they both chart pathologies of saturation and abundance. While this may be the case from a particular disciplinary view, discussing epistemic injustice with a broad spectrum of health researchers conferred the opposite impression: that of a highly pertinent and useful set of ideas not (yet) widely taken up, even in research that worked in almost identical spaces, on almost identical problems. 

This is not, of course, an argument that anyone’s work was (or is) ‘in need’ of a closer engagement with epistemic injustice; every Cruciblee had their own robust intellectual and practical tools, making for a compelling – and sometimes challenging – set of conversations. In broader literatures on health and healthcare, however, you can frequently find accounts of many of the phenomena discussed and taxonomized in work on epistemic injustice, but without any particular theoretical framework to interpret and organise them. 

Nobody is obliged to apply the insights of any particular literature to their work, unless, perhaps, the omission is especially glaring (or revealing of patterns of power and exploitation in the academy); but too often, in complicated work addressing multiple themes, meanings only half solidified can sometimes slip away. 

As the study of epistemic injustice moves across and beyond disciplinary lines, one of the biggest challenges will necessarily be around keeping these exchanges rich, complex, and mutually responsive. At the basic level of definition, epistemic injustice is a useful idea; where it can be genuinely transformative, though, is in the pluralism and depth of its conceptualisations, allowing us to think critically and rigorously about a number of significant barriers to health, justice, and care. 

Every discipline has something particular to offer here. For example, my work on the history of loneliness – and Michael Bresalier’s work on the history of tuberculosis vaccination – attends to how systems of knowledge and practice are built over time, in ways that fold in and perpetuate unjust epistemic phenomena. At the GW4 Crucible, I met researchers who, if they had the inclination, could use their expertise and training to take research on epistemic injustice in innovative and exciting directions. Even for a literature already experiencing some of the problems of success, that is an encouraging thought. 

Fred Cooper is a post-doctoral researcher and medical historian on project EPIC based at the University of Bristol.

Genocide Denialism and the Epistemology of Ignorance

Last week, Melanie Altanian started a post in parts last week, on her new book, The Epistemic Injustice of Genocide Denialism (Routledge 2024), which is open access. Here she focuses on genocide denialism, prolonged trauma, and retraumatization.

Cover of the book by Melanie Altanian

Denialism, prolonged trauma, and re-traumatization

When confronted with the topic of Turkish genocide denial, the respondents of Kalayjian et al.’s (1996) study expressed a range of negative emotions, including resentment, hatred, and anger/rage, which are appropriate responses to “a perception that the moral order has been violated, with no recompense having followed this disruption” (Miller and Miller 1987, 198). Denial also presents an insult to painful memories, thus constituting a further humiliation that is likely to re-traumatize survivors and force them to silence themselves regarding their experiences.

Survivors may also wilfully suppress their memories, as it would bring back all the pain and terror of their experiences. This may go along with constrictive behaviour in an attempt to create some sense of safety and to control their pervasive fear. However, by avoiding situations that remind them of the past trauma, or initiatives that involve future planning and risks, they “deprive themselves of those new opportunities for successful coping that might mitigate the effect of the traumatic experience” (Herman 2015 [1992], 59). This includes isolating themselves or remaining silent about their traumatic experience.

Importantly, survivors’ feelings of fear, distrust, and isolation are compounded when they are in an environment of incomprehension or hostility towards them and their testimonies. This creates a vicious cycle, as the shattered self “can be rebuilt only as it was built initially, in connection with others” (Herman 2015 [1992], 74). Rendering traumatic experiences intelligible to oneself and relevant others are essential steps towards resolution and closure.

These considerations have cross-generational significance. As a descendant of Armenian genocide survivors who escaped to France, Janine Altounian (1999, 339) describes from a psychoanalytic perspective the “two-fold collective trauma” that is transmitted to descendants and which they must deal with:

[F]irst, the extermination of the descendants’ families and the annihilation of their ancestors’ native land and cultural referents; and second, the dispersion of their parents, escapees stripped of their territorial and linguistic roots and of any narcissistic foundation for their psychic survival, throughout the Western world, in countries where the denials and silences of Realpolitik hold sway.

Altounian draws on her own experience receiving and processing this transmission. The task, she says, requires being “equipped with the psychic and linguistic apparatus necessary” (Altounian 2017, 70). Borrowing from the language of the host culture, the testimony of the descendant thus may benefit from an institutional context that lends authority to that language; “the privilege of his current status […] allows him to live in a time and under political conditions that tolerate his testimony” (73). This marks the role of the descendant as a witness-translator.

We can, then, see how an institutional context of genocide denialism inhibits practices required for successful trauma recovery, thus prolonging trauma across generations, encouraging ongoing constrictive behaviour, and entrenching a range of negative affects. 

As I argue in the book, genocide denialism presents an epistemology of ignorance that weaponizes genocide survivors and their descendants’ dependency on available shared concepts, meanings, and other epistemic resources they can authoritatively draw on to render their testimonies tolerated, credible, intelligible, and thereby effective. The aim is to terrorize them further and to sustain domination.

Melanie Altanian is assistant professor for epistemology and theory of science at the University of Freiburg. Her research focuses on issues in social and political epistemology, moral philosophy, and social philosophy.

Epistemic Injustice and Genocide

For the next two weeks, Melanie Altanian presents her new book, The Epistemic Injustice of Genocide Denialism (Routledge 2024), which is open access. In today’s and next week’s post, Altanian discusses particularly the psychological harms resulting from conditions of epistemic oppression created and sustained by genocide denialism.

Cover of the book by Melanie Altanian

In my recently published book, I argue for two intertwined theses: 

1. genocide denialism should be understood and explained as a substantive epistemic practice, one that creates and sustains ignorance and ignorant agency; 
2. this kind of ignorance is pernicious, because it perpetuates and sustains epistemic oppression. 

I elaborate on this in relation to two interrelated forms of epistemic oppression: 

• testimonial oppression, which concerns institutionalized disabling constraints on epistemic agency qua genocide testimony, and 
• hermeneutical oppression, which concerns institutionalized disabling constraints on epistemic agency qua genocide remembrance.

Silences in the aftermath of genocide

In the book, I stress the need for distinguishing two types of silence that may occur in the immediate and long-term aftermath of genocide – deliberate or resistant silence, and (coerced) silencing – and that it is by focusing on the latter that we get a clearer picture of the epistemic injustices that genocide survivors may encounter.

As opposed to deliberate or resistant silence, where survivors temporarily and strategically remain silent about their painful memories because it helps them rebuild their lives, (coerced) silencing usually occurs under conditions of genocide denialism, where the social uptake conditions for genocide testimony are rendered systematically dysfunctional.

Such epistemic oppression is intrinsically wrong and comes with a range of follow-on harms. In this post (published in two parts), I would like to draw attention to the psychological harms resulting from conditions of epistemic oppression created and sustained by genocide denialism.

Genocide, trauma, and recovery

Particularly as a long-term strategy to consolidate relations of domination, genocide denialism impacts the psychological well-being of both genocide survivors and their descendants. Besides being re-traumatizing, it obstructs the possibility of processing, thus prolonging, cross-generational personal and collective trauma. These trauma-effects have been studied to a great extent in relation to both the Holocaust and the Armenian genocide (Alayarian 2008, Azarian-Ceccato 2010, Karenian et al. 2010, Kupelian et al. 1998, Lehrner and Yehuda 2018).

For example, a study by Kalayjian et al. (1996) identified feelings of humiliation associated with loss of status, autonomy, property, and dignity among the stressors experienced and reported by survivors of the Armenian genocide, while they experienced recalling the deaths of their family members as most painful. Their responses “reflected feelings of helplessness, loss of control, resignation, uncontrollable re-experiencing of the traumatic events, and sadness”, while “the value and emphasis the Armenian culture places on togetherness served respondents as a coping style – sharing the pain and suffering by ‘sticking together’” (92). 

This already indicates the importance of a supportive environment to turn to for coping with trauma, and the above findings are congruent with trauma research more generally. In Trauma and Recovery, Herman (2015 [1992]) argues that traumatic events are characterized by an experience of helplessness in the face of overwhelming force. Such events “overwhelm the ordinary systems of care that give people a sense of control, connection, and meaning” (44). To recover from trauma thus requires the restoration of a sense of agency and control.

While trauma recovery always depends on social support, in cases of collective violence such as genocide, it must include a political response in the form of public recognition and repair. Rebuilding the survivor’s sense of order and justice requires community action, including assignment of responsibility for and reparation of the harms. We can thus begin to assess the perniciousness of genocide denialism, as it upholds the breach between traumatized persons and the community.

Melanie Altanian is assistant professor for epistemology and theory of science at the University of Freiburg. Her research focuses on issues in social and political epistemology, moral philosophy, and social philosophy.

"The Unequal Pandemic" Film Premiere with #ProjectEPIC

On Thursday 30th May, the short film "The Unequal Pandemic" (produced by Lorne Guy and Phil Webb) premiered in Bristol. The event was co-convened by University of Bristol's Centre for Black Humanities and the Epistemic Injustice in Healthcare (EPIC) Project with support from Good Guys Productions. Below you can read a discussion about the film and the premiere with one of the film's producers, Lorne Guy.

What is the film about?

The Unequal Pandemic delves below the sensational headlines around the Covid-19 pandemic to reveal the tragic family stories of how we were not all in it together.

The film charts how the pandemic swept across the UK and why exactly it was far more deadly for people in lower socio-economic areas, for ethnic minorities and for the disabled. It examines how the North-South divide was clearly highlighted and how front-line NHS doctors, deeply affected by what they witnessed, experienced ‘war like’ trauma which is still not spoken about.

Startling evidence from Prof Sir Michael Marmot and other world leading public health figures gives a clear picture of how wider societal and historical political choices led to the outcome of the UK having one of the worst pandemic death rates among European countries.

Our goal was to get the film's message directly out to those around the country who feel their voice is not being heard. We also wanted to initiate a live dialogue about deep-seated inequalities in the UK today which preceded the pandemic. For instance, from 2011-2018, the UK's life expectancy improvement was the lowest among all other rich or OECD countries apart from Iceland and the USA. Life expectancy was beginning to fall in deprived areas, which hadn’t happened since the second world war.

If you were from an ethnic minority like Black African, Black Caribbean, Indian, Bangladeshi, Pakistani you were far more likely (2, 3 sometimes 4 times) to die than your white counterpart. This is not the reason, it’s a whole raft of reasons that we explore in the film. For instance, in the film, Francesca's mum was poor and disabled and it seems clear that she died as a result of years of inequality. Similarly, Lobby Akkinola lost his Dad Femi, who was a key worker. He died at home before any help could get to him.

How did the film come about?

We were approached by MP Debbie Abrahams, who has a background in public health. She wanted to collaborate on a film around inequality and the pandemic. There was a concern that the Covid-19 Public Inquiry would not sufficiently account for how inequalities before the pandemic impacted people. For instance, how people on low incomes, ethnic minority communities, people with disabilities, and people in the North of England were disproportionately affected.

How was the premiere?

We saw a diverse audience made up of local Bristol groups organisations, activists, academics, journalists as well as affected individuals from as far away as Abergavenny, Wales. The film was introduced by the filmmakers and Dr Josie Gill (University of Bristol).

Following the screening of the 25-minute long film, a panel and audience Q&A took place. The panel was chaired by Dr Connor Ryan (University of Bristol), and the panel participants were Prof Havi Carel (ProjectEPIC Principal Investigator), Huda Hajinur (Caafi Health), and Dr Habib Naqvi MBE (Director, NHS Race and Health Observatory).

An engaging one-hour discussion and audience Q&A followed the screening. Some salient themes in the discussion were how, despite the fact that successful local action was often taken, it was often ignored or interrupted by government and how historical system failures led to community mistrust and exacerbated inequality. Dr Habib Naqvi highlighted and expanded on a quote within the film around the ‘causes of the causes’ of race inequality and disproportionate death toll for certain communities as a result.

The film has also been screened in Parliament. How was that?

The first screening of the film was at Parliament at the end of 2023 followed by an amazing panel discussion including Prof Sir Micheal Marmot, Prof Clare Bambra and Lobby Akinnola.

The reaction was incredible. It was an emotional event but also uplifting.

As a result, there was a demand to show the film wider so we then set out on a UK free screening tour in Preston, York, Newcastle, Liverpool and Manchester. These last two were supported and introduced by Mayor Steve Rotherham and Mayor Andy Burnham. We have just screened in Bristol, and will end with a London screening on June 25th, organised by UCL and the Covid 19 Bereaved Families for Justice.

Some reactions to the first parliament screening:

“A powerful film highlighting the deeply entrenched inequalities in society and how much needs to change to improve the health and resilience of our nation.” Kim Leadbeater, MP

“A heart-rending and sobering gem of a film… The powerful commentary by families and public health experts will live long in the memory.” Ian Byrne, MP

“It was an honour to be at this screening last night and hear from Lobby Akinnola and others share their experiences. Hopefully this gets picked up.” Prof Aaron Reeves

“The film left me as it did others very emotional” Alex Cunningham, MP