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.