Epistemic injustice and diagnostic approaches to mental ill-health

Epistemic injustice is evident in a plethora of contexts, some institutional, for which the discourse of hermeneutical injustice offers a helpful frame by way of its negotiation of meaning. Examples could include different treatments administered by healthcare institutions that unfortunately limit a patient’s voice and visibility. Other instances are well-trodden in the literature and media, and remain ever present, including gender and race issues, as presented by wide-ranging movements like Black Lives Matter and #MeToo.

A megaphone

Some examples of epistemic injustice are close to home and, sometimes, in the home. Relationships that once thrived can fracture when under sufficient pressure, whether between intimates, blood relations or in-laws, or something more general like the bonds between friends and other associates. In the throes of such breaks, testimonial injustice might be at work, concerned as this is with semiotic ruptures in spoken utterances that displace kindly intentions and good will. 

Where relational intimacy intersects with discourses that organise bonding experiences, for example, some kinds of religion and politics, the distinctions between hermeneutical and testimonial injustices are difficult to identify. The cliché that what is today’s deviance becomes tomorrow’s norm is continually challenged by the vicissitudes of lived experience that make possible the very identification of deviancy and normativity. The making of necessary interventions is, in this regard, highly problematic and, when it occurs in its zenith form, an achievement.

In 2021 my Master by Research dissertation, which explored some of these questions, was accepted in the University of Wales Trinity Saint David. My thesis, titled Diagnosis, misdiagnosis, and becoming better: An investigation into epistemic injustice and mental health, focused on diagnostic issues in the treatment of mental ill-health. Its main focus was to contextualise observations sometimes termed “empirical” by considering some of the existential contexts that experients of mental health treatment might find themselves in.

It is naturally the case that in an acute state, the solutions common to the biomedical model of mental ill-health are readily reached for. If a person suffers a psychotic breakdown then administering an antipsychotic drug could be a profoundly helpful and practical way of relieving distress. But there are many social domains that circumscribe, penetrate and, in turn, shape an individual’s diverse experiences of society. As well as religion, family, politics and the State, they could also include the stories we tell that frame those very societal categories. Psychoanalysis, literature, film and sociology are a handful of subject-disciplines that present telling-truth and telling-detail by offering “ways forward and out” of profoundly difficult moments in the life-course. My belief is that any line of enquiry that enables an experient to learn constructively and “re-find their feet”, so-to-speak, is both directive and instructive.

Antipsychotic medication

Concerned as it is with the mind as an aspect of embodiment that is organising as much as organised my research explores modes of being-and-becoming. In this regard, I am interested in two broad areas of exploration: first the clinical tools that enable a growth mind-set, whether employed by experients or physicians. Second, I lay out some of the general principles that might categorise those tools as philosophically resonant. They could be of a testimonial variety by highlighting signs and symbolic structures generative of psychosocial capacitation. 

Other, hermeneutical kinds may point to the diverse social movements that can lead an experient out of different forms of fog and miasma commonplace in contested diagnoses and misdiagnoses. In showing the presence and gravity of an epistemic injustice, there is laid the groundwork for a theoretical space where the experient can incrementally attain functionality. They may find ways of learning that which they themselves need vitally such that self-understanding becomes a real possibility. They might even encounter levels of personal, interpersonal and social responsivity expressive of epistemic justice and accountability.

Martyn Sampson

Martyn Sampson is an independent researcher of the philosophy of psychiatry and mental health. He is presently working on an extended project on stigma and phenomenology in regard to different psychiatric conditions.