A Feedback Loop between Testimonial and Hermeneutical Injustice

‘Epistemic injustice’ picks out a distinctive kind of harm inflicted upon somebody in their capacity as a knower. Miranda Fricker (2007) famously distinguished two subtypes of epistemic injustice, i.e. testimonial injustice and hermeneutical injustice. 

Testimonial injustice is primarily a matter of credibility deficit. Paradigmatically, a speaker incurs testimonial injustice when they are given less credibility than they deserve due to identity prejudice in the hearer. Hermeneutical injustice is, by contrast, a matter of unintelligibility. 

A speaker incurs hermeneutical injustice when, owing to the substantive exclusion of one’s reference social group from the production of collective hermeneutical resources, there are no shared concepts they can make use of to understand their own experiences and/or make those experiences intelligible to others. 

Harassment

In an article published in Rivista di filosofia, we provide an opinionated survey of the major debates surrounding epistemic injustice, and argue that testimonial injustice and hermeneutical injustice reinforce each other in a feedback loop that hasn’t been fully unpacked so far -- but see Medina (2012), McKinnon (2017), and Lagewaard (2020). Here we offer a glimpse of this loop, starting from how testimonial injustice may feed off hermeneutical injustice.

As already mentioned, hermeneutical injustice typically stems from what Fricker (2007: 152) calls hermeneutical marginalization, i.e. (i) the systematic exclusion of certain groups from, or (ii) their merely formal inclusion in, meaning-making practices. Oppressed groups have historically been denied equal hermeneutical participation in both senses (i) and (ii), and this can be partly (although not exclusively) explained by appealing to the operations of testimonial injustice. When a group is negatively stereotyped in certain domains, it is no wonder that its members tend not to be asked to participate in communicative practices and hermeneutical activities related to those domains. This tendency gives rise to preemptive testimonial injustice (Fricker 2007: 130). 

We claim that preemptive testimonial injustice may fuel hermeneutical marginalization in sense (i): the long exclusion of women from institutional sources of collective meanings such as higher education and academia may be partly explained in this way. More standard forms of testimonial injustice, where a speaker’s testimony is heard but not given due weight, may contribute to hermeneutical marginalization in sense (ii).

As we all well know, women had to fight an unfinished battle after getting access to academia in order for their voices to be given equal hearing and weight – owing, in part, to the persistence of biases affecting women’s epistemic standing.

To close the loop, hermeneutical injustice must feed off testimonial injustice. We maintain that this is perfectly plausible. Consider Carmita Wood’s case (Fricker 2007: 149-50). Living in a time when the concept of sexual harassment had not yet been crafted, Wood was unable to fully make sense of what she was going through, and a fortiori to communicate it clearly to others. Wood was a victim of hermeneutical injustice. But this is not it. We argue that, because of this, she was also very likely a victim of testimonial injustices. 

After all, there is a strong chance that some hearers assigned a credibility deficit to her due to the inevitably unfit concepts she made use of (e.g. flirting) when telling them about her experience and state of anxiety. If this in fact happened, what would otherwise have been received as testimony against discriminatory treatment, ended up sounding, at least to some hearers, as a confused outburst. 

The hermeneutical injustice perpetrated against Wood ‘spilled over’, making her testimony not only scarcely intelligible but also less credible than it would otherwise have been. Importantly, these instances of testimonial injustice may not have had their roots in prejudice against (people like) Carmita but may be entirely explained by the hermeneutical injustice women were suffering at the time.

Laura Caponetto (University of Milan, Cambridge University) is a philosopher specialising in philosophy of language, feminist philosophy, and social philosophy. Laura is the author of "Undoing things with words", published in Synthese in 2020. 

Tommaso Piazza (University of Pavia) is a philosopher specialising in epistemology and the philosophy of language. Tommaso is the author of "The Value of Truth and the Normativity of Evidence", published in Synthese in 2021.

Epistemic Injustice in Diagnosis

In this post Lisa Bortolotti interviews Anke Bueter (principal investigator) and Thor Hennelund Nielsen (post-doctoral researcher) on their exciting project, “Epistemic Injustice in Diagnosis” (January 2024 – December 2025) funded by a Starting Grant of the Aarhus University Research Foundation. 

Aarhus University, credit Lars Kruse / AU Foto

Lisa: How did you become interested in this project?

Anke: This project brings together my research interests in feminist epistemology and the philosophy of medicine and psychiatry.  It focuses specifically on diagnosis, as diagnosis is both a prerequisite of successful medical treatments and susceptible to pathocentric epistemic injustices. I wanted to further explore this area after working on the phenomenon of diagnostic overshadowing, in which a previous psychiatric diagnosis leads to diagnostic delays or missed diagnoses regarding somatic diseases (Bueter 2023).

Thor: Diagnostic practices in both somatic medicine and psychiatry – their internal reasonings and capacities to change peoples’ lives for better or worse – have always interested me academically and personally. I’ve been very fortunate that this project allows me to fulfil this interest through investigating the topic of overdiagnosis.

Lisa: What are your objectives and why do you think it is important to achieve them?

Anke: My primary interest lies in avoidable diagnostic errors, which are estimated to affect 10-20% of all medical cases. The project seeks to rethink diagnosis as an (ideally) collaborative epistemic process and to explore how epistemic injustices can hinder this process. For example, I am currently examining gender biases in psychiatric diagnostic criteria, as well as the important role of trust between patients and clinicians.

Thor: Studies within the field have tended to focus on either epistemic injustices of/leading to under- or misdiagnosis but haven’t paid particularly close attention to overdiagnosis, though the epistemic harms of the latter may be equally serious. I want to show that overdiagnosis is not just a problem in terms of iatrogenic harms or lost opportunity costs but also because it fundamentally affects the overdiagnosed patient’s ability to understand themselves and be understood by others.

Lisa: Does your project involve interdisciplinary or crossdisciplinary work? If so, what disciplines are involved?

Thor: The issue of overdiagnosis is crossdisciplinary at heart. The problem itself derives from medicine but is often studied through sociological methods and additionally calls for philosophical scrutiny to elucidate the concepts themselves and the injustices they may create.

Lisa: What do you expect will be the impact of your project, within philosophy and beyond it?

Anke: A better understanding of how epistemic injustice affects diagnosis, and of the mechanisms behind these issues, is a crucial first step toward mitigation. Beyond contributing to the philosophical discussion, we aim to raise awareness among the public and medical professionals about the need for epistemic justice in health care.

Thor: The ambition is to put overdiagnosis on the map within the epistemic injustice in healthcare discussion, and, conversely, open the concept of epistemic injustice to the medical debate on overdiagnosis. Hopefully this contributes to reducing the epistemic harms of overdiagnosis in the “real world” in the long run.

Anke Bueter is Associate Professor of Philosophy in the School of Culture and Society, Aarhus University. Anke is the author of Feminist Philosophy of Science (Cambridge University Press, 2024).

Thor Hennelund Nielsen is postdoctoral researcher in the School of Culture and Society, Aarhus University. Thor is the author of "The Dynamics of Disease: Toward a Processual Theory of Health", an article published in the Journal of Medicine and Philosophy in 2024.