Unusual Experiences and Beliefs

For Mental Health Awareness Week 2025, project EPIC organised a webinar focusing on the harms caused by negative stereotypes associated with people who have unusual experiences and beliefs. Panelists included Martino Belvederi Murri and Fiona Malpass. The event was supported by The Royal Institute of Philosophy and the Voice Collective.

Poster of the webinar

Martino is Associate Professor at the Institute of Psychiatry and Director of the School of Specialization in Psychiatry, working as a clinical psychiatrist in the Acute Psychiatric Inpatient Unit. His research integrates clinical psychiatry with advanced statistical modelling and computational psychiatry, focusing on late-life depression, early psychosis, and psychosomatics. He has a specific interest in depression phenotyping, demoralization, psychosis outcomes, physical activity interventions, cognitive factors, cannabis use.

First slide of Martino's presentation

Fiona works at Mind in Camden as the Project Development and Innovation Lead, which includes managing the Hearing Voices Projects, working with young people, prisons, forensic settings and immigration removal centres, and the London Hearing Voices network. They have a background in psychology and philosophy of mental health, as well as having personal experience of many forms of distress, including hearing voices. They use this in their work to build connections, as well as to challenge the status quo and provide provocations to ways of thinking and working.

What good support looks like
from Fiona's presentation

Both Martino and Fiona discussed whether the notion of epistemic injustice can be usefully applied to the situation of people who experience non-consensual reality, and reflected on the challenges that practices in healthcare and everyday prejudices in friends, family, teachers, and doctors may present for young people who hear voices.

The problem, according to Martino, emerges because we tend to think that if a person is suffering from a psychotic disorder or is experiencing a psychotic episode, then they are not able to judge any aspect of reality. That's a that is an unnecessary and wrong generalization. We see all the time that even when a person has a persecutory experience, they often are able to judge many, many situations. 

The job of the psychiatrist is not to assign a label of normality to people, but to help them by not increasing their suffering, relieving the harms, and reducing the risks. The most difficult challenge is to support a person in a moment of crisis, which might require depriving them for a certain time of their liberty, without negatively affecting their self-perception and their sense of dignity. Even in an involuntary admission, if possible, the person must be involved in decisions concerning their care. A humane care ultimately means respect and mutual understanding.

Forms of testimonial injustice in psychosis
from Martino's presentation

Martino concluded his presentation by discussing the existence of a paradox: although there is increasing attention to ethical and philosophical issues, there are reduced resources. Whereas healthcare professionals aim to do better, they have fewer resources at their disposal to improve care. 

Fiona talked about kind of work they do at the Voice Collective, which is based at London, Camden, but also about the collaboration with the EPIC project, thinking about agency and epistemic injustice, as it relates to young people who hear voices, or have other unusual perceptions or beliefs.

The Voice Collective works across London and the UK more broadly but has also an international reach. The bulk of the work is to support people under the age of 26, and their families, carers and supporters, with an emphasis on young people who have highly stigmatized and potentially overwhelming and distressing experiences. These experiences can be hearing voices, seeing things, tasting things, smelling things, having felt presences, having multiple senses of self, forms of dissociation, paranoia, the list goes on. 

The Voice Collective is established to provide more community grassroots care, coming from a non-clinical, non-pathologizing community perspective and adopting a pluralistic approach where many factors may be considered as relevant to people's experiences.

Factors contributing to distressing experiences 
from Fiona's presentation

They establish peer support groups for young people who have these experiences: one online group for 11 to 15 year olds; and a peer support group for an older age group, 16 to 25 year olds. Young people chat to each other, ask each other questions, and just offer solidarity and friendship to each other. Another activity is to set up advisory groups for research projects or steering groups for service development, because a big part of the Voice Collective approach is trying to help young people be heard and be listened to and have input into things to push back against the epistemic injustice that they face. The aim is to create spaces where young people's knowledge is valued.

Young people are often seen as incapable. There's often an emphasis on young people who hear voices being powerless. Their experiences are often framed as a deficit and part of a severe mental health issue. For some people voices can be massively distressing and overwhelming, but there are times where voices are helpful. Some people have very positive experiences of their voices, and neutral ones, too. So it is difficult for young people who have these less stereotyped versions of voices to talk about them for fear of their voices being seen as something inherently wrong, and an issue with them, and with how they experience the world. The healthcare system can be a very oppressive system to be part of where young people often experience a lot of coercion going along with whatever treatment pathway is recommended to them.

If you want to listen to the full presentations by Martino and Fiona, and follow the question and answer session that followed, watch the recording of the webinar below and let us know what you think.

Hermeneutical Disarmament

Hermeneutical Disarmament: How language change can undermine understanding and communication

Words and phrases enable us to understand the world and our experiences. In Epistemic Injustice, Miranda Fricker reports Wendy Sanford’s experience of depression following the birth of her child in the 1960s. Without a word to name her experience, Sanford thought that she was guilty of a “personal deficiency”. Upon learning the term postpartum depression at a workshop, Sanford’s perspective radically changed; she recognised what she was going through as a medical condition.

Changing meanings

However, words and phrases often change their meaning. Gaslighting refers to a kind of abuse in which one person causes another to doubt their own experiences. In Patrick Hamilton’s 1938 play Gas Light, Jack persuades his wife Bella that she cannot trust her perception or memory; when he takes a painting down from the wall and dims the gas lights, Jack convinces Bella that she is imagining these changes, giving him control over her. More recently, however, gaslighting is used to refer generally to lying or manipulating.

Taking these observations together reveals a problem. Words and phrases help us to understand and communicate about the world and our experiences of it. But the meaning of these words and phrases can change. When this happens, we might lose the words that we need to understand or communicate about whatever it is we want to understand or communicate about. I call this hermeneutical disarmament.

Hermeneutical disarmament

Hermeneutical disarmament: “the process by which a person is rendered less able to understand or communicate experiences, ideas, and other phenomena as a result of semantic change to the linguistic term (word or phrase) that could previously have been deployed for these purposes.” (Morgan 2025: 1076)

When the words we use change their meaning, this can leave us less able to understand and communicate about the original meaning of these words. It is clearly useful for victims of abusive manipulation (and their support network) to have a widely understood term, gaslighting, for this specific kind of psychological abuse. It helps them to understand what the victim is going through, aid existing victims, and reduce the likelihood of future victimisation. If this term disappears, because gaslighting comes to mean simply lying, then a useful tool is lost.

Words naming medical conditions can be similarly useful tools. Without the term postpartum depression, Sanford might have been unable to access relevant support and continued, mistakenly, to view her condition as a person failing.

In other cases, there is a risk that the misuse of medical terms might lead to changes in their meaning, depriving us of useful terminology. Some speakers use OCD (obsessive-compulsive disorder) to describe a particular care for cleanliness or organisation (“My flatmate is driving me crazy; she’s so OCD!”), rather than obsessions and compulsive behaviours that would warrant clinical intervention. Someone might say that they are depressed when they are feeling sad, even when they do not suffer from the often-debilitating psychological condition by this name.

When used literally, these terms serve as useful tools for people experiencing the relevant condition and those around them. They enable a person to understand what they are going through (just as postpartum depression assisted Wendy Sanford), explain this to others, and secure relevant accommodations in work and education. 

When these terms are (mis-)used to refer to something other than the medical condition in question, there is the risk that, over time, these alternative meanings might dominate, so that we lose generally understood phrases for the medical conditions. This would deprive people who suffer from these conditions and those around them of a useful tool for understanding and communicating. So, there is a risk that changes to the meaning of medical terms might inflict hermeneutical disarmament on those who experience these conditions.

Photo credit: Dustin Smith, Skywall Photography

Robert Morgan is a Lecturer and Consultant at IDEA: The Ethics Centre, University of Leeds, teaching mostly at the SWJTU-Leeds Joint School in Chengdu and at Centres for Doctoral Training around the UK. Robert’s research primarily focuses on applied sexual ethics, although he also works on topics in epistemology and metaphysics as these bear on how persons relate to each other. He is currently working on what it means for one person to touch another through something such as clothing (with Will Hornett), and on the value of interpersonal sexual activity.

 

Hermeneutical Sabotage

In today's post, Han Edgoose develops a concept of hermeneutical sabotage by engaging with the predicaments of transpeople in the UK.

As Nick Clanchy has said in a previous post on this blog, it is a scary time to be a trans person living in the UK right now. An April 2025 UK Supreme Court ruling, which defined ‘sex’ for the purposes of the Equality Act (the UK’s major piece of equalities legislation) as ‘biological sex’, has been interpreted by the Equality and Human Rights Commission (EHRC), the public body in charge of enforcing equalities legislation in the UK, as a trans bathroom ban. 

The EHRC’s interim guidance on the Supreme Court ruling not only bans trans people from using toilets and other single-sex spaces and services such as changing rooms and hospital wards that align with their identity, it also allows for them to be excluded from single-sex spaces that align with their sex assigned at birth. By severely restricting trans people’s ability to access toilets this ruling limits trans people’s ability to exist in public spaces and workplaces. 

It also curtails trans people’s ability to ensure their own health and wellbeing by restricting their access to domestic violence shelters and healthcare, and their ability to participate in sports. Shockingly, the Supreme Court judges claimed that this ruling ‘does not cause disadvantage to trans people’. 

The injustice caused by the Supreme Court ruling is not primarily epistemic. However, epistemic injustice is often a contributory factor to other injustices, and it is in this case. There are multiple ways in which the Supreme Court ruling could be understood to be committing epistemic injustice, but I’m just going to focus on one aspect of the ruling: its re-definition of the term ‘lesbian’, which, I argue, amounts to hermeneutical sabotage. 

Hermeneutical sabotage

In a paper published in the Australasian Journal of Philosophy last year, I argued that a form of epistemic injustice I name ‘hermeneutical sabotage’ is used as a tactic by harmful political movements to help them achieve their exclusionary and oppressive goals. Hermeneutical sabotage occurs (roughly) when the widely available conceptual resources for understanding the identity or experience of a marginalised group are actively worsened. 

This can be done in multiple ways, including by introducing new, prejudiced hermeneutical resources and distorting resistant hermeneutical resources developed by marginalised groups. Another way in which hermeneutical sabotage can occur is when particularly powerful people change the meaning of well-established terms, distorting the available hermeneutical resources. This is the type of hermeneutical sabotage that the Supreme Court Committed in their judgement on the term ‘lesbian’.

Hermeneutical sabotage and the definition of 'lesbian'

The Supreme Court ruling embraces the hermeneutical sabotage of the term ‘lesbian’ by accepting a definition of ‘lesbian’ that excludes all lesbian trans women, as well as lesbian cis women who are attracted to all women including trans women. 

According to the Supreme Court ruling, a lesbian is defined as a ‘female who is sexually attracted towards… other females’, (where ‘female’ is understood to refer to ‘biological sex’). This trans exclusionary view of lesbianism was embraced despite the fact that the vast majority of cisgender lesbians in the UK are supportive of trans people, and inhibits the ability of trans lesbians, as well as trans inclusive cis lesbians, to communicate an important aspect of their identity. 

This is a particularly powerful case of hermeneutical sabotage as the ruling encodes the sabotaged meaning of the term into the law. The Equality Act allows those who share a protected characteristic to organise groups and clubs that only include people who share that characteristic and exclude those who don’t. 

Excluding people on the basis of one of the protected characteristics outlined in the Equality Act is otherwise illegal. By defining lesbian in a trans exclusionary way membership clubs that include people who share the protected characteristic of ‘lesbian’ can now only include or exclude people on the basis of the sabotaged definition provided by the Supreme Court. This means that it appears to no longer be legal for a lesbian organisation in the UK to include trans lesbians or cis lesbians who are attracted to trans women. 

The hermeneutical sabotage of the term ‘lesbian’ is an epistemic injustice which inhibits the ability of trans and trans inclusive lesbians to use the word ‘lesbian’ to communicate their experiences effectively. The Supreme Court ruling not only intensifies this epistemic injustice by legally encoding the sabotaged meaning of the term ‘lesbian’, it also enacts further injustices as a consequence of this epistemic injustice that limit trans and trans inclusive lesbians’ ability to meet in organised groups and clubs, showing the clear connection between epistemic injustice and further non-epistemic injustices. 

Author bio

Han Edgoose is a lecturer at the University of Glasgow, where they also completed their PhD. They are a feminist philosopher whose research is focused on the contemporary 'trans panic' in the UK, and broader patterns of injustice and oppression. Their paper 'Hermeneutical Sabotage' is published in the Australasian Journal of Philosophy.

A Defence of the Epistemic Nature of Episodic Memory

According to a traditional view, memory capacities are epistemic in nature: they function to afford knowledge of the past. In the case of episodic memory (henceforth “EM”), the relevant knowledge is of particular events in the personal past. 

Recently, however, the philosophy of EM has witnessed a “non-epistemic” turn: critics of the traditional view claim that while EM has epistemic features, it isn’t essentially in the business of affording knowledge of particular events from the personal past (see e.g., a, b, c, d, e, f, g, h, i, j, k, l,). 

Against episodic memory as epistemic

Our paper considers three empirically motivated arguments against the traditional view: (1) “the argument from construction” appeals to evidence that the contents of EM are constructed rather than stored; (2) “the argument from error” appeals to evidence that EM is highly error-prone; and, finally, (3) “the argument from animals” appeals to evidence that some nonhuman animals can episodically remember. 

Responses

Against (1), we argue that EM’s constructive nature is consistent with its functioning to afford knowledge. Indeed, it’s doing so provides a plausible, straightforward basis for functions ascribed to it by critics in light of its being constructive (e.g., contributing to planning and future action, social cohesion, and/or an enduring sense of self over time). 

Against (2), we argue that studies of memory error (e.g., m, n, o) fail to show that EM lacks an essentially epistemic function. In fact, such studies identify errors as failures to afford non-accidental knowledge of particular events from the personal past. 

Against (3), we question whether ascriptions of EM to nonhuman animals in cognitive ethology (e.g., p, q, r, s) should be accepted at face value. But even if nonhuman animals possess a species of EM, we argue that humans plausibly possess a distinct species of EM. 

Finally, our paper responds to the concern that if EM has an essentially epistemic function, “disjunctivism”—the view that nonveridical memories aren’t really memories at all—follows, where disjunctivism is thought to be inconsistent with empirical practice. We show that disjunctivism (so understood) does not in fact follow from a view that understands EM as an epistemic capacity. 

Avoiding epistemic injustice

We develop our positive account of EM as an epistemic capacity in other work and use it to respond to  “analytic” arguments against the traditional views, i.e., arguments which rest on thought experiments rather than interpretations of empirical findings. 

One of the advantages of our account of EM is that it adopts a “social critical” approach to EM. Where rejecting the essentially epistemic nature of EM risks giving up the explanatory resources required to illuminate certain forms of gaslighting (or so our in-progress essay argues), our view is designed to illuminate ways in which episodic memory is implicated in gaslighting and other forms of epistemic injustice. 

For instance, by recognizing that epistemic capacities have diverse “modes of manifesting,” our view helps diagnose a key error in what we call the “Traumatic Untrustworthiness Argument” or “TUA.” According to the TUA, experiencing trauma negatively impacts the formation, consolidation, and recall of episodic memories of a traumatic event to such an extent that it is best not to trust testimony based on such memories. 

Among the TUA’s various weaknesses, we argue, is that it hastily infers the absence of a victim’s capacity to reliably episodically remember her trauma. This inference isn’t licensed, for, as we argue, a better hypothesis is that traumatic experience simply modifies a victim’s mode of manifesting her capacity to episodically remember her trauma.

Professor Alison Springle is Assistant Professor of Philosophy at the University of Miami (FL). She works on topics in the metaphysics, epistemology, and philosophy of science of memory, perception, and action. She’s currently working on a monograph which develops a novel account of mental representation.

Dr. Seth Goldwasser is a lecturer at the University of Miami. Seth’s research focuses primarily on skillful mental action with an emphasis on skillful remembering and imagining. He has also written on the ascription of normal-proper functions in cancer biology and on the epistemic status of traumatic memories.

Episodicity, Mental Illness and Epistemic Injustice

In today's post, Dr Sally Latham summarises for us a chapter in her recently defended PhD thesis on narratives of the self, mental illness and epistemic injustice:

Self-narratives, especially in illness, have become a social expectation. However the assumption that being narrative is the normal, psychologically healthy human condition, and regarding non-narrative experience as somehow deficient, risks epistemic injustice.

I identify several forms of philosophical narrativism, the position that self-narratives are necessary for some individual good. One of these positions is metaphysical narrativism, the view that having self-narratives is necessary for an individual to have personal identity (for example see Antony Rudd and Marya Schechtman). I argue that metaphysical narrativism underpins the psychological position that not being narrative is symptomatic of mental illness.

Episodic Experience 

Galen Strawson first introduced the concept of episodicity, when rejecting what he calls Psychological Narrativity, which is the empirical claim ‘that human beings typically see or live or experience their lives as a narrative or story of some sort, or at least as a collection of stories’.

Strawson makes a distinction between an episodic and diachronic sense of self. A diachronic self-experience is an experience of oneself as ‘something that has relatively long-term diachronic continuity, something that persists over a long stretch of time, perhaps for life’. An episodic, in contrast ‘has little or no sense that the self that one is was there in the (further) past and will be there in the (further) future, although one is perfectly well aware that one has long-term continuity considered as a whole human being.’ Strawson counts himself amongst episodics, and claims others include Bob Dylan, Iris Murdoch and AJ Ayer. Importantly, as episodics lack an extended sense of self, they will not be narrative, meaning they will not experience events narratively, or understand them as part of an extended life-story.

The existence of non-pathological episodics with personal identity, as Strawson claims he has, undermines metaphysical narrativism.

Counterargument to Strawson: Episodicity as Pathological 

In response, Mackenzie and Poltera (2010) argue that a truly episodic experience is always harmful, and precludes personal identity. They refer to the biography of Elyn Saks, The Centre Cannot Hold, in which she documents her struggles with a lack of identity and with alienation when suffering with schizophrenia. Her experience is one of randomness and disorder, rather than temporality and unity, and lacks a concept of ‘me’.

MacKenzie and Poltera claim that ‘this theme resonates with narrative approaches to identity’ and that Strawson’s own experience is not genuinely episodic. Rather, ‘the case of Saks shows what genuinely episodic self-experience is like and why it is identity-undermining’.

Episodicity and Epistemic Injustice

This dismissal of accounts of non-pathological episodicity can be understood as either testimonial or hermeneutical injustice. Testimonial injustice occurs when prejudice causes a hearer to give a deflated level of credibility to a speaker’s word, with prejudice in the economy of credibility (Fricker 2007). It is assumed that the episodic experience of self precludes personal identity, and must be pathological. Therefore the testimony of an episodic claiming personal identity and no mental distress is dismissed as being wrong about either their episodicity or their personal identity and mental wellbeing.

The irony is that narrative movement in healthcare aims to give the ill a voice. Yet here a testimony is dismissed as inauthentic because it has been predefined as impossible. The episodic faces a catch-22: if you are really an episodic, this is pathological and you do not have personal identity, but if you are mentally well and have personal identity you are not really an episodic. Either Mackenzie and Poltera are claiming that Strawson is fundamentally mistaken about his own experience, or they are redefining episodicity as identity-undermining, which begs the question.

This situation could also reveal hermeneutical injustice, which occurs at a prior stage, when a gap in collective resources puts someone at an unfair disadvantage when it comes to making sense of their social experiences. Narrativism is so dominant that we have failed to develop the resources for understanding non-narrative, episodic accounts of experience and identity as coherent and non-pathological. Many episodics are operating without Strawson’s hermeneutical toolbox for understanding episodic experience. In narratively dominant environments their experiences are not comprehended, leaving them misunderstood by others and even themselves.

Unless we recognise different experiences of the self (or lack thereof) as the starting point for approaching mental wellbeing, we risk seeing episodicity as illness instead of thinking about what episodic wellbeing and illness might look like, and this could have far-reaching and damaging implications.

Sally Latham is a Visiting Academic at the Open University and Research Assistant at the University of Birmingham. She recently defended her thesis in which she argues against the dominant narrative approach to mental illness, arguing that in many cases a non-narrative, Buddhist-inspired approach is preferable.

Stigma, Diagnosis, and Identity

This post is by Aneela Khan.

Unusual experiences

In a recent paper co-authored with Lisa Bortolotti, Andrew Fox, and Matthew Broome, forthcoming in Journal of Medicine and Philosophy, I explore how the stigma associated with a diagnosis of psychosis can result in epistemic injustice, wrongs done to someone specifically in their capacity as a knower. Drawing on findings from the Epistemic Injustice and Psychosis (EIP) study, I highlight how both testimonial and hermeneutical forms of epistemic injustice arise in clinical encounters and in people’s wider social worlds.

The study involved interviews with people diagnosed with schizophrenia spectrum disorders (clinical participants) and people who had unusual experiences without receiving a diagnosis (non-clinical participants). While both groups encountered stigma, it was only the clinical participants who experienced a significant loss of credibility and identity transformation as a result of being diagnosed. For many, the label of psychosis, often associated with stereotypes of dangerousness and incompetence, became a lens through which others interpreted their thoughts and behaviours, often overriding their own self-understandings.

Person having a religious experience

An example comes from two clinical participants, Anna and Zara. Both had experiences they initially interpreted through spiritual or religious frameworks. Anna felt guided by God, while Zara understood her voices as a punishment for her sins. In both cases, these meanings were overlooked or pathologised during their engagement with mental health services. Although both eventually found aspects of the medical model helpful, especially in accessing support, they also described feeling “funnelled” into a diagnostic identity that clashed with their personal beliefs and values.

I use the concept of epistemic injustice to make sense of these experiences. Testimonial injustice occurs when someone’s credibility is unfairly deflated, something that happens frequently to people with a diagnosis of psychosis. Hermeneutical injustice arises when individuals lack the social resources to make sense of what is happening to them, or when their interpretations are dismissed. This was particularly evident in how spiritual or cultural frameworks were marginalised in clinical settings.

Communication

Importantly, I found that non-clinical participants, those with unusual experiences but no diagnosis, were often able to make sense of what they were going through using personal, cultural or religious resources, and did not report the same harms to their credibility or sense of self. This comparison suggests that epistemic injustice is not caused by the experiences themselves, but by how they are framed and responded to by others.

I make several recommendations for clinical practice, including: 

• creating open epistemic spaces where patients can express alternative interpretations of their experiences, 
• supporting meaning-making; and 
• improving communication around diagnosis. 

By exploring the interplay between stigma, identity, relationships, and knowledge, we can contribute to  structural changes to reduce stigma and promote epistemic justice, not only in clinical settings, but also within families, communities, and wider society. 

The Importance of Kindness – and some great tunes

Today's post comes from EPIC's Jude Williams and it shares the experiences of members of the Choir with No Name on finding a community where they could be heard and understood.

The Choir With No Name Birmingham, Summer Spectacular 2025
St Martin’s in the Bullring, Birmingham, 19th June 2025

I’ve had the privilege of being part of the Choir with No Name Birmingham as a volunteer since 2017. And despite a couple of long absences due to health problems, I’m always welcomed back with open arms. And that’s the thing about this choir. It’s a weekly welcoming hug, for people affected by homelessness and marginalisation. Everyone is held and supported by the love and efficiency of Choir Manager Sally, the musical genius of Choir Director Pete, and a group of volunteers who cook a hot dinner for 50 and provide a friendly face and a listening ear for those who need it. 

Our members are all ages and from all walks of life, and together we raise the roof of St Martin’s Church in the Bullring, in joyous 4-part harmony. Our gigs range from homeless shelters to tv award ceremonies to recording with pop stars. If HS2 ever does get built, we’ll be the sound of the new Birmingham Curson St station clock. And although it’s the singing that we all adore, the camaraderie and the feeling of belonging, it’s the effect that choir has on individuals, in a safe place where their voices are heard, which is the most profoundly moving aspect. This choir changes lives, with a good dose of belted-out bangers along the way.

Our members have arrived at choir after years of trauma - homelessness, addiction, domestic abuse, to name but a few. Many have had countless experiences of epistemic injustice - they are resigned to not being listened to. And yet at choir, a safe non-judgmental space, members come back week after week, gaining in confidence and voice.

Gabriel, Bass brings the house down with his ‘Earth Song’ solo All Together Now

Jenny, our youngest member, joined choir nearly 2 years ago, at age 18. Living with autism and anxiety, Jenny had to leave home quickly, 2 days after her 18th birthday, moving into a flat which she sat in, alone, for 6 months. 

“When I came the first time I was really anxious but I got to like it and then love it. You can always speak to people so I got really close with Sally and it’s nice that I can sit with her and have a sing. She checks in midweek which I find quite helpful, especially when I’m having a tough week, I know she’s thinking of me. I don’t think people understand how much autism and anxiety can affect someone, especially when something in the past has happened. People might think it stays in the past, but it doesn’t, it’s like a luggage tag that you keep with you, so I find it hard some weeks cos it can just pop up out of the blue.”

It wasn’t long before Jenny was holding a mike on stage and singing solos. She’s in charge of the ‘clicker’ too, moving the screen on in rehearsal as we learn the songs off by heart. “Singing is very important in my daily routine. There’s always music on through my headphones..to try to control the background, to help with my anxiety.”

Jenny struggles with seeing healthcare professionals as she doesn’t believe they always take her needs into account. 

“I used to go to the doctors a lot when I was living with my Dad, because of my mental health, but I feel like, they didn’t really do much. They’d say ‘it’s just the situation that you’re in’, but there was more to it. I used to be referred to family services and stuff and I feel like they didn’t really understand it either, I feel like they were oblivious to it all, they misunderstood the whole situation. They let me down. Even things like a simple blood test, which could be quite easy for you. The minute I walk in that room I’m nervous and I feel like the nurses don’t take into consideration that I’m autistic. I don’t even think they read the notes, they just call you in and expect you to get on with it, and it’s not that simple.”

 

Talvin, Tenor at choir rehearsal, Spring 2025

Talvin, a gentle but vivacious singer-songwriter in his 30s, spoke to me about his experiences. Having coped with homelessness and mental health issues, he found the choir through SIFA Fireside, a Birmingham organisation offering homeless support services. 

“It was everything that I was told it was – welcoming, loving, communal, entertaining, dynamic - right up my street music wise. It helped me to elevate back to a stronger place because there were other people I got to interact with that could understand my brokenness and understand my position. Everybody from the choir has come from the streets, from brokenness, from broken marriages and they just needed time away. When I first came to choir, I saw all the mixture of people and I felt at home. The warmth, the singing, the love and eating together and I look forward to every Thursday. No matter what is going on, I feel like I’m coming to see family.”

Talvin has had good experiences with healthcare professionals, feeling lucky that he’s been aware that there is help out there. 

“For me to navigate my mental health through my traumas, I needed help and therapy has helped me a lot. I’ve had to wait a few years, but I’ve had it. Others I know have had problems with reaching a level of understanding with people who are supposed to be helping them from the mental health sector. Either just been given tablets or just not getting them and listening to them. I must say, I feel I’ve been spoiled that way, I’m getting emotional about that, because I know that’s not everyone’s experience. I love people who want to give back and I wasn’t aware that groups, like the choir existed. Had I known these groups were about, I feel that I’d have had more stability because what I’m seeking, needing, to help soothe my overwhelming mental moments, is based in these places.”

The Sopranos and Altos singing their hearts out

Each week we get to sing and laugh together, and there is an implicit understanding that as individuals, we are exactly who we are, and that’s ok. As Talvin so eloquently puts it: 

“There is such a dynamic of people here, and when we communicate and how we engage, we all somehow take that into consideration. Without even saying it. There is that understanding. It’s so unwritten, no one says anything, everyone just acts accordingly. Every week, it shows you what the world is but it comes with such an acceptance. I’ve seen people who are not necessarily getting up to sing, but they just need to be here, just need to be around something, and this ‘something’ is here. Sally’s love and sternness and keeping things together, but with all love. And Pete’s discipline in keeping the structure of our music is like a very silent hug. All of you, everyone is just amazing.”

It's humbling and a real privilege to be part of the Choir With No Name. We are a family and we hold each other up, quite literally as we hug and clap each other on the back in the middle of performances. It’s a simple idea – to sing and eat together – but it’s those simple acts, with kindness and acceptance that make such a profound difference to people’s lives. As Jenny says: 

“You might not understand autism but the thing is, you’re all very friendly and I know I can approach you, I can talk to you. Kindness is important. It’s not about being able to read the person inside out, it’s about being very understanding and kind. You don’t expect everyone to understand but everyone can be kind, kindness is a choice.”

And Talvin’s mental health has hugely improved since attending choir. 

“That consistency of coming week after week has really helped me. I know I have a place on a Thursday and it’s guaranteed, I can come. I can join in with the meal at moments when I can’t do that with my own family or any close people, and I’m yearning for it. There’s so much that pulls me back here and gives me that consistency.”

Our 2024 Member’s Survey showed that 96% of members surveyed felt that being part of the choir helped to improve their mental health. 97% had reduced their stress and /or anxiety and 100% felt a greater sense of belonging, confidence, positivity and purpose. And that is shown in bucketloads at a Choir With No Name gig – it’s a joy to behold. Come and check us out. And if you can’t make it to Birmingham, there are 6 other Choirs With No Name across the UK delivering equally brilliant results.

Jude Williams is an Alto, cooks a mean dahl for 50 and is Project Administrator for Project EPIC at the Institute of Mental Health, University of Birmingham. 

Understanding Experiences of Mood Disturbances in Depression

Anthony Fernandez answers some questions on an exciting new project, Understanding Experiences of Mood Disturbances in Depression.

Could you give us the background to the project?

Understanding Experiences of Mood Disturbances in Depression is a new project combining qualitative and philosophical methods to establish a preliminary taxonomy of mood disturbances experienced by people diagnosed with depression. It will be carried out in the Department of Psychology, University of Southern Denmark.

A one-year pilot is currently running, funded by EPICUR, The European University Alliance, and co-funded by the European Union. The pilot is carried out in collaboration with Julian Kiverstein at the Lemon Tree Center for Psychiatry, Psychotherapy and Philosophy, Department of Psychiatry, Amsterdam University Medical Center. The full four-year project is funded by Independent Research Fund Denmark. Parts of the project will be carried out in collaboration with Evan Kyzar and George Denfield at the Department of Psychiatry, Columbia University.

What do you want to investigate?

The project investigates how people diagnosed with depression experience mood disturbances during their depressive episodes. However, the aim isn’t to generate general descriptions of what it’s like to live with depression or how depression affects one’s day-to-day life. Rather, the project aims to critically interrogate common psychiatric concepts and develop more nuanced or refined concepts that better capture the variety of mood disturbances experienced by this population. 

The concept of “depressed mood”, for example, is poorly defined or not defined at all in psychiatric textbooks and diagnostic manuals. Instead, these texts tend to list a variety of affective states that are merely indicative of depressed mood, such as feeling sad, blue, despondent, empty, hopeless, or cheerless. It’s therefore unclear what a depressed mood even is, or what we mean when we say that someone has a depressed mood. By generating detailed descriptions using in-depth interviews and analyzing the transcripts with philosophical methods, we aim to revise and develop new mood-related concepts, producing a preliminary taxonomy of mood disturbance that can inform psychiatric research and clinical practice.

Why is this important?

Despite depression being one of the most common psychiatric disorders, treatments remain ineffective for many patients. One possible reason for the low response rates is that the diagnostic category of depression doesn’t capture a single disease entity. Rather, it likely captures a variety of heterogeneous conditions that, due to superficial similarities in experience and behavior, we’ve lumped under a common label. This heterogeneity is also reproduced at the level of symptoms, where a single symptom construct, such as depressed mood, may lump together states that should be disambiguated.

We aim to develop more precise concepts that capture specific mood disturbances experienced by people diagnosed with depression. These more specific concepts can then be used by researchers in other disciplines, such as clinical psychology, psychiatry, and neuroscience to determine, for instance, the prevalence of these mood disturbances, whether they correlate with treatment effects and course of illness, or even whether they correlate with biological markers. This is all work for after the project, though. Our immediate aim is to develop a preliminary taxonomy of mood disturbances.

Will the research programme be interdisciplinary?

The project is interdisciplinary through and through. My own background is in philosophy, although I’ve worked collaboratively with clinical psychologists and psychiatrists since my Ph.D. Julian Kiverstein, who’s collaborating on the pilot, has a similar background. The project also includes Martin Vestergaard Kristian, a postdoctoral researcher and clinical psychologist. He will conduct interviews using Phenomenologically Grounded Qualitative Research, an approach to qualitative study design and interviewing I co-developed with Allan Køster, also a philosopher and psychologist. Then we’ll hire on a PhD. student with a background in phenomenology and philosophy of psychiatry to help analyze the data and work on concept development. That’s the core team. But we also have two neuropsychiatrists, Evan Kyzar and George Denfield, who will help not only to develop our new mood disturbance concepts, but also make them accessible to an audience of psychiatrists and neuroscientists so we can disseminate our results in major journals in these fields.

What do you expect the impact to be?

I think the immediate impact will be more evidence that what we call major depressive disorder actually captures a diverse array of experiences and behaviors, which may be best to distinguish, both for research and clinical practice. In the longer term, I hope we’re able to identify and conceptualize mood disturbances that will eventually be shown to correlate with different course of illness or treatment outcomes, since that will have the most impact on clinical practice.

Anthony Vincent Fernandez is Associate Professor of Applied Philosophy and Theoretical Psychology at the Department of Psychology and the Department of Sports Science and Clinical Biomechanics, and a Senior Fellow of the Danish Institute for Advanced Study at University of Southern Denmark. His work focuses on the use of phenomenology in disciplines outside of philosophy, including psychiatry, nursing, anthropology, and sociology. He is co-editor of The Oxford Handbook of Phenomenological Psychopathology and co-editor-in-chief of Phenomenology and the Cognitive Sciences. He is currently writing new introduction to phenomenology, which details how researchers in the psychological, social, and health sciences, as well as in art and design, understand and use phenomenology. 

Who knows what in mental health? The conference (part two)

This is a brief report of some of the talks presented on the second day of the conference on expertise in mental health hosted by Radboud University. If you want to know what happened on day one, please check out this post.

Nijmegen

I started the programme with a talk on the relationship between epistemic injustice and expertise. One way of making sense of an expert agent is to think of them as agents who can provide evidence on the basis of which other agents form judgements and make decisions. I distinguished three ways in which we can see other agents as a source of evidence: (1) they offer an insight into their feelings and thoughts; (2) they acquired a competence by using knowledge obtained via training or education; (3) the acquired a competence by using knowledge obtained via another type of experience, such as work experience or an experience of illness. 

Slide from Lisa Bortolotti's presentation

All forms of expertise are afforded and perspectival, as they depend not only on the competence of the agent, but also the opportunity the agent has been afforded to share their perspective or reflect on their experience in the surrounding environment, and the values of the agents who seek evidence. Epistemically unjust practices can prevent agents from making an epistemic contribution as experts, offering some examples from recent research in youth mental health.

Next, work on lived experience by Owen Chevalier, Shannon Mahony, Anne Marie Gagné Julien, and Sarah Arnaud was presented in the context of anorexia nervosa. The presentation supported the epistemic argument that participatory research produces more objective, accurate, and rich knowledge about mental disorders; and offered preliminary suggestions for developing a participatory method in the philosophy of psychiatry (research needs to be collaborative, patient-directed, and interactive). By reviewing the literature on anorexia nervosa, Mahony and Chevalier provided evidence for the epistemic value of participatory research. 

Presentation on anorexia by Chevalier and Mahony

First-person accounts of anorexia highlight the epistemic tension between traditional researcher perspectives of the disorder and patient perspectives to identify areas where a participatory philosophy may be useful in resolving conflict. However, one concern was raised: philosophers, who often advocates for participatory research in psychiatry, have yet to adopt participatory methodology in philosophy as well.

The topic of anorexia was also discussed by Stephen Gadsby who focused on what it might mean to identify as anorexic. Questions about self-identification might change across time: initially a person may identify as someone who values and pursues thinness and only later they may see themselves as someone who has anorexia. Occasionally, in biographies about living with anorexia, the illness is separated by the self and personified. Maybe conflicts of identity are prompted by the illness itself. But this turns out to be also a treatment strategy, where users of service are encouraged to see their illness as distinct from the self ("There is the anorexia inside me and then there is the real me, the logical part of me").

Stephen Gadsby on first person accounts of anorexia

So one issue is how to interpret these reports. And this becomes a problem when lived experience advisors participate in research as there is self-selection: it is more likely that participation is offered when the person sees themselves as an anorexic and a person with a mental illness. People who don't see their condition as an illness or do not accept the way anorexia is framed in healthcare are less willing to participate in research which leaves us with skewed evidence. It is difficult to solve this problem and participatory research may be the way forward.

The last talk of the day (and of the conference) was by Ian James Kidd. The research question was what role epistemic injustice should have in efforts to understand negative epistemic experiences typical of depression. Kidd decided to focus on hermeneutical injustice which can be described as a lack of hermeneutical resources, an absence of apt resources, the presence of of inapt resources, and a lack of uptake. Sometimes, the resources don't exist. At other times, there are no good institutional or interpersonal places where the hermeneutic game can be played. Hermeneutical injustice can be extended or limited in breadth or depth.

Ian James Kidd

Depression experiences present hermeneutical disruption but should those be characterised in terms of hermeneutical injustice? Some of the hermeneutical frustration and inability related to depression might be integral to certain kinds of human experience and not cases of injustice as such. For phenomenologists, experience is a space for possibilities which for people with depression is altered so that possibilities and kinds of significance are reduced and the world becomes flat and empty. Depression might come with loss of self-esteem and epistemic self-trust, diminished positive epistemic emotion, and loss of aspirational hope. Standard epistemic injustice models do not accommodate these existential changes, this (as Kidd put it) "phenomenological drama".

The second day of the conference was as stimulating and varied as the first, and it inspired interesting conversations about future research goals and collaborations.

Who knows what in mental health? The conference (part one)

Radboud University hosted a conference on 11th and 12th June 2025 examining the interplay between the study of epistemic injustice and the debates on expertise by experience in mental healthcare. This is a brief report of some of the talks presented on the first day of the conference.

From the poster of the event

Roy Dings (one of the organisers together with Linde van Schuppen and Derek Strijbos) kicked off the event with a brief introduction to the motivation for a more in-depth analysis of experiential knowledge.

Roy Dings on experiential knowledge

First keynote talk was by philosopher of science and psychiatry Şerife Tekin. She started her presentation discussing sources of knowledge in psychiatry, including intervention-oriented science, clinical practices, cognitive science research, and self-related resources (self-reports). Self-related phenomena have been traditionally undermined.

Şerife Tekin and the cover of her new book 

Tekin argued that one problem is that the self has not been considered a legitimate topic of psychiatric investigation and this suggests that studying the self is not scientific. Another problem is that self reports are considered to be unrealiable due to the wide presence of biases and confabulation. Next, there are concerns about internet self diagnosis (what Tekin calls the TikTok problem) as some people see their entire identity as defined by the diagnosis they have and this does not offer insight into their own specific experiences. Finally, there is an objectivity problem: it is often thought that self reports are subjective and don't deliver the type of knowledge we need.

Tekin proposed a new model to represent the various facets of the self in experiential experience (physical, social, conceptual, narrative, and experiential). This model is a model of the patient that can offer responses to all the challenges usually faced by experiential knowledge. Even if self reports by themselves have epistemic limitations, it is by engaging with such reports that we make progress with understanding what people are going through.

Dings on the Attuned Responsiveness framework

The next talk was by Roy Dings and Derek Strijbos. They started asking what an expert by experience can contribute: what is unique and valuable about their contribution. Dings observed that it is not easy to be explicit about what it is that we should add to experiential knowledge to obtain expertise. So he developed with Strijbos a new framework called Attuned Responsiveness. One element is responsiveness: things matter to different people in different ways (what we notice and why) and a number of factors can be relevant (biology, culture, experience, self-reflection).

The other element is attunement: this is about being responsive to other people's responsiveness (being open) and about being active (making an effort to bridge dissimilarities in responsiveness by asking questions). Attunement is a core aspect of everyday social expertise but between people with lived experience there may be fewer dissimilarities. So we should include people with lived experience in psychiatric knowledge because they notice the right things and find the right words.

Strijbos on how to reconcile different types of expertise

Strijbos argued that experiential knowledge is not just knowledge of one's own experience. It is the acquisition of perceptual and agential skills that bring epistemic benefits and have an impact on how one addresses problems. What experience does is increase attuned responsiveness, in a way that would be hard or impossible to achieve in other ways (with more depth and detail). This framework can also explain and help tackle conflict among experts: different experts can be responsive to different aspects of a situation.

After lunch, Themistoklis Pantazakos presented on the scope of epistemic injustice in psychiatry and discussed the debates about whether the construct is useful when applied to interactions between healthcare professionals and mental health patients. There is a lot of push back against the overapplication of the notion of epistemic injustice to the mental healthcare context, based on criticism about some cases that are considered paradigmatic.

Pantazakos on the debate on testimonial injustice

Pantazakos argued that testimonial injustice in psychiatry is predominantly about the person's phenomenological experience: the patient is an authority when it comes to what it is to be them. Most of the cases cited as cases of testimonial injustice in psychiatry are not cases of phenomenological epistemic injustice and they are not even cases of testimonial injustice so the notion of testimonial injustice is not compromised by the failure of these cases to be convincing.

Next talk was based on the methodological assumptions embedded in the political turn in analytic philosophy: the claim to be assumed is that lived experience enables the acquisition of knowledge and is authoritative, and the philosophical work is to explain why this is the case. The authors of the paper, Cristina Borgoni, Miguel Núñez de Prado, Manolo Pinedo, contended that neurodivergent people face systematic barriers in making contributions to collective knowledge. The discussion analysed some of these barriers. 

Miguel Núñez de Prado presenting at the conference

The more constructive part of the talk proposed that we move beyond the concept of experiential knowledge and focus on the pluralism of types of knowledge, using instead the concept of knowledge by lived experience. Knowledge by lived experience is a distinct type of knowledge that arises from having a specific lived experience although what is known may not be itself part of the experience. Often this involves interlocking self-knowledge and knowledge of a specific situation or condition. Authority comes from self-knowledge and standpoint: questioning self-knowledge attributions is an ethical and an epistemic wrong and there is no such thing as neutral reason-giving, so being perspectival is not just inevitable but constitutive of knowledge.

Lubomira Radoilska started with a quote from Elyn Saks' memoir, The centre cannot hold, to exemplify what expertise by experience might look like. This prompted a detailed analysis of lived experience as a form of knowledge by acquaintance that, in the mental health context, comes with a credibility deficit due to stigma. Calling lived experience a form of expertise could serve as a way to counter the deficit. But there are also cases (extracted testimony) in which drawing from lived experience as a source of authority means that the reporting of the experience in situations of duress is attributed a credibility excess, and outweighs independent, conflicting evidence.

Lubomira Radoilska on the zetetic model

Radoilska developed an account of a ‘zetetic’ initiative showing that a shift of focus toward norms of inquiry would better support a sustained resistance to epistemic oppression than further attention to general epistemic or evidential norms. This is because the zetetic initiative emphasises the ongoing exercises of epistemic agency by marginalised inquirers with lived experiences rather than their pre-existing experiential knowledge as a resource they could share with, or transfer to others. The notion does justice to the dynamic and creative aspects of epistemic advantage gained in circumstances of social marginalisation, in contrast to the static habits of thought that help maintain ignorance of social privilege, e.g., effortless belief that everything is as it appears to be.

Slide on empathy by Julian Kiverstein

The final talk of the day was by Julian Kiverstein who focused on the ameliorative project: how to improve the lives of people with mental illness. The starting point is that lived experience escapes operationalisation and psychiatric knowledge is based on operationalising mental disorders (e.g. in the DSM). So lived experience is the blind spot. One account Kiverstein challenges is that by Matthew Broome and Lucienne Spencer who criticise radical empathy as an appropriation. According to Kiverstein, radical empathy is not a case of appropriation but encompasses the skill of active listening, and the virtues of humility, curiosity, and diligence.

The discussion throughout the day was very inspiring and helped bridge different approaches to experiential expertise and different philosophical frameworks.