Epistemic Injustice in Indian Mental Healthcare Across Generations

Indian mental health care is marked by an astonishing diversity, ranging from state-sanctioned therapy sessions to mobile phone applications and traditional modalities like temple rituals, spiritual healers, and family customs. As urban Gen Z populations increasingly engage with psychotherapy, spiritual models based on assumptions of karma, nazar ("evil eye"), or spirit possession remain influential on models of distress. These plural systems are in competition with one another, especially within clinical environments where biomedical models hold sway, creating epistemic injustice.

Fricker (2007) imagines epistemic injustice as unfair treatment of individuals as knowers. In medicine, it manifests in testimonial injustice (when the patient's testimony is questioned due to prejudice) and hermeneutical injustice (when people do not have the authorized language or map to express their suffering). In India, patients quite often present symptoms in religious or idiomatic terms, which are quite often pathologized or ignored by doctors. Halliburton's (2005) ethnography of South India shows how patients shift between psychiatrists and religious healers with ease, not due to ignorance but in a reflective pursuit of care that is sensitive to their lived lives. Clinical practices are seldom responsive to such mixed-up modes of explanation.

While it is common for patients in India to make sense of their symptoms in religious terms, and seek help from religious healers and clinicians alike, clinical practice can be unresponsive to the blending of these explanations.

This trend is carried over to the virtual realm. Sehgal et al. (2025) discovered Indian teenagers who used mental health chatbots preferred products that were culturally appropriate, anonymous, and personally tailored. Authors note computerized treatments, although promising, risk maintaining clinical hierarchies unless they keep in mind sociocultural backgrounds.

Gen Z is in an interesting position—most are receptive to therapy but still ensconced in families that adhere to traditional systems of faith. Between therapists and temples, they generally experience anxiety when mental health providers dismiss their models as unreasonable or unscientific, which undermines confidence and continues epistemic hierarchies.

While this discussion is being situated in India, the same dynamics occur everywhere. Minority and migrant communities in the UK and elsewhere have also reported exclusion when their belief systems are not compatible with Western clinical definitions. The Indian context thus provides a window with which to interrogate bigger questions: Whose knowledge is considered legitimate in mental health treatment? Who gets to say what's real or treatable suffering? 

Both Gen Z Indians and members of migrant communities might similarly feel adrift in a Western medical system that isn't compatible with their beliefs.

To resist epistemic injustice requires more than cultural sensitivity; it requires epistemic humility. Clinicians are required to work with, not supplant, patients' own explanatory models—religious, family, local. True healing is only available by acknowledging, not erasing, these multiple forms of knowing. 

Gen Z, standing at the crossroads of tradition and worldwide conversation about mental health, can possibly spearhead this transformation—given that their diverse experience is taken seriously. Listening to them is crucial towards the creation of an expansive and equitable system of mental healthcare.

Parinika Arora is based in New Delhi, India, and is a postgraduate student pursuing an MSc in Mental Health at the University of Birmingham, UK. With an undergraduate degree in Psychology from India, she has contributed to 7–8 academic book chapters exploring the intersections of psychology, AI, and mental health. She loves writing and sharing insights on mental health and psychology to reach a wider audience. Parinika also runs an Instagram page called PsyPrism focused on mental health awareness. Alongside her academic work, she serves as a director at Minus One Experiences Private Limited, an event management company based in India.

Menopause Apps, Empowerment and Epistemic Injustice

In women’s healthcare the problem of epistemic injustice may be compounded by women’s structural marginalisation. Fricker argues that healthcare professionals (HCPs) rarely adopt these negative positions on purpose, nevertheless they present a substantial barrier to women seeking to access support and treatment for a range of health issues including menopause. 

Mobile health applications (mHealth apps) provide a resource across a range of health topics including women’s health and menopause but there is debate in the literature as to whether these apps are empowering for women or whether, at least in terms of their promotional narratives, they reinforce sexist stereotypes and diminish women’s credibility as people who can ‘trust their own experiences and gather reliable knowledge about their own bodies’ (Hendl & Jansky, 2022). 

Picking up on this debate we wanted to understand more from the perspective of women using menopause apps and to find out what if any role they played in their experiences of empowerment and epistemic injustice. In our study we spoke to peri and post-menopausal women about their experiences of using menopause apps. Women told us they used the apps to find out more about menopause, to read other people’s experiences and in many cases, they tracked their menopausal symptoms, symptom triggers and menstrual information. 

This tracking data was often used to 'evidence' women’s symptoms and their changing menstrual cycle as part of their discussions with HCPs. Women felt more confident in talking about their menopause with their HCP if they had a visualisation or record of their symptoms whilst others simply used the tracking data to bolster their confidence in explaining their concerns and their treatment preferences. For these women, many of whom had previously had an unsatisfactory encounter with a HCP in which they felt they hadn't been believed or listened to about their menopause, using the apps was empowering. 

Whilst the idea of turning personal experience into knowledge and evidence seems to fit with a healthcare context that often priorities objective scientific decision-making, the app played a role in a number of ways. It certainly didn’t seem to ‘reveal’ knowledge of the body but allowed women to capture and document what they were already aware of in a format that made it easier for them to collate and present to HCPs. 

Many didn’t feel the need to share the data with HCPs; consulting the app before the appointment provided a confidence boost to their discussions. The data had other meanings for women beyond sharing and evidencing. These related to ongoing self-reflection, self-care and positive decision-making around their health and wellbeing and for many it complimented or was a natural progression from paper-based journaling.

Importantly, experiences with HCPs varied with some women discussing positive conversations with empathetic and understanding HCPs and using the apps led to positive acceptance of menopause and increased discussion with friends, family and work colleagues. Technology like this does not solve the problem of epistemic injustice and the marketing narratives around ‘taking control’ are often misleading. But for our women, the apps supplemented rather than undermined their belief and understanding of their own experiences of menopause. They felt confident to express their personal testimonies with a backup plan in their pocket if needed. Menopause apps might be a resource that supports productive and supportive encounters with HCPs and one that some women will find helpful even if only for a short period of time.

Elizabeth Sillence is an Associate Professor in the PaCT Lab at Northumbria University. Her work focuses on the role of digital technology in health and wellbeing with a particular focus on trust and decision-making. 

Alison Osborne is a senior researcher engaged in research focusing on health, well-being, technology, inclusion, and social justice. Her work has involved working closely with a variety of populations including women, veterans, bereaved families, LGBT+ communities and military children as well as stakeholders including local authorities, the NHS, charities, local and national government. Alison’s research aims not only to understand experiences and needs but to support meaningful change.

Preparedness for Epistemic Fairness in Genetic Testing and Genomic Medicine

With the advent of scalable Next-Generation Sequencing (NGS) to identify disease-causing variants in patient DNA, the NHS is currently rolling out its nationwide genomic medicine service. Their hope is to re-orient the current service model towards personalised medicine, in which information about a patient’s genome is used to decide the most advantageous treatment options. 

The promise of genomic medicine extends beyond treatment: the hope is that this technology can be harnessed in a model of disease prevention, whereby genetic testing will be used to identify patients most at risk of developing diseases before symptoms appear. In the practical example of pharmacogenomics, a genetic test result can be used to predict whether a patient will respond quickly, slowly, not at all, or adversely to a given medication. Not only does this protect patients from adverse drug reactions (ADRs), but it’s also a way for the NHS to economise; ADRs cost the NHS an estimated 2.2 billion pounds a year to treat. 

The NHS is charging ahead with this technology, with the Accelerating Genomic Medicine Strategy full of cinematic language such as “ground-breaking”, “cutting-edge”, “world-leading” and “revolution”. Already, regional Genomic Medicine Alliances, Genomic Laboratory Hubs and the Genomics Education Programme are the new normal, and the offer of Whole Genome Sequencing (WGS) in “routine care” is expected to become commonplace. Clinical researchers are forensically weighing up the benefits and challenges of embedding genomics at the GP surgery, while nursing and midwifery have been targeted as key areas for genomic practice expansion.

But for how many people is genetics a concept that they studied during their GCSEs and haven’t thought about since? For how many more people, those without any level of science education, is it something they have never considered? And yet, the personalised medicine model proposes that patient care should henceforth be guided by complex genetic information which patients may or may not be fully equipped to engage with meaningfully. 

Re-orienting care towards genomics is not without risk of hermeneutical injustice, where a patient’s treatment plan is explained using terminology which is largely unfamiliar to them; patients therefore risk being excluded from making sense of their own experiences. The inverse could also be true: a clinician may perceive a patient as unable to understand the underlying logic of genetic test results and therefore feels inclined to withhold some or all of this information, resulting in informational prejudice. 

However, alongside this re-arrangement of service models, a quieter revolution is taking place: social scientists and ethicists valiantly work to keep up with each new technology as it’s approved and rolled out. The Wellcome-funded Ethical Preparedness in Genomic Medicine (EPPiGen) project (2017-2025) dissected social and moral dilemmas of wide-scale genomic medicine implementation. EPPiGen’s focus was on the use of creative and participatory methods to explore the experiences of families accessing genetic testing; the team’s compassionate studies warmly complement the proof-of-concept molecular research which genomics more typically brings to mind. 

When researchers, doctors and families work together, we can head-off ethical dilemmas caused by genomic medicine.

As more and more clinical care is guided by genomics going forward, it becomes crucial to assess the dangers of epistemic injustice as a barrier which may exclude patients from fully participating in decisions made about their healthcare. Just as genomics relies on cutting-edge DNA sequencing technology, it should also acknowledge the powerful perspectives that social scientists, philosophers and ethicists can offer. 

The genomic revolution calls upon GPs, nurses, pharmacists and other clinicians to re-train towards a sparkling new iteration of their roles: something akin to a genetic educator, in addition to the rest of their work remit. This makes sense, given that clinicians are the ones who will be explaining complex genomic concepts to patients. Will updated training support clinicians in communicating genomic concepts effectively, in order to mitigate the potential epistemic fallout of these conversations?

The NHS does indeed evangelise genomic medicine, and rightly so - after all, its benefits are both hugely evident and also yet to be fully realised. But amongst the increasingly impressive test printouts, it remains crucial not to lose sight of the patient perspective. Going forward, researchers and policymakers will need to work together to understand how to keep epistemic fairness at the heart of widescale genomics implementation. At the same time, clinicians must support patients in understanding the complex nuances of this new model of care, thereby protecting patients’ capacity to make informed treatment decisions.

Sophie Webb is a Research Associate in Psychology at the University of Birmingham, as well as a part-time Genomic Medicine student. She is interested in patient and practitioner experiences of genomics implementation in the NHS, particularly communication challenges in genetic counselling. Her other interests include neurogenetics, and patient and public involvement and engagement (PPIE) in lab-based molecular research. She would love to chat on Bluesky or LinkedIn!

The Dynamics of Epistemic Injustice: Situating Epistemic Power and Agency

Every day in the context of work, school, family, or social interactions, we are constantly using, producing, and transmitting information and knowledge: answering a question, proposing an idea, writing a paper, using concepts and representations to interpret our personal experience or describe social interactions. 

To put it in philosophical terms, we are exercising our epistemic agency: that is, we are doing various things (‘agency’) with knowledge (‘epistemic’), such as using it, producing it, transmitting it. We exercise our epistemic agency successfully when we are adequately believed and understood as a result: that is, when we receive appropriate levels of credibility and intelligibility. However, individual and societal biases – related to our social identity, for instance – can interfere with the exercise of our epistemic agency. 

For example, someone may not believe me or fail to recognize my competence and abilities because I am a woman (i.e., I might receive diminished levels of credibility because of my interlocutors’ conscious or subconscious gender biases); or it might be difficult for me to convey my experience of disability because mainstream interpretive tools, such as concepts and social representations of disability, are inadequate to capture this marginalized experience, which as a result might remain largely misunderstood or misrepresented (i.e., I might receive diminished levels of intelligibility because of societal biases regarding disability in the mainstream pool of interpretive resources). 

Some individuals are given less credibility due to some feature of their identity (e.g. their gender) and this impacts their epistemic agency.

When individual or societal biases give rise to these sorts of credibility and intelligibility deficits, the person thereby faces epistemic injustice. Epistemic injustice is problematic because it undermines individuals’ exercise of their epistemic agency, or their capacity to use, produce, or transmit knowledge, which is central to our everyday lives, interactions, and exchanges.

The foregoing is a very brief and therefore very general glimpse of the large literature on epistemic injustice that has developed since the publication of Miranda Fricker’s 2007 book, which introduced the term ‘epistemic injustice’. My new book, titled The Dynamics of Epistemic Injustice: Situating Epistemic Power and Agency, makes three main contributions to this important literature on epistemic injustice and agency.

As the above suggests, the literature has so far focused on propositional knowledge and verbal modes of expression: oral or written contributions, the (lack of) production, use, or understanding of certain concepts, and so on. Philosophers, however, also recognize other kinds of knowledge besides propositional knowledge (or knowing that), namely non-propositional or experiential knowledge, including practical knowledge (or knowing how) and tacit, embodied, or affective knowledge (or knowing what it’s like). 

The cover of Amandine Catala's
The Dynamics of Epistemic Injustice:
Situating Epistemic Power and Agency.

Yet very little has been said about the non-propositional dimensions of our epistemic agency, or about non-propositional forms of epistemic injustice. This is the first contribution of my book: it provides a pluralist account of knowledge, epistemic agency, and epistemic injustice that takes into account not only their propositional but also their non-propositional aspects.

The second contribution of the book is that it provides a systematic account of epistemic agency and epistemic power. The literature often asserts that epistemic injustice is problematic because it undermines epistemic agency, and that epistemic injustice involves differential allocations of epistemic power. But the literature says almost nothing about what exactly epistemic agency and epistemic power are. Yet many fascinating and crucial questions arise if we want to grasp these two notions more precisely. 

The book offers a systematic account of epistemic agency that specifies its objects, expressive modes, contributing factors, and different stages, as well as a systematic account of epistemic power that identifies three types of epistemic power along with their various sites and mechanisms at both the individual and the structural levels.

Finally, the third contribution of the book is that it starts from case studies that bring up new forms of epistemic injustice. These case studies include deliberative impasses in divided societies, colonial memory, academic migration, the underrepresentation of members of non-dominant groups in certain fields, the marginalization of minoritized minds like intellectually disabled people, and the underdiagnosing of autistic women. 

Examples of the new forms of epistemic injustice that these case studies reveal include meta-epistemic injustice, testimonial domination, hermeneutical domination, meta-epistemic filtering, linguistic epistemic injustice, and existential hermeneutical injustice, among others.

Together, these three contributions yield a more complete and precise picture of epistemic injustice, power, and agency, thereby equipping us to more effectively and thoroughly address problematic yet transformable dynamics of epistemic injustice.

Amandine Catala is a Full Professor in the Department of Philosophy at Université du Québec à Montréal (UQAM), where she holds the Canada Research Chair on Epistemic Injustice and Agency. She is a Senior Research Associate at the African Centre for Epistemology and Philosophy of Science at the University of Johannesburg. Her research interests include epistemic injustice and agency, epistemic repair, neurodiversity, linguistic justice, and decolonization. Her book, The Dynamics of Epistemic Injustice: Situating Epistemic Power and Agency, was published by Oxford University Press in 2025.

Epistemic Injustice in the Mental Healthcare of Indigenous Peoples

Today's post is by Md Omar Faruk.

Symbol of healing

Philosopher Miranda Fricker coined the term epistemic injustice to refer to the harm experienced by people when their ability and capacity as knowers of knowledge is disregarded or devalued in a unfair fashion (Fricker, 2007). Essentially, we are referring to individuals who have been harmed in the process of co-creating and sharing knowledge, and whose capacity to reason and contribute as knowers has been dismissed or denied. 

People experience this injustice in two ways: testimonial injustice and hermeneutical injustice. Testimonial injustice takes place when the testimony of a person or group of people is deemed less credible. Simply put, the collective accounts of people are being denied on the pretext of not having substantial credibility or reliability. On the other hand, the absence of social understanding that helps conceptualize the experiences of a person or a group of people is at the heart of hermeneutical injustice. When we do not have sufficient conceptual resources be it understanding of the concepts or language to uncover the experiences, this paves the way for hermeneutical injustice. 

Both form of injustices has adverse impact on people’s self-esteem, social positioning, and ability to engage in creating knowledge. People representing minoritized and less advantaged groups are more vulnerable to these injustices leading to both physical and mental health consequences. By taking Bangladesh as an example, in this blog post, I shed light on how these injustices are contributing to the poor mental health status of Indigenous peoples and I present a framework to address them with a view to improving their mental health outcomes (Faruk, 2025).

Indigenous peoples in Bangladesh, particularly those living in the Chittagong Hill Tracts, experience distinctive challenges related to mental health due to historical, systemic, and cultural factors. These communities experience higher risks of mental health problems stemming from the legacy of colonialism, marginalization, language loss, cultural infiltration, land grabbing, and lack of access to adequate healthcare services including mental healthcare. Despite nationwide initiatives aimed at improving mental health awareness and reducing stigma, there has been little targeted effort to address the specific mental healthcare needs of Indigenous peoples in Bangladesh. 

Bangladesh

Their mental health experiences include anxiety, depression, and widespread stigma centering mental illness, all of which witnessed a significant increase during the COVID-19 pandemic. Nevertheless, Indigenous peoples’ perspectives and experiences are often excluded from mainstream mental health policies and services, contributing to epistemic injustices that further marginalize these groups. To address these injustices community-led, culturally sensitive interventions, increased engagement of Indigenous communities in policymaking, and the incorporation of Indigenous knowledge systems are crucial to improve mental health outcomes and achieve epistemic justice for these communities. 

Kaptai Lake

The key components of the framework are listed below:

• Community Engagement and Participatory Approaches: The current mental healthcare system in Bangladesh does not integrate community voices and encourage participation of Indigenous peoples which may contribute to the non-compliance on the traditional mental healthcare service systems. Therefore, engaging Indigenous communities primarily through consultations, focus groups, and participatory research to include their voices in the design and implementation of mental healthcare services is extremely important. This not only promotes mutual learning but ensures that services are tailored to their unique cultural context.

• Partnering with Indigenous-Led Organizations: To facilitate self-determined practices and promote Indigenous epistemologies in the development of mental healthcare programs, collaborating with organizations led by Indigenous peoples is crucial. This ensures the integration of cultural nuances that shape the distinct conceptualization of mental health and illness and paves the way for utilizing Indigenous healing practices.

• Utilizing Indigenous Healing Practices: Recognizing and incorporating traditional healing methods alongside mainstream mental healthcare interventions ensures cultural relevance potentially leading to acceptance. Growing evidence suggests that integrating Indigenous healing practices within clinical practices promotes culturally safe environments (Beaulieu & Reeves, 2022).

• Decolonial and Culturally Responsive Approaches: Mental healthcare programs aimed at respecting and valuing Indigenous epistemologies, promoting self-determination, and facilitating the use of Indigenous languages and practices may promote the deconstruction of colonial practices putting more emphasis on culturally responsive approaches.

• Training Mental Health Professionals: It is imperative that mental health professionals have adequate cultural competence and sensitivity to better understand and respect Indigenous beliefs, practices, and worldviews in an effort to to deliver more tailored and respectful care.

• Incorporating Indigenous Knowledge into Policy and Education: Indigenous people’s worldviews embedded into educational curricula, policy frameworks, and advocacy initiatives has the potential for systemic acknowledgment and supporting Indigenous ways of knowing in mental healthcare services.

These strategies intend to recognize Indigenous knowledge as a vital component of mental healthcare, promoting epistemic justice and ensuring that services are culturally sensitive and effective for Indigenous peoples in Bangladesh and beyond.

Md Omar Faruk is a clinical psychologist in Bangladesh is currently pursuing his PhD in School Psychology at the Louisiana State University in the US. 

His research focuses on understanding Indigenous people’s mental health experiences including the development of culturally sensitive mental healthcare interventions. 

Additionally, Faruk focuses on the promotion of positive school climate by strengthening student-teacher relationships contributing to the improved student social, emotional, and academic outcomes as well as increased well-being for teachers.

Epistemic Injustice and Chronic Pain Reports

This post is by Veronica de Souza Campos and Daniel De Luca-Noronha who recently published a paper in the Journal of Applied Philosophy, entitled: Misunderstanding Epistemic Injustice: The Case of Chronic Pain Reports.

Migraine

Our article critiques the prevalent tendency to interpret inadequate medical responses to chronic pain reports primarily through the frameworks of testimonial and hermeneutical injustice. While these approaches—drawn largely from Miranda Fricker’s influential work—illuminate important aspects of the problem, they overlook a crucial dimension: what we term inquisitive inertia. 

Inquisitive inertia refers to the failure of healthcare professionals to actively investigate patients’ reports of chronic pain, defaulting instead to prescribing analgesics and dismissing the case. As we argue, this constitutes a form of distributive epistemic injustice, in which patients are denied access to a vital epistemic good: the right to a thorough and sustained inquiry into their condition.

Our article opens with first-person accounts of chronic pain sufferers who report years of misdiagnosis, dismissal, or inadequate treatment. Many scholars interpret such cases as instances of testimonial injustice (where a speaker is discredited due to prejudice) or hermeneutical injustice (where gaps in collective interpretive resources render certain experiences unintelligible). While these forms of injustice are undoubtedly present, the authors contend that they are insufficient to fully explain the epistemic harms experienced by chronic pain patients.

Testimonial injustice certainly plays a role, particularly for women and racial minorities, who are disproportionately undertreated due to implicit bias. However, chronic pain poses distinctive epistemic challenges that go beyond identity-based credibility deficits. Chronic pain often lacks clear aetiology, resists objective measurement, and disrupts narrative coherence. This makes it difficult to describe, even for patients who are believed, because the phenomenon itself strains linguistic expression. As such, even an attentive and impartial listener may fail to grasp the full significance of the patient’s testimony.

Back pain

Hermeneutical injustice also falls short in some respects. Although the development of richer conceptual resources for pain is important, this alone does not resolve the expressive limitations inherent in chronic pain experience. The highly individual and often ineffable nature of chronic pain resists neat categorization, and the dominant biomedical framework, which assumes a direct correlation between tissue damage and reported pain, fails to accommodate cases where no such correlation exists.

We introduce inquisitive inertia as a distinct and under-recognized form of epistemic injustice in healthcare. This occurs when healthcare providers, despite medical indications, refrain from pursuing further inquiry into the patient’s condition. Instead of investigating, they prescribe and dismiss. Such inertia is reinforced by systemic pressures: fragmented care, short consultation windows, and bureaucratic constraints that discourage deeper engagement.

Addressing epistemic injustice in chronic pain requires more than correcting biases or expanding conceptual resources. It demands structural reform that enables and obliges healthcare professionals to take chronic pain reports seriously and to investigate them with the epistemic diligence they deserve.

Veronica Campos is an assistant professor at the Federal University of Minas Gerais (Brazil) and research fellow at the Jesuit School of Philosophy and Theology (Brazil). Her main areas of interest are epistemology, philosophy of pain, and philosophy of religion. 

Daniel De Luca-Noronha is an associate professor at the Jesuit School of Philosophy and Theology. His areas of interest include philosophy of pain, philosophy of emotions, and philosophy of religion. 

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.