Workshop report: Loneliness, Metaphor & Empathy

Last week, Project EPIC held a workshop at the University of Nottingham entitled 'Loneliness, Metaphor & Empathy'. This workshop featured three talks by Project EPIC postdocs Fred Cooper (Bristol), Kathleen Murphy-Hollies (Birmingham) and Eleanor Byrne (Nottingham). 

The workshop theme reflects some current research interests of the project postdocs. All three talks teased out varieties of epistemic injustice that can arise when certain forms of suffering are marginalised by others. Fred asked what epistemic injustices might be at stake in claiming that certain experiences are inherently unknowable, Kathleen discussed the role of various prejudices in shaping how uptake-worthy we take people's claims to be, and Eleanor discussed the extent to which attempts to empathise with others can result in epistemic injustices.

Fred began the day with his talk The Naked Terror: Joseph Conrad, 'True Loneliness' and the inability to know. Fred discussed themes of loneliness in Conrad's Under Western Eyes where there is an implication that loneliness--or rather, 'true loneliness'--is characteristically unknowable. He gives us the following quote:

Who knows what true loneliness is-not the conventional word, but the naked terror? To the lonely themselves it wears a mask. The most miserable outcast hugs some memory or some illusion. Now and then a fatal conjunction of events may lift the veil for an instant. For an instant only. No human being could bear a steady view of moral solitude without going mad. 

Fred Cooper

Fred argued for a closer historical interrogation of the ways that epistemically  unjust or constraining narratives on health and ilness are sustained over time.

Kathleen then talked about metaphorical meaning and giving 'uptake' to the experiences of people with delusions and various other false beliefs. She argued argued that the content of what people say is often over-scrutinised for accuracy and truth, and that these tendencies are often exacerbated by prejudices.

Kathleen Murphy-Hollies

For example, she mentions how the claims of asylum seekers are often over-scrutinised for truth and accuracy as a result of certain prejudices. Ultimately, Kathleen's position is that even when we highly doubt that a certain belief expressed is true, there are still possible meanings to give uptake to in our engagement with them. Kathleen argued that dismissing those meanings can constitute a form of epistemic injustice, and that giving uptake to metaphorical meaning is a way of engaging with the agents' best attempts to communicate their experiences.

Some members of Project EPIC (L>R; Alice Monypenny; Fred Cooper; Ian James Kidd; Eleanor Byrne; Kathleen Murphy-Hollies)

Eleanor Byrne then closed the day with her talk about empathy. Drawing on ongoing collaborative work with Allan Køster (Danish National Centre for Grief), Eleanor discussed the limits of empathic understanding in contexts of profound suffering. She engaged with recent critiques of empathy which state that certain experiences are too alien, too profoundly catastrophic, to be understood by others. She concedes that some experiences can evade understanding, but maintains that some basic form of empathy remains possible no matter the circumstances at hand. This, she called ground empathy. 

Eleanor drew on a passage by Georg Simmel in order to argue that no matter the profound difference in your circumstances, it is always possible to empathically relate to the other person by attending to the fact that we all share the same existential fragility. Simmel writes:

All the thoughts and fates that make us suffer are actually only the occasional causes that bring about a part of the infinite potential for suffering that is inherent in us. [...] The most uncanny thing is that on such occasions we get the inkling of an immeasurable store of suffering that we carry around with us as if in a sealed vessel; a dark being that is not yet reality, but is still there somewhere, from which fate always releases certain parts, but leaves behind an inexhaustible amount. Most of the time this vessel rumbles quite quietly within us, but sometimes, when a single misery or shock opens it, it starts to move, to tremble dully, and we feel – we ourselves do not know where or what it means – this terrible treasure of potential suffering that we carry around with us that is our dowry, which can never be fully realised, cannot be exhausted by any real misery.

(Simmel 1923, Fragmente und Aufsätze)

Eleanor takes this passage to be illustrative of the inherent fragility that lies within all of us, waiting to be made salient by misfortune. It is by attending to these facts of life, the contingency of our position, that we are able to empathically relate to (if not understand) others in times of catastrophic upheaval, illness and suffering. 

This was the first official Nottingham event for Project EPIC. Keep an eye out for updates and adverts for upcoming events across Nottingham, Bristol and Birmingham.

Deaf Interpreters and Epistemic Injustice

Today's post is a summary of Dr Kristin Snoddon's upcoming talk for the Linguistic Justice Society on the 27th of Jan, at 8:00 EST or 14:00 CET. You can register for the talk here. 

Deaf people are generally at greater risk of epistemic injustice—being wronged in their capacity as knowers—due to not being understood by those around them. In Fricker’s (2007) famous taxonomy, epistemic injustice encompasses testimonial injustice—being wronged as a giver of knowledge—as well as hermeneutical injustice—being wronged as a subject of social understanding. Deaf people also experience the epistemic exclusion which occurs when disabled people’s knowledge is refused admission into the general stock, and are perceived as having reduced moral status.

An example of testimonial injustice, compounded by having a perceived reduced status, occurs when a deaf person giving an account of their social experiences is not seen as credible. These social experiences could, for example, relate to not being understood, not understanding what has been said, and/or being left out of conversations. Hermeneutical injustice can be said to occur when due to other people’s lack of familiarity with deaf people’s social experiences, those experiences are not understood. This is because other people lack the conceptual resources to make sense of the deaf person’s behaviour. As Caponetto and Piazza wrote in an earlier blog post, hermeneutical injustice feeds off testimonial injustice since not being believed and not being understood are mutually reinforcing phenomena.

In my research, I seek to show how deaf interpreters, sign language interpreters who are deaf, illuminate the concept of epistemic injustice. Deaf interpreters often work alongside hearing sign language interpreters and provide what is termed intralingual interpreting within the same target language. In other words, both the hearing interpreter and the deaf interpreter use the same national sign language, with the hearing interpreter interpreting between a spoken and sign language and the deaf interpreter making use of discursive and semiotic resources to convey meaning that extends beyond the hearing interpreter’s rendition. (However, some deaf interpreters, such as deaf Canadian American Sign Language-Langue des signes québécoise interpreters, also provide interlingual interpreting between different source and target languages.)

"LSQ" in Langue des signes québécoise, curtesy of Danachos CC BY-SA 4.0

The deaf interpreters’ role is often seen as meeting the needs of deaf individuals who lack proficiency in a named language—such as migrants, people with additional disabilities, and people who do not know a standard sign language. These deaf individuals are at greater risk of epistemic injustice due to not being seen—at least by hearing sign language interpreters and other professionals—as intelligible. From this perspective, intelligibility is based on knowing and using a standard, national language, such as the sign language varieties which are most often taught in interpreter training programs and which have their origins in deaf schools.

Interviews with Canadian deaf interpreter participants described formative experiences that were rooted in deaf childhoods where a sign language was readily accessible in addition to other languages, and where they encountered a broad range of deaf lives. However, as recent work by Haualand et al. (2024) shows, most deaf children today lack spaces where they can acquire and use sign language. Without early and full access to a language in which deaf children are understood, there is ironically both an increased need for deaf interpreter services and a lack of support for the conditions that foster underlying deaf interpreter competencies.

In their work, deaf interpreters fill gaps in interpreting processes and support understanding for hearing interpreters as well as for medical and legal professionals. This support in turn enables public institutional processes, such as medical appointments and court hearings, to run more efficiently. More fundamentally, deaf interpreters see intelligibility where it has been overlooked and construct intelligibility in interaction with diverse deaf people. This enacts justice on both an epistemic and existential level, since being understood opens the door to other forms of justice and new ways of being in the world.

 

 

Kristin Snoddon is Associate Professor with the School of Early Childhood Studies, Toronto Metropolitan University, Canada. Her current research focuses on sign language ideologies and ideologies of understanding related to deaf interpreters.

Aesthetic Injustice, Epistemic Injustice, and Disability

Today's post comes from Professor Dominic McIver Lopes:

Aesthetic Injustice attempts to spotlight an overlooked variety of injustice. One way to get a fix on it contrasts it with what I call ‘weaponized aesthetics’. Another is to consider a case study of aesthetic injustice that targets disabled people. A nice feature of this case study is that it highlights the relationship between aesthetic injustice and epistemic injustice.

Cover for Aesthetic Injustice

Let’s start with the contrast between aesthetic injustice and weaponized aesthetics.

Weaponized aesthetics is well known to philosophers and other scholars. Unjust treatment of members of identity groups often harnesses stereotypes, some of which are propagated by elements of aesthetic culture, especially visual images and narratives. For example, some movies portray disabled people as helpless and pitiable – or as villainous. Buts of aesthetic culture serve as tools of social injustice.

An aesthetic injustice is a social arrangement that harms people in their aesthetic capacities, such as capacities to appreciate, make, curate, or collect. These capacities are exercised in social practices: Impressionism and social media memes are two different aesthetic practices. So, in aesthetic injustice, participants in aesthetic practices are harmed as makers, appreciators, and the like. Since harm is not sufficient for injustice, the book argues that harms are unjust when they cut against interests in the diversity or the autonomy of aesthetic practices.

That puts it all rather abstractly; an example would help. Consider tactile pictures used by blind people. That last sentence might surprise you. An impressive suite of studies by the Canadian psychologist John M. Kennedy showed that blind people correctly interpret drawings where raised lines trace objects’ contours. They can also make raised-line drawings, and some of Kennedy’s subjects figured out on their own how to render scenes in perspective. This came as a surprise not only to sighted people but also to blind people. Everyone had internalized a conception of vision and depiction that made the very idea of ‘tactile pictures used by blind people’ seem absurd.

The neglect of tactile imaging is arguably an aesthetic injustice. It harms blind people by depriving them of access to a field of aesthetic engagement in ways that cut against an interest in there being diverse imaging practices and also an interest in there being an imaging practice where blind people are at home. The argument is hardly simple; it must navigate some tricky obstacles. You’ll have to read Aesthetic Injustice for more details!

There’s something that the book doesn’t emphasize. Recall that an aesthetic injustice is a social arrangement that harms people in their aesthetic capacities. This account leaves opens the means by which aesthetic injustice is produced. One might think that the very idea of tactile pictures seemed absurd as a result of epistemic injustice, specifically what Miranda Fricker called ‘hermeneutical injustice’.

Hermeneutical injustice is not the same as aesthetic injustice. Distinguishing them equips us to study how they interact. As I write in the book, different kinds of unjust social arrangements ‘cling to each other like burrs’.

Dominic McIver Lopes FRSC is University Killam Professor at the University of British Columbia. He works mainly in aesthetics, and has published books on the meaning and value of images, new technologies in the arts, the nature of art, and aesthetic value. 

His most recent book, Aesthetic Injustice, was published by Oxford University Press in 2024.

Epistemic Justice in Mental Healthcare

This week we announce the publication of an edited collection which is entirely open access: Epistemic Justice in Mental Healthcare: Recognising agency and promoting virtues across the lifespan (Palgrave 2024), edited by myself, Lisa Bortolotti. The book is an output of project EPIC, featuring eight new chapters exploring epistemic justice in mental health. 

Epistemic Justice in Mental Healthcare

In the Preface (downloadable here), Matthew Broome and I frame the discussion as a way to affirm the role of the mental health patient as a person, an agent, and a collaborator. When we are mental health patients, we are persons because we are more than our health or our diagnosis, we have needs and interests that matter and that affect the way in which our health impacts our lives. 

We are also agents, because despite the vulnerabilities of our status as patients, we have a perspective that matters and the capacity to contribute to positive change. Crucially to the success of clinical encounters, we are partners in the project of addressing our health issues. We can collaborate with healthcare professionals by sharing our experiences and participating in decision making.

Chapter 1, Being understood: epistemic injustice towards young people seeking support for their mental health, is authored by Michael Larkin with members of the Agency Projects team including lived experience researchers from McPin. It addresses some of the factors that make clinical interactions unsuccessful, offering some suggestions for improving clinical communication. The focus is on ensuring that young people are understood and supported at times of crisis, that they are not blamed for the difficulties they face, and that they are not reduced to a diagnostic label.

Chapter 2, Challenging stereotypes about young people who hear voices, is authored by myself, Lisa Bortolotti, Kathleen Murphy-Hollis, Fiona Malpass, and young people from the Voice Collective. It highlights three stereotypes associated with voice hearing that have harmful consequences for young people's relationships and opportunities to thrive, in the family, the school, and the clinic. These are incompetence, dangerousness, and diversity leading to exclusion. The chapter illustrates the impact of these stereotypes based on the young people's experiences, and encourages further empirical research in this area.

Chapter 3, Reacting to demoralization and investigating the experience of dignity in psychosis: reflections from an acute psychiatric ward, authored by a team led by Martino Belvederi Murri, addresses the unique challenges to epistemic justice that emerge in an acute ward, where coercion may be used. The use of coercion may engender situations that are detrimental for individual dignity and morale. One such effect is demoralization, which may increase the risk of suicide. The chapter provides an overview of the work on these topics and offers some suggestions for strategies that might improve the experience of psychiatric inpatient care.

Chapter 4, Not all diagnosis are created equal: Comparing depression and borderline personality disorder diagnoses through the lens of epistemic injustice, authored by Jay Watts, examines four aspects of epistemic injustice: objectification, moral agency, trivialization, and narrative agency. It compares personality disorder and depression, arguably the least and most popular diagnoses with patients in psychiatry. The analysis emphasises the importance of epistemic injustice as a tool in critically evaluating the usefulness of specific psychiatric diagnoses, encouraging a shift in clinical training to embrace reflective practices and restructure power dynamics in clinical encounters. 

Chapter 5, Resisting perceptions of patient untrustworthiness, authored by Eleanor Palafox-Harris, argues that a beneficial therapeutic relationship between patient and clinician requires mutual trust. In order to effectively treat someone, a clinician has to trust the patient’s reports of their symptoms but many psychiatric diagnoses are stereotypically associated with traits that indicate untrustworthiness (such as irrationality). In this chapter Palafox-Harris illustrates how psychiatric labels can signal stereotypes of untrustworthiness, reducing patients' perceived epistemic credibility.

Chapter 6, Preserving dignity and epistemic justice in palliative care for patients with serious mental health problems, with Luigi Grassi as lead author, considers the challenges faced by people with serious mental disorders who are at the end of life and promotes a person-centred approach, which can increase the sense of personal dignity and epistemic justice. Dignity Therapy can be applied in palliative care settings, offering people an opportunity to reflect upon crucial existential and relational issues and prepare their legacy.

Chapter 7, Promoting good living and social health in dementia, with Rabih Chattat as lead author, explores the notion of good living in the case of dementia and highlights the role of social health in preserving wellbeing. Discrimination impacts people with dementia in diagnosis disclosure, advance care planning, and decision making. The chapter critically examines the labelling of the behaviour of people with dementia as problematic and pathological even when it is a reaction to difficulties in communication.

Chapter 8, Ameliorating epistemic injustice with digital health technologies, authored by Elisabetta Lalumera, discusses the potential of digital phenotyping for ameliorating epistemic injustice in mental health. There is a concern that the evidence digital health technologies gather may overshadow individual experiences but, through a fictional case study, Lalumera portrays digital phenotyping as way to support shared decision-making. 

The book aims to help understand how the demands of epistemic justice relate to and complement recent research on agency in youth mental health, person-centred care, dignity therapy, stigmatising diagnoses, good living, social health, and access to digital technologies. As illustrated in the figure below, people seeking help should preserve crucial roles as agents and collaborators with valuable perspectives, multiple interests and needs, the capacity to contribute to positive change, and the capacity for shared decision making.

The mental health patient as an agent

Alice Monypenny joins Project EPIC

We are thrilled to announce that Dr Alice Monypenny will be joining project EPIC from May 2025. As an introduction, we asked her some questions about her research.

What are your research interests?

I’m interested in the idea of epistemic agency – what it means to be a part of the processes and activities through which we produce and share knowledge. A lot of recent research related to epistemic injustice focuses on the ways in which people may have their epistemic agency limited, for example by being excluded from conversations, lacking adequate hermeneutical resources or being regarded as unreliable informants. However, I am interested in exploring the strategies people from oppressed and marginalised communities develop to cope with epistemic injustice.

In my recent work, I have argued that sometimes epistemic vices, such as closed-mindedness or intellectual arrogance, can be developed as coping strategies in hostile environments. My most recent paper (coming out in the Journal of Philosophical Research soon) defends a position in virtue/vice epistemology, called ‘normative contextualism’, which states that sometimes, depending on context, these traits may not be intellectual vices because of the role they play in allowing their bearer to cope with the challenges of their epistemic environment. 

I’m also interested more generally in how positive environments enable people to have a voice, my PhD research focused on understanding the role of safe spaces in education. 

Alice Monypenny

Why is studying epistemic injustice in healthcare important?

Understanding what it is like to live in our own bodies is such a fundamental part of being able to understand and interpret our experiences and how we interact with the world around us. That is why I think that understanding epistemic injustice within healthcare is so important – if someone lead to doubt their ability to understand their own experience of embodiment and make sense of the symptoms or conditions they experience, then this can have a significant impact on how they view themselves as a knower. It’s important to think about the ways in which healthcare systems and institutions can undermine people’s sense of understanding their own experiences – whether that’s through negative interactions with healthcare professionals or alienating language and labels. 

What are you working on at the moment?

I’m currently interested in the strategies adopted by patients and those seeking diagnosis and treatment when they interact with healthcare professionals, particularly when they hold back information about their symptoms or medical history. I’m using Kristie Dotson’s concept of ‘testimonial smothering’ to understanding this practice and exploring the way in which it can be an exercise of epistemic agency by enabling those who use it to carefully navigate tricky relationships with healthcare professionals who are gatekeeper to treatment and diagnosis. At the moment I’m exploring two case studies: patients with chronic pain; and trans and non-binary individuals seeking to access gender-affirming care. I’m also interested in the ways that patient communities and networks share information and resources such as tips for engaging with doctors or what to say in order to be taken seriously and get access to the right diagnoses and treatments.