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.