Wednesday, 25 February 2026

The mental aspects of urban justice

Life in cities is often a matter of extremes. It can be both stimulating and stressful. It can be socially enriching and isolating. It can involve encounters with political openness and with xenophobia. The kind of experiences one has in a city is not a mere matter of luck. Structural injustices and concrete policy decisions shape the lives of urban dwellers—not only what they do, but also what they feel, believe and desire. This is the guiding question of the research project I began last year at the University of Antwerp, titled Affect In the City (AFFINITY): The emotional dimensions of urban justice (2025-2028).

Cities are a main topic of investigation in the social sciences and the humanities, as well as some philosophical traditions—cities are in central works of Plato, Al-Farabi, Walter Benjamin, or Henri Lefevbre. The last few years have seen a booming number of philosophical works on cities from a broadly analytic approach (including books on spatial agency, urban equality and housing justice), as well as the creation of academic venues partly or wholly dedicated to urban space. I am myself a member-at-large of the Philosophy of the City Research Group, and there are other projects with a broader focus on philosophy of space at Stirling and Eichstätt. In the areas of moral and political philosophy, we can talk of the emergence of local normative theory, which has the local as the main target and scope and looks not only at cities, but also at rural space.

Project AFFINITY aims to highlight the role of mental life in local normative theory, by drawing from insights into affective and epistemic injustice, cognitive scaffolding, and theories of self-narration. The working assumption is that social conventions and policy applications have a great impact on people’s mental lives within urban settings, by shaping how they feel, how they act, and how they think about themselves and their surroundings.

As Joel Krueger argues, elements of the environment scaffold urban dwellers’ cognitive-affective processes, for example, whether people feel like they belong in the city or whether they believe they are welcome in certain spaces. Krueger focuses on the extreme kind of marginalization that occurs in homelessness. But the influence of elements of urban space on people’s minds can also be assessed more broadly.

Think of something as apparently trivial as traffic lights. In England, pedestrians have 6 seconds to cross during a green light. This is way too fast for disabled and elderly people. Or think about the names of your city’s streets. Do they commemorate people like you? Or do they perpetuate the belief that you need to be a certain kind of person for your city to be proud of you, or that only certain stories count? These elements of urban life do not merely create short-lived, isolated experiences of stress, discomfort, or alienation. Over time, they accumulate into significant harms to subjective well-being (including positive emotions and mental health) and block access to hermeneutical resources that are crucial to self-understanding.

The project will examine three dimensions of city life (belonging, environment, and narrative) to understand how policy decisions shape mental processes, and whether these effects align with the principles of urban justice. The first publication looks into the demands on policy-makers to ensure that disadvantaged people are not unfairly burdened at an emotional level by gentrification and migration. I am currently researching the affective harms of oversized cars, the legitimacy of anger against tourists, the connection between loneliness and the 15-minute city, and the influence of public urban commemoration in self-narration, as well as planning many exciting collaborations. In this way, project AFFINITY  aims to place the mental dimensions of urban justice at the centre of local normative theory. By doing so, it will help clarify what is needed for a good life in the city that is accessible to all, and guide the design of policies capable of addressing non-material urban problems—such as loneliness, lack of safety and disenfranchisement—which compound and reinforce social and economic inequalities.


Picture of Pilar Lopez Cantaro
Bio: Pilar Lopez-Cantero is a Marie Skłodowska-Curie/YUFE4Postdocs Fellow at the University of Antwerp, and is currently the Principal Investigator of project AFFINITY (grant No 101081327). She works on practical philosophy, ethics and political philosophy — particularly questions about personal relationships, self-narration, travel, and the city.

 

 

Wednesday, 11 February 2026

Abolitionist perspectives on epistemic injustice in psychiatry

This post by Cath Roper and Nina Joffee-John explores abolitionist perspectives on how to address epistemic injustices in mental healthcare, drawing on interviews with mental health service users/survivors.



Unlike physical health, which protects the principle of informed consent to treatment, specific legislation enables public mental health services to authorise detention, administer treatment to persons without consent, and use restrictive practices. In most jurisdictions, such legislation operates across inpatient and community settings, invoking human rights issues.

People who have been labelled as ‘mentally ill’ belong to a group whose testimony can be doubted on grounds that it is faulty, unreliable, untrustworthy. We are often seen to lack ‘competence’ and ‘insight’ and our knowledge is not given credence. We can even be placed under the aegis of mental health legislation on these grounds.

Most of the researchers in our study had a lived experience of public mental health services.  Because of this, our perspectives could be regarded as inherently untrustworthy and we could experience  ‘testimonial injustice’.  The epistemic power of law and medicine, with their positivist, scientific worldviews, have the potential to combine and disqualify other worldviews, in particular the worldviews of people labelled ‘mentally ill’.

As researchers, we ourselves could be subject to testimonial injustice.  Our research could be dismissed on grounds of being ‘biased’ because we sought our key informants for their critique of mental health laws, a voice seldom heard in the formal literature. We aimed to gather the opinions of advocates and survivor activists on this topic in order to amplify these perspectives, contributing to epistemic justice.

Ongoing debate about coercion authorised under mental health laws is generally discussed by legal and clinical academics and typically centres on when it can be justified and how it can be reduced. Using a snowball sampling technique, we conducted interviews with 15 key informants across 5 different countries, who were known to hold a critique of mental health laws.

Informants thought these laws were discriminatory, caused harm and could not be justified. Mental health laws were criticized for breaching human rights, denying legal capacity, and displacing consent while forced psychiatric interventions were equated with torture and violations of freedom of opinion and expression. Psychiatric abolition was linked to broader movements like prison abolition and anti-colonial activism. Activism was positioned as essential to dismantle coercive systems and create new possibilities for non-violent, community-led care.

Abolition was proposed as a necessary response to the injustices of mental health laws,  involving daily steps toward creating a more just and equitable society.  Our findings showed imperatives to dismantle mental health laws on human rights grounds and to de-carcerate care. An urgent need to consider First Nations or Indigenous peoples’ activism and self-determination as abolition leadership was prominent in our findings. Informants suggested investing in social determinants, community-based care, and peer-led support systems as alternatives to coercive mental health practices.

Examples from countries without mental health laws, such as Thailand and Nepal were highlighted.  Peru was presented as a country that has come closest to putting a supported decision-making regime in place that operates on an equal basis for all citizens. Community-based models like Trieste, Italy, were highlighted, which were founded on social inclusion and human rights. Human rights frameworks, such as the UN Convention on the Rights of Persons with Disabilities (CRPD), were seen as powerful tools for advocacy and reform.

Abolition theory and practice provide ‘hermeneutic resources’ so people can understand their social experience, informing social justice and community-led responses to care. Taken together, our findings provide a step-by-step model for abolition in psychiatry.

To read the full open access article and share through your networks: https://www.sciencedirect.com/science/article/pii/S0160252725000937 

Author bios


Cath and Nina are lived experience academics working at the University of Melbourne, Australia. Each has lived experience of involuntary mental health treatment and detention, including seclusion and restraint, which profoundly shaped their understandings of and commitment to social justice, equity, and freedom. They use these perspectives to consistently critique the ethics and operations of mental health laws. Nina is pursuing a career in law.

Wednesday, 28 January 2026

Psychotherapy, self-understanding, and epistemic injustice

This post by Anna Drożdżowicz and J.P. Grodniewicz explores the epistemic injustices that can arise in the context of psychotherapy.




Despite the recent surge of interest in the topic of epistemic injustice in various health care settings, relatively little attention has been paid to the risks of perpetrating epistemic injustice in the context of psychotherapy. In our recent article (Epistemic injustice and psychotherapy) published in Philosophical Psychology, we focus specifically on this topic. We propose, first, that many forms of epistemic injustice can arise in psychotherapy, and, second, that we should pay close attention to them, as they threaten an important goal of therapeutic work, namely, helping and empowering clients/patients to understand themselves better.

The goal of psychotherapy 

But let’s start from the beginning. What is psychotherapy? In general, we can think of psychotherapy as a psychological service that relies on collaboration between a psychotherapist and a client/patient. Usually, psychotherapy consists of a series of meetings and conversations that often span years (although some therapies are considerably shorter). The therapist and the client/patient talk about different aspects of the client/patient’s life, focusing especially on various forms of mental suffering that the client/patient experiences, and looking for ways to alleviate them. During that process, they also develop a relationship that most psychotherapeutic traditions consider to be an important healing factor.

Typically, the main goal of psychotherapy is to improve the client/patient’s mental health and well-being. Interestingly, an important aspect of therapeutic work consists in creating the context in which clients/patients can learn more about themselves, know themselves better, or—as we like to think about it—deepen their self-understanding.

Understanding and self-understanding

What is understanding? Whenever we try to understand a complex phenomenon, be it the political history of 19th-century Poland, jet propulsion, or genetic drift, we need to do two things. First, we need to acquire a lot of information about this subject domain, a significant portion of which has to be true. Second, we need to figure out the ways in which the information relates to each other. How did partitions and uprisings shape the fate of 19th-century Poland? How do the forces of combustion and aerodynamics interact to make jet propulsion work? How do random mutations and population size together influence genetic drift? And so on.

It is no different in the case of self-understanding. In order to understand ourselves, we have to possess a lot of information about how we feel and what we think in various situations, what motivates us, how we behave and react, and so on. Moreover, we have to figure out what the relations between these things are. What causes what? Which elements tend to co-occur, and how do they influence each other?

Good psychotherapy can be an excellent opportunity to acquire such self-understanding, thereby helping us make various choices and decisions on the way to the life we envision for ourselves and hope for.

Epistemic injustice in psychotherapy

Unfortunately, epistemic injustice in psychotherapy can preclude clients/patients from improving their self-understanding.

First, if the therapist treats the client/patient only as a source of information and not as an active partner in their joint work, the client/patient loses the chance to contribute their perspective. In the paper, we interpret cases like that as cases of participatory injustice in psychotherapy. In such cases, the resulting self-understanding of the client/patient may be less accurate or limited.

Second, we can think of cases in which a therapist attaches little weight to, or outright does not believe, some of the things the client/patient says, because they have previously classified the client/patient as suffering from a particular psychiatric disorder (e.g., narcissistic personality disorder) and have acquired a certain prejudice against that group. We present this as an example of testimonial injustice in psychotherapy. In such cases, the therapist may prevent the client/patient from acquiring new information about themselves and from grasping the relations between different pieces of information.

Finally, if the therapist is excessively attached to using certain categories, such as medical categories employed in a classification of mental disorders, which are alien to the client/patient, they may deprive the client/patient of the opportunity to develop their own, and more helpful, forms of self-understanding. We interpret this as an instance of hermeneutical injustice in psychotherapy.

Epistemic injustice in psychotherapy may not be more common than in other areas of medicine and healthcare. Nevertheless, the epistemic harms it can produce are, in our view, particularly interesting, given that psychotherapy relies heavily on fostering one’s self-understanding.

Author bios


Anna Drożdżowicz (left) is a Professor of Philosophy at the University of Inland Norway (website: https://annadariadrozdzowicz.wordpress.com/)

J.P. Grodniewicz (right) is an Assistant Professor of Philosophy at the Copernicus Center for Interdisciplinary Studies at the Jagiellonian University (website: www.grodniewicz.pl)



Wednesday, 14 January 2026

Combatting Epistemic Injustice through Self-diagnosis

Endometriosis is a chronic disease characterised by the growth of endometrial tissue outside of the uterine cavity (Parasar, 2017). Symptoms include infertility, cyclical and non-cyclical chronic pelvic pain, dysmenorrhoea (painful lower abdominal cramping during menstruation that effects quality of life), dyspareunia (pain during sexual intercourse), dyschezia (pain on defecation) and dysuria (pain on urinating) (Horne, 2022).


Endometriosis


The path to diagnosis can be long with an average wait time of 8 years and 10 months in the UK. According to Endometriosis UK, throughout this journey, many people feel dismissed by doctors and struggle to feel heard. 

As a response to the struggle to receive diagnosis, many have identified this condition themselves through research, resulting in self-diagnosis (Hallstrom, 2024).

Epistemic injustice and self-esteem

The gold standard test for diagnosing endometriosis is laparoscopic surgery (Allaire, 2023). According to NICE, more accessible tests, such as examinations and ultrasound scans, cannot be used to exclude it.  Therefore, referral for surgery strongly relies on testimony. This testimony is vulnerable to epistemic injustice. 

Fricker describes epistemic injustice as the idea that people can be discriminated against in their capacity as a knower based on prejudices about them. Testimonial injustice is where prejudices impact the credibility given to a knower’s testimony. Hermeneutical injustice is structural discrimination due to gaps in resources attributed to underrepresentation of marginalised individuals (Byskov, 2021). 

By denying credibility to these testimonies, we devalue contributions of experience and are dismissive of patients’ attempts to understand themselves. This undermines epistemic self-esteem by creating situations where people question their judgement of their experiences (Hallstrom, 2024).

I argue that self-diagnosis can combat epistemic injustice by improving communication in consultations.  This may not result in confirmation of the self-diagnosis but can combat the undermining of epistemic self-esteem.  

Communication

Effective bidirectional communication is vital in healthcare. However, the use of different language and concepts to express their situation between the patient and the clinician can cause misunderstandings. This can constitute testimonial injustice as their pain may fulfil the referral criteria but be denied due to their language not reflecting or mimicking the official NICE guidance surrounding the pathological pain of endometriosis. This undermines epistemic self-esteem by devaluing the patient’s contribution.   

The processes involved in self-diagnosis can combat this through creating access to communication aids. These aids, such as The Endometriosis Toolkit, can bridge the gap in communication by targeting language, providing a guide for noting observations and exploring other symptoms (check out the Menstrual health project). This can combat testimonial injustice by promoting a shared language and promoting effective communication. Therefore, epistemic self-esteem is maintained by having contributions valued. 

However, barriers to finding communicative aids online include variations in digital literacy. By encouraging individuals to improve their knowledge, whilst not supporting those unable to access resources, we risk worsening epistemic disparities. However, these aids are now available to those on social media and through schools, as in 2021 the UK Department for Education has mandated menstrual education which includes advice on when to seek help.

As many patients are young when symptoms first appear, discussions with those in their social groups are vital (Hallstrom, 2024). They can compare their symptoms to their peers and medical framework. Understanding the framework in doctors’ appointments can help them communicate their issue in accordance with guidelines, allowing them to access resources. This knowledge can diminish testimonial injustice through promoting a shared language and promote epistemic self-esteem by valuing their testimony.


Endometriosis


Dismissal of self-diagnosis

Affirmation of one’s self-diagnosis is not the aim of the appointment, but rather is a starting point for discussion. It can help understand and communicate the patient’s perspective. This questioning of symptoms and self-diagnosis can feel undermining, but effective communication in consultations can validate experiences even if the conclusion is not the acceptance of one’s self-diagnosis. When experiences are validated, damage to epistemic self-esteem can be negated.



This post is by Emily Bywater, a recent graduate from the University of Birmingham who completed an elective project with Kathleen Murphy-Hollies on tackling epistemic injustice in healthcare, with a focus on endometriosis. She provides us with a summary of her essay, which explores the philosophical and ethics issues which relate to practicing as a doctor.