Epistemic Injustice in dialogue with phenomenological psychopathology

In this post, Lea Nickel explores the potential and limitations of phenomenological psychopathology for better valuing the experiences of people diagnosed with mental health problems.

Image credit: Wellcome Collection

People who are suspected of having or have been diagnosed with a mental disorder are often stereotyped in ways that undermine their credibility. The concept of epistemic injustice is an important analytical tool for capturing these experiences. Testimonial injustice can manifest itself in the form of prejudiced overgeneralization of statements and behaviour. An example would be when all statements made by a person with delusions are seen as delusional, therefore, interpreted as part of the delusional belief system. 

Another form of testimonial injustice is “diagnostic overshadowing”, which describes the tendency to attribute physical symptoms to a pre-existing diagnosis of a mental disorder. Hermeneutic injustice is fuelled by the dominant status of the third-person biomedical perspective on experiences and the excess credibility of psychiatric knowledge. These forms of injustice not only hinder individual recovery but also contribute to the structural discrimination of people with mental disorders. This highlights the need for a more inclusive incorporation of the experiences of those impacted.

I see phenomenological psychopathology as a suitable starting point for this. Rooted in Husserl's vision of phenomenology as a ‘rigorous science’ that strives for knowledge without preconception, phenomenological psychopathology is focused on the exploration of patients' first-person experiences. By actively bracketing assumptions and deep-rooted prejudices and empowering patients to develop their own interpretative frameworks, the factors contributing to epistemic injustice are reduced. In the following, however, I will examine one possible limitation of phenomenological psychopathology with regard to improving epistemic injustice.

When we deal with epistemic injustice in the psychiatric context, identity biases that affect people because of their mental disorder are central. We call those sanistic prejudices. Sanism, like other “isms”, is based on deeply rooted social constructs and structures that aim to disadvantage or exclude certain groups, and thus contribute to the maintenance of social inequalities. However, forms of discrimination rarely occur in isolation. If a person is impacted by sexism, racism, classism, ageism, ableism, homophobia, or transphobia, then these oppressive mechanisms also operate in the context of mental disorders. 

This can only be captured by an intersectional approach, which leads us to a closer inspection of the “phenomenological reduction” used in phenomenological psychopathology. In general, this means questioning assumptions about the person as well as their symptoms and possible diagnoses, in order to follow Husserl’s call to get “to the things themselves”. This, however, can lead to certain dimensions of experience, such as racialized and gendered experiences, being lost. As a result, differences in experience due to the different situations of those affected cannot be reflected. If the experiences of marginalized people are taken as a basis for knowledge without reflection and without naming the oppressive structures that produced these experiences, these very structures can be re-naturalized. In the context of phenomenological psychopathology, this could be countered through an “intersectional unfolding” as proposed by Spencer (2024). Here, the various social positionings and their effects can be addressed.

An interesting starting point for this is the connection between rationality and femininity. Historically, the feminine – and consequently women – have been pathologized as unstable, hysterical, deceitful, and irrational. What such an intersectional unfolding can look like is shown in Ruth Bankey's paper “La Donna è Mobile: Constructing the irrational woman”. She shows, based on intensive conversations with women impacted by agoraphobia with panic attacks, that their experience can be described as a fear of embodying the hysterical image, characterized by excessive femininity, loss of control, and potential “madness”. While phenomenological reduction carries the risk of perpetuating a kind of ignorance and thus upholding seemingly neutral conditions of experiences an intersectional framework allows clinicians to recognize how overlapping identities shape experiences of distress.

In general, the sexist ideas surrounding mental disorders make it difficult for marginalized people to understand their experiences beyond these discriminatory constructions. Thus, in order to fully analyse epistemic injustice in the psychiatric context, there must be an awareness of the intersections of different axes of discrimination. This addition would facilitate the capturing of different experiences and structures of meaning that arise from different social positions. Not only can phenomenological psychopathology be fruitful for combating epistemic injustice in the psychiatric context, the debate on epistemic injustice can be used to renew phenomenological psychopathology and make it more epistemically just.

Lea Nickel

Lea Nickel is a PhD candidate in the Department of Medical Ethics and History of Medicine at the University Medical Center Göttingen, Germany. Her dissertation is focused on the influence of AI on doctor-patient communication. Her research interests lie in the fields of ethics of AI, empirical ethics and epistemic injustice. She is particularly keen on amplifying patients’ perspectives in the design, evaluation, and implementation of AI-based technologies in medicine. 

She wrote her master’s thesis on epistemic injustice in the psychiatric context: “Reden ist Silber, Zuhören ist Gold. Phänomenologische Psychopathologie im Dialog mit epistemischer Ungerechtigkeit” [Talking Is Silver, Listening Is Gold: Phenomenological Psychopathology in Dialogue with Epistemic Injustice]. In November 2025 she was awarded the Prize for “Philosophy and Ethics in Psychiatry and Psychotherapy” by the German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology for a shortened version of her thesis (forthcoming).

Loneliness: Canary in the Coalmine

In this reflection, Olivia Sagan situates her critical practice on loneliness in conversation with research on epistemic injustice.

Loneliness started getting a bad rap some time ago, accused of being the antithesis of happiness and labelled an epidemic, a public health issue and a lurking, silent killer. Two decades of research activity into this dark menace has linked loneliness to negative outcomes that run from depression to cardiovascular disease to premature death. Alarm bells clang about the rising rates of loneliness amongst the old, the young, and those in between. 

Meanwhile, governments scramble to develop policy and loneliness interventions. These appear to have dubious efficacy and in most cases pop a band aid over the deep gashes of a retreating welfare state which once provided amenities known to alleviate - if not circumvent - loneliness in the first place. I am not suggesting loneliness doesn’t exist. Given the multi-directional pressures of this quarter of the 21st century, however, my pitch is that the ‘loneliness pandemic’ is not about not having enough pals, but more a deeply discomposing existential ache: a heavy dose of Kierkegaardian anxiety, the dizziness of freedom, as we, free-floating fragmented ‘subjects’, try and make sense of multiple seismic changes to the Way Things Were. An uncertainty; a new malaise in the time of monsters, and one that we need to find new ways of negotiating. 

My main worry, meanwhile, is how alarmist discourses on loneliness may, via contagion, be nudging us to think ourselves into it. We know the stories we construct and hold on to about who and how we are become further enscripted into us, courtesy of our brain’s plasticity. In thinking ourselves into loneliness, succumbing to its vicious loop, we fall into another pathologized, medicalised, and individualised state of lack of agency. Such lack of agency and attendant anomie and torpor has alluring psychic and financial ramifications for Big Pharma, the burgeoning loneliness industry, and, as many commentators from Hannah Arendt on have grimly noted, political polarisation. 

Part of how we actually become lonely may be a feeling of not mattering - a deceptively trivial-sounding experience that has more than a bit to do with feeling unseen and unheard. An army of commentators have argued that the loss of trust in politics and a slide towards populism, a ‘thin-centred ideology’, are in part due to feeling overlooked and undervalued. At a time when it is apparently easier than ever to voice opinions, we are less likely to be heard, or to hear others. Third spaces, actual physical locations where people can convene, see, be seen, heard, matter - are in fast decline. Emerging accounts of people falling for the flattery of AI are telling – the “social sycophancy” of AI chatbots being an unanticipated offshoot of our hardwired need to be seen, recognised, and valued. 

Although not without its well-argued weaknesses, research on epistemic injustice has a role to play in constructing the uber-lonely subject in our sociopolitical moment. Testimonial injustice may indeed contribute to a sense of exclusion, thwarting the construction of a shared world: the very foundation Hannah Arendt saw as necessary for preventing loneliness. Working in tandem with hermeneutical injustice, epistemic loneliness is solidified through an inability to make one's own experiences intelligible even to oneself. 

When testimony and knowledge are discredited, we cannot establish the ‘web of human relationships’ that Arendt identified as constituting the realm of human affairs. The lonely person, like the epistemically marginalised, speaks into a void where our words cannot build shared reality, a form of ‘epistemic death’ where one's capacity to know and be known is fundamentally compromised. 

On the upside, this ‘loneliness crisis’ may help inspire us into a re-reckoning: about the essentially lonely business of being human at a particular moment of dehumanisation, which, even if we don’t fully endorse an ecological and spiritual collapse-ridden vision of, we can surely recognise. And about the need for moral transformation and overdue revisiting of human kindness. The kindness in that micro-ethic moment when we look at another human being and see them, and they speak to us and we listen and we disagree with them and we still listen. Not with epistemic justice, but with epistemic humility.

To know more: The ontological dislocation of loneliness. 

Reidpath, D. D. (2025). Decolonising epistemic injustice in global health. SocArxiv. https://doi.org/10.31235/osf.io/s2e8q_v1

Arendt, H. (1958). The Human Condition. University of Chicago Press.

Medina, J. (2013). The epistemology of resistance: Gender and racial oppression, epistemic injustice, and resistant imaginations. Oxford University Press.

Professor Sagan is Director of the Centre for Applied Social Sciences at Queen Margaret University Edinburgh, a chartered psychologist and former psychodynamic counsellor with 20 years’ experience of working with adults with long term mental health difficulties. Taking a critical perspective of the biomedical model of human distress, Olivia’s phenomenological research foregrounds explorations of autonomous strategies that people develop through which they confront, negotiate and make meaning of their conditions and experiences. Her work thus explores the resilience and creativity of the ‘ill’ – in the face of discrimination, stigma, isolation and structural inequality.

Olivia Sagan