In this post, Sofia Martellini reports back from a workshop on Trust and Affective Justice at the University of Bristol.
On June 9th, Project EPIC and the Centre for Health, Humanities and Science co-sponsored an afternoon of guest lectures and group discussions, on the theme of Trust and the Affective Dimensions of Health and Healthcare.
While my talk
highlighted one aspect of epistemic injustice in healthcare, the wide range of
expertise exhibited by the other speakers brought diverse and interesting
perspectives on the meaning of Trust and Affectivity.
Professor Havi Carel opened with a
provocation: we walk through the world with a deep, unspoken faith in our
bodies. We quietly, blindly believe that we're going to be ok and we are
capable of doing what we want with our bodies. Illness has the capacity to
shatter this tacit certainty, even more so in critical or end-of-life
conditions, where our body becomes uncapable of the most basics of actions. She
distinguished bodily doubt in everyday illness from radical bodily doubt; the kind that sets
in at the extremes of experience. Here, continuity collapses entirely, the body
becomes entirely medicalized, subjectivity dropping away as the body is treated
as an object from those around it. Her discussion of ICU experiences, also
sourcing from her own personal experience, where passivity is total and people
simply have things done to them, was particularly striking.
Dr Ross Pain then turned our attention
to Indigenous healthcare in Australia, where outcomes between white and
indigenous people remain deeply inequitable. Different contexts have different
ways of understanding and processing pain, and Dr Pain highlighted philosophy’s
tendency of overgeneralizing in order to arrive to a theoretical explanation.
When philosophical concepts like epistemic injustice travel across different
cultural contexts, do they actually fit? His notion of the "fittingness
condition" asks us to reckon honestly with the limits of our conceptual
tools.
Drawing on my time in the LeTs-Care
research project, I argued that informal caregivers are victims of
hermeneutical injustice, since they lack the shared concepts to make sense of,
and communicate, their own experience. In Mediterranean contexts especially,
there is often no culturally resonant word for "caregiver" at all; caring
is only a part of family duty, invisible and unnamed. My proposed PhD aims to
address this through phenomenological interviews and a broader look at how care
appears across different cultures, asking whether these radically different
ways of understanding care are given any epistemic recognition in the policies
that are supposed to help caregivers today.
Doctoral fellow Anna Pathmanathan then
brought the discussion to the clinic and the prescription pad, presenting
research on antibiotic prescribing disparities across minoritized ethnic
populations in primary care. Combining large-scale data with patient and
prescriber interviews, her work surfaces how systemic inequity can hide in
plain sight, encoded in everyday clinical decisions. The doctor-patient trust
relationship varies across social status, culture and other variables, filled
with prejudices and epistemic inequalities: understanding how this complex dynamic
works can bring light to the issue of overmedicalization, still much present in
the UK.
Finally, Cristina Ganz examined
communication-based epistemic injustices in doctor-patient relations, mapping
how discursive, epistemic, and affective injustices layer on top of each other
in clinical interactions. Her clear framework showed how different ways of
addressing patients corresponded to different kinds of epistemic injustice and
separating them allows us to understand how to better direct the dialogue
between doctor and patient.
The variety and depth of different interventions showed how an
apparently simple concept like trust can be conjugated in meaningful but
diverse ways, tied to the notion of epistemic injustice. From the creation of a
theoretical concept such as radical bodily doubt, to empirical research
projects meant to show trust relationships and the issues of philosophy when
applied to real cases of trust loss, epistemic injustice and trust intertwine
throughout different disciplines and cases. This event made me realize even
more intensely how fundamental interdisciplinarity is for better research and
progress, especially in fields where theory and practice come into contact.
Without culturally specific, in-depth empirical research, philosophers can risk
falling into overgeneralization, as Dr Ross Pain showed; on the other hand,
through philosophically developed concepts such as epistemic injustice,
negative clinical experiences can be better understood. By sharing our
experiences and projects, our collective understanding of epistemic injustice,
trust and affective dimensions can grow throughout different disciplines,
bringing progress and new solutions to epistemic injustice issues all over the
world.
Sofia Martellini is a Philosophy
PhD candidate at the University of Bristol, supervised by Professor Havi Carel
and Wilhelm Dagmar. Her research sits at the intersection of epistemic
injustice, phenomenology and ethics of care, with a particular focus on
informal caregiving and the hermeneutical gaps that leave carers without
adequate concepts to make sense of their own experience. She holds degrees in
Philosophy from KU Leuven and Applied Ethics from Utrecht University and has
been involved in the LeTs-Care European research project. She spoke at the CHHS
& EPIC workshop in June 2026.
