In today’s post, Karlijn van Vlerken summarises a talk she gave as part of the 2025 PhenoLab Summer School in Phenomenology of Mental Health in Foligno, Italy.
The promise of phenomenological research
Lived experience is increasingly recognized as an invaluable source of knowledge for the field of psychiatry. Voices that were historically denied as epistemic agents are now more often included in psychiatric research, practice, and policy-making, due to the advocacy of psychiatric survivors and activists. Phenomenological research focuses on the first-person perspective, and puts the unique knowledge derived from first-hand experience of a mental disorder at the very centre of the research. This way, subjective and lived experiences are prioritized as legitimate forms of knowledge. Phenomenology offers a space to articulate the inarticulable, to express disruptions to our ordinary ways of being, even when they are difficult to put into words. Phenomenological research can therefore identify and address epistemic injustice in psychiatry, helping move towards the realization of epistemic justice (1). However, if not carefully conducted, there are also ways in which phenomenological research can be epistemically problematic.
Potential problems of phenomenological research
Firstly, we should be aware of the selection bias that is often present in the inclusion of participants for phenomenological research in the psychiatric context. In order to participate in phenomenological interviews, people need a certain level of linguistic and conceptual ability (2). They need to be reflective, articulate, and comfortable talking about their experience. People with learning disabilities or cognitive impairments are often excluded from phenomenological research, both implicitly and explicitly. Ironically, these are traits that are strongly linked to certain mental disorders. This is called ‘elite capture’: the knowledge produced comes from the most privileged participants, while others are left out (3). In addition, typically only individuals who recognise or agree with their psychiatric diagnosis are included in the research.
Another tendency in phenomenological research is the heavy use of technical and very specific language and an over-reliance on metaphor. While this serves a purpose and is to some extent part and parcel of phenomenology, it must also be clear that some people do not or cannot relate to some more complex formulations. You can think of people that have certain cognitive disabilities, but also persons that experience concretism (when figurative language is interpreted literally) who may struggle to grasp the abstract meaning behind complex and metaphorical language.
There are also several epistemic harms that can arise from how empathic understanding is used in phenomenological psychopathology. For example, epistemic co-opting can occur when a clinician or a researcher assumes a level of subjective understanding of a patient's lived experience that they simply cannot possess (4). In doing so, they co-opt something that doesn't belong to them, which can harm the patient by undermining their role as a self-defining knower. A related risk is epistemic objectification, which occurs when someone is treated merely as a source of information rather than as an epistemic agent with interpretive authority.
These problems can lead to the empowerment of more educated sufferers, but also to further epistemic marginalization of the experiences of individuals with learning disabilities or other cognitive dysfunctions, or members of other groups routinely excluded from research participation, or vulnerable to exploitation when they are included. In turn, this can tap into different kinds of discrimination and negative stereotyping which can aggravate epistemic harms.
Pragmatic suggestions
First, research should facilitate and find creative and artistic ways to evidence non-linguistic forms of expressing experience alongside the linguistic forms that are widely present in most phenomenological research. The second thing that can be important to mitigate potential epistemic risks in phenomenological research is to be reflective of one’s own limitations and be transparent about them in research reports. Although it might not be possible to completely overcome selection bias in phenomenological research, it is necessary to be clear about who is and who is not included in the research and why. Third, co-production and joint research between experts by experience and academics and clinicians has the potential to contribute towards more level degrees of epistemic agency between all the actors. Lastly, in order to prevent epistemic losses, researchers need to put explicit effort into translating their findings into resources and tools that can actually be used by people experiencing mental disorders and that can help them express their experiences and first-person knowledge.
Sources
1. Kidd IJ, Spencer L, Carel H. Epistemic injustice in psychiatric research and practice. Philos Psychol. 2022 Dec;0(0):1–29.
2. Scrutton AP. Epistemic Injustice and Mental Illness. In: The Routledge Handbook of Epistemic Injustice. Routledge; 2017.
3. Okoroji C, Mackay T, Robotham D, Beckford D, Pinfold V. Epistemic injustice and mental health research: A pragmatic approach to working with lived experience expertise. Front Psychiatry. 2023 Mar 28;14:1114725.
4. Spencer L, Broome M. The epistemic harms of empathy in phenomenological psychopathology. Phenomenol Cogn Sci. 2023 Aug 12; Available from: https://link.springer.com/10.1007/s11097-023-09930-1
Karlijn van Vlerken is a PhD candidate at the Erasmus University in Rotterdam, the Netherlands. She studied medicine and philosophy, and worked in psychiatric care for two years. Her current research focuses on phenomenology of postpartum psychosis.
