International Network for Philosophy and Psychiatry 2025

Members of the Project EPIC symposium at INPP 2025 (from left to right):
Jodie Russell, Matthew Broome, Elisabetta Lalumera and Lara Calabrese 

From the 29th - 31st of May 2025, members of team EPIC attended the 26th annual conference for the International Network for Philosophy and Psychiatry at the University of Leipzig and delivered a symposium based around core chapters in our recently published, open-access book. The conference involved many parallel sessions with amazing talks from established academics and early-career researchers alike. We've provided a bite-sized summary here of our EPIC symposium.

Panel discussion

The symposium was introduced and chaired by Professor Matthew Broome, project EPIC co-investigator at the University of Birmingham (pictured far right), who introduced the project as a whole as well as some of the background to epistemic injustice and related projects himself and Co-I Lisa Bortolotti have worked on. The latter research involved qualitative investigations into epistemic injustice and voice-hearing and work on enhancing agency in youth mental health.

This lead neatly into the first talk of the symposium by EPIC research fellow Dr Jodie Russell at the University of Birmingham titled "Young People with Psychosis at the Intersection of Identities" (pictured below).

Jodie's presentation

Jodie explained to delegates some of the philosophical thought involving her investigation into epistemic injustice among young people with psychosis. She noted that her population of study are likely to have multiple intersecting identities, many of which may be marginalised. Jodie then introduced the phenomena of "intersectional invisibility" whereby individuals become structurally invisible with respect to one or more of their identities because of the other identities they belong to. This is due to the fact that having other group identities may make you an 'atypical' member of other group identities.

Jodie's hypothesis is that many of her participants are likely to feel intersectionally invisible; she notes that there are various demographic features of the population she's studying that make them unique. For example, the population of Birmingham is ethnically diverse, young and religious compared to the rest of the country. 

The city also has one of the highest incident rates of psychosis, and psychosis itself is over-represented by individuals from Black, Asian and Minority Ethnic (BAME) backgrounds. Moreover, the prevalence of psychosis among young people is relatively small compared to other mental disorders. When it comes to mental health research, then, Jodie suggests that it may be a challenge to recruit these participants and address epistemic gaps when potential participants might see themselves as not belonging in certain epistemic spaces (e.g. at universities, among other young people, or other people with mental disorder).

Lara's presentation

This talk was followed by Dr Lara Calabrese (pictured above), Research Fellow and EPIC Research Assistant at the University of Bologna, who discussed the results of her scoping review on epistemic injustice and dementia and outlined the next steps for her qualitative study. Lara noted that people with dementia are particularly vulnerable to epistemic injustice; this is because, in part, Lara notes, of the symptoms of dementia themselves. 

Under the traditional view of dementia, many symptoms are understood as meaningless and the result of brain damage rather than, as on the person-centred view, meaningful communications. Lara notes that many people with dementia are not involved in their won care decisions (as in Advanced Care Planning) and the diagnosis might not be communicated directly to the person with dementia themselves. Epistemic injustice, therefore, may interfere with many of the basic rights of people with dementia.

In Lara's scoping review of the topic, she uncovered 5 key themes: 

1. Theoretical models and perspectives that apply epistemic injustice to dementia
2. The exclusion of individuals with later stages of dementia from research
3. Institutional exclusion of certain individuals with dementia as representative of dementia
4. The ethical implications of epistemic injustice for Advance Directives for people with dementia
5. The impact of media representations of dementia

Elisabetta's presentation

The symposium was then drawn to a close with the final talk by Dr Elisabetta Lalumera (pictured above), Associate Professor of Philosophy at the University of Bologna and EPIC project partner. Elisabetta's talk, titled "Ameliorating epistemic injustice with digital health technologies", made the case for the promising use of artificial intelligence to overcome knowledge-based injustice often perpetuated by human clinicians and care-givers. She notes, for example, the use of technologies in healthcare already that have brought patient benefits, such as the use of self-tracking apps. Elisabetta notes, however, that there is still the possibility that technology can perpetuate epistemic injustices (which has been pointed out in the literature). 

Nevertheless, Elisabetta suggests that this might primarily be due to the application of assistive technologies themselves, rather than inherent bias; for example a patient's claims might be undermined because the assistive technology is given epistemic priority over patient testimony by the clinician themselves. She also notes an unequal level of transparency between patient and clinician when assessing the claims of assistive technologies because clinicians are likely to have a better understanding of how the technologies work. 

While much work needs to be done to address implicit biases in the data sets that AI are trained on, AI can nevertheless be a fruitful tool in the way that it is 'rigid' and applies the same criteria to everyone, regardless of gender, race and class. This technology should be used to support and validate, not replace the patient's experience.

Toxic Positivity and Epistemic Injustice

 

Toxic positivity (TP) is “the phenomenon of people being positive and optimistic to a degree that is unreasonable in a given situation, and as such makes others feel as if their own (less than positive) feelings are invalid or in some way wrong, thus having the potential to cause harm to the victim” (de Rijk 2025). For example, if one loses a loved one and tries to garner support from a friend who then tells you that you should not be sad because your loved one is in a better place, you may have fallen victim to TP. 

Features of  Toxic Positivity

TP has four features: 

1) appropriate emotion in the victim as a starting point

2) unreasonable optimism on the part of the perpetrator

3) dismissal of the victim 

4) potential harm to the victim 

Toxic Positivity and Epistemic Injustice

I have argued (de Rijk 2025) that TP is an epistemic injustice because it has the potential to undermine knowledge to which the victim ought to have a claim so wronging the victim as a knower (Fricker 2007). Further, this is a particularly sneaky kind of epistemic injustice because it often masquerades as something good, because optimism is seldom considered problematic. Knowledge might be undermined through TP in at least three ways, all of which have their root in the doubt-instigation that is caused through dismissal. 

First, TP can make a victim doubt their belief and genuinely doubting a belief means that it can no longer count as knowledge. Second, TP could make a victim lose their belief because they might think the best course of action in response to genuinely doubting their belief. Thirdly, a victim may lose self-trust, which is a precondition for acquiring and maintaining knowledge (e.g., Zagzebski 2012; Dormandy 2024), although this would only happen in the most serious cases. 

Toxic Positivity and Getting Proper Medical Help

I now argue that TP that undermines knowledge formed through negative emotional experiences related to health can prevent one from timeously seeking proper healthcare. Imagine you are suffering a serious bout of depression but remain highly functional. You confide in a friend that you think you are depressed and need help. But your friend responds by pointing out that you do not seem depressed, you are going about your life as normal and even cracking jokes with your friends and colleagues, he suggests that maybe you are just feeling stressed about an upcoming deadline and when it has passed you will feel better. 

This makes some sense to you, and you begin to seriously doubt that you really are depressed even though you continue to feel all the symptoms of depression. Nonetheless, the doubt sown by TP acts as a defeater to your belief that you are depressed. 

So, you do not seek proper treatment for your depression (because why should you seek treatment if you are not really depressed?) and eventually suffer a complete nervous breakdown. In this case, TP has prevented you from seeking timeous medical help and as a result you ended up in a far worse position than you might otherwise have been.

This is just one way that TP undermining knowledge in connection with our health can prevent one seeking healthcare. But it is sufficient to show that undermining knowledge formed through negative emotions related to health can be detrimental to taking the right steps to ensure that one receives proper medical help before one’s condition worsens. 

Shené de Rijk is a PhD candidate at the University of Johannesburg in South Africa. She is affiliated with the African Centre for Epistemology and Philosophy of Science (ACEPS). Her dissertation is centred on investigating the phenomenon of toxic positivity in the field of social epistemology. Other than toxic positivity and social epistemology (and epistemic injustice in particular), her research interests include applied ethics, especially bioethics on which she has also written.

EPIC Summer School 2026

From July 14th to July 17th, 2026 project EPIC will host a Summer School at Ce.U.B (Centro Residenziale Universitario di Bertinoro) in Bertinoro, Italy. The event is made possible by generous funding by Wellcome, which will also subsidise the delegates' subsistence costs.

Poster of the event

Information about the event will be regularly updated on this page and a detailed programme posted closer to the time. 

The Fortress in Bertinoro

Summer School morning sessions

There will be lectures by the investigators and partners on the project:

• Martino Belvederi Murri (University of Ferrara)
• Matthew Broome (University of Birmingham)
• Lisa Bortolotti (University of Birmingham and University of Ferrara)
• Havi Carel (University of Bristol)
• Rabih Chattat (University of Bologna)
• Luigi Grassi (University of Ferrara)
• Ian J. Kidd (University of Nottingham)
• Elisabetta Lalumera (University of Bologna)
• Michael Larkin (Aston University)
• Rose McCabe (City St. George's University of London) 
• Sheelagh McGuinness (University of Bristol). 

Topics for lectures will encompass perspectives from philosophy, psychology, psychiatry, history, legal scholarship, clinical practice, and lived experience:

• the ineffability of illness
• AI-enhanced healthcare and epistemic injustice
• phenomenological approaches to epistemic injustice in medicine
• the role of dignity and person-centred care in an epistemic just healthcare
• the importance of clinical communication for good and epistemically just medicine
• moral responsibility and epistemic injustice
• legal and clinical approaches to epistemic injustice
• the centrality of agency in youth mental health
• co-design and co-production as ameliorative strategies
• epistemic injustice in dementia, schizophrenia, and depression.

One of the meeting rooms at the venue

Summer School afternoon sessions

EPIC researchers Jodie Russell, Kathleen Murphy-Hollies, Dan Degerman, Fred Cooper, Ellie Byrne, Alice Monypenny and Michael Bresalier will also participate, leading reading groups and discussion sessions on recent journal articles and book chapters.

 

Topics for discussion will include: 

• uptake of delusional beliefs
• vaccine hesitancy and epistemic injustice
• silence and testimonial smothering
• loneliness
• affective injustice
• phenomenology and intersectionality.

Apply!

If you are interested in joining us, there is a form you can fill to apply. The deadline for applications is 1st March 2026 and the outcome will be made known to applicants by 2nd April 2026.

The project EPIC team is looking forward to seeing you in Bertinoro!

Rethinking silence and epistemic agency in mental illness

In the scholarship on epistemic injustice and mental illness, silence figures almost exclusively as an epistemic harm. More specifically, we usually understand silence as a deficit in epistemic agency resulting from social prejudice or an unfair lack of adequate conceptual resources. Often that is indeed the case, and breaking such imposed and harmful silences is crucial for achieving epistemic justice.

However, this picture of silence is incomplete and potentially harmful. It ignores the possibility that silence can play an epistemically constructive role in the lives of people with mental illness, and that discouraging or breaking silence in such cases could be destructive. This is a possibility I explore in a recent article. Focusing on experiences of silence among people experiencing mania, I argue that silence can be a powerful act of epistemic agency – the capacity to acquire, maintain, and share knowledge competently and freely.

Epistemically agential silence

I articulate three kinds of epistemically agential silence: communicative silence, listening silence, and withholding silence. Each refers to a literal silence – an absence of speech or noise – through which a person is attempting to perform an epistemic action:

1. Communicative silence is a silence through which a person intends to share knowledge with others. An example would be when you use your silence to express disapproval of something inappropriate someone has said.
2. Listening silence is a silence through which a person intends to acquire knowledge from a speaker. An example would be when you fall silent in a conversation so your interlocutor can speak and you can hear what they have to say.
3. Withholding silence is a silence through which a person intends to withhold knowledge from others. The function of such a silence might be to maintain knowledge, as when you decide not to share something with a person who might manipulate you into thinking you are mistaken. Its function can also be to avoid sharing knowledge, as you might do when you know an audience isn’t equipped to understand what you have to say.

These silences are plausibly important for everyone, but they seem particularly important for those who experience mania.

Losing silence in mania

Two common symptoms of mania are increased talkativeness and an uncontrollable urge to speak. First-person accounts suggest that people with these symptoms often find that their capacity to perform epistemically agential silence has been impaired.

Some describe losing the ability to perform listening silence. For example, in her memoir of living with bipolar disorder, Terri Cheney describes how, when she was severely manic, she’d become unable to ‘shut up and listen’. Another writer with bipolar, Bassey Ikpi, says that in mania she sometimes 'couldn’t remember how to quiet her brain enough to listen’.

Others report becoming unable to perform withholding silence. For instance, one contributor to a bipolar forum says that when she is manic, she does not ‘know how to stop talking’ and ends up telling everyone that she has bipolar, even if they have no need to know or are prejudiced or ignorant about mental illness.

This can have a profoundly negative impact on individuals with mania. Losing the capacity for silence can deprive them of vital information and undermine their support networks. Meanwhile, losing the capacity for withholding silence may lead individuals to reveal information about themselves and their illness in circumstances where disclosure might expose them to misunderstanding or discrimination.

People who experience mania are often well aware of these risks. Therefore, when they feel their capacity for silence is deteriorating, they may look for new ways to stay silent when they need to—for example, by clenching their jaw, jiggling their leg, or digging their nails into their palms. For them, silence is not an epistemic harm but a hard-won epistemic achievement.

The costs of misunderstanding silence

So silence can clearly have significant epistemic value for people with mania. This is why the assumption that silence is a sign of epistemic injustice may inadvertently perpetuate or even exacerbate harm. For example, it may prompt a well-intentioned individual to misunderstand a manic person’s epistemically agential silence as evidence of epistemic oppression and, therefore, seek to break their silence, perhaps by urging them to speak. That may end up undermining the epistemic agency of the manic person and expose them to epistemic and hazards they were trying avoid through silence.

To avoid contributing to this, those of us researching epistemic injustice must begin to explicitly acknowledge in our work that silence is a diverse phenomenon. Sometimes it does represent epistemic oppression. But it can also be empowering, constituting a vital epistemic tactic that ill persons and other vulnerable individuals use to navigate complex interpersonal, institutional, and social landscapes. If analyses of epistemic injustice in healthcare and beyond are to be relevant and helpful, this is not something we can ignore.

Dan Degerman is a Research Fellow on the EPIC project and a AHRC Research, Development, and Engagement Fellow on the 'Beyond Voice' project. His current research explores the relationship between silence and epistemic injustice in bipolar disorder.

Agential epistemic injustice is bad for medicine

On occasion of Mental Health Awareness Week 2025 (in the UK 12-18th May and in other European countries 19-25th May), I suggest that some forms of epistemic injustice may prevent mental health interactions from fulfilling their clinical goals, and thus need to be identified and avoided not just for moral reasons but to enhance clinical practice. I offer this argument in a paper recently published open access in Philosophy of Medicine. 

Youth mental health

What is agential epistemic injustice?

Medina has identified a phenomenon called "agential epistemic injustice" which occurs when the exercise of epistemic agency in people from marginalised groups is  constrained,  manipulated,  or  distorted. A speaker does not need to be silenced for epistemic injustice to occur. The speaker's contribution to a conversation or to an epistemic project can be actively solicited. However, if their contribution is then challenged or reconstrued by the listener, without being first explored in its own right, there is still a problem. This "failed uptake" is often due to the speaker's agency being called into question. 

I believe that the notion of agential epistemic injustice is especially apt to capture problems with interactions involving people who are experiencing a mental health crisis because the stigma associated with poor mental health tends to target people’s epistemic agency. When people struggle with their mental health, it is assumed that their agency is compromised, and their capacities for rational thought, appropriate affect and mood, competent decision-making, and autonomous action are negatively affected by their health condition.

Failed uptake

What are the effects of agential epistemic injustice?

Recent qualitative studies of communication between practitioners and young people accessing mental health emergency services (Bergen et al. 2023) suggests that the young people's reports are not always validated  and  explored. Instead, practitioners sometimes fail to legitimise the young person's concerns and imply that their descriptions of the way they feel is inaccurate or inconsistent with previous medical notes or observable data. Statements  that support the practitioner’s view are accepted and integrated in a narrative explanation of the situation that goes on to inform the decision-making  process. But statements that are in tension with the practitioner’s view are undermined. 

These challenges often compromise the quality of the exchange, with young people gradually withdrawing and reducing their engagement. Everyone may agree that validating and exploring patient reports may have a positive psychological impact on patients. But some have argued that such benefits come at a cost, and that epistemic justice in clinical interactions may be an obstacle to improving health outcomes for patients. This surprises me, because I have come to think of the avoidance of agential epistemic injustice not just as "a nice to thing to do" or as what morality demands, but as a way to increase the chance that the medical goals of the clinical interactions are met.

A clinical interaction is successful when it leads to

1. understanding the nature of the problem the person is seeking support for;
2. identifying the best means of support for the person experiencing the problem; and
3. promoting favourable conditions for the person to address the problem via those means.

Clinical interactions characterised by agential epistemic injustice are less likely to achieve (1)-(3). I offer two arguments for this conclusion. 

Knowledge argument: 

• A genuine exchange of information enables knowledge about the person’s experiences to be shared, including knowledge about how a mental health issue is affecting the person's life. 
• Agential epistemic injustice may prevent a genuine exchange of information from happening, leading to practitioners offering a premature diagnostic label or suggesting treatment options that are based on partial information and thus turn out to be misguided or ineffective.

Trust argument:

• When patients’ experiences and concerns are not considered as valuable contributions to the exchange, this may contribute to their feeling incompetent and losing trust in themselves. 
• If the practitioner treats patients just as a diagnostic puzzle to solve, this may suggest that the practitioner is not interested in what they are experiencing or is unwilling to explore their concerns further. 
• Agential epistemic injustice negatively affects the capacity patients have to address the problems they have via the means identified in the interaction: the patient may feel disempowered and helpless and medical advice is less likely to be perceived as something worth following and, if another crisis is experienced, people may be reluctant to seeking support again. 

Good communication in a clinical interaction

Agential epistemic injustice as an obstacle to good medicine

To sum up, lack of information due to reduced engagement may compromise diagnosis and render suggestions for further support irrelevant or unlikely to be taken up. Moreover, making people feel inadequate, unable to report their own feelings in a coherent or persuasive way, may cause them to doubt their own capacity to help themselves and get better. The impression that practitioners are not interested in what happened to them may also interfere with people's willingness to access services again, and their trust in medical advice, potentially compromising adherence.

In an interaction whose goals can be met when all participants make a genuine epistemic contribution, practices characterized by agential epistemic injustice are not just morally problematic but they constitute an obstacle to the interaction achieving its goals. Clinical interactions are no different.

The Added Value of Epistemic Injustice

During #PhiloFortnight2025 the British Philosophical Association launched a campaign to raise awareness of the role of philosophy in our lives. As part of this initiative, EPIC at Birmingham organised a webinar to launch the recently published open-access book, Epistemic Justice in Mental Healthcare (Palgrave 2025). 

Poster of the event

The panelists (all partners of project EPIC) presented their research and then engaged in discussion about the importance of the notion of epistemic injustice and the strategies we should adopt to reduce the harms that come from it. 

In this post, I want to share our conversation about what we might call "the added value of epistemic injustice": when we analyse patient-doctor relationships and clinical interactions more broadly, we tend to use a variety of concepts, including person-centred care, feeling understood, dignity, trust, social health, good living, and agency. 

What does the appeal to epistemic injustice add to these analyses? Aren't the concepts we have used so far, those that preceded the application of the notion of epistemic injustice to the heathcare context, sufficient? Each of the panelists gave an insightful reply to this question.

A slide from Michael's presentation on feeling understood

Michael Larkin described a case he encountered in a paper on consent where a young man hit one of the doctors. When he was asked why, he said that he did so because he was angry. But then in interactions with other doctors, this idea that anger was what caused the young man to act was challenged and reinterpreted: one doctor said that the young man acted that way because he was delusional. 

Another doctor said that the young man acted that way because he had schizophrenia. And the young person did not recognise these as reasons why he hit the doctor, repeating that yes, maybe he was delusional and he had schizophrenia, but he acted that way because he was angry. Michael remarked that the notion of epistemic injustice would have been very useful in that context, due to its precision, because it precisely identifies a failure to recognise knowledge. 

A slide from Rose's presentation about clinical communication

Rose McCabe remarked that the idea of "injustice" is also very important in the notion of epistemic injustice and goes beyond what we may convey when we talk about trust. Although people who use services know when this happens, when healthcare professionals dismiss or reinterpret what they have to say in a way that misrepresents them, they don't always have the right language to report it or to refer to it. 

Having a way to reflect on communication and the respective epistemic stances in clinical interactions is valuable. Also, research on epistemic injustice is welcome because relationships and communication are crucial to the experience of services by people who seek help, but have not always been the focus of research. The epistemic injustice literature has zoomed in on those issues.

A slide from Luigi's presentation on dignity

Luigi Grassi observed how rejecting a person's explanation for their own behaviour because they are delusional is not the only situation in which epistemic injustice happens: when people talk about their symptoms, even when they are not diagnosed with a serious mental illness, doctors often tell them that it is all in their head, do not believe them, and even suggest that what they are reporting is not possible. 

Epistemic injustice is an important new perspective that is central to research and training and should be made into a tool -- just like there is a dignity inventory there could be an epistemic injustice inventory.

A slide from Rabih's presentation on stigma and its consequences

Rabih Chattat argued that talking about epistemic injustice is not the same as talking about stigma because the notion of justice brings to the fore that there are rights that are being violated, such as the right to self-determination, and this is evident in the treatment of older people with dementia. 

To this, Rose added that epistemic injustice also enable us to see important connections between what happens in healthcare (where a doctor may dismiss the subjective experience of a patient) and what happens in other contexts where there is a power imbalance (for instance, where a teacher dismisses the perspective of a student). 

A slide from Elisabetta's presentation on bias in diagnosis

Elisabetta Lalumera highlighted another aspect of epistemic injustice that is very distinctive. When we treat an expert as a non-expert, we act unwisely. When we are committing epistemic injustice, it is not just that we are not being nice to the person who is sharing their knowledge, but we are also throwing out valuable information because of a prejudice. It is a mistake of judgement that harms us as well as the person whose knowledge we dismiss.

If you are intrigued by this discussion and want to watch the whole webinar, it is available here:

Why agency is not compromised by delusional or conspiracy beliefs

This post is by EPIC investigator Lisa Bortolotti.

It may be surprising to realise how many researchers from various disciplines are interested in the relationship between clinical delusions and beliefs in conspiracy theories: on the surface, the former often have bizarre contents and signal a psychological disruption to the person's life that is often explained by a psychiatric diagnosis, whilst the latter seem to be deeply embedded in societal debates, are shared by groups (even by entire sub-cultures), and are not usually accompanied by distress.

In a recent paper, I argue that one thing they do have in common is how delusions and beliefs in a conspiracy theory are received. People who report delusional and conspiracy beliefs tend to be excluded from common epistemic projects. What do I mean by that?

Although there is a recognition that all speakers have a unique perspective and interests, and the capacity to pursue goals and make decisions, exploring delusional or conspiracy beliefs is not considered worthwhile. And it is considered a waste of time and resources to engage with people's goals and decisions of people when these are informed by delusional or conspiracy beliefs. That is because, in the eyes of the interpreters, those beliefs do not just happen to be false but undermine the confidence in the speakers' capacity to exercise their epistemic agency. 

But is this stance justified? I argue that it is not. It is a mistake to think that the presence of a belief that has some characteristics (e.g., a belief that we find implausible but that the speaker holds onto strenuously and identifies with) is sufficient reason to doubt the capacity of the speaker to exercise their agency. Rather, the endorsement of a delusional or conspiracy belief is usually a direct manifestation of the speaker's epistemic agency.

When do we endorse beliefs that are deemed delusional? When we have an unusual experience that demands an explanation. When we attempt to impose meaning on a confusing and distressing reality. When we need to manage overwhelming emotions to avoid an entire paralysis of agency. When we make sense of unexpected and distressing events. When we intend to show loyalty or affiliation to groups characterised by a certain ideology. When alternative explanations seem somehow unavailable or disempowering to us.

There are many reasons why people may endorse a belief that appears implausible to others and yet becomes important to how they see themselves and the world around them, to the point that it becomes difficult to give up the belief or recognise the strength of the evidence against it. But there is no good reason to think that the belief formation process or its outcome are themselves signs of irremediable irrationality or even of a pathology.

As I show in the paper, many of the cognitive biases and psychological needs that have been identified as antecedents of delusions and conspiracy theories characterise human belief formation more generally, though their influence can be heightened in some people due to background knowledge and reasoning style, or to their experience of adverse and stressful circumstances.

What does this have to do with epistemic injustice, you may ask. I think it is at the core of it. Epistemic justice is not achieved when people believe each other's testimonies uncritically or accept that all hermeneutical resources are equally good. Rather, epistemic justice is achieved when all epistemic agents are treated as such, and not as broken records, puppets or sheep: their views are not dismissed before being explored, but they are listened to with interest and curiosity. Agreement is not the goal, engagement is. 

Psychiatry as mind-shaping

 In this post, project EPIC postdoc Jodie Russell summarises her recent paper “Psychiatry as Mind-shaping”, published in Erkenntnis:

I make the case that researchers in mental health, clinicians and the wider public participate in a process called mind-shaping. By highlighting the involvement of these individuals in shaping the minds of people with disordered experiences, we can better understand phenomena like looping effects (when the behaviour of the person being labelled changes in response to that label, which in turn changes the meaning of the label). Moreover, characterising psychiatry as mind-shaping also helps us understand harms like epistemic injustice in a new light. But, first, let me unpack what I mean by psychiatry as mind-shaping.

Mind-shaping is a particular theory of social cognition – the study of how we understand each other. In contrast to traditional theories of social cognition, where we try to ‘read’ the minds of other people, the mind-shaping thesis proposes that understanding occurs through trying to get another person to conform to some set of shared rules. For example, I understand that my partner is hungry because their behaviour conforms to certain norms of being a ‘hungry person’, i.e., they rub their stomach, look wistfully at the kitchen, or graze on near-by biscuits. In this example, I try to understand what ‘type’ of person my partner is trying to be, assuming their behaviour conforms to some norms of that ‘type’ that I also adhere to.

In this way, I argue that researchers and clinicians are trying to understand what kinds of people individuals with disordered experiences are. In other words, clinicians and researchers might try and understand whether someone is a ‘well’ or ‘unwell’ person, a person with schizophrenia, or a person with a brain disease etc.

However, under the mind-shaping view, this process of categorizing people comes with certain expectations; in order for social understanding to be successful, it may be necessary to conform to certain norms. For example, for my partner and I to successfully coordinate over our shared task of making food for dinner, I really need to know that my partner is hungry. If they act hungry when they aren’t, we’ll make food for no reason. If they don’t act hungry when they are, my partner starves (if they are feeling melodramatic). Either way, if my partner is unreliable in conforming to norms, it makes working together to make dinner more difficult, and communication in general might struggle if they are not in some way reliable. There are therefore certain expectations at play in social understanding; if you are a hungry person, you should act like it. This is what it means to be mind-shaped.

This has, however, some unintended consequences when it comes to mental health research, namely, that individuals with mental disorder who are labelled may be prone to particular “expectancy effects”. In other words, by being labelled or studied in a particular way, as a particular kind of person, people with mental disorder may be obligated to act in certain ways. One such case study of this can be seen in a study conducted by Örmonet al. (2014). They noticed that the women in their study who had experienced abuse did not often have their experiences validated by clinicians, with their history of abuse considered irrelevant to diagnosis, and thus the women did not receive what they felt was the appropriate care. As such, the women responded to this treatment by changing their behaviour to conform to particular disorder categories that were seen as worthy of care (such as bipolar disorder). In this case, I argue that the women conformed to norms of being mentally unwell that clinicians typically expected to find; by understanding their patients as unwell, the clinicians were then able to provide some kind of care for these women. In this way, both the patients and clinicians were mind-shaped in order to coordinate on some goal (getting care for the women).

The consequences of this particular case study, however, was that the struggle of the women to have their abuse acknowledged was then interpreted by clinical staff through the lens of mental illness. This struggle was then either a mental health problem or secondary to the mental health problem. It is in this way that I think we should pay closer attention to the effects of mind-shaping, and how it may perpetuate epistemic injustices. Given that a core part of social understanding is the expectation we conform to shared norms, we may not only present very narrow options to individuals with mental disorder if they want to be understood by others (e.g. through the lens of specific disorder categories that may or may not fit their experiences), we may also exclude as irrelevant, or un-understandable, those behaviours, thoughts and feelings, which don’t fit our expectations but that are nevertheless important to the individual in question. The solution, I would want to propose, is giving people with mental disorder more agency to determine what norms are in play so that they might be better understood on their own terms.

Epistemic Justice in Mental Healthcare

This week we announce the publication of an edited collection which is entirely open access: Epistemic Justice in Mental Healthcare: Recognising agency and promoting virtues across the lifespan (Palgrave 2024), edited by myself, Lisa Bortolotti. The book is an output of project EPIC, featuring eight new chapters exploring epistemic justice in mental health. 

Epistemic Justice in Mental Healthcare

In the Preface (downloadable here), Matthew Broome and I frame the discussion as a way to affirm the role of the mental health patient as a person, an agent, and a collaborator. When we are mental health patients, we are persons because we are more than our health or our diagnosis, we have needs and interests that matter and that affect the way in which our health impacts our lives. 

We are also agents, because despite the vulnerabilities of our status as patients, we have a perspective that matters and the capacity to contribute to positive change. Crucially to the success of clinical encounters, we are partners in the project of addressing our health issues. We can collaborate with healthcare professionals by sharing our experiences and participating in decision making.

Chapter 1, Being understood: epistemic injustice towards young people seeking support for their mental health, is authored by Michael Larkin with members of the Agency Projects team including lived experience researchers from McPin. It addresses some of the factors that make clinical interactions unsuccessful, offering some suggestions for improving clinical communication. The focus is on ensuring that young people are understood and supported at times of crisis, that they are not blamed for the difficulties they face, and that they are not reduced to a diagnostic label.

Chapter 2, Challenging stereotypes about young people who hear voices, is authored by myself, Lisa Bortolotti, Kathleen Murphy-Hollis, Fiona Malpass, and young people from the Voice Collective. It highlights three stereotypes associated with voice hearing that have harmful consequences for young people's relationships and opportunities to thrive, in the family, the school, and the clinic. These are incompetence, dangerousness, and diversity leading to exclusion. The chapter illustrates the impact of these stereotypes based on the young people's experiences, and encourages further empirical research in this area.

Chapter 3, Reacting to demoralization and investigating the experience of dignity in psychosis: reflections from an acute psychiatric ward, authored by a team led by Martino Belvederi Murri, addresses the unique challenges to epistemic justice that emerge in an acute ward, where coercion may be used. The use of coercion may engender situations that are detrimental for individual dignity and morale. One such effect is demoralization, which may increase the risk of suicide. The chapter provides an overview of the work on these topics and offers some suggestions for strategies that might improve the experience of psychiatric inpatient care.

Chapter 4, Not all diagnosis are created equal: Comparing depression and borderline personality disorder diagnoses through the lens of epistemic injustice, authored by Jay Watts, examines four aspects of epistemic injustice: objectification, moral agency, trivialization, and narrative agency. It compares personality disorder and depression, arguably the least and most popular diagnoses with patients in psychiatry. The analysis emphasises the importance of epistemic injustice as a tool in critically evaluating the usefulness of specific psychiatric diagnoses, encouraging a shift in clinical training to embrace reflective practices and restructure power dynamics in clinical encounters. 

Chapter 5, Resisting perceptions of patient untrustworthiness, authored by Eleanor Palafox-Harris, argues that a beneficial therapeutic relationship between patient and clinician requires mutual trust. In order to effectively treat someone, a clinician has to trust the patient’s reports of their symptoms but many psychiatric diagnoses are stereotypically associated with traits that indicate untrustworthiness (such as irrationality). In this chapter Palafox-Harris illustrates how psychiatric labels can signal stereotypes of untrustworthiness, reducing patients' perceived epistemic credibility.

Chapter 6, Preserving dignity and epistemic justice in palliative care for patients with serious mental health problems, with Luigi Grassi as lead author, considers the challenges faced by people with serious mental disorders who are at the end of life and promotes a person-centred approach, which can increase the sense of personal dignity and epistemic justice. Dignity Therapy can be applied in palliative care settings, offering people an opportunity to reflect upon crucial existential and relational issues and prepare their legacy.

Chapter 7, Promoting good living and social health in dementia, with Rabih Chattat as lead author, explores the notion of good living in the case of dementia and highlights the role of social health in preserving wellbeing. Discrimination impacts people with dementia in diagnosis disclosure, advance care planning, and decision making. The chapter critically examines the labelling of the behaviour of people with dementia as problematic and pathological even when it is a reaction to difficulties in communication.

Chapter 8, Ameliorating epistemic injustice with digital health technologies, authored by Elisabetta Lalumera, discusses the potential of digital phenotyping for ameliorating epistemic injustice in mental health. There is a concern that the evidence digital health technologies gather may overshadow individual experiences but, through a fictional case study, Lalumera portrays digital phenotyping as way to support shared decision-making. 

The book aims to help understand how the demands of epistemic justice relate to and complement recent research on agency in youth mental health, person-centred care, dignity therapy, stigmatising diagnoses, good living, social health, and access to digital technologies. As illustrated in the figure below, people seeking help should preserve crucial roles as agents and collaborators with valuable perspectives, multiple interests and needs, the capacity to contribute to positive change, and the capacity for shared decision making.

The mental health patient as an agent

Alice Monypenny joins Project EPIC

We are thrilled to announce that Dr Alice Monypenny will be joining project EPIC from May 2025. As an introduction, we asked her some questions about her research.

What are your research interests?

I’m interested in the idea of epistemic agency – what it means to be a part of the processes and activities through which we produce and share knowledge. A lot of recent research related to epistemic injustice focuses on the ways in which people may have their epistemic agency limited, for example by being excluded from conversations, lacking adequate hermeneutical resources or being regarded as unreliable informants. However, I am interested in exploring the strategies people from oppressed and marginalised communities develop to cope with epistemic injustice.

In my recent work, I have argued that sometimes epistemic vices, such as closed-mindedness or intellectual arrogance, can be developed as coping strategies in hostile environments. My most recent paper (coming out in the Journal of Philosophical Research soon) defends a position in virtue/vice epistemology, called ‘normative contextualism’, which states that sometimes, depending on context, these traits may not be intellectual vices because of the role they play in allowing their bearer to cope with the challenges of their epistemic environment. 

I’m also interested more generally in how positive environments enable people to have a voice, my PhD research focused on understanding the role of safe spaces in education. 

Alice Monypenny

Why is studying epistemic injustice in healthcare important?

Understanding what it is like to live in our own bodies is such a fundamental part of being able to understand and interpret our experiences and how we interact with the world around us. That is why I think that understanding epistemic injustice within healthcare is so important – if someone lead to doubt their ability to understand their own experience of embodiment and make sense of the symptoms or conditions they experience, then this can have a significant impact on how they view themselves as a knower. It’s important to think about the ways in which healthcare systems and institutions can undermine people’s sense of understanding their own experiences – whether that’s through negative interactions with healthcare professionals or alienating language and labels. 

What are you working on at the moment?

I’m currently interested in the strategies adopted by patients and those seeking diagnosis and treatment when they interact with healthcare professionals, particularly when they hold back information about their symptoms or medical history. I’m using Kristie Dotson’s concept of ‘testimonial smothering’ to understanding this practice and exploring the way in which it can be an exercise of epistemic agency by enabling those who use it to carefully navigate tricky relationships with healthcare professionals who are gatekeeper to treatment and diagnosis. At the moment I’m exploring two case studies: patients with chronic pain; and trans and non-binary individuals seeking to access gender-affirming care. I’m also interested in the ways that patient communities and networks share information and resources such as tips for engaging with doctors or what to say in order to be taken seriously and get access to the right diagnoses and treatments.

EPIC's Year in Review and Festive Greetings

Celebrating a Remarkable First Year

As we wrap up EPIC’s inaugural year, our project manager Charlotte Withers reflects on our journey and achievements. 

EPIC was established with a range of ambitious goals: fostering collaborations, appointing key personnel, building a vibrant community, and establishing a robust online presence. Thanks to the dedication and creativity of our team, we are proud to say we have accomplished these aims and set the stage for an exciting future.

Festive version of the EPIC logo

Fostering Collaborations

Collaboration is at the heart of EPIC’s mission. This year, we’ve developed a strong network of partnerships across institutions and countries. Our investigators at Birmingham, Nottingham, Swansea, and Bristol have made significant strides in building internal and cross-institutional connections.

• Institutional Efforts: the Nottingham team developed a research network, and the Birmingham team launched a reading group and this blog to connect scholars and ideas.

• International Partnerships: the Birmingham team are collaborating with the University of Ferrara on a case study addressing depression and demoralization in cancer patients and with the University of Bologna on dementia research.

These collaborations have created a foundation for innovative, interdisciplinary research in the years to come.

Ground-breaking Publications

EPIC’s inaugural year has also been a banner year for publications:

• Bortolotti edited an open-access collection entitled Epistemic Justice in Mental Healthcare (Palgrave), with a preface by Bortolotti and Broome.
• Articles have appeared in leading journals such as Kidd's article in Philosophy, Psychiatry, & Psychology, Degerman's article in Philosophical Psychology, Russell's article in Erkenntnis, and Kidd and Carel's article in Social Epistemology.
• Chapters have been prepared for inclusion in edited collections, such as a chapter co-authored by Broome, McGuinness and Kidd on ‘Epistemic injustice, informed consent, and shared decision-making in mental health care’ and a chapter co-authored by Bortolotti, Murphy-Hollies, and Byrne on 'Epistemic Injustice in Mental Health: new directions'.

Future publications include two anticipated monographs and proceedings from upcoming conferences in Leipzig and Nottingham. 

EPIC has also prioritized accessible outputs, publishing in venues such as Psychology Today and The Conversation and producing a number of podcasts and videos for the general public.

Building Community

Creating a thriving community has been central to EPIC’s success.

• Online Engagement: EPIC hosts monthly seminars, featuring renowned speakers such as Miranda Fricker, and offers a ‘Friends of EPIC’ sign-up on our website to keep stakeholders engaged.
• Social Media Presence: Our website, blog, and Facebook page share regular updates, alongside impactful campaigns like ‘Women in Philosophy’ and ‘World Mental Health Day.’

Presentations and Outreach

EPIC members have shared their work globally, presenting at prestigious venues, including International Society for Psychological and Social Approaches to Psychosis (ISPS-US), the Chilean Society for Neurology, Psychiatry and Neurosurgery (SONEPSYN), and seminars and conferences at the universities of Cambridge, Aarhus, Eindhoven, Tokyo, California Irvine, and Prague - to mention just a few.

Our outreach efforts have made epistemic injustice accessible to broader audiences, including the following:

• Workshops with the Voice Collective resulted in co-produced videos and open-access resources.
• Collaboration with the Patients Association and the WHO Behavioural and Cultural Insights Hub are producing impactful briefing papers.

Memorable Events

EPIC launched with an inspiring event in Bristol featuring a commissioned musical piece by Toby Young. We’ve since hosted workshops for early-career women in philosophy and epistemic injustice scholars, with more exciting events planned through 2025/26.

Looking Ahead

EPIC’s first year has been a resounding success. From fostering meaningful collaborations to publishing innovative research and building a vibrant community, we have laid a strong foundation for the future.

Here’s to an even more impactful year ahead!

Happy 2025 to the EPIC blog readers