Narrative Deference

This blog post is a write-up of a paper by project postdoc Ellie Byrne which was published in Topoi in September as part of a special issue entitled Scaffolding Bad: Varieties of Situated Cognitive Harm edited by David Spurrett, Giovanna Colombetti and John Sutton. 

When I worked on the project Grief: A Study of Human Emotional Experience (PI Matthew Ratcliffe) at York, we obtained hundreds of first-person testimonies from grieving people about their experiences. I think regularly about some of the things people wrote, but there’s one in particular I keep coming back to: “My childhood is now only remembered by me. I’m an only child. So that time seems completely inaccessible.” (#208)

To me, this quote drew attention to the extent to which having other people available to corroborate our memories influences how we understand ourselves. We do this all the time and all throughout our lives: we might ask our parents to corroborate some significant childhood experience of ours, or ask a sibling to confirm that we’ve remembered something correctly. Later in life, we may ask a friend to corroborate how we remember coping with a breakup or our partner to remind us of a certain order of events in a particularly busy period.

We also enlist others to fill in the gaps for things we do not remember well. We might not really remember much at all about these experiences; perhaps just diffuse ‘feelings’ associated with certain events. In such cases, we might end up pretty reliant on our friends, family and partners to tell us what happened, how we felt about what happened and how those feelings have shaped who we are today.

According to the philosopher Richard Heersmink, autobiographical memories are the building blocks of our autobiographical self-narratives. Heersmink, situating some of his work within the field of ‘distributed cognition’, has emphasised that since our memories are distributed between people, it makes sense to say that our self-narratives are too. In my paper, I followed Heersmink in drawing attention to the extent to which we can rely on others for our autobiographical self-narratives, and the ways that this can be both good and bad for us. My paper introduces a concept which I call ‘narrative deference’, defined as the phenomenon whereby one is more dependent upon another person for central aspects of one’s autobiographical self-narrative than on oneself.

As I started to present this idea at conferences and workshops, there was a consistent theme in Q&A discussions: each time, multiple people in the audience had thought of contexts in which this phenomenon is harmful. This led me to think about the phenomenon in terms of another one of my research interests: affective injustice.

Affective injustice scholar Shiloh Whitney connects affective injustice to a distinctively affective form of gaslighting, the phenomena whereby casting doubt on someone is the means through which they are made to doubt themselves: “in gaslighting, the way others respond to me begins to impair an aspect of my relationship to myself. In particular, the noncooperative response I receive from some second person(s) when I express my experiences to them begins to impair some aspect of my ability to make sense of my own experience to myself in the first person” (Whitney 2023, pp.31–32). 

Understood this way, we can see how the affective influence others have on us can be used to undermine our self-trust over time such that our autobiographical self-narrative possibilities are restricted. While gaslighting is primarily discussed in the context of romantic relationships, it is being increasingly recognised how gaslighting can also occur in healthcare settings.

In a variety of contexts, an ill person might narratively defer to another because it presents itself as the best immediate option. Perhaps narratively deferring to my parents allows me to maintain a coherent or desirable autobiographical self-narrative. Perhaps deferring to my doctor allows me to make sense of an otherwise overwhelming and confusing situation. Perhaps deferring to my partner prevents conflict and maintains my bond with the person who cares for me. This deference can surely help me to secure lots of things that are good for me, but my most fundamental sense of self is also made vulnerable by it.

I think there is a lot of interesting and important future work to be done in exploring how this phenomenon operates in both epistemic and affective injustices in healthcare.

Eleanor Byrne

Eleanor is a postdoctoral research fellow at the University of Birmingham and part of Project EPIC. She specialises in affective and existential dimensions of illness experiences, particularly Functional Neurological Disorders. She has worked on grief in illness and experiences of post-viral fatigue such as Long Covid. She is currently developing a project on phenomenology and functional seizures. 

Understanding Oneself through Others Day 1

Winterbourne House and Garden

This is a report by Jodie Russell. On 23rd and 24th September Eleanor Byrne and Kathleen Murphy-Hollies organised a workshop at the University of Birmingham, bringing together researchers interested in the area of the intersection of epistemic injustice and distributed cognition. The venue for the workshop was the beautiful Winterbourne House and Garden. 

On day one, postdoctoral researchers on EPIC Kathleen Murphy-Hollies, Eleanor Byrne, and Jodie Russell and EPIC project partner Michael Larkin introduced project EPIC and talked about their research to date. Kathleen is interested in how our self concepts and our relationships with others shape our identities. Eleanor is working on affective injustice, a type of injustice that relates to how a persons’s emotions are given (or denied) uptake by others. Jodie aims to establish an intersectional, feminist approach to psychiatry. Michael is going to work with the EPIC Birmingham team to develop a case study on epistemic injustice in young people with psychosis and his own research is about the importance on relationships for youth mental health.

Some key information about project EPIC

Our first speaker was our keynote Allan Køster from the Danish National Centre for Grief with a talk titled "Consolation: a fundamental existential category". Køster made the case for a new understanding of the phenomena of consolation to better capture how it relates to grief and loss. 

Slide from Køster's presentation

Køster noted, for example, that doctors are often faced with instances where they must inform a terminally ill patient of their prognosis. In such cases, there is little hope the doctor can offer the patient which raises the question of how we are to face such situations when inevitable and where little comfort can be offered. 

This is where we often turn to the practice of consolation, but what consolation is, is not yet clear. 

Køster thus presented an existential account of consolation based on the work of Heidegger. On this account, life is felt to be overwhelmingly burdensome, and this isn’t something we live in spite of, but, instead, it’s a fundamental aspect of our existence. 

Consolation should then be seen as, according to Køster, the attempt to unburden oneself or another from the weight of existence. This can be achieved through a kind of “delegating” or distributing the weight of that burden onto the world and others. For example, when we feel consoled by a walk through nature, part of the burden of existence is offloaded onto our environment. 

Our next presentation was given by Zuzanna Rucińska from the University of Antwerp. Her talk was titled "Understanding suicidality as a situated phenomenon" and focused on the cognitive and affective scaffolding of individuals with suicidal ideation. 

Rucińska began by presenting a puzzle around suicidality; individuals who experience suicidal thoughts are often ambivalent about life. Rucińska noted that in attempting to takes one’s own life, individuals often change their mind in the act. There is, nevertheless, for many individuals, an authentic desire to die that can come and go over a lifetime. Given this ambivalence, the question is raised as to why some people attempt to end their lives. 

Rucińska's presentation

Rucińska then proposed to answer this question through providing an account based on the interplay of the individual and her situation. Rucińska noted, for instance, the significance of the method of suicide; individuals do not change methods when their preferred method isn’t available, and studies on the restriction of particular products which are used in culturally preferred methods of suicide showed a reduction in suicide mortality. 

From this, Rucińska suggested that the environment can afford for suicidal actions; a suicidal person will perceive and attend to the features of her environment that will assist her in taking her life. These are features others might not necessarily notice due to our individual histories which have shaped how spaces are meaningful to us in specific ways. Moreover, the desire to die and to live are not contradictory but reflect the very dynamic relationship all individuals have with the environment where, for the suicidal, the opportunity to take one’s life might appear and recede as they navigate the world. 

Rucińska’s analysis implies further that a different environment will afford for different actions. Therefore, on a situated view, not only do we better understand the phenomenology of suicidality but this also potentially opens up new avenues for suicide prevention. 

After a hearty lunch break, our morning session was followed up by an interesting talk by Zamir Kadodia from the University of Exeter on a joint project with Joel Krueger on "Epistemic Injustice, Niche Construction & Neurodiversity".  

Kadodia introduced the neurodiversity paradigm from which their critique stems. This paradigm characterises neurodiversity as cognitive difference and states that the idea of a “healthy” or “normal” brain or mind is a construction. This is in contrast to the pathology paradigm which has characterised neurodiversity as disorder.  

According to the neurodiversity paradigm, neurodivergent individuals, such as those that are autistic, should be considered as a minority group. This is especially important to consider, Kadodia notes, as neurodivergent voices have been historically excluded from attempts to understand neurodivergence itself.

Kadodia and Krueger’s goal, however, is to highlight more surreptitious forms of marginalisation experienced by neurodivergent individuals. Kadodia discussed here an example from Miranda Fricker; in this case, an individual mistakes a shy person for being insincere because their shy behaviour (e.g. avoiding eye contact) makes the individual appear to be untrustworthy. Fricker counts this as a case of bad luck, not epistemic injustice, but Kadodia argued that this case looks different when we swap in the shy person for an autistic person. 

Slide in Kadodia's presentation

In this new example, Kadodia argued that this is a case of epistemic injustice because the neurodivergent person is being judged by norms of trustworthy behaviour that are determined and enacted by neurotypical individuals. As marginalised individuals, neurodivergent people don’t get to contribute to these epistemic norms, but are nevertheless expected to conform to them. This is worrisome because it means that norms of communication for neurodivergent individuals are given less credibility, which leads to a "neurotype identity prejudice", meaning that neurodivergent needs are neglected or, in the worst cases, stigmatised. 

Kadodia then problematised this further by translating this discussion around neurotypical norms to the framework of niche construction, arguing that stereotypes about neurodivergent people in the social imagination become entrenched in material practices, e.g. habits and interactions with the physical and social environment, just as neurotypical norms also become part of the habitual and embodied ways of being in the world.  

Kadodia thus called for the need for neurodiversification, which entails a greater representation of neurotypes and even a clash between different norms in order to facilitate a constructive conversation over the niches we live in. 

Slide from Latham's presentation

Afterwards, Sally Latham from Birmingham Metropolitan College talked to us about "Why self-help is not always helpful". Latham began with some self-help examples in popular culture we are all too familiar with, for instance, the idea of changing how you think in order to transform your situation. 

Latham made the case that much pop culture self-help emphasise a narrative of personal responsibility and individual choice; it is through our own efforts, these narratives suggest, that we will overcome our circumstances. However, drawing on Frank and Foucault, Latham argued that these narratives perpetuate a "ruse of liberation". This is achieved through technologies of the self, what are techniques used to understand oneself and even transform oneself.  

These technologies themselves can be used to control individuals through self-monitoring. In this way, Latham compared self-help to the panopticon; it becomes a way through which to constantly monitor and measure our 'selves' through the various exercises self-help prescribes. Self-help is given normative force for this purpose from its proximity to psychology and the authority of wellbeing 'experts'.  

The flip side of this, Latham described, is that reactions to negative life events that don't follow the positive, self-actualising framework of self-help become taboo. This is tantamount to epistemic injustice by excluding particular social experiences, which marginalises individuals who cannot face, e.g., illness with positivity. Due to the focus on individual responsibility, this may also lead to the blaming of vulnerable people for their negative outlook on life. Latham proposed, as one solution, that we should change the definition of self-help itself so that it might be more fruitful in future. 

Lastly, presented in a hybrid format, Lucy Osler (Cardiff University) and Louise Richardson-Self (University of Tasmania) closed the first day of the workshop with the talk “It Just Goes to Show That You Actually Need to Listen to Your Patients Sometimes: Distributed Cognition, Epistemic Injustice, and the (Under)diagnosis of Endometriosis".

Slide from Osler and Richardson-Self's presentation

Osler and Richardson started by informing us on some statistics on endometriosis. Shockingly, 1 in 7 people assigned female at birth are diagnosed, and diagnosis can take more than 8 years in the UK. The consequences of a delayed diagnosis involve a range of physical and social harms. Osler and Richardson, however, were focussing on epistemic and affective harms. 

They argued that there are persistent, systematic identity-tracking prejudices within wider western healthcare practices. In particular, women experience disproportionate levels of bias in diagnosis and treatment of health conditions. Richardson noted further that the level of confidence gynaecologist and women’s health GP’s have in their skills in managing patients with chronic pelvic pain is worryingly low. Moreover, gynaecologists report that they are not likely to consider patient beliefs and goals in regards to managing chronic pelvic pain.

Not only can this lead to physical and social harms, patients with endometriosis also suffer epistemic and affective harms as their testimony is overlooked or discredited. These patients are thus left with feelings of self-doubt, abandonment, shame, and mistrust of the medical establishment. This raises the question of what features enable the dynamic between medical practitioner and patient to play out in ways that perpetuate epistemic harms in the case of endometriosis.

Osler framed this issue in terms of niche construction and scaffolding; medical knowledge is often distributed among healthcare professionals, medical tools and textbooks which come together to form the niche of western healthcare. The underdiagnosis of endometriosis in women can be understood, Osler argued, in terms of the failure of this medical niche to epistemically support those with endometriosis. 

Rounding off their talk, Richardson and Osler then introduced the symbol of the “Endo Warrior” as a form of resistance of epistemic injustice through empowerment. The use of social media is critical this process as a safe space and efficient medium for sharing expertise and experience.

This talk closed the first day of the workshop. Next week we will report from the second day of the workshop. Watch this space!

Affective injustice and borderline personality disorder

Borderline personality disorder (BPD) is a contentious and heavily stigmatized diagnosis. This is something one cannot help but become acutely aware of when navigating the healthcare system with a BPD diagnosis. We are stereotyped as attention-seeking, manipulative and intentionally antagonistic. Such stereotypes and beliefs about people with this diagnostic label inevitably influence clinical encounters. Moments after being diagnosed, a well-meaning nurse encouraged me not to disclose my diagnosis if I were ever to seek private psychotherapy. Some therapists, he noted, simply refuse to work with people diagnosed with BPD.

I am particularly concerned with how diagnostic criteria for BPD may interact with negative stereotyping in particularly harmful ways. One of the nine diagnostic criteria (of which five are required) for BPD listed in the DSM-5-TR is display of ‘Inappropriate, intense anger or difficulty controlling anger’. This criterion is notably wide and stated examples range from extreme sarcasm to recurrent physical fights. The openness of the criterion is not in itself a bad thing, it may even be necessary for clinicians to apply it to individual persons with unique and complex ways of being in the world. The danger is that such openness can increase use of stereotyping that can lead to situations wherein our anger is dismissed – from the outset – as inappropriate and pathological.

Initially, this may seem like a case of testimonial injustice – roughly, a form of epistemic injustice wherein someone’s standing as a knower and credible testifier is undermined due to negative prejudices about their identity. For example, the idea that people diagnosed with BPD are purposefully hostile could lead clinicians to make biased assessments of the legitimacy and proportionality of our anger.

The ‘problem’ with anger, however, is that it is not clear that what we are dealing with are claims to knowledge and, consequently, that prejudice-driven dismissals of anger as inappropriate or pathological always involve an epistemic wrong. Imagine a case where negative stereotypes lead clinicians to assume that (nearly) all anger experienced and expressed by someone with a BPD diagnosis is inappropriate and pathological. Even in instances where the anger may indeed be inappropriate because it involves or is based on an incorrect belief, the fact that such anger is met with an assumption of (a pathological kind of) inappropriateness seems wrong. It is not clear to me that this wrong is epistemic.

Mit liv (My life in Danish) by Leif Hakon Olesen, from a collection (Livsbilleder, 1995) of painting and poetry made by service users at the social institution Basen that operated in the Danish town of Aarhus in the 1990s.

Instead, it may be a distinctly affective wrong, a form of affective injustice. Affective injustice has been defined as the phenomenon whereby people are wronged as feeling or affective beings. It may, for example, occur when racialised people’s anti-racist anger is dismissed as counterproductive to constructive debate, in turn, putting them in a normative conflict between their apt emotional responses to racial injustice and desire to better their situation.

It may also occur, I would argue, when the affective experiences of people diagnosed with BPD are viewed through a lens of pathology and negative stereotypes to a degree that makes it incredibly hard (if not impossible) to have our anger be seen as genuine and sometimes appropriate reactions to past trauma, neglect, discrimination and apathy.

Astrid Fly Oredsson is a self-described PhD drop-out with formal training in philosophy and lived experience of navigating various healthcare systems with a BPD diagnosis. 

Her research interests lie in topics such as psychiatric diagnoses, emotional experience and epistemic and affective injustice.

Affective and Mnemonic Injustice

This is a report on the workshop held online on 30-31 January 2024, entitled: Affective and Mnemonic Injustice. Thanks to Felipe Carvalho, Nathália de Ávila and Em Walsh for their detailed and interesting report.

Workshop poster

One of us – Felipe Carvalho – is a philosopher of emotion with a keen interest in its political aspects, while the other two – Nathália de Ávila and Em Walsh – are philosophers of memory whose works address specially negative-valenced emotions in psychopathology. So, when the idea came of organizing a Zoom workshop together, we thought it would be a great idea to explore these two topics in combination. After all, there are obvious interconnections between them – provoking a traumatic experience upon another person, for example, is a kind of injustice that has both an affective and a mnemonic component. We thus hoped that the talks in this workshop, and the discussion that would follow them, could bring out these and other interconnections

Marina Trakas (CONICET, Argentina) opened the workshop discussing instances where fear generalization results in harm to others and represents forms of injustice, particularly through mnemonic capacities. Mnemonic injustice refers to the phenomenon wherein inequality and discrimination arise through how stereotypes influence the way we remember. In an effort to provide a tangible illustration rooted in real-life experience, she exemplified how the academic accomplishments of individuals belonging to minority groups, such as a woman or a Black candidate, may be misrepresented or undervalued by members of the hiring committee due to the impact of stereotypes on memory. 

This could result in their achievements and qualities not being duly acknowledged (epistemic harms) and consequently, facing difficulties in securing employment (practical harms), leading to feelings of stress and anxiety (affective harms). Ultimately, this could perpetuate the development of inaccurate or distorted beliefs regarding their own academic capabilities and talents (further epistemic harms). Marina claimed that on a personal level, by embracing strategies encouraged by society, mnemonic injustice stems from various memory biases that can be tackled through fostering mnemonic humility - an expression proposed by Vilius Dranseika that works as a sort of epistemic virtue that relies on metamemory (i.e. knowledge about how our memory systems work and their inherent processes). This relation will be the focus of her future works on the matter. For now, her aim was to show how mnemonic injustice sheds light on a previously unnoticed aspect of social epistemology, particularly evident in instances of fear generalization.

The next speaker was Francisco Gallegos (Wake Forest, USA), a Mexican philosopher who introduced concepts from Mexican existentialism to discuss affective injustice and authenticity—a philosophical discourse with a clear Heideggerian background. In his profound and captivating presentation, which adeptly referenced several interdisciplinary works by women and Latin American thinkers as if it were commonplace rather than exceptional, Gallegos analyzed the notion of "Zozobra." This concept refers to the inability to feel at home in the world in an anxious and oscillating manner that reflects cynicism, nostalgia, apocalyptic thinking, and inaction simultaneously. 

In a post-pandemic context that coincides with wars, genocide, and a collapsing economy and climate simultaneously, there is no need to assert the audience’s collective identification with an emotion of this kind. In philosophical debates, while some Mexican existentialists, like Jorge Portilla, argue that zozobra arises from social disintegration and societal dysfunctions, others like Emilio Uranga and Gloria Anzaldúa view the emotion as inherent to the human condition, capable of being utilized as a source of authenticity with the aim of reversing it. Gallegos, we understand, combines both approaches. By introducing the concept of "affective goods'' (i.e., all that contributes to an excellent emotional life), he identified which ones are fundamental and their conditions of possibility (i.e., their inherent affective freedoms, affective resources, affective opportunities, and forms of affective recognition) in order to define affective injustice as the morally objectionable deprivation of those affective goods. 

He then questioned how one can pursue authenticity (as something more individually-oriented) within contexts over which we have little power (as they adhere to pre-established rules beyond our control), such as restrictive work settings that censor personal expression, the inability to pursue personal projects due to excessive work demands, or being subjected to punishment for affirming one’s identity, as we daily see in the experience of the LGBTQIA+ community. The response, in turn, emphasized the roles of transparency, non-conformity, integrity, and growth. By concluding the presentation with more questions than definitive answers, Gallegos underscored the importance of exploring which affective and mnemonic environments contribute to emotional integrity, thereby reducing injustices.

People sharing ideas in an online meeting

The second day of the workshop began with Joel Krueger (Exeter, UK), a philosopher who has already explored, in previous works, the various harms and injustices faced by neuroatypical individuals (for example, here, here and here). This time, however, these harms were framed within the concept of affective injustice. In particular, Joel argued that significant theoretical gain could be achieved by framing affective injustice within an ecological psychology framework, in order to highlight how features of the built environment can be responsible for affective injustices. 

In order to argue for this claim, Joel focused on two cases studies: hostile architecture, such as spikes installed on flat surfaces to prevent individuals from sitting or lying down, dividers on benches to discourage lying down or stretching out, etc., as well as masking practices in autism, which refer to the adoption of behavior and styles of expression in order to conceal certain autistic traits, as a compensatory strategy that help autistic individuals navigate the social world. Both of these cases, Joel argued, deprive bodies of access to subsidiary affective goods (a notion Joel borrows from Francisco Gallegos), such as affective freedoms, resources and recognition, making people feel affectively powerless (the feeling that a significant portion of one’s life is manipulated by others with greater affective power). To put it in the vocabulary of ecological psychology, their affordance spaces are designed in ways that weaken their spatial agency and thus diminish their ability to feel at home in the world. 

Finally, the workshop ended with Katherine Puddifoot. Katherine is a philosopher at Durham University, whose interests encompass mental health, epistemology (implicit biases; memory errors, etc) and trauma. In her talk, she explored instances of mnemonic injustice, where memory processes contribute to unfair treatment of others, as well as situations where misunderstandings about memory result in injustice. This presupposition is an outcome of her recent collaboration with Marina Trakas, specifically the paper about fear generalization, which is listed below. 

This joint work led her to now advocate for a perspective on memory rooted in social justice. Those who embrace this viewpoint will judge a memory account acceptable only if it aligns with the principles of equity: arguing for a social justice perspective on memory requires a significant shift away from approaches that view memory as a natural kind. Nonetheless, she claims that adopting this stance is warranted due to the crucial role an accurate understanding of memory plays in promoting fairness. In order to clarify her argument, Katherine carefully examined different concepts of memory within the contemporary anglophone literature on philosophy of cognitive sciences, such as Markus Werning’s trace minimalism (2020).

Wonderful questions and discussions followed all the talks, and we wished we had more time to explore all the suggestions and interconnections that appeared in the Q & A. We thus hope that this blog post will foster the debate on affective and mnemonic injustice. We believe that philosophical accounts of memory and emotion harbor profound political implications, and that contrary to being peripheral, the political dimensions of memory and affectivity occupy a central position in inquiries concerning the mechanisms, objectives, and societal implications of memory and emotional processes. 

Workshop speakers: Katherine, Francisco, Joel, and Marina 

If you’d like to know more about these topics, we encourage you to get in touch with the organizers and/or the speakers, and check some of the papers that were discussed in the workshop, which are listed below:

• Joel Krueger – An Ecological Approach to Affective Injustice
• Francisco Gallegos - Affective Injustice and Fundamental Affective Goods
• Katherine Puddifoot - Mnemonic Injustice
• Marina Trakas & Katherine Puddifoot - Fear Generalization and Mnemonic Injustice 

Eleanor Byrne joins EPIC!

Eleanor Byrne will join project EPIC in 2024 as a research fellow in the Philosophy Department at the University of Birmingham. Here she tells us about her research and her interest in epistemic injustice.

Ellie Byrne

Hi Ellie! What are your main research interests?

Hi! I’m a philosopher working mainly in the philosophy of medicine and psychiatry. Within this, I focus primarily on the emotions and the types of medical conditions where there appear to be strong affective components that are not very well understood. 

My PhD focused on fatigue syndromes, and my first postdoc in Sweden focused on Long Covid. I have since been working a little bit on non-epileptic seizures. This understanding gap about the affective lives of patients relates to a host of scientific and social issues which I seek to unpick philosophically. 

Often with tools from phenomenology and the enactivist tradition under my arm, I try to develop a more complex and dynamic framework for understanding the emotions in medicine. My first explicit attempt at that can be found here. I also do a little bit of work on grief, emotion regulation and narrative.

Why do you think it is important to study epistemic injustice in healthcare?

A consistent theme in my own research is how lack of understanding about the emotions in illness causes a significant epistemic burden for patients. For instance, Long Covid patients with anxiety and depression symptoms are often stuck trying to arbitrate between competing explanations about what causes their symptoms, which nonetheless do not seem fully satisfactory. Uncertainty and confusion about one’s emotional life also brings challenges for one’s self-concept: is this the virus or is it me? Who am I now? This epistemic burden relates to all manner of epistemic injustices in healthcare which deserve careful study.

What I find exciting about the study of epistemic injustice in healthcare is how it is progressing: it’s incredibly encouraging to see new distinctions and concepts are coming to fruition that enable us to better capture a subtle dynamic or problem that has long caused significant harm and suffering. I think there is remarkable ameliorative potential, as well as philosophical interest, in the study of epistemic injustice in healthcare.

What are you working on right now?

I’m currently working on a newer concept intricately connected to epistemic injustice: affective injustice. These are injustices that relate to how a persons’s emotions are given (or denied) uptake by others. Uptake failures generally reflect credibility deficits. For instance, the anger of a woman will be given less uptake than the anger of a man because being a woman affords her less credibility.

I am developing a framework of affective injustice that is sensitive to not only discrete emotions like anger, but also to longer-term and diffuse affective experiences like moods, malaises and existential feelings. These affective experiences are common in illness, and failures to give such experiences uptake is responsible for a significant amount of suffering, alienation, shame and self-concept distress. I hope that this work can be a useful part of the wider project goal to develop ameliorative strategies for epistemic injustices in healthcare.