Philosophy of Medicine Roundtable 2025 (part two)

This is a brief report of some of the talks delivered on the second day of the Philosophy of Medicine Roundtable hosted by King's College London in June 2025. For a report of day one, please go here.

From the poster of the Roundtable

The second day of the event started with a presentation by Devora Shapiro on the role of EBM (evidence-based medicine) in enabling phenomena such as medical gaslighting and illness invalidation. Shapiro discussed cases where patients are told that there are no medical issues for them, because the test results come back with no indication of pathology, and yet the patient has a complaint that matters to them and is not given sufficient uptake.

A slide of Shapiro's presentation

The discussion following the presentation centred on what causes the problems of power-imbalanced relationships between doctors and patients, whether it is EBM or something else, for instance a failure to provide care or a lack of recognition that, although successful, medicine cannot tackle all human problems.

In one of the several talks by project EPIC members at the Roundtable, Elisabetta Lalumera asked why definitions matter in medicine and how linguistic labels function as operational tools. Conceptual engineering and conceptual choice may serve various goals such as diagnostic utility and inclusivity. One example of the importance of definitions is the change in the definition of pain, which has been revised in 2020 to include the sensations of those who cannot describe pain such as infants, nonverbal patients and animals.

Elisabetta Lalumera on definitions of pain

Such revision was motivated by inclusivity and ethical concerns so it was a deliberate value-laden choice. The new definition has the merit of avoiding the risk of epistemic injustice (e.g. when a patient claims to be in pain but no lesion is found) but has risks as well, being more vague, more difficult to operationalise, and likely leading to overmedicalisation of human experience.

In the next talk, Kathleen Murphy-Hollies, postdoc on project EPIC, presented a talk about what it means to give uptake to the metaphorical meaning of delusions. Murphy-Hollies started talking about the experience of entomologists being contacted by people with delusions of parasitosis claiming that they are suffering from an infestation. How should entomologists deal with these cases? To what extent should they believe the people claiming an infestation?

Each testimony has two aspects: the propositional content conveyed and the perspective conveyed in the statement. We can fail to believe what the person says and yet take their perspective seriously. Maybe delusions express metaphorical meaning that is worth trying to understand. Murphy-Hollies builds on account by Federico Bongiorno and Rosa Ritunnano to explore the metaphorical interpretation of delusional utterances.

Kathleen Murphy-Hollies on delusions

In the rest of the talk, Murphy-Hollies observed how metaphorical meaning is not just relevant to people reporting delusional beliefs, but is often conveyed in cases of reports by people who experienced trauma or have implicit knowledge. This observations lead to a new understanding of uptake which is not just believing what the person is saying but is about mutual engagement.

Dan Degerman talked about the medicalisation of silence. Silence has been seen as a cause of depression (not talking about something might lead someone to become depressed), as a symptom of depression (it appears in the criteria for depression), as a problem in the workplace (underperforming) and as a cause and symptom of depression in that context.

Dan Degerman on silence

Degerman asks why the medicalisation of silence is a worry. Silence is a diagnostic marker for depression and can be associated with distress. But by medicalising silence we represent it as a threat, we end up avoiding it, and we obscure its benefits:

• social benefits
• epistemic benefits
• medical benefits.

More important, we may override the benefits of silence for medical or health-related reasons.

As hopefully shown by these remarks on some of the talks, the second day of the Philosophy of Medicine Roundtable was very rich and addressed a variety of issues in the metaphysics, epistemology, and ethics of medicine.

Hysteria, Hermeneutical Injustice and Conceptual Engineering

In "Hysteria, Hermeneutical Injustice, and Conceptual Engineering", I look at what Miranda Fricker, in her Epistemic Injustice. Power and the Ethics of Knowing (2007) calls “hermeneutical injustice”, as it arises in the medical context. By drawing on the complex history of hysteria, I argue that the very concept HYSTERIA was used for diagnostic purposes for millennia, before its dismissal with the DSM-III in 1980, due to power structures affected by negative prejudice against women. 

Stereotypical representation of hysteria

I then argue that HYSTERIA fits the central conditions of the concept HERMENEUTICAL INJUSTICE. Yet, reflection on the case of HYSTERIA also signals the need for widening the understanding of the concept HERMENEUTICAL INJUSTICE itself. This is methodologically important for two reasons. First, because instead of considering the medical field merely as an area of application or testing of philosophical ideas, it uses medical data to improve a philosophical notion. Accordingly, I propose that hermeneutical injustice may depend not only on gaps in hermeneutical resources, but also on the presence of faulty ones, such as HYSTERIA. 

Second, once thus improved upon, HERMENEUTICAL INJUSTICE can be used to advocate for other forms of amelioration of concepts, which still embed identity prejudice against certain groups. I claim that it can do so by eschewing the more traditional path taken in current debates on the amelioration of concepts such as WOMAN. These debates risk perpetrating an “essentialist” outlook – let it be grounded in biological “nature” or in socially-acquired “nature” – on what women “really” are (or should be), which is fraught with problems.

By bringing the concept of HERMENEUTICAL INJUSTICE to bear onto this kind of discussion we can bypass that “essentialist” outlook altogether and be more inclusive and open to further applications of WOMAN, if these applications can help people, such as transwomen, to make sense of their experience and if doing so can help remove identity prejudice against them. 

The debate over the concept WOMAN is but one example of the areas in which a reconfigured concept of HERMENEUTICAL INJUSTICE could play a role. In fact, once so reconfigured, HERMENEUTICAL INJUSTICE could also be used to diagnose what is epistemically amiss in the use of those slurs, epithets and pejoratives which likewise embed identity prejudice against certain groups.

In fact, HYSTERIA is a clear example of a harmful concept rooted in identity prejudice against women. Its use undermines women’s ability to understand, express, and reason about their experiences, perpetuating forms of epistemic injustice like testimonial and what I call “rational(ity) injustice”— that is, the injustice of downplaying, diminishing and impeding the development of women’s rational abilities, due to identity prejudice against them. Therefore, I argue that using “hysterical"” and related terms descriptively should be banned.

Still, HYSTERIA could potentially be reclaimed by women, like other harmful concepts rooted in identity prejudice that were initially rejected for their damaging effects but later embraced by marginalized groups to strenghten identity and belonging.

Annalisa Coliva is Professor of Philosophy at University of California Irvine, and Editor in Chief of the Journal for the History of Analytic Philosophy. 

Annalisa's interests are in Epistemology, Philosophy of mind and language, and History of Analytic Philosophy.