Unusual Experiences and Beliefs

For Mental Health Awareness Week 2025, project EPIC organised a webinar focusing on the harms caused by negative stereotypes associated with people who have unusual experiences and beliefs. Panelists included Martino Belvederi Murri and Fiona Malpass. The event was supported by The Royal Institute of Philosophy and the Voice Collective.

Poster of the webinar

Martino is Associate Professor at the Institute of Psychiatry and Director of the School of Specialization in Psychiatry, working as a clinical psychiatrist in the Acute Psychiatric Inpatient Unit. His research integrates clinical psychiatry with advanced statistical modelling and computational psychiatry, focusing on late-life depression, early psychosis, and psychosomatics. He has a specific interest in depression phenotyping, demoralization, psychosis outcomes, physical activity interventions, cognitive factors, cannabis use.

First slide of Martino's presentation

Fiona works at Mind in Camden as the Project Development and Innovation Lead, which includes managing the Hearing Voices Projects, working with young people, prisons, forensic settings and immigration removal centres, and the London Hearing Voices network. They have a background in psychology and philosophy of mental health, as well as having personal experience of many forms of distress, including hearing voices. They use this in their work to build connections, as well as to challenge the status quo and provide provocations to ways of thinking and working.

What good support looks like
from Fiona's presentation

Both Martino and Fiona discussed whether the notion of epistemic injustice can be usefully applied to the situation of people who experience non-consensual reality, and reflected on the challenges that practices in healthcare and everyday prejudices in friends, family, teachers, and doctors may present for young people who hear voices.

The problem, according to Martino, emerges because we tend to think that if a person is suffering from a psychotic disorder or is experiencing a psychotic episode, then they are not able to judge any aspect of reality. That's a that is an unnecessary and wrong generalization. We see all the time that even when a person has a persecutory experience, they often are able to judge many, many situations. 

The job of the psychiatrist is not to assign a label of normality to people, but to help them by not increasing their suffering, relieving the harms, and reducing the risks. The most difficult challenge is to support a person in a moment of crisis, which might require depriving them for a certain time of their liberty, without negatively affecting their self-perception and their sense of dignity. Even in an involuntary admission, if possible, the person must be involved in decisions concerning their care. A humane care ultimately means respect and mutual understanding.

Forms of testimonial injustice in psychosis
from Martino's presentation

Martino concluded his presentation by discussing the existence of a paradox: although there is increasing attention to ethical and philosophical issues, there are reduced resources. Whereas healthcare professionals aim to do better, they have fewer resources at their disposal to improve care. 

Fiona talked about kind of work they do at the Voice Collective, which is based at London, Camden, but also about the collaboration with the EPIC project, thinking about agency and epistemic injustice, as it relates to young people who hear voices, or have other unusual perceptions or beliefs.

The Voice Collective works across London and the UK more broadly but has also an international reach. The bulk of the work is to support people under the age of 26, and their families, carers and supporters, with an emphasis on young people who have highly stigmatized and potentially overwhelming and distressing experiences. These experiences can be hearing voices, seeing things, tasting things, smelling things, having felt presences, having multiple senses of self, forms of dissociation, paranoia, the list goes on. 

The Voice Collective is established to provide more community grassroots care, coming from a non-clinical, non-pathologizing community perspective and adopting a pluralistic approach where many factors may be considered as relevant to people's experiences.

Factors contributing to distressing experiences 
from Fiona's presentation

They establish peer support groups for young people who have these experiences: one online group for 11 to 15 year olds; and a peer support group for an older age group, 16 to 25 year olds. Young people chat to each other, ask each other questions, and just offer solidarity and friendship to each other. Another activity is to set up advisory groups for research projects or steering groups for service development, because a big part of the Voice Collective approach is trying to help young people be heard and be listened to and have input into things to push back against the epistemic injustice that they face. The aim is to create spaces where young people's knowledge is valued.

Young people are often seen as incapable. There's often an emphasis on young people who hear voices being powerless. Their experiences are often framed as a deficit and part of a severe mental health issue. For some people voices can be massively distressing and overwhelming, but there are times where voices are helpful. Some people have very positive experiences of their voices, and neutral ones, too. So it is difficult for young people who have these less stereotyped versions of voices to talk about them for fear of their voices being seen as something inherently wrong, and an issue with them, and with how they experience the world. The healthcare system can be a very oppressive system to be part of where young people often experience a lot of coercion going along with whatever treatment pathway is recommended to them.

If you want to listen to the full presentations by Martino and Fiona, and follow the question and answer session that followed, watch the recording of the webinar below and let us know what you think.

Who knows what in mental health? The conference (part two)

This is a brief report of some of the talks presented on the second day of the conference on expertise in mental health hosted by Radboud University. If you want to know what happened on day one, please check out this post.

Nijmegen

I started the programme with a talk on the relationship between epistemic injustice and expertise. One way of making sense of an expert agent is to think of them as agents who can provide evidence on the basis of which other agents form judgements and make decisions. I distinguished three ways in which we can see other agents as a source of evidence: (1) they offer an insight into their feelings and thoughts; (2) they acquired a competence by using knowledge obtained via training or education; (3) the acquired a competence by using knowledge obtained via another type of experience, such as work experience or an experience of illness. 

Slide from Lisa Bortolotti's presentation

All forms of expertise are afforded and perspectival, as they depend not only on the competence of the agent, but also the opportunity the agent has been afforded to share their perspective or reflect on their experience in the surrounding environment, and the values of the agents who seek evidence. Epistemically unjust practices can prevent agents from making an epistemic contribution as experts, offering some examples from recent research in youth mental health.

Next, work on lived experience by Owen Chevalier, Shannon Mahony, Anne Marie Gagné Julien, and Sarah Arnaud was presented in the context of anorexia nervosa. The presentation supported the epistemic argument that participatory research produces more objective, accurate, and rich knowledge about mental disorders; and offered preliminary suggestions for developing a participatory method in the philosophy of psychiatry (research needs to be collaborative, patient-directed, and interactive). By reviewing the literature on anorexia nervosa, Mahony and Chevalier provided evidence for the epistemic value of participatory research. 

Presentation on anorexia by Chevalier and Mahony

First-person accounts of anorexia highlight the epistemic tension between traditional researcher perspectives of the disorder and patient perspectives to identify areas where a participatory philosophy may be useful in resolving conflict. However, one concern was raised: philosophers, who often advocates for participatory research in psychiatry, have yet to adopt participatory methodology in philosophy as well.

The topic of anorexia was also discussed by Stephen Gadsby who focused on what it might mean to identify as anorexic. Questions about self-identification might change across time: initially a person may identify as someone who values and pursues thinness and only later they may see themselves as someone who has anorexia. Occasionally, in biographies about living with anorexia, the illness is separated by the self and personified. Maybe conflicts of identity are prompted by the illness itself. But this turns out to be also a treatment strategy, where users of service are encouraged to see their illness as distinct from the self ("There is the anorexia inside me and then there is the real me, the logical part of me").

Stephen Gadsby on first person accounts of anorexia

So one issue is how to interpret these reports. And this becomes a problem when lived experience advisors participate in research as there is self-selection: it is more likely that participation is offered when the person sees themselves as an anorexic and a person with a mental illness. People who don't see their condition as an illness or do not accept the way anorexia is framed in healthcare are less willing to participate in research which leaves us with skewed evidence. It is difficult to solve this problem and participatory research may be the way forward.

The last talk of the day (and of the conference) was by Ian James Kidd. The research question was what role epistemic injustice should have in efforts to understand negative epistemic experiences typical of depression. Kidd decided to focus on hermeneutical injustice which can be described as a lack of hermeneutical resources, an absence of apt resources, the presence of of inapt resources, and a lack of uptake. Sometimes, the resources don't exist. At other times, there are no good institutional or interpersonal places where the hermeneutic game can be played. Hermeneutical injustice can be extended or limited in breadth or depth.

Ian James Kidd

Depression experiences present hermeneutical disruption but should those be characterised in terms of hermeneutical injustice? Some of the hermeneutical frustration and inability related to depression might be integral to certain kinds of human experience and not cases of injustice as such. For phenomenologists, experience is a space for possibilities which for people with depression is altered so that possibilities and kinds of significance are reduced and the world becomes flat and empty. Depression might come with loss of self-esteem and epistemic self-trust, diminished positive epistemic emotion, and loss of aspirational hope. Standard epistemic injustice models do not accommodate these existential changes, this (as Kidd put it) "phenomenological drama".

The second day of the conference was as stimulating and varied as the first, and it inspired interesting conversations about future research goals and collaborations.

Who knows what in mental health? The conference (part one)

Radboud University hosted a conference on 11th and 12th June 2025 examining the interplay between the study of epistemic injustice and the debates on expertise by experience in mental healthcare. This is a brief report of some of the talks presented on the first day of the conference.

From the poster of the event

Roy Dings (one of the organisers together with Linde van Schuppen and Derek Strijbos) kicked off the event with a brief introduction to the motivation for a more in-depth analysis of experiential knowledge.

Roy Dings on experiential knowledge

First keynote talk was by philosopher of science and psychiatry Şerife Tekin. She started her presentation discussing sources of knowledge in psychiatry, including intervention-oriented science, clinical practices, cognitive science research, and self-related resources (self-reports). Self-related phenomena have been traditionally undermined.

Şerife Tekin and the cover of her new book 

Tekin argued that one problem is that the self has not been considered a legitimate topic of psychiatric investigation and this suggests that studying the self is not scientific. Another problem is that self reports are considered to be unrealiable due to the wide presence of biases and confabulation. Next, there are concerns about internet self diagnosis (what Tekin calls the TikTok problem) as some people see their entire identity as defined by the diagnosis they have and this does not offer insight into their own specific experiences. Finally, there is an objectivity problem: it is often thought that self reports are subjective and don't deliver the type of knowledge we need.

Tekin proposed a new model to represent the various facets of the self in experiential experience (physical, social, conceptual, narrative, and experiential). This model is a model of the patient that can offer responses to all the challenges usually faced by experiential knowledge. Even if self reports by themselves have epistemic limitations, it is by engaging with such reports that we make progress with understanding what people are going through.

Dings on the Attuned Responsiveness framework

The next talk was by Roy Dings and Derek Strijbos. They started asking what an expert by experience can contribute: what is unique and valuable about their contribution. Dings observed that it is not easy to be explicit about what it is that we should add to experiential knowledge to obtain expertise. So he developed with Strijbos a new framework called Attuned Responsiveness. One element is responsiveness: things matter to different people in different ways (what we notice and why) and a number of factors can be relevant (biology, culture, experience, self-reflection).

The other element is attunement: this is about being responsive to other people's responsiveness (being open) and about being active (making an effort to bridge dissimilarities in responsiveness by asking questions). Attunement is a core aspect of everyday social expertise but between people with lived experience there may be fewer dissimilarities. So we should include people with lived experience in psychiatric knowledge because they notice the right things and find the right words.

Strijbos on how to reconcile different types of expertise

Strijbos argued that experiential knowledge is not just knowledge of one's own experience. It is the acquisition of perceptual and agential skills that bring epistemic benefits and have an impact on how one addresses problems. What experience does is increase attuned responsiveness, in a way that would be hard or impossible to achieve in other ways (with more depth and detail). This framework can also explain and help tackle conflict among experts: different experts can be responsive to different aspects of a situation.

After lunch, Themistoklis Pantazakos presented on the scope of epistemic injustice in psychiatry and discussed the debates about whether the construct is useful when applied to interactions between healthcare professionals and mental health patients. There is a lot of push back against the overapplication of the notion of epistemic injustice to the mental healthcare context, based on criticism about some cases that are considered paradigmatic.

Pantazakos on the debate on testimonial injustice

Pantazakos argued that testimonial injustice in psychiatry is predominantly about the person's phenomenological experience: the patient is an authority when it comes to what it is to be them. Most of the cases cited as cases of testimonial injustice in psychiatry are not cases of phenomenological epistemic injustice and they are not even cases of testimonial injustice so the notion of testimonial injustice is not compromised by the failure of these cases to be convincing.

Next talk was based on the methodological assumptions embedded in the political turn in analytic philosophy: the claim to be assumed is that lived experience enables the acquisition of knowledge and is authoritative, and the philosophical work is to explain why this is the case. The authors of the paper, Cristina Borgoni, Miguel Núñez de Prado, Manolo Pinedo, contended that neurodivergent people face systematic barriers in making contributions to collective knowledge. The discussion analysed some of these barriers. 

Miguel Núñez de Prado presenting at the conference

The more constructive part of the talk proposed that we move beyond the concept of experiential knowledge and focus on the pluralism of types of knowledge, using instead the concept of knowledge by lived experience. Knowledge by lived experience is a distinct type of knowledge that arises from having a specific lived experience although what is known may not be itself part of the experience. Often this involves interlocking self-knowledge and knowledge of a specific situation or condition. Authority comes from self-knowledge and standpoint: questioning self-knowledge attributions is an ethical and an epistemic wrong and there is no such thing as neutral reason-giving, so being perspectival is not just inevitable but constitutive of knowledge.

Lubomira Radoilska started with a quote from Elyn Saks' memoir, The centre cannot hold, to exemplify what expertise by experience might look like. This prompted a detailed analysis of lived experience as a form of knowledge by acquaintance that, in the mental health context, comes with a credibility deficit due to stigma. Calling lived experience a form of expertise could serve as a way to counter the deficit. But there are also cases (extracted testimony) in which drawing from lived experience as a source of authority means that the reporting of the experience in situations of duress is attributed a credibility excess, and outweighs independent, conflicting evidence.

Lubomira Radoilska on the zetetic model

Radoilska developed an account of a ‘zetetic’ initiative showing that a shift of focus toward norms of inquiry would better support a sustained resistance to epistemic oppression than further attention to general epistemic or evidential norms. This is because the zetetic initiative emphasises the ongoing exercises of epistemic agency by marginalised inquirers with lived experiences rather than their pre-existing experiential knowledge as a resource they could share with, or transfer to others. The notion does justice to the dynamic and creative aspects of epistemic advantage gained in circumstances of social marginalisation, in contrast to the static habits of thought that help maintain ignorance of social privilege, e.g., effortless belief that everything is as it appears to be.

Slide on empathy by Julian Kiverstein

The final talk of the day was by Julian Kiverstein who focused on the ameliorative project: how to improve the lives of people with mental illness. The starting point is that lived experience escapes operationalisation and psychiatric knowledge is based on operationalising mental disorders (e.g. in the DSM). So lived experience is the blind spot. One account Kiverstein challenges is that by Matthew Broome and Lucienne Spencer who criticise radical empathy as an appropriation. According to Kiverstein, radical empathy is not a case of appropriation but encompasses the skill of active listening, and the virtues of humility, curiosity, and diligence.

The discussion throughout the day was very inspiring and helped bridge different approaches to experiential expertise and different philosophical frameworks.

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.

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.

Philosophy of Medicine Roundtable 2025 (part one)

The Philosophy of Medicine Roundtable was held at King's College London on 2nd and 3rd June 2025. Here is a brief account of some of the talks and posters presented on the first day of the event.

Bush House in London, conference venue

The first talk was by John Ioannidis, "Research results: the false, the fake, the useless, and the untouchables". The presentation started with the statement that "Science is the best thing that can happen to humans". Yet, Ioannidis argued that most scientific research has used non-reproducible and sub-optimal research practices.

Results can be:

• False = due to random error or bias
• Fake = not real, crafted, fabricated
• Useless = not having a meaningful purpose
• Untouchable = impossible to access or use.

John Ioannidis

Problems:

• Megajournals publish too many papers and have high acceptance rates (25-60%). Review is fast and authors pay to publish.
• Predatory journals publish poor science and have an acceptance rate of 100%.
• Extreme publishing behaviour is another threat (researchers publish 60 research articles every year) and get high citation rates in problematic ways.
• Many fake papers are generated through AI and only a few are detected and retracted.

In the rest of the presentation, Ioannidis analysed in more detail the challenges of doing science in a way that produces results that are not fake, not useless, and accessible; and suggested some ways we can improve scientific practices.

In the first break of the conference, participants were invited to look at the research posters. One of these posters was by EPIC postdoctoral researcher Jodie Russell. Russell's work is on intersectional invisibility. You can download her poster here.

Jodie Russell on intersectionality

In the afternoon,  Maria Cristina Amoretti presented a paper about the distinction between values and biases in medicine, co-authored with Elisabetta Lalumera. While values guide research priorities and clinical decision-making, biases are typically seen as distortions to be eliminated. However, this view is too simplistic: both values and biases can promote or hinder medical knowledge and patient care. 

Cristina Amoretti and... Pimpa!

Amoretti and Lalumera proposed a functional distinction: values are explicit, discussable, and justifiable judgments shaping medical aims, whereas biases are implicit tendencies influencing reasoning in ways not explicitly articulable. Values are not always beneficial, and biases are not always harmful. Instead, their roles in medical research and clinical practice need further examination.

In another talk, Elena Popa and Jay Zameska discussed the relationship between social determinants of health and various conceptions of causation. The empirical evidence linking wide social issues such as inequality or poverty to health outcomes justifies the search for interventions on these high-level phenomena. This can be a more efficient way of improving the health of a population in contrast with targeting individuals suffering from downstream health effects. 

Elena Popa presenting

But it is difficult to fit insights from population health science with biomedical approaches which focus on downstream causes and which have been preponderantly used in public health. For Pola and Zameska, overcoming the dominance of narrow biomedical models requires considering a wider range of causal concepts, particularly mechanistic and dispositional ones. The suitability of these concepts can then be assessed by analyzing the interventions resulting from them through the lens of priorities in public health

ethics.

Another break in the conference meant another look at the posters! Themistoklis Pantazakos prepared a poster on the role of biomarkers in debates about pathologization.

Themistoklis Pantazakos on biomarkers

Rebecca Brione presented on the importance of philosophy of language for doctor-patient interactions. In particular, Brione focused on failed refusals of medical treatment. Should the patient have the right to refuse treatment, and if so, under what circumstances? Little attention has been paid to the speech act of refusal itself. 

Brione argued that philosophy of language offers the resources we need to develop a more sophisticated understanding of medical refusal (and similar speech acts), in isolation and in context. These resources enable us both to conceptualise refusal as a normative act, and to understand what is required for a patient to succeed in their attempt to refuse treatment. 

Rebecca Brione on medical refusal

Brione presented a novel account of refusal as an assertion which attempts to add both a direct proposition and presupposed content about the normative landscape to the communicative common ground (the shared beliefs, knowledge and information that form the background for an assumed-collaborative conversation).

The first day of the Roundtable was very rich and thought-provoking, showcasing the variety of issues that can be tackled by philosophers of medicine.

Digital Age: Mental Health, Cognitive Robotics, and AI

On the 9th of April 2025, Seiara Imanova organised an event, along with Andrew Hicklin, called "The Digital Age: Mental Health, Cognitive Robotics & AI", held at the Edgbaston campus, University of Birmingham as well as online. This post is a report of the event.

Speakers of The Digital Age event

The goal of the event was to highlight just how important the digital world has become, and the ways it’s shaping so many areas of our lives. As technology continues to shape how we communicate, understand who we are, and engage with systems of care, it’s crucial that we pause and critically examine what this means for fields like mental health, psychiatry, and beyond.

Seiara Imanova introduced Lucienne Spencer

The event began with an insightful presentation by Lucienne Spencer (University of Oxford), titled “Social Media & Shifts of Ontic Power in Mental Health”, which explored how digital spaces, such as social media platforms, can act as catalysts for shifts in psychiatric authority. In other words, online platforms like TikTok, Instagram as well as AI powered chatbots, are changing who gets to define, talk about, and influence mental health and psychiatry. Dr. Spencer highlights that although this shift could be considered a kind of ontic empowerment for people with mental ill health, re-shaping diagnostic categories in digital spaces carries the risk of distorting and diluting their original meaning.

Spencer’s presentation was followed by another incredible talk by Alan Winfield (University of Bristol), titled: “The Ethical Roboticist - From robot ethics to ethical robots”. Winfield looked at questions such as what do robot ethicists actually do, what kinds of harm can robots and AI cause, as well as ways for setting an ethical standard and regulations. Perhaps most striking was his demonstration of The AI Incidents Database, which highlighted why ethics was important in robotics, and how AI is already causing harm in the real world.

Alan Winfield's presentation

Last but most definitely not least, the third presentation was given by Paris Lalousis (King’s College London) titled: “Artificial Intelligence in Mental Health: Challenges, Pitfalls, and Opportunities” which is based on the excellent work he does at his AIM Lab at King’s. In contrast, Lalousis discussed the growing need for AI in healthcare, particularly in psychiatry, by highlighting the limitations of current neuroscientific approaches, such as the constraints of neuroimaging, the challenges posed by diagnostic ambiguity and high comorbidity rates between psychiatric conditions. 

Presentation by Paris Lalousis

Lalousis argued that intelligent systems hold significant potential to address these gaps. He presented his study on how the use of machine learning can better predict remission for patients with mental disorders such as schizophrenia or bipolar, and a glimpse into precision medicine.

The event hoped to achieve its goal which was to foster meaningful reflection on both the possibilities and ethical tensions that arise as human experience becomes more entangled with algorithmic and artificially intelligent systems. You can watch the live recording of the event below.

Understanding Oneself through Others Day 2

This is a report by Jodie Russell and Lisa Bortolotti. 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. 

You find a report of day one here.

Winterbourne

On day two, Katherine Puddifoot offered her keynote presentation, entitled "Affect, Attention, and Injustice: The Injustice of Neglected Affect". Katherine started from the observation that affective states, like anxiety, worsen in some illnesses like COPD (Chronic obstructive pulmonary disease). Should we draw attention to those affective states? The talk focused on there being an injustice of Neglected Affect. The injustice occurs where people have affective states like fear and anxiety which are preventing them from having their objective basic needs like health, education, and longevity met.

Slide from Katherine Puddifoot's presentation

The people who are experiencing the affect could benefit from being given information about their affective states and how to modulate them. However, drawing attention to the affect risks leading them to engage in negative self-stereotyping, and fear judgement and generally distrust others—each of which could prevent them from gaining knowledge and understanding about their affective states and how to modulate them. 

This presents an epistemic dilemma for those who notice that others have affective states like fear and anxiety that are undermining their objective basic needs: whether they draw attention to the affective states or not, they risk causing the person experiencing the affect to miss out on knowledge and understanding about how to modulate it. Already vulnerable people, who possess affective states that are negatively impacting their objective basic needs, are further disadvantaged because they are unable to access knowledge and understanding that would support their objective basic needs by modulating their affect. 

J.P. Grodniewicz is presenting and Ellie Byrne chairing

The second talk was by J.P. Grodniewicz and Anna Drożdżowicz, and concerned epistemic injustice in the context of psychotherapy. For J.P, and Anna, psychotherapy is a form of psychological service that involves a collaborative process based on the relationship between (at least one) psychotherapist and (at least one) client/patient. Although psychotherapy can be a valuable experience with multiple positive outcomes, the path to achieving these outcomes may be long and difficult. Specifically, in some cases, patients/clients can be vulnerable to various forms of harm and injustice.

In this talk, they discussed the epistemic goals of psychotherapy and specific risks related to clients’/patients’ attempts to achieve these goals. First, they argued that the main epistemic goal of psychotherapy is deepening one’s self-understanding, characterized as a kind of objectual understanding which consists of grasping coherence-making relations between constituents of a body of information about oneself.

Second, they argued that patients/clients may risk various forms of epistemic injustice that may further hinder them from acquiring and/or deepening self-understanding in psychotherapy. Epistemic injustice arises when one’s capacity as an epistemic agent is denied. Epistemic injustice is widely discussed in the context of psychiatry; however, epistemic injustice in psychotherapy has received relatively little attention.

They offered examples that illustrate how three forms of epistemic injustice can arise in psychotherapeutic encounters:

• Testimonial injustice in psychotherapy occurs when the client’s words and/or capacity to provide knowledge are wrongfully assigned less credibility by the psychotherapist due to epistemically irrelevant factors rooted in systematic or interpersonal dynamics.
• Hermeneutical injustice in psychotherapy occurs when clients are wronged in their capacity to make sense of their experiences due to limitations in their conceptual resources or due to having the conceptual resources of the psychotherapist imposed on them against their interest(s).
• Contributory injustice occurs in psychotherapy when clients cannot contribute their perspectives and interpretations because their contribution is dismissed or undermined by the psychotherapist.

In each case, they argued that epistemic injustice may result in specific epistemic harms related to achieving and/or deepening one’s self-understanding in the course of psychotherapy. In the end, they briefly discussed some ways of mitigating these risks.

Slide from David Hahn's presentation

The third talk was by David Hahn and was entitled: "Self-Illness Ambiguity, Alienation, and Distributed Self-Understanding". David started from the observation that feeling uncertain about who we are can affect our agency and our relationships so it is important to resolve self-illness ambiguity. But how should we do so? In realist accounts, what is internal is who we really are but mental illness is simplified as it appears like a virus that "attacks" the self. The self is actually more intertwined and complex; the definition of what 'self' is, is a judgement or decision.

Self-discovery approaches presuppose self-knowledge, and reify both the self and illness. Most authors advocate for a narrative view of the self that can be just as reifying as the realist view even if the self is constructed. One of course could ask whether the narrative is "good" in the sense of authentic, but this may not be helpful to someone who is experiencing self-illness ambiguity.

If we reject both realist and constructivist view of the self-illness ambiguity, what is left? The self is not constituted of new facts but interpretations and a critical theory is needed, drawn from Jaeggi's account of alienation. On Jaeggi's account, alienation is a relation of relationlessness, a disrupted appropriation of inner and outer world. It is not to be understood as a lack of knowledge but as an inability to lead one's life, due to an alienated relationship between self and world.

So, overcoming ambiguities doesn't involve asking what is "really me" but, instead, asking practical-ethical questions in the process of learning how to live an unalienated life.

Slide from the presentation by Vespermann and Tirkkonen

Daniel Vespermann and Sanna Tirkkonen discussed existential injustice and focused on the phenomena of background feelings (which are phenomenologically different from emotions). Distressing background feelings of uncertainty, existential guilt, or worthlessness are enduring and remain unaffected by momentary changes of social situations. These feelings condition episodic emotions, thought processes, and behavioral tendencies. As affective states, they also impact on a person’s commitments, concerns, and values. Background feelings thus have an important guiding function in our lives.

Daniel and Sanna argued that distressing feelings require hermeneutic labor and prompt regulatory efforts, which are often scaffolded by the social environment. Given this premise, background feelings are generally vulnerable to unjust social influences. Despite the burgeoning literature on affective injustice and hostile scaffolding, how background feelings can be subject to social injustice has remained underdeveloped in these debates.

Because of their fundamental role for people’s affective, cognitive, and practical capacities, Daniel and Sanna call the wronging of background feelings existential injustice. They introduced two dimensions of existential injustice that lead to feelings of inadequacy and thus exacerbate mental distress. First, attention guidance and narrative practices can impede understanding and regulating one’s background feelings by limiting potential perspectives on one’s affective condition.

Second, they analyzed the regulatory role of attention guidance. Patterns of attention predetermine sources of affect regulation. Directing attention away from distressing stimuli or thoughts again helps to modulate emotional strain. However, what becomes perceptually salient is shaped in specific sociocultural contexts and these selection histories can lead to maladaptive adaptations to context-specific values.

Third, Daniel and Sanna clarified the idea that different narrative practices shape self-relevant information. Since narratives can be a means of determining criteria for the appropriateness and fittingness of affective states, they may also impose unjust demands on individuals’ affect regulation. Thus, narrative practices can generate cognitive frames that prevent beneficial reappraisals of affective interaction patterns.

Together, these dimensions reinforce the painful salience of distressing background feelings and foreclose experiences of support or validation. Being hindered from reframing one’s condition evokes feelings of inadequacy, that one’s affective condition is inappropriate or even incoherent.

Slide from the presentation by Isern-Mas

 

Carme Isern-Mas presented on "The Affective Injustice of therapy Speak". Although therapy speak is not properly analysed in philosophy, it is an important phenomenon to study in relation to epistemic injustice because it can be seen to promote both epistemic and affective injustice. Carme used some interesting examples to how how therapy speak can be weaponised, including the case of Jonah Hill who talked about 'boundaries' to control his partner's behaviour, or the case of a boss sending employees on a 'wellbeing' course to deal with burn-out caused by the stress in the workplace.

Obviously, therapy speak isn't always a bad thing and it can even help overcome epistemic injustice, challenge stigma around mental health, and help identity new phenomena. However, it can be misapplied, and lead to over-simplification, trivialisation, dilution of meaning, pathologization, and inappropriate self-diagnosis. As a consequence, people using therapy speak can discredit the testimony of others for no good reason, evade responsibility for their behaviour, signal that their status is privileged, and give to an impartial observer the impression that they are adopting an objective stance.

Therapy speak also exploits the authority of medical advice, conflates descriptive and normative terms, hides normative claims, and provides to the person who uses it the opportunity to merely deny the other person's perspective on the basis of this more "scientific" and "objective" stance that however may have no medical justification and a very vague relationship with the concepts actually used by therapists.

Therapy speak also perpetuates affective injustice by contributing to deny uptake for the other person's testimony, silencing different perspectives or objections to the "medicalised" interpretation of the situation, testimonial smothering, perpetuating the claim that the other person suffers from a credibility deficit and demanding that the listener (who may be the oppressed member of the group) regulate their own emotions in line with the speaker's interpretation. On a broader scale, it may also result into an example of emotional imperialism.

Day one speakers!

Day two speakers!