Abolitionist perspectives on epistemic injustice in psychiatry

This post by Cath Roper and Nina Joffee-John explores abolitionist perspectives on how to address epistemic injustices in mental healthcare, drawing on interviews with mental health service users/survivors.

Unlike physical health, which protects the principle of informed consent to treatment, specific legislation enables public mental health services to authorise detention, administer treatment to persons without consent, and use restrictive practices. In most jurisdictions, such legislation operates across inpatient and community settings, invoking human rights issues.

People who have been labelled as ‘mentally ill’ belong to a group whose testimony can be doubted on grounds that it is faulty, unreliable, untrustworthy. We are often seen to lack ‘competence’ and ‘insight’ and our knowledge is not given credence. We can even be placed under the aegis of mental health legislation on these grounds.

Most of the researchers in our study had a lived experience of public mental health services.  Because of this, our perspectives could be regarded as inherently untrustworthy and we could experience  ‘testimonial injustice’.  The epistemic power of law and medicine, with their positivist, scientific worldviews, have the potential to combine and disqualify other worldviews, in particular the worldviews of people labelled ‘mentally ill’.

As researchers, we ourselves could be subject to testimonial injustice.  Our research could be dismissed on grounds of being ‘biased’ because we sought our key informants for their critique of mental health laws, a voice seldom heard in the formal literature. We aimed to gather the opinions of advocates and survivor activists on this topic in order to amplify these perspectives, contributing to epistemic justice.

Ongoing debate about coercion authorised under mental health laws is generally discussed by legal and clinical academics and typically centres on when it can be justified and how it can be reduced. Using a snowball sampling technique, we conducted interviews with 15 key informants across 5 different countries, who were known to hold a critique of mental health laws.

Informants thought these laws were discriminatory, caused harm and could not be justified. Mental health laws were criticized for breaching human rights, denying legal capacity, and displacing consent while forced psychiatric interventions were equated with torture and violations of freedom of opinion and expression. Psychiatric abolition was linked to broader movements like prison abolition and anti-colonial activism. Activism was positioned as essential to dismantle coercive systems and create new possibilities for non-violent, community-led care.

Abolition was proposed as a necessary response to the injustices of mental health laws,  involving daily steps toward creating a more just and equitable society.  Our findings showed imperatives to dismantle mental health laws on human rights grounds and to de-carcerate care. An urgent need to consider First Nations or Indigenous peoples’ activism and self-determination as abolition leadership was prominent in our findings. Informants suggested investing in social determinants, community-based care, and peer-led support systems as alternatives to coercive mental health practices.

Examples from countries without mental health laws, such as Thailand and Nepal were highlighted.  Peru was presented as a country that has come closest to putting a supported decision-making regime in place that operates on an equal basis for all citizens. Community-based models like Trieste, Italy, were highlighted, which were founded on social inclusion and human rights. Human rights frameworks, such as the UN Convention on the Rights of Persons with Disabilities (CRPD), were seen as powerful tools for advocacy and reform.

Abolition theory and practice provide ‘hermeneutic resources’ so people can understand their social experience, informing social justice and community-led responses to care. Taken together, our findings provide a step-by-step model for abolition in psychiatry.

To read the full open access article and share through your networks: https://www.sciencedirect.com/science/article/pii/S0160252725000937 

Author bios

Cath and Nina are lived experience academics working at the University of Melbourne, Australia. Each has lived experience of involuntary mental health treatment and detention, including seclusion and restraint, which profoundly shaped their understandings of and commitment to social justice, equity, and freedom. They use these perspectives to consistently critique the ethics and operations of mental health laws. Nina is pursuing a career in law.

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.

Workshop report: Loneliness, Metaphor & Empathy

Last week, Project EPIC held a workshop at the University of Nottingham entitled 'Loneliness, Metaphor & Empathy'. This workshop featured three talks by Project EPIC postdocs Fred Cooper (Bristol), Kathleen Murphy-Hollies (Birmingham) and Eleanor Byrne (Nottingham). 

The workshop theme reflects some current research interests of the project postdocs. All three talks teased out varieties of epistemic injustice that can arise when certain forms of suffering are marginalised by others. Fred asked what epistemic injustices might be at stake in claiming that certain experiences are inherently unknowable, Kathleen discussed the role of various prejudices in shaping how uptake-worthy we take people's claims to be, and Eleanor discussed the extent to which attempts to empathise with others can result in epistemic injustices.

Fred began the day with his talk The Naked Terror: Joseph Conrad, 'True Loneliness' and the inability to know. Fred discussed themes of loneliness in Conrad's Under Western Eyes where there is an implication that loneliness--or rather, 'true loneliness'--is characteristically unknowable. He gives us the following quote:

Who knows what true loneliness is-not the conventional word, but the naked terror? To the lonely themselves it wears a mask. The most miserable outcast hugs some memory or some illusion. Now and then a fatal conjunction of events may lift the veil for an instant. For an instant only. No human being could bear a steady view of moral solitude without going mad. 

Fred Cooper

Fred argued for a closer historical interrogation of the ways that epistemically  unjust or constraining narratives on health and ilness are sustained over time.

Kathleen then talked about metaphorical meaning and giving 'uptake' to the experiences of people with delusions and various other false beliefs. She argued argued that the content of what people say is often over-scrutinised for accuracy and truth, and that these tendencies are often exacerbated by prejudices.

Kathleen Murphy-Hollies

For example, she mentions how the claims of asylum seekers are often over-scrutinised for truth and accuracy as a result of certain prejudices. Ultimately, Kathleen's position is that even when we highly doubt that a certain belief expressed is true, there are still possible meanings to give uptake to in our engagement with them. Kathleen argued that dismissing those meanings can constitute a form of epistemic injustice, and that giving uptake to metaphorical meaning is a way of engaging with the agents' best attempts to communicate their experiences.

Some members of Project EPIC (L>R; Alice Monypenny; Fred Cooper; Ian James Kidd; Eleanor Byrne; Kathleen Murphy-Hollies)

Eleanor Byrne then closed the day with her talk about empathy. Drawing on ongoing collaborative work with Allan Køster (Danish National Centre for Grief), Eleanor discussed the limits of empathic understanding in contexts of profound suffering. She engaged with recent critiques of empathy which state that certain experiences are too alien, too profoundly catastrophic, to be understood by others. She concedes that some experiences can evade understanding, but maintains that some basic form of empathy remains possible no matter the circumstances at hand. This, she called ground empathy. 

Eleanor drew on a passage by Georg Simmel in order to argue that no matter the profound difference in your circumstances, it is always possible to empathically relate to the other person by attending to the fact that we all share the same existential fragility. Simmel writes:

All the thoughts and fates that make us suffer are actually only the occasional causes that bring about a part of the infinite potential for suffering that is inherent in us. [...] The most uncanny thing is that on such occasions we get the inkling of an immeasurable store of suffering that we carry around with us as if in a sealed vessel; a dark being that is not yet reality, but is still there somewhere, from which fate always releases certain parts, but leaves behind an inexhaustible amount. Most of the time this vessel rumbles quite quietly within us, but sometimes, when a single misery or shock opens it, it starts to move, to tremble dully, and we feel – we ourselves do not know where or what it means – this terrible treasure of potential suffering that we carry around with us that is our dowry, which can never be fully realised, cannot be exhausted by any real misery.

(Simmel 1923, Fragmente und Aufsätze)

Eleanor takes this passage to be illustrative of the inherent fragility that lies within all of us, waiting to be made salient by misfortune. It is by attending to these facts of life, the contingency of our position, that we are able to empathically relate to (if not understand) others in times of catastrophic upheaval, illness and suffering. 

This was the first official Nottingham event for Project EPIC. Keep an eye out for updates and adverts for upcoming events across Nottingham, Bristol and Birmingham.

Behind the Stigma: the podcast

Today's post is by Seiara Imanova. 

When I began my Master’s in Psychology at King's College London, I quickly realized there was a significant gap between the advancements in mental health research and how that knowledge is communicated to the public. This inspired me to start my podcast, Behind the Stigma, with the goal of bridging the divide between academic discussions in psychology, neuroscience, and mental health, and making them accessible to the general public.

Logo of Behind the Stigma

Although psychology is a science, in the way that it uses empirical research and rigorous methodologies to understand phenomena, its practical applications—especially in clinical work—are often deeply rooted in subjectivity (biases, power dynamics, and social hierarchies etc). This is particularly evident when we examine the lived experiences of individuals, especially those from marginalized groups. These groups are often silenced or undervalued, a concept known as epistemic injustice.

Epistemic injustice refers to how certain individuals or communities have their knowledge and experiences systematically dismissed or ignored. Below are a few episodes where we tackle these critical issues:

Race, Culture & Social Equalities in Mental Health with Hári Sewell

In this episode, Hari Sewell, founder and Director of HS Consultancy, offers insights into the systemic forces driving racial disparities in healthcare. For example, he explains how societal attitudes shape patient outcomes by highlighting the disproportionate detention rates of Black individuals in psychiatric wards compared to their white counterparts. Also, how unconscious biases subtly influence clinical decision-making, affecting everything from patient engagement to the formulation of treatment plans. His insights underscore the urgent need to confront these systemic issues in order to build more just and equitable mental health practices.

Returning to Wholeness: A Story with Psychiatric Nurse Neseret Bemient

In this episode, Neseret Bemient, a former psychiatric nurse in Canada, shares her profound journey toward wholeness and alternative healing. Neseret reflects on her experiences in psychiatric care, revealing how her role often involved navigating a system that frequently dismissed the voices of patients. Diagnosed with medication-induced bipolar disorder, she discusses the ways in which her history and lived experiences as a refugee was an important factor in understanding her wellbeing. Neseret emphasizes the importance of integrating spirituality and holistic approaches into practice, shedding light on the issues within psychiatric care. She urges us to recognize and validate the diverse experiences and knowledge of individuals diagnosed with mental health conditions.

Philosophy of Psychiatry with Lisa Bortolotti 

In this episode, philosopher Lisa Bortolotti delves into the distinctions between delusions and irrational beliefs, as well as exploring implications for agency in youth mental health. She discusses her research examining how young people navigate clinical encounters within mental health settings, highlighting how practitioners often undermine or dismiss young people's contributions due to negative stereotypes, which can lead to epistemic injustice by discrediting their experiences. By advocating for a greater focus on individual agency and integrative approaches, she highlights the necessity of validating diverse experiences in mental health, with practices that validate young people's voices and nurture their sense of agency, ultimately encouraging better mental health outcomes that involve users in decision making. 

Through the podcast, I strive to create a platform for meaningful dialogue around mentalhealth. I believe that by fostering understanding and empathy, we can work together to create a more equitable mental health landscape for all.

Seiara Imanova is a doctoral candidate at the University of Birmingham. Behind the Stigma has explored a range of topics, including AI and mental health, the effects of antidepressant, psychedelics as a therapy, and institutional racism.