The Asthma + Lung UK Breathing Space Garden at RHS Chelsea Flower Show 2026

This post by Kate Binnie reports on a groundbreaking approach to creating space for reflection and conversation about respiratory ill health at the Chelsea Flower Show.

In communities disproportionately affected by deprivation and respiratory ill health, the legacy of mining and heavy industry, smoking-related disease, air pollution and occupational exposures (dust, chemicals) is compounded by healthcare inequalities and the inverse care law, whereby resources are often least available in areas of greatest need. For millions of people living with chronic lung conditions, the resulting breathlessness limits everyday life, undermining physical, psychological, social, financial and spiritual wellbeing.

Yet breathlessness remains remarkably difficult to talk about. People living with lung conditions often struggle to communicate their experience, while health professionals may lack the time, confidence or psychosocial resources to treat it as more than a lungs-and-brain "problem." Miranda Fricker describes this as hermeneutical injustice: "a significant area of experience obscured from understanding owing to prejudicial flaws in shared resources for social interpretation." In other words, when something cannot be communicated, it may be rendered invisible.

This is a phenomenon that my PhD research explored. Among the 50 patients and professionals I interviewed, experiences of shared understanding — what Hutchinson has called ‘Breathing Space’ were rare and challenging for all concerned within systems of care that do not provide the space and time to explore the breathless person's social, cultural and personal history. From a critical realist perspective, my analysis indicated not only gaps in interpersonal communication and at service level (epistemic injustices in themselves), but that these gaps are generated and sustained by deeper and persistent social, cultural and material conditions – what Alderson calls ’hostile absences’.

The Asthma + Lung UK Breathing Space garden, which has just won a silver medal at RHS Chelsea Flower Show 2026, emerged as a creative response to these experiences of restriction and absence. Drawing on findings from my research into how mind-body interventions help people living with lung conditions, the garden sought to embody their antonyms: space and presence.

Designed by my partner Angus Thompson in collaboration with patients and staff at the Breathing Space lung rehabilitation centre in Rotherham — where the garden is currently being rehomed —  the garden is grounded in a simple idea:  when we create even momentary conditions of safety and calm, the body can naturally find its own way back to easier breathing.

Inspired by the Japanese concepts of ma and yohaku no bi (the beauty of empty space and time), Angus translated empirically grounded ideas from my research into a design that reframes emptiness as possibility:  a calm, green space in which space, choiceful movement, reflection and connection become possible.

For us, the design team, the most striking aspect of the Chelsea garden was the conversations it made possible with hundreds (if not thousands, as 160,000 people visited the show this year) of visitors. One of our volunteers handing out leaflets for Asthma + Lung UK reflected:

There were people living with asthma, relatives of miners, and so many from Rotherham, Sheffield and the surrounding communities. The garden seemed to create an atmosphere of trust that encouraged people, especially men, to open up and share deeply personal experiences. I honestly couldn't believe how willing people were to connect and talk.

Design features such as the oxygen cylinders supporting the Breathing Space platform, the 6:4 breathing rhythm reflected in the fencing, the carbon-capture concrete, and the calming effect of the planting acted as unexpected conversation starters. Visitors frequently responded by sharing personal and family experiences of lung disease, loss, caring, hope, meaning and recovery. Respiratory professionals were equally enthusiastic, welcoming the rare visibility afforded to their often underfunded speciality and asking when they, too, might have a Breathing Space garden at their own hospital.

This matters because hermeneutical injustice is not only a problem of individual communication and epistemic asymmetry between patients and professionals in the clinical setting, but a problem of collective understanding which limits the potential of everyone concerned with lung disease. When experiences remain difficult to articulate, societies, institutions and healthcare cultures struggle to recognise, respond or make space for them.  We were delighted that for one week at Chelsea, a carefully designed garden could become a site of shared interpretation in which conversations about breathing, breathlessness, recovery and hope could be expressed and understood in new ways.

The garden is now relocated at the Breathing Space lung rehabilitation centre in Rotherham, where many of the ideas that shaped its design emerged through conversations with patients, families and staff. The garden is now under the ownership of the local community and is beginning a new life beyond Chelsea.

Acknowledgements

The garden was funded by Project Giving Back https://www.givingback.org.uk for Asthma + Lung UK https://www.asthmaandlung.org.uk

Designed by Angus Thompson https://www.angusthompsondesign.com and built by Dan Flynn.

Sculpture by Oliver Barratt https://www.oliverbarratt.co.uk

Rotherham Breathing Space https://www.therotherhamft.nhs.uk/patients-and-visitors/our-sites/breathing-space

Author bio

Kate is an HCPC registered music therapist with 20 years’ clinical experience in palliative care, based in Oxford. In 2016, she completed an MSc in palliative care from King’s College London funded by the Samuel Sebba Scholarship.  Kate is also a qualified yoga and mindfulness teacher and works with people with chronic and life-limiting conditions and their families into bereavement. She delivers training workshops for clinicians at www.sobelleducation.org.uk, and she is a guest lecturer on the MSc in Palliative Care at KCL and on the UK’s first PG training in Psycho-spiritual care at Oxford Brookes University. After 5 years as senior research associate on the Wellcome-funded Life of Breath project, Kate is now in the final year of her part-time PhD at the Wolfson Centre for Palliative Care Research at the Hull York Medical School funded by UKRI (i3) exploring the relationship between emotion regulation and breathlessness in advanced disease. 

Hermeneutical Sabotage

In today's post, Han Edgoose develops a concept of hermeneutical sabotage by engaging with the predicaments of transpeople in the UK.

As Nick Clanchy has said in a previous post on this blog, it is a scary time to be a trans person living in the UK right now. An April 2025 UK Supreme Court ruling, which defined ‘sex’ for the purposes of the Equality Act (the UK’s major piece of equalities legislation) as ‘biological sex’, has been interpreted by the Equality and Human Rights Commission (EHRC), the public body in charge of enforcing equalities legislation in the UK, as a trans bathroom ban. 

The EHRC’s interim guidance on the Supreme Court ruling not only bans trans people from using toilets and other single-sex spaces and services such as changing rooms and hospital wards that align with their identity, it also allows for them to be excluded from single-sex spaces that align with their sex assigned at birth. By severely restricting trans people’s ability to access toilets this ruling limits trans people’s ability to exist in public spaces and workplaces. 

It also curtails trans people’s ability to ensure their own health and wellbeing by restricting their access to domestic violence shelters and healthcare, and their ability to participate in sports. Shockingly, the Supreme Court judges claimed that this ruling ‘does not cause disadvantage to trans people’. 

The injustice caused by the Supreme Court ruling is not primarily epistemic. However, epistemic injustice is often a contributory factor to other injustices, and it is in this case. There are multiple ways in which the Supreme Court ruling could be understood to be committing epistemic injustice, but I’m just going to focus on one aspect of the ruling: its re-definition of the term ‘lesbian’, which, I argue, amounts to hermeneutical sabotage. 

Hermeneutical sabotage

In a paper published in the Australasian Journal of Philosophy last year, I argued that a form of epistemic injustice I name ‘hermeneutical sabotage’ is used as a tactic by harmful political movements to help them achieve their exclusionary and oppressive goals. Hermeneutical sabotage occurs (roughly) when the widely available conceptual resources for understanding the identity or experience of a marginalised group are actively worsened. 

This can be done in multiple ways, including by introducing new, prejudiced hermeneutical resources and distorting resistant hermeneutical resources developed by marginalised groups. Another way in which hermeneutical sabotage can occur is when particularly powerful people change the meaning of well-established terms, distorting the available hermeneutical resources. This is the type of hermeneutical sabotage that the Supreme Court Committed in their judgement on the term ‘lesbian’.

Hermeneutical sabotage and the definition of 'lesbian'

The Supreme Court ruling embraces the hermeneutical sabotage of the term ‘lesbian’ by accepting a definition of ‘lesbian’ that excludes all lesbian trans women, as well as lesbian cis women who are attracted to all women including trans women. 

According to the Supreme Court ruling, a lesbian is defined as a ‘female who is sexually attracted towards… other females’, (where ‘female’ is understood to refer to ‘biological sex’). This trans exclusionary view of lesbianism was embraced despite the fact that the vast majority of cisgender lesbians in the UK are supportive of trans people, and inhibits the ability of trans lesbians, as well as trans inclusive cis lesbians, to communicate an important aspect of their identity. 

This is a particularly powerful case of hermeneutical sabotage as the ruling encodes the sabotaged meaning of the term into the law. The Equality Act allows those who share a protected characteristic to organise groups and clubs that only include people who share that characteristic and exclude those who don’t. 

Excluding people on the basis of one of the protected characteristics outlined in the Equality Act is otherwise illegal. By defining lesbian in a trans exclusionary way membership clubs that include people who share the protected characteristic of ‘lesbian’ can now only include or exclude people on the basis of the sabotaged definition provided by the Supreme Court. This means that it appears to no longer be legal for a lesbian organisation in the UK to include trans lesbians or cis lesbians who are attracted to trans women. 

The hermeneutical sabotage of the term ‘lesbian’ is an epistemic injustice which inhibits the ability of trans and trans inclusive lesbians to use the word ‘lesbian’ to communicate their experiences effectively. The Supreme Court ruling not only intensifies this epistemic injustice by legally encoding the sabotaged meaning of the term ‘lesbian’, it also enacts further injustices as a consequence of this epistemic injustice that limit trans and trans inclusive lesbians’ ability to meet in organised groups and clubs, showing the clear connection between epistemic injustice and further non-epistemic injustices. 

Author bio

Han Edgoose is a lecturer at the University of Glasgow, where they also completed their PhD. They are a feminist philosopher whose research is focused on the contemporary 'trans panic' in the UK, and broader patterns of injustice and oppression. Their paper 'Hermeneutical Sabotage' is published in the Australasian Journal of Philosophy.

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.

A Feedback Loop between Testimonial and Hermeneutical Injustice

‘Epistemic injustice’ picks out a distinctive kind of harm inflicted upon somebody in their capacity as a knower. Miranda Fricker (2007) famously distinguished two subtypes of epistemic injustice, i.e. testimonial injustice and hermeneutical injustice. 

Testimonial injustice is primarily a matter of credibility deficit. Paradigmatically, a speaker incurs testimonial injustice when they are given less credibility than they deserve due to identity prejudice in the hearer. Hermeneutical injustice is, by contrast, a matter of unintelligibility. 

A speaker incurs hermeneutical injustice when, owing to the substantive exclusion of one’s reference social group from the production of collective hermeneutical resources, there are no shared concepts they can make use of to understand their own experiences and/or make those experiences intelligible to others. 

Harassment

In an article published in Rivista di filosofia, we provide an opinionated survey of the major debates surrounding epistemic injustice, and argue that testimonial injustice and hermeneutical injustice reinforce each other in a feedback loop that hasn’t been fully unpacked so far -- but see Medina (2012), McKinnon (2017), and Lagewaard (2020). Here we offer a glimpse of this loop, starting from how testimonial injustice may feed off hermeneutical injustice.

As already mentioned, hermeneutical injustice typically stems from what Fricker (2007: 152) calls hermeneutical marginalization, i.e. (i) the systematic exclusion of certain groups from, or (ii) their merely formal inclusion in, meaning-making practices. Oppressed groups have historically been denied equal hermeneutical participation in both senses (i) and (ii), and this can be partly (although not exclusively) explained by appealing to the operations of testimonial injustice. When a group is negatively stereotyped in certain domains, it is no wonder that its members tend not to be asked to participate in communicative practices and hermeneutical activities related to those domains. This tendency gives rise to preemptive testimonial injustice (Fricker 2007: 130). 

We claim that preemptive testimonial injustice may fuel hermeneutical marginalization in sense (i): the long exclusion of women from institutional sources of collective meanings such as higher education and academia may be partly explained in this way. More standard forms of testimonial injustice, where a speaker’s testimony is heard but not given due weight, may contribute to hermeneutical marginalization in sense (ii).

As we all well know, women had to fight an unfinished battle after getting access to academia in order for their voices to be given equal hearing and weight – owing, in part, to the persistence of biases affecting women’s epistemic standing.

To close the loop, hermeneutical injustice must feed off testimonial injustice. We maintain that this is perfectly plausible. Consider Carmita Wood’s case (Fricker 2007: 149-50). Living in a time when the concept of sexual harassment had not yet been crafted, Wood was unable to fully make sense of what she was going through, and a fortiori to communicate it clearly to others. Wood was a victim of hermeneutical injustice. But this is not it. We argue that, because of this, she was also very likely a victim of testimonial injustices. 

After all, there is a strong chance that some hearers assigned a credibility deficit to her due to the inevitably unfit concepts she made use of (e.g. flirting) when telling them about her experience and state of anxiety. If this in fact happened, what would otherwise have been received as testimony against discriminatory treatment, ended up sounding, at least to some hearers, as a confused outburst. 

The hermeneutical injustice perpetrated against Wood ‘spilled over’, making her testimony not only scarcely intelligible but also less credible than it would otherwise have been. Importantly, these instances of testimonial injustice may not have had their roots in prejudice against (people like) Carmita but may be entirely explained by the hermeneutical injustice women were suffering at the time.

Laura Caponetto (University of Milan, Cambridge University) is a philosopher specialising in philosophy of language, feminist philosophy, and social philosophy. Laura is the author of "Undoing things with words", published in Synthese in 2020. 

Tommaso Piazza (University of Pavia) is a philosopher specialising in epistemology and the philosophy of language. Tommaso is the author of "The Value of Truth and the Normativity of Evidence", published in Synthese in 2021.

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.

Stigma as a Barrier to Self-Understanding

This blogpost is written by Alexander Edlich and Alfred Archer, writing about their recent paper in Social Epistemology entitled 'Rejecting Identities: Stigma and Hermeneutical Injustice'.

To seek, and accept, medical help, it is often necessary to realize that one needs it. Sometimes, however, people refuse to accept they need help, and this disables them from accessing medical resources. This refusal need not be due to stubbornness but can be the result of unjust social factors. In particular, we suggest that stigma can unjustly prevent people from making sense of their situation, including stigmatized illnesses. 

Take, for instance, the American writer Caroline Knapp’s account of her struggle to accept the idea that she was an alcoholic in her memoir Drinking: A Love Story. She describes how at times she was so drunk that she would ‘drive home with one eye shut, to avoid double vision’ (p. 54). 

After being advised by her therapist that she should stop drinking, she decided to attend an Alcoholics Anonymous meeting. Once in the meeting though, she felt a strong revulsion to accepting that she belonged there. As she describes it, she “looked around at the dingy room with the old men sipping coffee from foam cups and I thought, No way. No way in hell I’m doing this. This is not me. I do not belong here’ (pp. 190–191).

For Knapp to accept that she was an alcoholic would mean ‘owning up to flaws and imperfections and depths of confusion I was too ashamed to reveal’. This shame that she felt about her alcoholism was a response to the social stigma attached to it. Even when she had accepted her alcoholism and stopped drinking, Knapp continued to be very careful about which people she would discuss it with ‘for fear of being judged’ (p. 244). 

What prevented Knapp first from accepting and even longer from communicating about her situation was the stigma attached to alcoholism, and thus a social factor burdening those suffering from it. This made it harder for her to seek help.

The cover of Knapp's book

Knapp is far from alone in struggling with this, the stigma attached to alcoholism is a significant barrier to people seeking out medical assistance. This difficulty in accepting one’s addiction is a major problem, given that this acceptance is crucial for overcoming the addiction and also for seeking help in the first place.

While medical professionals are aware of the importance of reducing the stigma attached to medical conditions like addiction, the impact of stigma on self-understanding is not only practical, but, we argue, also creates a particular type of hermeneutical injustice: those whose experiences are stigmatized are unjustly made to reject helpful descriptions of their situation.

Hermeneutical injustice is the label philosophers use, coined by Miranda Fricker, to describe cases where the social practices of knowing, learning, and communicating are unjust so that persons in particular social positions are deprived of the means to make sense of their experiences. In paradigmatic cases, this occurs because dominant discourses do not include concepts that are needed to make sense of the experiences of marginally situated agents.  

For example, Fricker argues that before the development of the concept ‘sexual harassment’ people who experienced unwanted sexual attention in the workplace were not able to properly name their experiences. In this case, they were unfairly prevented from fully understanding the situation they were in because they lacked the concepts needed to articulate what it is they were experiencing, which, consequently, also disabled them from sharing their experiences. 

The stigma related to addiction (and other stigmatized experiences, like homosexuality or suffering intimate partner violence) also unfairly prevents people from making sense of their experiences but does so in a subtly different way. Here the conceptual resources are available to people. The concept of an alcoholic or an addict was available to Knapp and once she accepted that it applied to her, she was able to access the resources she needed to manage her addiction, including a supportive community of people struggling with the same problem. 

What prevented Knapp from accessing these resources was not the absence of a concept but the stigma that was attached to it. Knapp denied herself access to the hermeneutic resources that go with the label ‘alcoholic’ because of the stigma attached to this identity, which led her to refuse to accept that the label applied to her. In this way, stigma can unjustly cause people to reject helpful descriptions of their situation or identity.

To come to terms with a condition like addiction and to seek help about it, it is important to understand one’s situation and to accept it. Some people refuse such acceptance, and they can suffer gravely from it. This is a problem for medical practice, but, importantly, it can also be a problem of justice: to offer help, but also to treat people justly, we must make sure that stigma does not stand in the way of self-understanding.

Alexander Edlich completed his PhD at Ludwig-Maximilians-Universität Munich in 2023, where he then was a postdoctoral researcher. He works on moral responsibility (specifically blame, protest, and apology), the philosophy of emotions, and feminist and LGBTQ ethics.

Alfred Archer is Associate Professor of Philosophy at Tilburg University. He is interested in ethics, social philosophy, philosophy of sport, and moral psychology. He is the co-author of Honouring and Admiring the Immoral: An Ethical Guide (Routledge 2021), Why It’s OK to be a Sports Fan (Routledge 2024) and Extravagance and Misery: The Emotional Regime of Market Societies (OUP 2024).

Epistemic injustice and diagnostic approaches to mental ill-health

Epistemic injustice is evident in a plethora of contexts, some institutional, for which the discourse of hermeneutical injustice offers a helpful frame by way of its negotiation of meaning. Examples could include different treatments administered by healthcare institutions that unfortunately limit a patient’s voice and visibility. Other instances are well-trodden in the literature and media, and remain ever present, including gender and race issues, as presented by wide-ranging movements like Black Lives Matter and #MeToo.

A megaphone

Some examples of epistemic injustice are close to home and, sometimes, in the home. Relationships that once thrived can fracture when under sufficient pressure, whether between intimates, blood relations or in-laws, or something more general like the bonds between friends and other associates. In the throes of such breaks, testimonial injustice might be at work, concerned as this is with semiotic ruptures in spoken utterances that displace kindly intentions and good will. 

Where relational intimacy intersects with discourses that organise bonding experiences, for example, some kinds of religion and politics, the distinctions between hermeneutical and testimonial injustices are difficult to identify. The cliché that what is today’s deviance becomes tomorrow’s norm is continually challenged by the vicissitudes of lived experience that make possible the very identification of deviancy and normativity. The making of necessary interventions is, in this regard, highly problematic and, when it occurs in its zenith form, an achievement.

In 2021 my Master by Research dissertation, which explored some of these questions, was accepted in the University of Wales Trinity Saint David. My thesis, titled Diagnosis, misdiagnosis, and becoming better: An investigation into epistemic injustice and mental health, focused on diagnostic issues in the treatment of mental ill-health. Its main focus was to contextualise observations sometimes termed “empirical” by considering some of the existential contexts that experients of mental health treatment might find themselves in.

It is naturally the case that in an acute state, the solutions common to the biomedical model of mental ill-health are readily reached for. If a person suffers a psychotic breakdown then administering an antipsychotic drug could be a profoundly helpful and practical way of relieving distress. But there are many social domains that circumscribe, penetrate and, in turn, shape an individual’s diverse experiences of society. As well as religion, family, politics and the State, they could also include the stories we tell that frame those very societal categories. Psychoanalysis, literature, film and sociology are a handful of subject-disciplines that present telling-truth and telling-detail by offering “ways forward and out” of profoundly difficult moments in the life-course. My belief is that any line of enquiry that enables an experient to learn constructively and “re-find their feet”, so-to-speak, is both directive and instructive.

Antipsychotic medication

Concerned as it is with the mind as an aspect of embodiment that is organising as much as organised my research explores modes of being-and-becoming. In this regard, I am interested in two broad areas of exploration: first the clinical tools that enable a growth mind-set, whether employed by experients or physicians. Second, I lay out some of the general principles that might categorise those tools as philosophically resonant. They could be of a testimonial variety by highlighting signs and symbolic structures generative of psychosocial capacitation. 

Other, hermeneutical kinds may point to the diverse social movements that can lead an experient out of different forms of fog and miasma commonplace in contested diagnoses and misdiagnoses. In showing the presence and gravity of an epistemic injustice, there is laid the groundwork for a theoretical space where the experient can incrementally attain functionality. They may find ways of learning that which they themselves need vitally such that self-understanding becomes a real possibility. They might even encounter levels of personal, interpersonal and social responsivity expressive of epistemic justice and accountability.

Martyn Sampson

Martyn Sampson is an independent researcher of the philosophy of psychiatry and mental health. He is presently working on an extended project on stigma and phenomenology in regard to different psychiatric conditions.