Epistemic injustice in phenomenological research in psychiatry

In today’s post, Karlijn van Vlerken summarises a talk she gave as part of the 2025 PhenoLab Summer School in Phenomenology of Mental Health in Foligno, Italy. 

Image credit: Marcus Spiske, Unsplash.

The promise of phenomenological research

Lived experience is increasingly recognized as an invaluable source of knowledge for the field of psychiatry. Voices that were historically denied as epistemic agents are now more often included in psychiatric research, practice, and policy-making, due to the advocacy of psychiatric survivors and activists. Phenomenological research focuses on the first-person perspective, and puts the unique knowledge derived from first-hand experience of a mental disorder at the very centre of the research. 

This way, subjective and lived experiences are prioritized as legitimate forms of knowledge. Phenomenology offers a space to articulate the inarticulable, to express disruptions to our ordinary ways of being, even when they are difficult to put into words. Phenomenological research can therefore identify and address epistemic injustice in psychiatry, helping move towards the realization of epistemic justice (Kidd et al. 2025). However, if not carefully conducted, there are also ways in which phenomenological research can be epistemically problematic. 

Potential problems of phenomenological research

Firstly, we should be aware of the selection bias that is often present in the inclusion of participants for phenomenological research in the psychiatric context. In order to participate in phenomenological interviews, people need a certain level of linguistic and conceptual ability (Scrutton 2017). They need to be reflective, articulate, and comfortable talking about their experience. 

People with learning disabilities or cognitive impairments are often excluded from phenomenological research, both implicitly and explicitly. Ironically, these are traits that are strongly linked to certain mental disorders. This is called ‘elite capture’: the knowledge produced comes from the most privileged participants, while others are left out (Okoroji et al. 2023).  In addition, typically only individuals who recognise or agree with their psychiatric diagnosis are included in the research. 

Another tendency in phenomenological research is the heavy use of technical and very specific language and an over-reliance on metaphor. While this serves a purpose and is to some extent part and parcel of phenomenology, it must also be clear that some people do not or cannot relate to some more complex formulations. You can think of people that have certain cognitive disabilities, but also persons that experience concretism (when figurative language is interpreted literally) who may struggle to grasp the abstract meaning behind complex and metaphorical language.

There are also several epistemic harms that can arise from how empathic understanding is used in phenomenological psychopathology. For example, epistemic co-opting can occur when a clinician or a researcher assumes a level of subjective understanding of a patient's lived experience that they simply cannot possess (Spencer and Broome 2023). In doing so, they co-opt something that doesn't belong to them, which can harm the patient by undermining their role as a self-defining knower. A related risk is epistemic objectification, which occurs when someone is treated merely as a source of information rather than as an epistemic agent with interpretive authority. 

These problems can lead to the empowerment of more educated sufferers, but also to further epistemic marginalization of the experiences of individuals with learning disabilities or other cognitive dysfunctions, or members of other groups routinely excluded from research participation, or vulnerable to exploitation when they are included. In turn, this can tap into different kinds of discrimination and negative stereotyping which can aggravate epistemic harms. 

Pragmatic suggestions 

First, research should facilitate and find creative and artistic ways to evidence non-linguistic forms of expressing experience alongside the linguistic forms that are widely present in most phenomenological research. 

The second thing that can be important to mitigate potential epistemic risks in phenomenological research is to be reflective of one’s own limitations and be transparent about them in research reports. Although it might not be possible to completely overcome selection bias in phenomenological research, it is necessary to be clear about who is and who is not included in the research and why. 

Third, co-production and joint research between experts by experience and academics and clinicians has the potential to contribute towards more level degrees of epistemic agency between all the actors. 

Lastly, in order to prevent epistemic losses, researchers need to put explicit effort into translating their findings into resources and tools that can actually be used by people experiencing mental disorders and that can help them express their experiences and first-person knowledge. 

Karlijn van Vlerken is a PhD candidate at the Erasmus University in Rotterdam, the Netherlands. She studied medicine and philosophy, and worked in psychiatric care for two years. Her current research focuses on phenomenology of postpartum psychosis. 

The mental aspects of urban justice

Life in cities is often a matter of extremes. It can be both stimulating and stressful. It can be socially enriching and isolating. It can involve encounters with political openness and with xenophobia. The kind of experiences one has in a city is not a mere matter of luck. Structural injustices and concrete policy decisions shape the lives of urban dwellers—not only what they do, but also what they feel, believe and desire. This is the guiding question of the research project I began last year at the University of Antwerp, titled Affect In the City (AFFINITY): The emotional dimensions of urban justice (2025-2028).

Cities are a main topic of investigation in the social sciences and the humanities, as well as some philosophical traditions—cities are in central works of Plato, Al-Farabi, Walter Benjamin, or Henri Lefevbre. The last few years have seen a booming number of philosophical works on cities from a broadly analytic approach (including books on spatial agency, urban equality and housing justice), as well as the creation of academic venues partly or wholly dedicated to urban space. I am myself a member-at-large of the Philosophy of the City Research Group, and there are other projects with a broader focus on philosophy of space at Stirling and Eichstätt. In the areas of moral and political philosophy, we can talk of the emergence of local normative theory, which has the local as the main target and scope and looks not only at cities, but also at rural space.

Project AFFINITY aims to highlight the role of mental life in local normative theory, by drawing from insights into affective and epistemic injustice, cognitive scaffolding, and theories of self-narration. The working assumption is that social conventions and policy applications have a great impact on people’s mental lives within urban settings, by shaping how they feel, how they act, and how they think about themselves and their surroundings.

As Joel Krueger argues, elements of the environment scaffold urban dwellers’ cognitive-affective processes, for example, whether people feel like they belong in the city or whether they believe they are welcome in certain spaces. Krueger focuses on the extreme kind of marginalization that occurs in homelessness. But the influence of elements of urban space on people’s minds can also be assessed more broadly.

Think of something as apparently trivial as traffic lights. In England, pedestrians have 6 seconds to cross during a green light. This is way too fast for disabled and elderly people. Or think about the names of your city’s streets. Do they commemorate people like you? Or do they perpetuate the belief that you need to be a certain kind of person for your city to be proud of you, or that only certain stories count? These elements of urban life do not merely create short-lived, isolated experiences of stress, discomfort, or alienation. Over time, they accumulate into significant harms to subjective well-being (including positive emotions and mental health) and block access to hermeneutical resources that are crucial to self-understanding.

The project will examine three dimensions of city life (belonging, environment, and narrative) to understand how policy decisions shape mental processes, and whether these effects align with the principles of urban justice. The first publication looks into the demands on policy-makers to ensure that disadvantaged people are not unfairly burdened at an emotional level by gentrification and migration. I am currently researching the affective harms of oversized cars, the legitimacy of anger against tourists, the connection between loneliness and the 15-minute city, and the influence of public urban commemoration in self-narration, as well as planning many exciting collaborations. In this way, project AFFINITY  aims to place the mental dimensions of urban justice at the centre of local normative theory. By doing so, it will help clarify what is needed for a good life in the city that is accessible to all, and guide the design of policies capable of addressing non-material urban problems—such as loneliness, lack of safety and disenfranchisement—which compound and reinforce social and economic inequalities.

Bio: Pilar Lopez-Cantero is a Marie Skłodowska-Curie/YUFE4Postdocs Fellow at the University of Antwerp, and is currently the Principal Investigator of project AFFINITY (grant No 101081327). She works on practical philosophy, ethics and political philosophy — particularly questions about personal relationships, self-narration, travel, and the city.

 

 

Epistemic Injustice in the Mental Healthcare of Indigenous Peoples

Today's post is by Md Omar Faruk.

Symbol of healing

Philosopher Miranda Fricker coined the term epistemic injustice to refer to the harm experienced by people when their ability and capacity as knowers of knowledge is disregarded or devalued in a unfair fashion (Fricker, 2007). Essentially, we are referring to individuals who have been harmed in the process of co-creating and sharing knowledge, and whose capacity to reason and contribute as knowers has been dismissed or denied. 

People experience this injustice in two ways: testimonial injustice and hermeneutical injustice. Testimonial injustice takes place when the testimony of a person or group of people is deemed less credible. Simply put, the collective accounts of people are being denied on the pretext of not having substantial credibility or reliability. On the other hand, the absence of social understanding that helps conceptualize the experiences of a person or a group of people is at the heart of hermeneutical injustice. When we do not have sufficient conceptual resources be it understanding of the concepts or language to uncover the experiences, this paves the way for hermeneutical injustice. 

Both form of injustices has adverse impact on people’s self-esteem, social positioning, and ability to engage in creating knowledge. People representing minoritized and less advantaged groups are more vulnerable to these injustices leading to both physical and mental health consequences. By taking Bangladesh as an example, in this blog post, I shed light on how these injustices are contributing to the poor mental health status of Indigenous peoples and I present a framework to address them with a view to improving their mental health outcomes (Faruk, 2025).

Indigenous peoples in Bangladesh, particularly those living in the Chittagong Hill Tracts, experience distinctive challenges related to mental health due to historical, systemic, and cultural factors. These communities experience higher risks of mental health problems stemming from the legacy of colonialism, marginalization, language loss, cultural infiltration, land grabbing, and lack of access to adequate healthcare services including mental healthcare. Despite nationwide initiatives aimed at improving mental health awareness and reducing stigma, there has been little targeted effort to address the specific mental healthcare needs of Indigenous peoples in Bangladesh. 

Bangladesh

Their mental health experiences include anxiety, depression, and widespread stigma centering mental illness, all of which witnessed a significant increase during the COVID-19 pandemic. Nevertheless, Indigenous peoples’ perspectives and experiences are often excluded from mainstream mental health policies and services, contributing to epistemic injustices that further marginalize these groups. To address these injustices community-led, culturally sensitive interventions, increased engagement of Indigenous communities in policymaking, and the incorporation of Indigenous knowledge systems are crucial to improve mental health outcomes and achieve epistemic justice for these communities. 

Kaptai Lake

The key components of the framework are listed below:

• Community Engagement and Participatory Approaches: The current mental healthcare system in Bangladesh does not integrate community voices and encourage participation of Indigenous peoples which may contribute to the non-compliance on the traditional mental healthcare service systems. Therefore, engaging Indigenous communities primarily through consultations, focus groups, and participatory research to include their voices in the design and implementation of mental healthcare services is extremely important. This not only promotes mutual learning but ensures that services are tailored to their unique cultural context.

• Partnering with Indigenous-Led Organizations: To facilitate self-determined practices and promote Indigenous epistemologies in the development of mental healthcare programs, collaborating with organizations led by Indigenous peoples is crucial. This ensures the integration of cultural nuances that shape the distinct conceptualization of mental health and illness and paves the way for utilizing Indigenous healing practices.

• Utilizing Indigenous Healing Practices: Recognizing and incorporating traditional healing methods alongside mainstream mental healthcare interventions ensures cultural relevance potentially leading to acceptance. Growing evidence suggests that integrating Indigenous healing practices within clinical practices promotes culturally safe environments (Beaulieu & Reeves, 2022).

• Decolonial and Culturally Responsive Approaches: Mental healthcare programs aimed at respecting and valuing Indigenous epistemologies, promoting self-determination, and facilitating the use of Indigenous languages and practices may promote the deconstruction of colonial practices putting more emphasis on culturally responsive approaches.

• Training Mental Health Professionals: It is imperative that mental health professionals have adequate cultural competence and sensitivity to better understand and respect Indigenous beliefs, practices, and worldviews in an effort to to deliver more tailored and respectful care.

• Incorporating Indigenous Knowledge into Policy and Education: Indigenous people’s worldviews embedded into educational curricula, policy frameworks, and advocacy initiatives has the potential for systemic acknowledgment and supporting Indigenous ways of knowing in mental healthcare services.

These strategies intend to recognize Indigenous knowledge as a vital component of mental healthcare, promoting epistemic justice and ensuring that services are culturally sensitive and effective for Indigenous peoples in Bangladesh and beyond.

Md Omar Faruk is a clinical psychologist in Bangladesh is currently pursuing his PhD in School Psychology at the Louisiana State University in the US. 

His research focuses on understanding Indigenous people’s mental health experiences including the development of culturally sensitive mental healthcare interventions. 

Additionally, Faruk focuses on the promotion of positive school climate by strengthening student-teacher relationships contributing to the improved student social, emotional, and academic outcomes as well as increased well-being for teachers.

Scripts, Standard Minds, and Unjust Treatment in Healthcare Settings

Today's post comes from Gen Eickers and summarises their recent book on social scripts and their importance in healthcare:

In healthcare, epistemic and other forms of injustice are seen when patients’ lived experiences or knowledge are dismissed or undermined, resulting in unjust treatment. One key factor in this may be the role of scripts — specific normative knowledge structures that healthcare providers, for example, apply when interacting with their patients.

How do scripts work? In Scripts and Social Cognition: How We Interact with Others (Routledge, 2025), I argue that social interactions are normatively structured and that scripts, due to their reliance on social norms, provide an apt resource for explaining how we navigate the social world. Social interactions are subject to (context-sensitive) conditions of social appropriateness. 

Scripts allow us to retain extensive information about social interactions—including what is and isn't socially appropriate in each situation. That is, scripts serve as guidelines for social behavior that specify expectations about others’ behavior as a function of their identity, situational context, the cultural setting, and respective roles in that context. 

My script account, spelled out in Scripts and Social Cognition, introduces social forces (i.e., social structures, norms, and roles) to explore what structures social interaction, and to gain an understanding of whether and how scripts are related to social norms, structures, and roles. In so doing, it also sheds light on the ways that social categories, such as gender, disability, and class, impact social interaction. As social norms are stored in scripts, scripts also enshrine various biases. 

These impact our social interactions and the way we understand other people. So, scripts not only capture how to behave as someone in an institutional social role (e.g., an academic) in a framed social situation (e.g., a colloquium), but scripts also capture how to behave as a person with a specific social identity (e.g., a disabled trans man) or social group membership in a specific context. 

This accounts for the social structures in which social interactions are embedded and addresses the issue that members of less dominant social groups (such as queer, trans, Black, disabled, mad communities) are particularly subject to interactive injustice. That is, members of less dominant social groups may often find themselves to not be perceived, interpreted, or treated as equal social agents in social interactions. In this way, scripts can be considered loci of social knowledge, and sometimes they may be loci of unjust treatment.

Scripts that guide interactions in healthcare settings are often shaped by medical norms and cultural assumptions about health, which, in turn, can lead to the (further) marginalization of patients’ voices. Unjust treatment in healthcare settings may arise when the concept of a 'standard mind' is narrowly defined but universally applied. In a lot of healthcare or medical contexts, mental health and health in general is viewed through a standardized lens that excludes many subjective experiences that don't conform to norms around health, and, thus, don't fit this standard. 

When such 'non-standard minds' express their lived realities, their experiences are often disregarded. For a specific interaction within a healthcare setting this might mean: when a patient expresses symptoms that don't align with the standard scripts a healthcare professional has, the patient's account may be dismissed as unreliable, and care may be denied.

Consider, for example, a trans person seeking support by healthcare professionals in order to receive hormone replacement therapy. Healthcare professionals often rely on DSM or ICD categorizations of transness, which define transness via gender dysphoria, i.e., a negatively valenced experience, sometimes even framed as suffering. 

This dysphoria framework is shaped by norms around health and is taken to be the standard model for how trans minds work. But not all trans people experience their transness via dysphoria, or through a dysphoria framework. 

In such cases, the standard scripts applied by mental health professionals don't fit, and as a result, patients may be denied authority over their own experiences; an injustice that disproportionately affects those in multiply marginalized groups. Though I think our minds, standard or not, do have tools to do better: scripts can be combined and adjusted – for example, by gaining awareness of trans realities, different scripts may emerge about how to interact with trans people. The standard healthcare script, thus, may be complemented by scripts pertaining to gender equality.

Gen Eickers’ research is located in the philosophy of mind and emotion and the philosophy of technology as they intersect with social epistemology, social ontology, and trans and feminist philosophy. They  approach philosophical research in an interdisciplinary way, including sociology and social psychology in their work. They work primarily on scripts, social norms, social interaction, emotion, injustice, transness and gender, and social media.

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.

Epistemic Microaggressions in Healthcare

In its relatively short history, the growing literature on epistemic injustice in healthcare has come a long way in highlighting the distinctly epistemic dimensions of medical encounters that can lead to a variety of injustices for patients. Such injustices are often the result of differences in relationships of institutional, professional, and social power (Kidd and Carel 2017, Freeman and Stewart 2024, Stewart and Freeman, 2022). 

This literature is mostly focused on how phenomena such as testimonial injustice and hermeneutical injustice render patients epistemically vulnerable. Additionally, it has helped to illuminate some of the ways in which patients from marginalized groups have their epistemic agency constrained, undermined, or ignored as they attempt to make claims about their bodies, identities, or health status to healthcare professionals. However, this literature has only recently started to attend to some of the more subtle, covert, and insidious mechanisms of epistemic dismissal.

 
In our recently published book, Microaggressions in Medicine, we engage with some of these seemingly subtler forms of epistemic (and other) types of injustice and harm in medical contexts. Let’s zoom out to mention the overall aims and goals of the book before zooming back in to focus on the epistemic dimensions of these injustices.

The two main theoretical aims of Microaggressions in Medicine are to reconceptualize how microaggressions have been understood by psychologists and philosophers and to introduce a new conceptualization of microaggressions that we call a harm-based account. 

Our harm-based account categorizes microaggressions according to the kind of harm that results for those who experience them. As such, we propose and argue for the following three kinds of microaggressions: epistemic microaggressions that result in epistemic harm, emotional microaggressions that result in emotional harm, and self-identity microaggressions that result in harms to one’s sense of self.

Microaggressions in Medicine (2024)

There are three applied aims of the book. 

• Using first-personal narratives, case studies, and testimonies of patients who are members of marginalized groups, we develop this harm-based account within medical contexts. 
• Analyzing these case studies, we illuminate the serious and enduring harms of microaggressions and argue that they can ultimately lead to delaying or avoiding medical care, damaged trust relations with healthcare professionals, and ultimately worse health outcomes for patients who experience them. 
• We introduce practical tools and strategies to help healthcare professionals reduce microaggressions in their practices and institutions, thereby diminishing harm caused to patients.

In what follows, and drawing on chapter 4 of the book, we focus on epistemic microaggressions, epistemic harm, and discuss why attending to epistemic microaggressions is an important part of the larger picture of epistemic injustice in healthcare.

In medical contexts, epistemic microaggressions are intentional or unintentional verbal or gestural slights made by healthcare professionals that dismiss, ignore, or otherwise fail to recognize claims that patients make about their bodies or health. Epistemic microaggressions result in epistemic harm to recipients (here, patients), namely, harm to them in their capacity as knowers. 

One example of an epistemic microaggression that we develop in the book is the story of what happened to the famous sociologist, professor, writer, and MacArthur “genius” award winner, Tressie McMillan Cottom. Despite her social standing and countless intellectual and academic achievements, as a self-described fat, Black (and at the time, pregnant) woman, Cottom knew that given her identity, she would face an array of discriminations. For this reason, she carefully chose her physicians. Or so she thought.

When she was four months pregnant, bleeding and experiencing acute pain, Cottom knew that something was terribly wrong. Yet when she and her then husband arrived at her doctor’s office, instead of being seen immediately or being sent directly to the emergency department, she was told to sit patiently in the waiting room. When she finally got to see her doctor, he looked at her and quickly said that she was probably just too fat and that for “women like her,” spotting was typical at this stage of pregnancy. She was sent home.

When, later that night, her pain escalated, the on-call nurse assured her over the phone that because the pain was in her bowel and not her lower back, that it was probably constipation and that she should try to go to the bathroom. After three days of such pain and no sleep, Cottom went to the hospital, where she was told that she’d probably just eaten something that was “bad” for her. 

After insisting that she get an ultrasound, it showed the fetus, in addition to two large tumors. Upon seeing this, the nurse scolded Cottom: “You should have said something” (Cottom 2019, 84). Soon thereafter, Cottom went into early labor. She gave birth to her daughter, who died soon after she was born (ibid., 85). While making plans for how to handle her daughter’s remains, another nurse said: “Just so you know, there was nothing we could have done since you never told us that you were in labor” (ibid.).

There are countless microaggressive harms that Cottom experienced. It’s important to underscore however, that the result of those microaggressions was nothing micro. Our analysis focuses on how racialized and gendered epistemic microaggressions combine in ways that are unique to Black women (what we call the misogynoir of microaggressions).

In this case, it was clear that Cottom knew that there was something wrong, tried to convey this knowledge to her healthcare team, and continued to be viewed as lacking credibility with regards to her knowledge of her body. As a result of the entrenched biases and stereotypes about Black women, Cottom experienced a panoply of racialized gendered epistemic microaggressions. 

As a pregnant Black woman who was bleeding and in pain, her bleeding was attributed to her fatness. Then, her pain in her bowel was dismissed as being the consequences of something “bad” that she’d eaten, where “bad” has racist undertones about the kinds of food that Black people eat. Finally, after the death of her newborn daughter, she was blamed for not having spoken up sooner, with the implication that the death was in part her fault and could have been prevented had she spoken up.

Cottom is powerless relative to the healthcare professionals.

Her knowledge of her body is ignored.

Repeatedly, healthcare professionals assumed they knew better.

On account of her race, gender, and body size, Cottom suffered the epistemic harm of not being recognized as a credible knower, the practical harms of severe physical pain, the death of her daughter, as well as the enduring trauma of the whole experience.

These consequences are macro and tragic. But we are most concerned with the epistemic racialized gendered microaggressions that contributed to them. Cottom’s credibility as a knower was denied due to her race, gender, and body size and as a result, her knowledge claims were ignored or dismissed.

The racialized gendered epistemic microaggressions that Cottom experienced are reflections of imbalances in epistemic and other sorts of social power that themselves mirror broader patterns at play both within and beyond healthcare contexts. Healthcare workers belong to an elite professional class. They’re assumed to have epistemic authority within and beyond that context. They often exert epistemic power over their patients by blocking them from making meaningful contributions to clinical exchanges. This epistemic situation both reflects and reifies assumptions about power in the epistemic domain. For example, it makes clear who creates, controls, and deploys knowledge and who doesn’t; who is “rational” or “objective” and who isn’t (cf. Code 1991).

The epistemic microaggressions on which we have focused, combined with more macro and explicit stereotypes and assumptions about Black women, result in epistemic harms to patients: they’re denied the full status of knower, which is central to human dignity and value (Fricker 2007; Pohlhaus Jr. 2017; Dotson 2011). 

Because the epistemic contributions of patients who are members of marginalized groups are routinely blocked, over time this can result in patients coming to doubt their own epistemic capacities, especially as microaggressions add up and their harms accumulate (Evans and Mallon 2020). As we saw and as we develop further in our book, epistemic microaggressions can also lead to harmful health and other consequences.

As Cottom’s case makes clear, epistemic microaggressions are harmful to the epistemic status and agency of marginalized patients. A complete understanding of epistemic justice and injustice in healthcare and the myriad ways they manifest must include attention to the subtle epistemic dismissals and indignities that epistemic microaggressions reflect.

Heather Stewart is Assistant Professor of
Philosophy at Oklahoma State University.

Lauren Freeman is a Professor of 

Philosophy at University of Louisville.