EPIC Seminar: Expertise, Lived Experience and Legal Processes

 Sheelagh McGuinness reports from an EPIC seminar in February 2026.

In February 2026 EPIC hosted the first in a series of seminars examining the relationship between legal processes and epistemic injustice. The event brought together researchers from philosophy, law, and social science to consider how legal and regulatory frameworks can exacerbate or ameliorate the epistemic marginalisation of those who engage with them.

Professor Lisa Bortolotti (EPIC/University of Birmingham) opened with a conceptual analysis of expertise and its relationship to epistemic injustice, arguing that expertise should be understood both in terms of the knowledge an individual possesses and as a form of performance in a particular environmental context. An agent may hold relevant expertise yet be unable to exercise it if the conditions necessary for effective performance are not in place. Examples include not being invited to contribute, if space constrains or excludes their perspective, or if their testimony is challenged or reframed without genuine engagement.

Bortolotti paid particular attention to experts by experience, focusing on people with lived experience of mental health services participating in healthcare research. She identified three stages at which such expertise may be obstructed: exclusion from participation entirely; inclusion on terms that do not permit meaningful contribution; and formal inclusion accompanied by insufficient uptake of testimony. Each stage, she argued, can be understood through existing concepts in the epistemic injustice literature, including participatory injustice and testimonial injustice.

You can read more about this research here.

Dr Lucy Series (University of Bristol) introduced the labyrinthine world of mental health and mental capacity law, offering an account of how lived experience has (or has not) shaped these frameworks in England and Wales. Series’ presentation began by outlining the commonly accepted distinction of mental health law as a coercive instrument and mental capacity law as a more benign mechanism for substitute decision‑making in a person’s best interests. She proceeded to detail the ways in which this distinction is inaccurate. In particular, she highlighted how the 2005 Mental Capacity Act can in practice authorise detention and involuntary treatment and often with fewer procedural safeguards than those available under the 1983 Mental Health Act.

Series traced the involvement of disabled people and mental health service users in shaping these legal frameworks over several decades. She concluded by considering the relationship between legal complexity and genuine participation. Where legal frameworks are highly technical and their implications difficult to foresee, consultation processes that do not invest in participant understanding risk generating outcomes that diverge sharply from what advocates intended. She closed by asking what structural conditions are necessary for expertise by experience to be genuinely incorporated into legal and regulatory processes.

The final presentation applied the conceptual frameworks outlined in earlier presentations to empirical research on bereaved families' experiences of two distinct legal processes: coroner's inquests and fitness to practise hearings. Professor Sara Ryan (Manchester Metropolitan University) presented findings from research with family members who had engaged with these processes following healthcare-related harm, including the deaths of relatives with learning disabilities or autism. You can read more about this research here.

Families reported entering these processes as relative novices, surrounded by professionals whose familiarity with procedural norms gave them significant epistemic advantage. Families were expected to provide instruction without understanding what that meant procedurally, leading to a form of disconnection that Ryan characterised as epistemic marginalisation. The fitness to practise hearings produced comparable difficulties including:

• witness statements were altered or reduced in scope without notification
• charges were revised between referral and hearing
• participants who had prepared to give evidence were informed at very short notice that their testimony was no longer required.

Some participants stated that they would not make a referral again and one described the fitness to practise process as more distressing than the bereavement itself.

Ryan concluded by emphasising how modest reforms, for example, clearer communication, named contacts, and acknowledgement of the person who died as an individual have the potential to meaningfully ameliorate epistemics injustices.

The event offered compelling insights into how epistemic injustice operates across healthcare, law, and regulatory practice. A consistent pattern emerged across all three contexts (through the obstruction of expertise by experience in clinical settings, the failure of legal frameworks to meaningfully incorporate the perspectives of those they affect, and the systematic marginalisation of bereaved families in coronial and fitness to practise processes). The people with the biggest stake in these processes are routinely denied the epistemic standing to influence them. Addressing this requires not only conceptual clarity about what epistemic justice demands but also sustained attention to the structural and institutional conditions that make genuine participation possible.

Sheelagh McGuinness

Sheelagh McGuinness is professor of law at the Centre for Health Law and Society, University of Bristol. Her research interests include the regulation of reproduction, and health law more generally. Sheelagh is currently a co-investigator on two projects: Epistemic injustice in healthcare funded by the Wellcome Trust and Reproductive Borders and Bordering Reproduction (RBBR): Access to Care for Women from Ethnic Minority and Migrant Groups funded by the AHRC. Sheelagh is a member of the Board of Trustees of the British Pregnancy Advisory Board (BPAS). 

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.

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.

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.

Who knows what in mental health? The project

In this post, Lisa Bortolotti interviews Roy Dings and Linde van Schuppen on their new project, Who knows what in mental healthcare. To stay tuned on their project, follow them on Bluesky, or join their LinkedIn group.

Doctor or patient: who is the expert?

Lisa: How did you get interested in “Who knows what in mental healthcare”? 

Roy: Trends such as democratization of knowledge and increasing distrust in traditional ‘experts’ have made the question of ‘Who knows what?’ in mental health care an urgent one. Dutch mental health care is rapidly transforming to integrate so-called ‘experts-by-experience’ in health practice and organization. But what does an expert-by-experience ‘know’?

I got particularly interested when my wife was asked to help set up a training program for expertise-by-experience at a university of applied science. When I’d ask her about it, she would regularly talk about ‘experiential knowledge’ and as a philosopher, I was immediately intrigued. I would ask “What do you mean by that?” but she, nor her colleagues, could give me an answer that I found satisfactory from a philosophical point of view. 

Recent studies confirm that definitions of experiential knowledge are typically lacking and, when provided at all, relatively uninformative. For instance, people may define experiential knowledge simply as ‘knowledge derived from personal experience’ or ‘knowledge that is lived through’. But what exactly is this kind of knowledge that we gain from experience, that cannot be obtained by reading a book, or practicing skill? What makes it so that it cannot be obtained in any other way? And to what extent can such knowledge be transferred to a person that has not lived the experience itself?

When I talked about these open questions with people in the field of expertise-by-experience, many of them seemed to cherish the ‘mysterious’ nature of experiential knowledge and found that answers could fundamentally not be put into words. Some added that I represented a ‘typical academic’ in my emphasis on conceptual rigor. They would sometimes discard what I had to say on the basis of me being an academic, and therefore a part of the system that the movement of expertise-by-experience is trying to change. I could understand this, and even felt that this was justified to some extent, but I also worried that this attitude (of being reluctant to elaborate on what is meant, precisely, with experiential knowledge) would be detrimental to the movement in the long-run.

At this point, I had already developed some strong intuitions myself – that expertise-by-experience is indeed vital to mental health care, that experts-by-experience do add something valuable, complementary and possibly unique. But I too struggled to explicate what this experiential knowledge consisted of. And so, as an ally, I felt that it had to be clarified in order to convince our ‘opponents’ (scientists or clinicians who are critical and dismissive about experiential knowledge ). Importantly though, given that experiential knowledge is ‘the new kid on the epistemic block’, I also felt that it was up to proponents of this concept to elucidate it. 

Linde: I had seen Roy working on the topic for a while before I joined the project. By that time, we had already had some lively discussions about the subject, and we still do! It is not a topic that is easily exhausted.

Linde van Schuppen

Lisa: What are the aims of the project?

Roy and Linde: The ultimate aim of our project is to provide some conceptual tools that allow various parties in mental health care to tackle implementational questions. The main question that people have been addressing has been something to the extent of ‘Should people with lived experience be included in mental health care, policy organization and science?’, where proponents respond with a ‘Yes, because they add experiential knowledge’, opponents counter with ‘No, their contribution remains unclear’. 

However, implementation-focused discussions take the affirmative answer as a given, and shift the emphasis to ‘HOW should we include people with lived experience’? That is, what roles should experts-by-experience play, exactly? How should disagreements between, for example, clinicians and experts-by-experience in practice be resolved? How can we substantiate the value of their input in everyday practice? In order to answer these questions, we need to understand what experiential expertise and knowledge consists of. 

In a recent paper, we distinguish between a descriptive and a normative challenge. The descriptive challenge is to clarify what the unique and complementary epistemic contribution is of people with lived experience, precisely. In other words, it aims to get clear on what experiential knowledge or expertise-by-experience consists of. In addition, the normative challenge asks how we should evaluate the contributions of people with lived experience. We think there are a number of normative issues related to expertise-by-experience that often get ignored in this field, such as whether and to what extent a person with lived experience can speak ‘on behalf of’ another group of people who have more or less similar experiences. 

Importantly, the project also aims to oscillate between fairly practical issues (such as implementation and suitable tasks for experts-by-experience) and theoretical ones (such as whether and to what extent can we disentangle strictly epistemological or phenomenological analyses from more political and ethical ones). For this reason, we are also very keen to connect to the EPIC project, given that epistemic injustice and expertise-by-experience have some interesting but underexplored connections.

This brings us to a last set of aims for our project: on the one hand, we are trying to ‘pioneer’ some of the dimensions of the phenomenon of expertise-by-experience. That is, rather than providing a ton of answers, we are also still in the phase of identifying the right questions. On the other hand, we are trying to bring together experts from a range of fields who have meaningful things to say about the complex phenomenon of expertise-by-experience (including phenomenologists, epistemologists, ethicists, but also clinicians, cognitive scientists and of course experts-by-experience). In order to enable the creation of this kind of epistemic community of sorts, we organize a variety of events, which we hope will result in establishing an international ‘network’ of interested and collaborating experts.

Lisa: Do you consider the project interdisciplinary? What are the methodological challenges you envisage?

Roy and Linde: We definitely consider the project to be interdisciplinary. We are combining many different points of view: different domains of philosophy, clinical perspectives, experts-by-experience and some narrative and cognitive linguistic theory as well. 

It is also interdisciplinary in a more methodological sense. For starters, it is philosophical, as it tries to elucidate the ways in which we can meaningfully connect experience to various forms of knowledge and expertise (e.g. by drawing on epistemology, phenomenology and philosophy of mind and science). But we are using qualitative empirical methods as well. 

Experts-by-experience can add a lot to scientific research practices – not only with regards to the substantive contributions they make to theory forming about that which they have experienced, but also since they might have specific sensitivities about what is relevant and meaningful when looking at data. We will be working with several experts-of-experience throughout our project, both in the role of fellow researchers, and as interviewees.

An obstacle that we aim to overcome by being interdisciplinary, is that lay people and experts-by-experience are obviously not ‘trained’ in e.g. epistemology (or abstract thinking in general). As a result, when you simply ask experts-by-experience about what experiential knowledge is according to them, then you either get responses that mimic what those experts-by-experience were told during training (as in this study), or you get mixed responses, where experts-by-experience disagree whether they should be called experts or possess knowledge at all (as in this study). 

These studies hinge on the premise that lay people are able to explicate and articulate a very abstract thing, namely to offer an account of what a certain type of knowledge consists of. Philosophers themselves have struggled with the question of what experience teaches for decades, so we cannot reasonably expect lay people to solve this puzzle on the spot. 

Now, our project aims to bypass this obstacle in two ways. First, we rely on semi-structured interviews to ask various parties (not only experts-by-experience, but also other mental health professionals) what they think experiential knowledge consists of, but ask a lot more (philosophy-based) follow-up questions. Second, and more importantly, we try to explicate what experts-by-experience implicitly think about experiential knowledge. On the one hand, we want to ask them to provide concrete examples of cases where they feel their experiential knowledge was of real added value, or where they experienced conflict between perspectives in everyday practice. 

We aim to deduce from those examples some characteristics of the knowledge at stake. On the other hand, we also aim to use tools from linguistics to analyze testimony of experts-by-experience, patients (i.e. who have not been trained as experts-by-experience) and professionals, to again explicate the epistemic contributions that are taken to be at stake. For instance, we are now exploring the use of linguistic ‘certainty markers’ to explore what claims experts-by-experience are more and less certain about with respect to certain elements of illness or recovery. The idea is that the more conviction we feel about a certain claim, the more we consider it to be knowledge.

Finally, we will have Nina de Boer starting an associated postdoc project in October. Nina will explore whether and to what extent we may clarify experiential knowledge with tools and concepts from complexity science, premised on the idea that experts-by-experience seem able to “grasp” the complexity involved in mental illness from a first-person or tacit perspective.

Roy Dings

Lisa: What impact would you like the project to have on mental healthcare? 

Roy and Linde: We hope that a more solid (conceptual) foundation for expertise-by-experience will allow for a significant and long-term impact on the field. It will enable us to establish the importance of an integration of experts-by-experience in mental health care and in the decision-making bodies of institutions. 

We also hope to help shape epistemic practices in a way that provides tools to experts-of-experience to navigate difficult contexts in their everyday work. The vague expectations that professionals have around their role, can result in uncomfortable situations for them. Experts-by-experience can for example be expected to speak for people they are not comfortable speaking for, or put on the spot in sharing vulnerable experiences in a context that doesn’t facilitate them feeling safe. 

Some clarity on why expertise-by-experience should be involved in task A and role B, but perhaps not in task A and role B (which are better left to other epistemic parties, such as professionals or scientists), or in what context certain roles ‘work’ for them as well, might help to improve this. 

We also hope that a solid conceptual foundation can help bring confidence to experts-of-experience in these situations, and in general: you have something very valuable to bring to the table, and it is not vague, or up for discussion, and you are the best person for this task.

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.

Metaphor and Epistemic Injustice in Schizophrenia

Today we interview Francesca Ervas and Lina Lissia on their project entitled: “Metaphor and Epistemic Injustice in Mental Illness: The Case of Schizophrenia” funded by PRIN, an Italian funding scheme to support research projects of national interest. The project investigates epistemic injustice in metaphorical communication in the case of mental illness. A series of seminars has been planned as part of the project and the final meeting will be a conference held in Cagliari on 22-24 October 2025.

Metaphorical communication

Lisa: What are the research interests that gave rise to this project? 

Francesca and Lina: The project was born due to a common interest in metaphor as a way to express the self/mental illness relationship. The link with epistemic injustice, defined as the injustice towards a person as a knower, came later, and was based on the idea that metaphor can precisely be seen as an epistemic device. We were interested in both forms of epistemic injustice, as Miranda Fricker defined them in 2007: 1) as a failure to attribute credibility to people with mental illness (testimonial injustice), and 2) as an attempt to marginalize their epistemic resources thus not recognizing their ability to interpret their own experience of illness (hermeneutical injustice). 

The project builds on understanding and empirically investigating both the cognitive and social mechanisms behind testimonial and hermeneutical injustice, where people with mental illness often face epistemic challenges in credibility and interpretation. We hypothesized that metaphor can have a role as a communicative tool to overcome the ineffable and inarticulate nature of the mental illness experience and, notwithstanding social stigmas and interpretive difficulties, to reach an affective attunement with the relevant others (families, friends, doctors, healthcare professionals, other people in their social lives, etc.). 

Lisa: What are the main objectives of your project?

Francesca and Lina: Focusing on schizophrenia, the project analyzes the cognitive and bodily mechanisms at the root of the failure to attribute credibility (testimonial injustice) and interpretive capacities (hermeneutical injustice) to people with mental illness, when they communicate their illness to other people via metaphors vs. their literal counterparts.

We hypothesized that affective attunement in communication is a cooperative enterprise that needs to overcome both patients’ difficulties in embodying metaphors in illness communication and interpreters’ negative social and moral stereotypes, which concur to create the case for epistemic injustice.

The project involves three research units: the University of Cagliari (UniCa), the University of Messina (UniMe), and the University of Chieti (UniCh), respectively exploring:

1. the interpreter’s perspective (UniCa, Prof. Francesca Ervas, PI of the project)
2. the mental-ill speaker’s perspective (UniMe, Prof. Valentina Cuccio)
3. the mental-ill speaker/interpreter interaction (UniCh, Prof. Francesca Ferri)

Such factors help us understand the cognitive mechanisms responsible for the missing attunement between people with mental illness and interpreters. 

Metaphor is proposed as a valuable resource to foster a better attunement between the speakers with schizophrenia and the interpreters and to possibly prevent or overcome epistemic injustice in illness communication. Metaphor is indeed a necessary tool for people with schizophrenia to express their illness and themselves in relationship with the illness, but also for relevant others to access what the speaker feels as meaningful to articulate of their experience of illness.

Working together

Lisa: Does your project involve different disciplines and perspectives? 

Francesca and Lina: The three research units have different disciplinary backgrounds and methodologies: philosophy of language and experimental pragmatics (UniCa); philosophy of mind and psycholinguistics (UniMe); cognitive neuroscience and psychiatry (UniCh). UniCa and UniMe embrace a theoretical-philosophical approach to the problem of epistemic injustice in the case of metaphor. 

All the units adopt an experimental approach to empirically investigate the cognitive mechanisms at the basis of the problem, focusing on schizophrenia. However, each unit tackles the very same problem from different angles and via different empirical methodologies. Check out the members and the disciplinary background of all our teams.

Lisa: What do you expect the impact of this project to be?

Francesca and Lina: Results will significantly advance the understanding of the theoretical, linguistic and cognitive aspects of metaphor use in mental illness communication, with interdisciplinary scientific and academic impact and social impact on public policies and health institutions. A social campaign, based on the experimental data on metaphors production/understanding and the active engagement of stakeholders, will also be designed and produced, with an impact on the general public. 

Finally, the outcomes have the potential to lead to the development of novel rehabilitative interventions and novel social behaviors to prevent epistemic injustice.

The Metaphor and Epistemic Injustice in Schizophrenia project team:

Francesca Ervas, Martina Montalti, Valentina Cuccio, Alice Guerrieri, Francesca Ferri, Lucienne Huby, Lina Lissia.

Special Issue: Renewing Phenomenological Psychopathology

 

The Renewing Phenomenological Psychopathology project is an International Exchange Award funded by the Wellcome Trust that acts as a catalyst for innovative and interdisciplinary in the field of phenomenological psychopathology. The project leaders are Professor Matthew Broome and Professor Giovanni Stanghellini. 

Through this grant, we created a network of diverse international scholars from across disciplines and career stages. This was formed through awards (including international exchange fellowships, small grants, and knowledge exchange events). The aim of the project is to revitalize phenomenological psychopathology for the 21st century as a democratic discipline with a historicised and inclusive account of the experience of mental illness.

While we had made some significant headway in disrupting this field, more work needed to be done. For this reason, we sought to create a special issue on the theme of Renewing Phenomenological Psychopathology. Through this special issue, we ask: What is the future of phenomenological psychopathology? We invited contributors to shake up previously sedimented ideas in phenomenological psychopathology and reconstruct this vital phenomenological tradition. Due to the volume of high-quality submissions, the special issue was split into two parts. 

The first part focused on how phenomenological psychopathology can be applied in new ways to gain a deeper understanding of specific psychiatric conditions. One of the core achievements attributed to phenomenological psychopathology has been a richer understanding of an array of psychiatric experiences that had previously been limited to biological accounts. However, not only has our understanding of these conditions drastically transformed since the conception of phenomenological psychopathology in the early 1900s, but entirely new conditions have been recognised and defined. 

Section one of the special issue explores the following mental health conditions (or neurodiversities): Schizophrenia, Depression, Autism and Post-Traumatic Stress Disorder. The papers in the first section either challenge hitherto engrained ideas attached to a given condition or apply phenomenological psychopathology to conditions that have been overlooked by the discipline thus far. 

The second section of the special issue strives to revitalise the very methodology of phenomenological psychopathology. Although the vestiges of phenomenology can be found across disciplines, phenomenological psychopathology has done little to engage with fields outside of philosophy and psychiatry. Advances in disciplines such as anthropology, sociology, neuroscience, critical race theory, and linguistics offer exciting new opportunities which are missed by such a guarded approach.

The second section of the special issue coalesces around three key themes. The first theme involves addressing and ameliorating inequalities in phenomenological psychopathology. The second theme involves examining the role of value and virtue in phenomenological psychopathology. The third theme focuses on fusing phenomenological psychopathology with new approaches across disciplines. 

After a long period of obscurity, phenomenological psychopathology has re-emerged. A new focus on the patient’s voice has given the approach a valued place among once more dominant methodologies. The aim of this special issue is not to sever our roots. Rather, we hope to bring all that is fruitful in the tradition of phenomenological psychopathology into the present, opening it up to new possibilities.

Dr Lucienne Spencer is a Postdoctoral Researcher in Mental Health Ethics located within the Neuroscience, Ethics and Society (NEUROSEC) Team in the Department of Psychiatry, University of Oxford. Her research primarily focuses on phenomenology, epistemic injustice and the philosophy of psychiatry.

How Psychiatrists Navigate the Complexities of Diagnostic Reasoning

 

With mental health problems being more openly discussed in public, and individuals with mental health issues becoming an increasingly important and sometimes critical voice in mental health care, the way psychiatrists practice their craft has also become an object of deeper interest for a broader audience. One central aspect of psychiatric practice is diagnostic reasoning. 

When you visit a psychiatrist because you are suffering, you expect them, among other things, to determine whether you suffer from a mental disorder and, if so, which one. While it's crucial to recognize that this is part of a psychiatrist's job description, what is not trivial is the further question: how exactly does a psychiatrist arrive at the diagnostic conclusions they write in their reports and communicate to their patients? How does the psychiatrist know what the patient’s mental disorder is?

A swift response that someone at least vaguely familiar with psychiatry might give is, “Well, they ask the patients for their symptoms and compare these to the list of mental disorders in the DSM/ICD, which tells them what the diagnosis is,” or something along those lines. Though tempting to close the matter here, it is not that easy. Criteria and symptom lists do not apply themselves to patients; it has to be judged whether they apply to the patient. Furthermore, patients are imperfect sources of information. Imperfect in the sense that they will not automatically and correctly tell you all their symptoms, and sometimes they may claim to have symptoms but misjudge their problems. 

For example, some patients think it is normal to be socially isolated as they have been so for many years, so they will not mention social isolation as one of their problems. On the other hand, patients may say they ruminate about something, while the pattern of cognition that constitutes their “rumination” is more accurately classified as generalized worrying, in the language of psychopathology. These cases show that the process of psychiatric diagnostic reasoning implies more complicated patterns of reasoning and information gathering. A truism for any clinician supporting this is: You can't just pick up a DSM and be good at diagnostics; diagnosing is a skill to learn.

Just picking up the DSM isn't enough; diagnosing is a skill!

If this is so, how does proper psychiatric diagnostic reasoning work? Not many philosophers of psychiatry have attempted to provide a theory of this practical aspect of the epistemology of psychiatry. Some work can be found among scholars committed to the Phenomenological Tradition of psychiatry, some in the works of those focusing on the interpersonal quasi-hermeneutic sense-making processes between clinicians and patients, and finally, some thoughts are to be found among philosophers of psychiatry approaching the field from the perspective of philosophy of science.

In my recent book “How Does The Psychiatrist Know?”, the first book-length treatment of psychiatric diagnostic reasoning, I side with those approaching it from a philosophy of science perspective. I argue we should consider how the procedures of clinical psychiatric diagnostics typically look, i.e., what is taught in many of the central textbooks on psychiatric diagnostics and the standards of the leading psychiatric expert communities. Based on this, psychiatric diagnostic reasoning can largely be seen as a cognitive modelling process, quite similar to the procedures we see in scientific modelling.

For clinicians, philosophers, and anyone else willing to dig through an academic textbook to get an idea of the whole story I put forward, the book is available open access.

 

Adrian Kind is a postdoctoral researcher at the Charité Medical University in Berlin, Germany. He holds a PhD in Philosophy and master degrees in Philosophy as well as Psychology. He is a psychodynamic psychotherapist in advanced training. His main areas of interests are philosophy of psychiatry, philosophy of psychology and philosophy of medicine. He also works on philosophy of sports and philosophy of religion.

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.