Epistemic injustice, disposability, and disrespect in inquests and fitness to practise proceedings

In this post, Professor Sara Ryan discusses the epistemic problems of public engagement in legal processes intended to facilitate listening. 

Inquest and fitness to practise processes are both fundamentally designed for the public good; the former involving a coroner-led investigation into unexpected deaths and the latter, an examination into the skills, knowledge, character and health of individual health or social care professionals by their relevant regulatory body such as the General Medical Council or the Nursing Midwifery Council. My research with members of the public involved in these processes found that each at times generated avoidable secondary trauma. This finding undermines their aims to safeguard life, ensure accountability, and uphold standards and confidence.

Public members play a central role in these processes, typically motivated by preventing others from having similar experiences. Families come to these unfamiliar spaces as novices with the expectation that their stories and their personhood matter. Instead, disrespect is repeated and amplified. Entangled within both processes is ignorance and epistemic injustice as the knowledge of families is discounted by the coroner and regulatory bodies. For example, coroners may not understand the context of a young autistic person and prioritise the views of an expert witness who works within a medical deficit model, focusing on what was ‘wrong’ with the person rather than their actual life. A fracture is generated between public expectations that they will be listened to and the aims of coroners and regulatory bodies which hold the power to make key decisions about what is and is not included in hearings and how participants are treated. 

The core focus for regulatory bodies is the construction of a robust case against the registrant and ensuring relevant people in the moment are in place to perform their role as witnesses. We found families are subjected to disposability and dismissal; of their evidence in statement form and spoken word, and are consequently treated with a lack of humanity and care. The coroner seeks to answer a small set of questions in relation to the person who died, and while family wellbeing is a central consideration, this does not always translate in practice. Inquests can become overly detached and expert-dominated – a form of technocratic accountability – which means the person who died can be dehumanised and their family excluded from being fully involved in the process of finding out what happened and why.

Accountability and change are key drivers for bereaved families, yet discrediting the person who died, or family members, seems to be an accepted strand of current practices suggesting epistemic injustice can be the default mode of  these processes. Experiences could leave participants so dissatisfied or distressed they questioned the purpose of getting involved. One participant, for example, described her experience as a witness in a fitness to practise hearing more distressing than the death of her child, while another described feeling ‘rock bottom’. 

Both contexts are, in effect, contested epistemic arenas. Overt, subtle and mundane mechanisms, including inequalities around legal funding and epistemic authority, silence families, underlining their overall lack of institutional power. A lack of information, support and expectation management can generate pre-hearing feelings of frustration and foreboding. We found evidence of what Sarah Ahmed calls ‘words that get under the skin as the use of language, or wrong spelling of a name, caused distress. Forms of communication were problematic as the name of the deceased person was spelled wrong and regulatory staff were described as ‘computer people’ offering no dialogue or acknowledgement of the harm participants had experienced. 

We found little evidence of kindness and empathy. Instead, families are expected to endure patterns of micro-violences including the insensitive and adversarial actions of legal representatives and court formalities. The epistemic landscape in both contexts can be further dominated by independent experts’ epistemic privilege in relation to their professional position, regardless of what they know or understand. For example, a lack of understanding of autism, mental health issues or even the Mental Capacity Act was raised by some participants.

We conclude that coronial inquests and fitness to practise hearings, as currently constituted, are inherently unjust. Far from delivering truth or accountability for the public good, they become sites of further dehumanisation, compounding original harm through epistemic injustice, dismissal, disposability and micro-violences. These processes will continue to generate avoidable secondary trauma until systemic reform centres respect, kindness, empathy, and genuine care instead of procedural ends.

Ahmed, S., 2021. Complaint!, Duke University Press.

Ryan S, Ribenfors F, Mikulak M, Coles D. Between epistemic injustice and therapeutic jurisprudence: Coronial processes involving families of autistic people, people with learning disabilities and/or mental ill health. Sociol Health Illn. 2025 Feb;47(2):e13855. https://doi.org/10.1111/1467-9566.13855. 

Sara Ryan is a Professor of Social Care, Manchester Metropolitan University, and her research focuses on the lives and deaths of people with learning disabilities and autistic people. 

Epistemic Injustice in dialogue with phenomenological psychopathology

In this post, Lea Nickel explores the potential and limitations of phenomenological psychopathology for better valuing the experiences of people diagnosed with mental health problems.

Image credit: Wellcome Collection

People who are suspected of having or have been diagnosed with a mental disorder are often stereotyped in ways that undermine their credibility. The concept of epistemic injustice is an important analytical tool for capturing these experiences. Testimonial injustice can manifest itself in the form of prejudiced overgeneralization of statements and behaviour. An example would be when all statements made by a person with delusions are seen as delusional, therefore, interpreted as part of the delusional belief system. 

Another form of testimonial injustice is “diagnostic overshadowing”, which describes the tendency to attribute physical symptoms to a pre-existing diagnosis of a mental disorder. Hermeneutic injustice is fuelled by the dominant status of the third-person biomedical perspective on experiences and the excess credibility of psychiatric knowledge. These forms of injustice not only hinder individual recovery but also contribute to the structural discrimination of people with mental disorders. This highlights the need for a more inclusive incorporation of the experiences of those impacted.

I see phenomenological psychopathology as a suitable starting point for this. Rooted in Husserl's vision of phenomenology as a ‘rigorous science’ that strives for knowledge without preconception, phenomenological psychopathology is focused on the exploration of patients' first-person experiences. By actively bracketing assumptions and deep-rooted prejudices and empowering patients to develop their own interpretative frameworks, the factors contributing to epistemic injustice are reduced. In the following, however, I will examine one possible limitation of phenomenological psychopathology with regard to improving epistemic injustice.

When we deal with epistemic injustice in the psychiatric context, identity biases that affect people because of their mental disorder are central. We call those sanistic prejudices. Sanism, like other “isms”, is based on deeply rooted social constructs and structures that aim to disadvantage or exclude certain groups, and thus contribute to the maintenance of social inequalities. However, forms of discrimination rarely occur in isolation. If a person is impacted by sexism, racism, classism, ageism, ableism, homophobia, or transphobia, then these oppressive mechanisms also operate in the context of mental disorders. 

This can only be captured by an intersectional approach, which leads us to a closer inspection of the “phenomenological reduction” used in phenomenological psychopathology. In general, this means questioning assumptions about the person as well as their symptoms and possible diagnoses, in order to follow Husserl’s call to get “to the things themselves”. This, however, can lead to certain dimensions of experience, such as racialized and gendered experiences, being lost. As a result, differences in experience due to the different situations of those affected cannot be reflected. If the experiences of marginalized people are taken as a basis for knowledge without reflection and without naming the oppressive structures that produced these experiences, these very structures can be re-naturalized. In the context of phenomenological psychopathology, this could be countered through an “intersectional unfolding” as proposed by Spencer (2024). Here, the various social positionings and their effects can be addressed.

An interesting starting point for this is the connection between rationality and femininity. Historically, the feminine – and consequently women – have been pathologized as unstable, hysterical, deceitful, and irrational. What such an intersectional unfolding can look like is shown in Ruth Bankey's paper “La Donna è Mobile: Constructing the irrational woman”. She shows, based on intensive conversations with women impacted by agoraphobia with panic attacks, that their experience can be described as a fear of embodying the hysterical image, characterized by excessive femininity, loss of control, and potential “madness”. While phenomenological reduction carries the risk of perpetuating a kind of ignorance and thus upholding seemingly neutral conditions of experiences an intersectional framework allows clinicians to recognize how overlapping identities shape experiences of distress.

In general, the sexist ideas surrounding mental disorders make it difficult for marginalized people to understand their experiences beyond these discriminatory constructions. Thus, in order to fully analyse epistemic injustice in the psychiatric context, there must be an awareness of the intersections of different axes of discrimination. This addition would facilitate the capturing of different experiences and structures of meaning that arise from different social positions. Not only can phenomenological psychopathology be fruitful for combating epistemic injustice in the psychiatric context, the debate on epistemic injustice can be used to renew phenomenological psychopathology and make it more epistemically just.

Lea Nickel

Lea Nickel is a PhD candidate in the Department of Medical Ethics and History of Medicine at the University Medical Center Göttingen, Germany. Her dissertation is focused on the influence of AI on doctor-patient communication. Her research interests lie in the fields of ethics of AI, empirical ethics and epistemic injustice. She is particularly keen on amplifying patients’ perspectives in the design, evaluation, and implementation of AI-based technologies in medicine. 

She wrote her master’s thesis on epistemic injustice in the psychiatric context: “Reden ist Silber, Zuhören ist Gold. Phänomenologische Psychopathologie im Dialog mit epistemischer Ungerechtigkeit” [Talking Is Silver, Listening Is Gold: Phenomenological Psychopathology in Dialogue with Epistemic Injustice]. In November 2025 she was awarded the Prize for “Philosophy and Ethics in Psychiatry and Psychotherapy” by the German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology for a shortened version of her thesis (2026).

When symptoms are silenced: Understanding epistemic injustice in women’s healthcare

In this post, Shame and Medicine’s Farina Kokab explores the epistemic dimensions of her work on women’s reproductive health.

Image credit: Wellcome Collection

Across healthcare systems, women prepare themselves for consultations knowing that the burden of proof often rests on them. Experiences of dismissal are not isolated incidents but reflect a long-standing pattern in which women’s symptoms are questioned, reframed, or minimised. This pattern cuts across chronic pain, reproductive health, and autoimmune conditions, and is intensified for women from marginalised ethnic and socioeconomic backgrounds. What appears, on the surface, to be a communication gap is better understood as a form of epistemic injustice embedded within medical training, clinical cultures, and organisational structures.

Dismissal rarely appears as an outright refusal to believe a patient. It often manifests in subtle behaviours that cumulatively undermine credibility: the shift in tone, the sigh, the avoidance of eye contact, the referral that leads nowhere, or the decade-long delay in diagnosing endometriosis. These are all moments through which women begin to question their own interpretations of their bodies. Within biomedical frameworks that privilege measurable evidence, women’s complex, fluctuating, and often invisible symptoms are easily reattributed to mood, stress, or hormones. Such explanations position the problems within the woman rather than within the condition, leaving her responsible for both her suffering and the failure to resolve it.

This dynamic is particularly stark in reproductive healthcare. After childbirth, women managing tears, surgeries, and complications are frequently sent home with minimal support, relying on limited resources, and the expectation that over-the-counter analgesia will suffice. Requests for help may be interpreted as exaggeration or dependency, reinforcing long-standing assumptions about feminine emotionality. In these contexts, women learn that speaking up carries risk: the risk of being labelled difficult, anxious, or attention-seeking. Silence, then, becomes a strategy for self-preservation, even as it delays or obstructs care.

Epistemic injustice offers a useful lens for understanding these experiences. Testimonial injustices occur when women’s accounts are given reduced credibility because of gendered assumptions about reliability, exaggeration, or emotional instability. Hermeneutical injustice appears when women lack the shared social or clinical language to articulate phenomena such as birth trauma, reproductive coercion, or chronic fatigue. Without interpretive frameworks that recognise these experiences, women struggle to make themselves intelligible within clinical encounters, and clinicians struggle to interpret their narratives in ways that guide action. Dismissal, in this sense, is not merely a failure of empathy but an epistemic harm with direct clinical consequences.

Structural conditions further shape these encounters. Time-pressured appointments encourage heuristic thinking, and organisational incentives prioritise throughput over deliberative listening. Clinicians often face their own emotional burdens when they cannot offer solutions, especially to patients who repeatedly seek reassurance or validation. Intersectionality compounds these challenges: women who are racialised, working class, migrants, or young are more likely to be stereotyped and thus more vulnerable to epistemic exclusion and exhaustion.

Women respond to these credibility deficits with considerable efforts. They rehearse their accounts before appointments, bring advocates to support their claims, modify the way they describe pain, conduct their own research, or seek alternative providers. These adaptive strategies illuminate the labour required simply to be heard and highlight the structural gaps within the system. They show that credibility must be worked for, rather than assumed, and that women often navigate healthcare environments that are neither receptive nor prepared for their stories.

Improving these dynamics requires more than individual goodwill. Listening must be treated as a clinical skill, central to diagnosis and care planning. Women’s interpretations of their own bodies should be given meaningful space, especially in contexts of diagnostic uncertainty. Organisational cultures that support curiosity, collaborative reasoning, and shared decision-making can reduce the epistemic burden placed on patients. Emerging work by female clinicians and advocacy groups demonstrates that alternative models are possible.

Ultimately, attending to epistemic justice is not just optional; it is necessary for safe and equitable care. Recognising women as credible knowers of their own bodies is a foundational step towards transforming healthcare encounters from sites of dismissal into spaces of understanding.

References:

Fricker, M (2007). Epistemic Injustice: Power and the Ethics of Knowing. Oxford University Press

Werner, A., & Malterud, K. (2003). “It is hard work behaving as a credible patient: encounters between women with chronic pain and their doctors” Social Science & Medicine, 57(8), 1409-1419

Hoffman, D.E., & Tarzian, A.J. (2001). “The girl who cried pain: a bias against women in the treatment of pain” Journal of Law, Medicine & Ethics, 29(1), 13-27

Farina Kokab

Farina is an experienced Qualitative Researcher with an interest in theoretical and conceptual framing of health inequalities, specifically women’s reproductive health. Her background in Psychology and Social Research enable her to undertake inter-disciplinary research and teaching. She is currently working as a Research Fellow on the Wellcome-Funded project, Shame and Medicine.

Combatting Epistemic Injustice through Self-diagnosis

Endometriosis is a chronic disease characterised by the growth of endometrial tissue outside of the uterine cavity (Parasar, 2017). Symptoms include infertility, cyclical and non-cyclical chronic pelvic pain, dysmenorrhoea (painful lower abdominal cramping during menstruation that effects quality of life), dyspareunia (pain during sexual intercourse), dyschezia (pain on defecation) and dysuria (pain on urinating) (Horne, 2022).

Endometriosis

The path to diagnosis can be long with an average wait time of 8 years and 10 months in the UK. According to Endometriosis UK, throughout this journey, many people feel dismissed by doctors and struggle to feel heard. 

As a response to the struggle to receive diagnosis, many have identified this condition themselves through research, resulting in self-diagnosis (Hallstrom, 2024).

Epistemic injustice and self-esteem

The gold standard test for diagnosing endometriosis is laparoscopic surgery (Allaire, 2023). According to NICE, more accessible tests, such as examinations and ultrasound scans, cannot be used to exclude it.  Therefore, referral for surgery strongly relies on testimony. This testimony is vulnerable to epistemic injustice. 

Fricker describes epistemic injustice as the idea that people can be discriminated against in their capacity as a knower based on prejudices about them. Testimonial injustice is where prejudices impact the credibility given to a knower’s testimony. Hermeneutical injustice is structural discrimination due to gaps in resources attributed to underrepresentation of marginalised individuals (Byskov, 2021). 

By denying credibility to these testimonies, we devalue contributions of experience and are dismissive of patients’ attempts to understand themselves. This undermines epistemic self-esteem by creating situations where people question their judgement of their experiences (Hallstrom, 2024).

I argue that self-diagnosis can combat epistemic injustice by improving communication in consultations.  This may not result in confirmation of the self-diagnosis but can combat the undermining of epistemic self-esteem.  

Communication

Effective bidirectional communication is vital in healthcare. However, the use of different language and concepts to express their situation between the patient and the clinician can cause misunderstandings. This can constitute testimonial injustice as their pain may fulfil the referral criteria but be denied due to their language not reflecting or mimicking the official NICE guidance surrounding the pathological pain of endometriosis. This undermines epistemic self-esteem by devaluing the patient’s contribution.   

The processes involved in self-diagnosis can combat this through creating access to communication aids. These aids, such as The Endometriosis Toolkit, can bridge the gap in communication by targeting language, providing a guide for noting observations and exploring other symptoms (check out the Menstrual health project). This can combat testimonial injustice by promoting a shared language and promoting effective communication. Therefore, epistemic self-esteem is maintained by having contributions valued. 

However, barriers to finding communicative aids online include variations in digital literacy. By encouraging individuals to improve their knowledge, whilst not supporting those unable to access resources, we risk worsening epistemic disparities. However, these aids are now available to those on social media and through schools, as in 2021 the UK Department for Education has mandated menstrual education which includes advice on when to seek help.

As many patients are young when symptoms first appear, discussions with those in their social groups are vital (Hallstrom, 2024). They can compare their symptoms to their peers and medical framework. Understanding the framework in doctors’ appointments can help them communicate their issue in accordance with guidelines, allowing them to access resources. This knowledge can diminish testimonial injustice through promoting a shared language and promote epistemic self-esteem by valuing their testimony.

Endometriosis

Dismissal of self-diagnosis

Affirmation of one’s self-diagnosis is not the aim of the appointment, but rather is a starting point for discussion. It can help understand and communicate the patient’s perspective. This questioning of symptoms and self-diagnosis can feel undermining, but effective communication in consultations can validate experiences even if the conclusion is not the acceptance of one’s self-diagnosis. When experiences are validated, damage to epistemic self-esteem can be negated.

This post is by Emily Bywater, a recent graduate from the University of Birmingham who completed an elective project with Kathleen Murphy-Hollies on tackling epistemic injustice in healthcare, with a focus on endometriosis. She provides us with a summary of her essay, which explores the philosophical and ethics issues which relate to practicing as a doctor. 

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.

Epistemic Injustice and Chronic Pain Reports

This post is by Veronica de Souza Campos and Daniel De Luca-Noronha who recently published a paper in the Journal of Applied Philosophy, entitled: Misunderstanding Epistemic Injustice: The Case of Chronic Pain Reports.

Migraine

Our article critiques the prevalent tendency to interpret inadequate medical responses to chronic pain reports primarily through the frameworks of testimonial and hermeneutical injustice. While these approaches—drawn largely from Miranda Fricker’s influential work—illuminate important aspects of the problem, they overlook a crucial dimension: what we term inquisitive inertia. 

Inquisitive inertia refers to the failure of healthcare professionals to actively investigate patients’ reports of chronic pain, defaulting instead to prescribing analgesics and dismissing the case. As we argue, this constitutes a form of distributive epistemic injustice, in which patients are denied access to a vital epistemic good: the right to a thorough and sustained inquiry into their condition.

Our article opens with first-person accounts of chronic pain sufferers who report years of misdiagnosis, dismissal, or inadequate treatment. Many scholars interpret such cases as instances of testimonial injustice (where a speaker is discredited due to prejudice) or hermeneutical injustice (where gaps in collective interpretive resources render certain experiences unintelligible). While these forms of injustice are undoubtedly present, the authors contend that they are insufficient to fully explain the epistemic harms experienced by chronic pain patients.

Testimonial injustice certainly plays a role, particularly for women and racial minorities, who are disproportionately undertreated due to implicit bias. However, chronic pain poses distinctive epistemic challenges that go beyond identity-based credibility deficits. Chronic pain often lacks clear aetiology, resists objective measurement, and disrupts narrative coherence. This makes it difficult to describe, even for patients who are believed, because the phenomenon itself strains linguistic expression. As such, even an attentive and impartial listener may fail to grasp the full significance of the patient’s testimony.

Back pain

Hermeneutical injustice also falls short in some respects. Although the development of richer conceptual resources for pain is important, this alone does not resolve the expressive limitations inherent in chronic pain experience. The highly individual and often ineffable nature of chronic pain resists neat categorization, and the dominant biomedical framework, which assumes a direct correlation between tissue damage and reported pain, fails to accommodate cases where no such correlation exists.

We introduce inquisitive inertia as a distinct and under-recognized form of epistemic injustice in healthcare. This occurs when healthcare providers, despite medical indications, refrain from pursuing further inquiry into the patient’s condition. Instead of investigating, they prescribe and dismiss. Such inertia is reinforced by systemic pressures: fragmented care, short consultation windows, and bureaucratic constraints that discourage deeper engagement.

Addressing epistemic injustice in chronic pain requires more than correcting biases or expanding conceptual resources. It demands structural reform that enables and obliges healthcare professionals to take chronic pain reports seriously and to investigate them with the epistemic diligence they deserve.

Veronica Campos is an assistant professor at the Federal University of Minas Gerais (Brazil) and research fellow at the Jesuit School of Philosophy and Theology (Brazil). Her main areas of interest are epistemology, philosophy of pain, and philosophy of religion. 

Daniel De Luca-Noronha is an associate professor at the Jesuit School of Philosophy and Theology. His areas of interest include philosophy of pain, philosophy of emotions, and philosophy of religion. 

Hermeneutical Disarmament

Hermeneutical Disarmament: How language change can undermine understanding and communication

Words and phrases enable us to understand the world and our experiences. In Epistemic Injustice, Miranda Fricker reports Wendy Sanford’s experience of depression following the birth of her child in the 1960s. Without a word to name her experience, Sanford thought that she was guilty of a “personal deficiency”. Upon learning the term postpartum depression at a workshop, Sanford’s perspective radically changed; she recognised what she was going through as a medical condition.

Changing meanings

However, words and phrases often change their meaning. Gaslighting refers to a kind of abuse in which one person causes another to doubt their own experiences. In Patrick Hamilton’s 1938 play Gas Light, Jack persuades his wife Bella that she cannot trust her perception or memory; when he takes a painting down from the wall and dims the gas lights, Jack convinces Bella that she is imagining these changes, giving him control over her. More recently, however, gaslighting is used to refer generally to lying or manipulating.

Taking these observations together reveals a problem. Words and phrases help us to understand and communicate about the world and our experiences of it. But the meaning of these words and phrases can change. When this happens, we might lose the words that we need to understand or communicate about whatever it is we want to understand or communicate about. I call this hermeneutical disarmament.

Hermeneutical disarmament

Hermeneutical disarmament: “the process by which a person is rendered less able to understand or communicate experiences, ideas, and other phenomena as a result of semantic change to the linguistic term (word or phrase) that could previously have been deployed for these purposes.” (Morgan 2025: 1076)

When the words we use change their meaning, this can leave us less able to understand and communicate about the original meaning of these words. It is clearly useful for victims of abusive manipulation (and their support network) to have a widely understood term, gaslighting, for this specific kind of psychological abuse. It helps them to understand what the victim is going through, aid existing victims, and reduce the likelihood of future victimisation. If this term disappears, because gaslighting comes to mean simply lying, then a useful tool is lost.

Words naming medical conditions can be similarly useful tools. Without the term postpartum depression, Sanford might have been unable to access relevant support and continued, mistakenly, to view her condition as a person failing.

In other cases, there is a risk that the misuse of medical terms might lead to changes in their meaning, depriving us of useful terminology. Some speakers use OCD (obsessive-compulsive disorder) to describe a particular care for cleanliness or organisation (“My flatmate is driving me crazy; she’s so OCD!”), rather than obsessions and compulsive behaviours that would warrant clinical intervention. Someone might say that they are depressed when they are feeling sad, even when they do not suffer from the often-debilitating psychological condition by this name.

When used literally, these terms serve as useful tools for people experiencing the relevant condition and those around them. They enable a person to understand what they are going through (just as postpartum depression assisted Wendy Sanford), explain this to others, and secure relevant accommodations in work and education. 

When these terms are (mis-)used to refer to something other than the medical condition in question, there is the risk that, over time, these alternative meanings might dominate, so that we lose generally understood phrases for the medical conditions. This would deprive people who suffer from these conditions and those around them of a useful tool for understanding and communicating. So, there is a risk that changes to the meaning of medical terms might inflict hermeneutical disarmament on those who experience these conditions.

Photo credit: Dustin Smith, Skywall Photography

Robert Morgan is a Lecturer and Consultant at IDEA: The Ethics Centre, University of Leeds, teaching mostly at the SWJTU-Leeds Joint School in Chengdu and at Centres for Doctoral Training around the UK. Robert’s research primarily focuses on applied sexual ethics, although he also works on topics in epistemology and metaphysics as these bear on how persons relate to each other. He is currently working on what it means for one person to touch another through something such as clothing (with Will Hornett), and on the value of interpersonal sexual activity.

 

Hermeneutical Sabotage

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

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

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

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

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

Hermeneutical sabotage

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

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

Hermeneutical sabotage and the definition of 'lesbian'

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

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

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

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

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

Author bio

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

A Defence of the Epistemic Nature of Episodic Memory

According to a traditional view, memory capacities are epistemic in nature: they function to afford knowledge of the past. In the case of episodic memory (henceforth “EM”), the relevant knowledge is of particular events in the personal past. 

Recently, however, the philosophy of EM has witnessed a “non-epistemic” turn: critics of the traditional view claim that while EM has epistemic features, it isn’t essentially in the business of affording knowledge of particular events from the personal past (see e.g., a, b, c, d, e, f, g, h, i, j, k, l,). 

Against episodic memory as epistemic

Our paper considers three empirically motivated arguments against the traditional view: (1) “the argument from construction” appeals to evidence that the contents of EM are constructed rather than stored; (2) “the argument from error” appeals to evidence that EM is highly error-prone; and, finally, (3) “the argument from animals” appeals to evidence that some nonhuman animals can episodically remember. 

Responses

Against (1), we argue that EM’s constructive nature is consistent with its functioning to afford knowledge. Indeed, it’s doing so provides a plausible, straightforward basis for functions ascribed to it by critics in light of its being constructive (e.g., contributing to planning and future action, social cohesion, and/or an enduring sense of self over time). 

Against (2), we argue that studies of memory error (e.g., m, n, o) fail to show that EM lacks an essentially epistemic function. In fact, such studies identify errors as failures to afford non-accidental knowledge of particular events from the personal past. 

Against (3), we question whether ascriptions of EM to nonhuman animals in cognitive ethology (e.g., p, q, r, s) should be accepted at face value. But even if nonhuman animals possess a species of EM, we argue that humans plausibly possess a distinct species of EM. 

Finally, our paper responds to the concern that if EM has an essentially epistemic function, “disjunctivism”—the view that nonveridical memories aren’t really memories at all—follows, where disjunctivism is thought to be inconsistent with empirical practice. We show that disjunctivism (so understood) does not in fact follow from a view that understands EM as an epistemic capacity. 

Avoiding epistemic injustice

We develop our positive account of EM as an epistemic capacity in other work and use it to respond to  “analytic” arguments against the traditional views, i.e., arguments which rest on thought experiments rather than interpretations of empirical findings. 

One of the advantages of our account of EM is that it adopts a “social critical” approach to EM. Where rejecting the essentially epistemic nature of EM risks giving up the explanatory resources required to illuminate certain forms of gaslighting (or so our in-progress essay argues), our view is designed to illuminate ways in which episodic memory is implicated in gaslighting and other forms of epistemic injustice. 

For instance, by recognizing that epistemic capacities have diverse “modes of manifesting,” our view helps diagnose a key error in what we call the “Traumatic Untrustworthiness Argument” or “TUA.” According to the TUA, experiencing trauma negatively impacts the formation, consolidation, and recall of episodic memories of a traumatic event to such an extent that it is best not to trust testimony based on such memories. 

Among the TUA’s various weaknesses, we argue, is that it hastily infers the absence of a victim’s capacity to reliably episodically remember her trauma. This inference isn’t licensed, for, as we argue, a better hypothesis is that traumatic experience simply modifies a victim’s mode of manifesting her capacity to episodically remember her trauma.

Professor Alison Springle is Assistant Professor of Philosophy at the University of Miami (FL). She works on topics in the metaphysics, epistemology, and philosophy of science of memory, perception, and action. She’s currently working on a monograph which develops a novel account of mental representation.

Dr. Seth Goldwasser is a lecturer at the University of Miami. Seth’s research focuses primarily on skillful mental action with an emphasis on skillful remembering and imagining. He has also written on the ascription of normal-proper functions in cancer biology and on the epistemic status of traumatic memories.

Stigma, Diagnosis, and Identity

This post is by Aneela Khan.

Unusual experiences

In a recent paper co-authored with Lisa Bortolotti, Andrew Fox, and Matthew Broome, forthcoming in Journal of Medicine and Philosophy, I explore how the stigma associated with a diagnosis of psychosis can result in epistemic injustice, wrongs done to someone specifically in their capacity as a knower. Drawing on findings from the Epistemic Injustice and Psychosis (EIP) study, I highlight how both testimonial and hermeneutical forms of epistemic injustice arise in clinical encounters and in people’s wider social worlds.

The study involved interviews with people diagnosed with schizophrenia spectrum disorders (clinical participants) and people who had unusual experiences without receiving a diagnosis (non-clinical participants). While both groups encountered stigma, it was only the clinical participants who experienced a significant loss of credibility and identity transformation as a result of being diagnosed. For many, the label of psychosis, often associated with stereotypes of dangerousness and incompetence, became a lens through which others interpreted their thoughts and behaviours, often overriding their own self-understandings.

Person having a religious experience

An example comes from two clinical participants, Anna and Zara. Both had experiences they initially interpreted through spiritual or religious frameworks. Anna felt guided by God, while Zara understood her voices as a punishment for her sins. In both cases, these meanings were overlooked or pathologised during their engagement with mental health services. Although both eventually found aspects of the medical model helpful, especially in accessing support, they also described feeling “funnelled” into a diagnostic identity that clashed with their personal beliefs and values.

I use the concept of epistemic injustice to make sense of these experiences. Testimonial injustice occurs when someone’s credibility is unfairly deflated, something that happens frequently to people with a diagnosis of psychosis. Hermeneutical injustice arises when individuals lack the social resources to make sense of what is happening to them, or when their interpretations are dismissed. This was particularly evident in how spiritual or cultural frameworks were marginalised in clinical settings.

Communication

Importantly, I found that non-clinical participants, those with unusual experiences but no diagnosis, were often able to make sense of what they were going through using personal, cultural or religious resources, and did not report the same harms to their credibility or sense of self. This comparison suggests that epistemic injustice is not caused by the experiences themselves, but by how they are framed and responded to by others.

I make several recommendations for clinical practice, including: 

• creating open epistemic spaces where patients can express alternative interpretations of their experiences, 
• supporting meaning-making; and 
• improving communication around diagnosis. 

By exploring the interplay between stigma, identity, relationships, and knowledge, we can contribute to  structural changes to reduce stigma and promote epistemic justice, not only in clinical settings, but also within families, communities, and wider society. 

Understanding Experiences of Mood Disturbances in Depression

Anthony Fernandez answers some questions on an exciting new project, Understanding Experiences of Mood Disturbances in Depression.

Could you give us the background to the project?

Understanding Experiences of Mood Disturbances in Depression is a new project combining qualitative and philosophical methods to establish a preliminary taxonomy of mood disturbances experienced by people diagnosed with depression. It will be carried out in the Department of Psychology, University of Southern Denmark.

A one-year pilot is currently running, funded by EPICUR, The European University Alliance, and co-funded by the European Union. The pilot is carried out in collaboration with Julian Kiverstein at the Lemon Tree Center for Psychiatry, Psychotherapy and Philosophy, Department of Psychiatry, Amsterdam University Medical Center. The full four-year project is funded by Independent Research Fund Denmark. Parts of the project will be carried out in collaboration with Evan Kyzar and George Denfield at the Department of Psychiatry, Columbia University.

What do you want to investigate?

The project investigates how people diagnosed with depression experience mood disturbances during their depressive episodes. However, the aim isn’t to generate general descriptions of what it’s like to live with depression or how depression affects one’s day-to-day life. Rather, the project aims to critically interrogate common psychiatric concepts and develop more nuanced or refined concepts that better capture the variety of mood disturbances experienced by this population. 

The concept of “depressed mood”, for example, is poorly defined or not defined at all in psychiatric textbooks and diagnostic manuals. Instead, these texts tend to list a variety of affective states that are merely indicative of depressed mood, such as feeling sad, blue, despondent, empty, hopeless, or cheerless. It’s therefore unclear what a depressed mood even is, or what we mean when we say that someone has a depressed mood. By generating detailed descriptions using in-depth interviews and analyzing the transcripts with philosophical methods, we aim to revise and develop new mood-related concepts, producing a preliminary taxonomy of mood disturbance that can inform psychiatric research and clinical practice.

Why is this important?

Despite depression being one of the most common psychiatric disorders, treatments remain ineffective for many patients. One possible reason for the low response rates is that the diagnostic category of depression doesn’t capture a single disease entity. Rather, it likely captures a variety of heterogeneous conditions that, due to superficial similarities in experience and behavior, we’ve lumped under a common label. This heterogeneity is also reproduced at the level of symptoms, where a single symptom construct, such as depressed mood, may lump together states that should be disambiguated.

We aim to develop more precise concepts that capture specific mood disturbances experienced by people diagnosed with depression. These more specific concepts can then be used by researchers in other disciplines, such as clinical psychology, psychiatry, and neuroscience to determine, for instance, the prevalence of these mood disturbances, whether they correlate with treatment effects and course of illness, or even whether they correlate with biological markers. This is all work for after the project, though. Our immediate aim is to develop a preliminary taxonomy of mood disturbances.

Will the research programme be interdisciplinary?

The project is interdisciplinary through and through. My own background is in philosophy, although I’ve worked collaboratively with clinical psychologists and psychiatrists since my Ph.D. Julian Kiverstein, who’s collaborating on the pilot, has a similar background. The project also includes Martin Vestergaard Kristian, a postdoctoral researcher and clinical psychologist. He will conduct interviews using Phenomenologically Grounded Qualitative Research, an approach to qualitative study design and interviewing I co-developed with Allan Køster, also a philosopher and psychologist. Then we’ll hire on a PhD. student with a background in phenomenology and philosophy of psychiatry to help analyze the data and work on concept development. That’s the core team. But we also have two neuropsychiatrists, Evan Kyzar and George Denfield, who will help not only to develop our new mood disturbance concepts, but also make them accessible to an audience of psychiatrists and neuroscientists so we can disseminate our results in major journals in these fields.

What do you expect the impact to be?

I think the immediate impact will be more evidence that what we call major depressive disorder actually captures a diverse array of experiences and behaviors, which may be best to distinguish, both for research and clinical practice. In the longer term, I hope we’re able to identify and conceptualize mood disturbances that will eventually be shown to correlate with different course of illness or treatment outcomes, since that will have the most impact on clinical practice.

Anthony Vincent Fernandez is Associate Professor of Applied Philosophy and Theoretical Psychology at the Department of Psychology and the Department of Sports Science and Clinical Biomechanics, and a Senior Fellow of the Danish Institute for Advanced Study at University of Southern Denmark. His work focuses on the use of phenomenology in disciplines outside of philosophy, including psychiatry, nursing, anthropology, and sociology. He is co-editor of The Oxford Handbook of Phenomenological Psychopathology and co-editor-in-chief of Phenomenology and the Cognitive Sciences. He is currently writing new introduction to phenomenology, which details how researchers in the psychological, social, and health sciences, as well as in art and design, understand and use phenomenology.