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.

Epistemic Injustice in Diagnosis

In this post Lisa Bortolotti interviews Anke Bueter (principal investigator) and Thor Hennelund Nielsen (post-doctoral researcher) on their exciting project, “Epistemic Injustice in Diagnosis” (January 2024 – December 2025) funded by a Starting Grant of the Aarhus University Research Foundation. 

Aarhus University, credit Lars Kruse / AU Foto

Lisa: How did you become interested in this project?

Anke: This project brings together my research interests in feminist epistemology and the philosophy of medicine and psychiatry.  It focuses specifically on diagnosis, as diagnosis is both a prerequisite of successful medical treatments and susceptible to pathocentric epistemic injustices. I wanted to further explore this area after working on the phenomenon of diagnostic overshadowing, in which a previous psychiatric diagnosis leads to diagnostic delays or missed diagnoses regarding somatic diseases (Bueter 2023).

Thor: Diagnostic practices in both somatic medicine and psychiatry – their internal reasonings and capacities to change peoples’ lives for better or worse – have always interested me academically and personally. I’ve been very fortunate that this project allows me to fulfil this interest through investigating the topic of overdiagnosis.

Lisa: What are your objectives and why do you think it is important to achieve them?

Anke: My primary interest lies in avoidable diagnostic errors, which are estimated to affect 10-20% of all medical cases. The project seeks to rethink diagnosis as an (ideally) collaborative epistemic process and to explore how epistemic injustices can hinder this process. For example, I am currently examining gender biases in psychiatric diagnostic criteria, as well as the important role of trust between patients and clinicians.

Thor: Studies within the field have tended to focus on either epistemic injustices of/leading to under- or misdiagnosis but haven’t paid particularly close attention to overdiagnosis, though the epistemic harms of the latter may be equally serious. I want to show that overdiagnosis is not just a problem in terms of iatrogenic harms or lost opportunity costs but also because it fundamentally affects the overdiagnosed patient’s ability to understand themselves and be understood by others.

Lisa: Does your project involve interdisciplinary or crossdisciplinary work? If so, what disciplines are involved?

Thor: The issue of overdiagnosis is crossdisciplinary at heart. The problem itself derives from medicine but is often studied through sociological methods and additionally calls for philosophical scrutiny to elucidate the concepts themselves and the injustices they may create.

Lisa: What do you expect will be the impact of your project, within philosophy and beyond it?

Anke: A better understanding of how epistemic injustice affects diagnosis, and of the mechanisms behind these issues, is a crucial first step toward mitigation. Beyond contributing to the philosophical discussion, we aim to raise awareness among the public and medical professionals about the need for epistemic justice in health care.

Thor: The ambition is to put overdiagnosis on the map within the epistemic injustice in healthcare discussion, and, conversely, open the concept of epistemic injustice to the medical debate on overdiagnosis. Hopefully this contributes to reducing the epistemic harms of overdiagnosis in the “real world” in the long run.

Anke Bueter is Associate Professor of Philosophy in the School of Culture and Society, Aarhus University. Anke is the author of Feminist Philosophy of Science (Cambridge University Press, 2024).

Thor Hennelund Nielsen is postdoctoral researcher in the School of Culture and Society, Aarhus University. Thor is the author of "The Dynamics of Disease: Toward a Processual Theory of Health", an article published in the Journal of Medicine and Philosophy in 2024.

Project launch for EPIC!

On Monday 13th May, we celebrated the launch of Project EPIC in Bristol. The launch was held at a beautiful and unique historic venue in Bristol, The Mount Without. We welcomed colleagues from the Universities of Bristol, Nottingham, and Birmingham, as well as representatives from our funder, Wellcome, friends and colleagues from other Universities, doctors, local art therapists and more. 

The evening began with an introductory address from the Principal Investigator, Professor Havi Carel, who introduced the topic of epistemic injustice in healthcare and why it matters. This was followed by short, three-minute snap-shot talks from each of the project's researchers summarising what interests them about the project. 

We heard from Lisa Bortolotti, Matthew Broome, Ian James Kidd, Michael Larkin, Michael Bresalier, Ellie Byrne, Fred Cooper, Dan Degerman and Kathleen Murphy-Hollies on a range of topics, including how epistemic injustice in healthcare relates to intersectionality and wider socio-political structures, phenomenology, emotional dysregulation, self-understanding, loneliness, and silence.

The EPIC project team 

The first part of the evening was closed by the Bristol University Singers, conducted by Elinor Cooper. The choir first sang an excerpt from ‘under the surface’ composed 2015, called ‘We measure time in breath’, followed by 'Bawo Thixo Somandla - Sidumo Nyamezele’ - a protest song widely sung during the apartheid period - and ‘We are’ by Ysaye M Barnwell.

The final of four pieces was composed by Toby Young, with lyrics by Jennifer Thorp. It was commissioned specially for Project EPIC. An excerpt as follows:

    What I keep is vigil

    What I pray is mute

    What I breathe is secret

    What I know is brute

The musical composition will grow as the project progresses, and we can't wait to see what themes emerge from the research that we'll do together.

The University Singers

The remainder of the event was spent networking and mingling with our guests. Bringing together researchers, healthcare practitioners, patients, and their advocates, clearly demonstrated the scope and the potential of the project to better understand, and ameliorate, epistemic injustices in healthcare. 

Recordings of our talks and the musical composition will be made available in due course. 

Watch this space!