Project EPIC on World Mental Health Day 2024

On the occasion of World Mental Health Day (#WMHD2024), we asked project EPIC team members to share a quote and a resource relevant to their work on epistemic injustice in healthcare.

Jodie Russell

Jodie is a researcher working at the University of Birmingham on one of EPIC case studies. Jodie is the author of "Problems for Enactive Psychiatry as a Practical Framework", published open access in Philosophical Psychology, highlighting the limitations of enactivism in reducing the harm and suffering experienced by individuals diagnosed with mental disorders.

 

Lisa Bortolotti

Lisa is an investigator in project EPIC, based at the University of Birmingham. Lisa has co-authored with Kathleen Murphy-Hollies a paper entitled "Why We Should Be Curious about Each Other", published open access in Philosophies, arguing that curiosity a good antidote to epistemic injustice. Lisa also edited and contributed a chapter to the forthcoming open access book on Epistemic Justice in Mental Healthcare (Palgrave Pivot).

Dan Degerman

Dan is a researcher on project EPIC, based at the University of Bristol. Dan's research explores the idea that it might not always be good to talk about one's mental health. If you want to know more, you can read Dan's article written for the Conversation.

Havi Carel

Havi is project EPIC principal investigator, based at the University of Bristol. Havi's work focuses on the experience of illness and she pioneered the application of the notion of epistemic injustice to healthcare. Watch this video where she introduces project EPIC.

Rabih Chattat

Rabih is a project EPIC partner, based at the University of Bologna. Rabih's work focuses on psychosocial interventions in dementia and the clinical psychology of ageing. He recently wrote a post for the EPIC blog on good living and social health as applied to dementia. Rabih also contributed a chapter on these themes to the forthcoming open access book on Epistemic Justice in Mental Healthcare (Palgrave Pivot).

Jude Williams

Jude is the project manager for EPIC at the University of Birmingham. Jodie volunteers for the Choir with No Name, the choir that gives homeless people a voice. If you want to know more about what the Choir is about and what impact it has, please read this.

Matthew Broome

Matthew is an investigator on EPIC and directs the Institute of Mental Health at the University of Birmingham. He recently co-authored a paper with Lucienne Spencer on epistemic injustice and claims of suicidality that can be found here. Together with Michael Larkin, Lisa Bortolotti, and Rose McCabe, Matthew contributed a chapter on youth mental health to the forthcoming open access book on Epistemic Justice in Mental Healthcare (Palgrave Pivot).

Eleanor Byrne

Eleanor is a researcher on project EPIC, based at the University of Birmingham. Eleanor works in the philosophy of medicine, on conditions that impact on the mental and physical capacities of those affected. In this podcast, she discusses an area at the intersection of philosophy and psychotherapy, focusing on experiences of fatigue.

Elisabetta Lalumera

Elisabetta is an EPIC project partner based at the University of Bologna. Elisabetta works in the philosophy of medicine. You can read this blog post where she talks about how to achieve epistemic justice in the biomedical paradigm. Elisabetta also contributed a chapter on digital health technologies to the forthcoming open access book on Epistemic Justice in Mental Healthcare (Palgrave Pivot).

Rose McCabe

Rose is an EPIC project partner based at City University, London. Rose specialises in research on clinical communication and contributes to the design of interventions to improve the capacity of professionals to listen to people who seek support for their mental health. See an example here. Together with Michael Larkin, Lisa Bortolotti, and Matthew Broome, Rose contributed a chapter on youth mental health to the forthcoming open access book on Epistemic Justice in Mental Healthcare (Palgrave Pivot).

Lara Calabrese

Lara is interested in ways of explaining and ameliorating the stigmatisation of people with dementia. She is a researcher at the University of Bologna, and is going to collect the data for one of EPIC case studies. 

Luigi Grassi

Luigi is an EPIC project partner, working at the University of Ferrara. Luigi recently shared some of this research interests in dignity and stigma in end of life care on the EPIC blog. Luigi also contributed a chapter on these themes to the forthcoming open access book on Epistemic Justice in Mental Healthcare (Palgrave Pivot)

Kathleen Murphy-Hollies

Kathleen is a researcher at the University of Birmingham. Kathleen has worked with some entomologists to better understand delusions of parasitosis, when people come to believe that their bodies have been infested by insects. To know more about this fascinating condition and the challenges it poses, go here.

Martino Belvederi Murri

Martino is an EPIC project partner, working at the University of Ferrara. Martino recently shared of his research interests in demoralisation and testimonial injustice in an acute psychiatric ward on the EPIC blog. Martino also contributed a chapter on these themes to the forthcoming open access book on Epistemic Justice in Mental Healthcare (Palgrave Pivot).

Self-narratives and medicalization: the effects of psychiatric diagnoses

This post is by Richard Hassall, a qualified clinical psychologist, now retired. After retirement, Richard enrolled at the University of Sheffield to do an MA in philosophy, followed by a PhD which was completed in 2022. At the time of writing, Richard is an affiliate researcher attached to the Department of Philosophy at Sheffield.

Richard Hassall

My area of interest is philosophy of psychiatry, with a particular interest in the nature of psychiatric diagnostic categories and the effect these have on the individuals who receive them. I argue in my PhD thesis that a psychiatric diagnosis may, in some cases, lead the recipient to becoming a victim of epistemic injustice, and specifically of hermeneutical injustice. I argue that this effect can be understood in terms of narrative theory and the self-narratives that individuals construct for themselves.

People gain meaning in their lives through their self-narratives, but such narratives can be changed by the person’s social circumstances and by extraneous events. Receiving a psychiatric diagnosis is one such event in some people’s lives, and it can significantly impact on the recipient’s self-narrative.

The codification of psychiatric diagnoses in disease nosologies, such as the DSM-5 of the American Psychiatric Association, can convey the implication that these represent disease entities of some sort. Patients are often told that their condition is “an illness like any other”. The reductionist methodology characteristic of the biomedical model of diseases can suggest that mental disorders are somehow caused by neurochemical abnormalities in the brain, an idea reinforced by the frequent treatment of such disorders with medication. Consequently, the diagnosis may be understood as a medicalized explanation of the person’s difficulties. However, most such diagnoses are based purely on symptom descriptions and do not explain how the person’s symptoms arose.

The medicalization implicit in psychiatric diagnoses conveys a biomedical narrative which may conflict with or marginalise the recipients’ previous self-narratives at a time when they will be experiencing significant emotional distress. As such, the recipients’ own hermeneutical resources can become marginalised. In other words, their capacity for understanding and expressing their own experiences can be minimised or neglected by clinicians. This can result in them becoming victims of hermeneutical injustice, particularly if they are mistakenly led to believe that their condition is a chronic one, from which full recovery is unlikely to happen.

The biomedical narrative associated with such diagnoses can undermine the recipients’ beliefs about their sense of agency and lead to feelings of hopelessness about recovery. While it is not an inevitable consequence of such diagnoses, there is evidence from testimonies of former service-users that this can happen to some people.