EPIC Seminar Series

The Project EPIC team are pleased to announce our seminar series which takes place on the last Monday of each month at 14:00 (UK time). The talks are streamed online and are open to anybody who would like to engage with the project.

Our first talk back in March was by Professor Miranda Fricker, whose 2007 book Epistemic Injustice: Ethics and the Power of Knowing catalysed the field we now know as Epistemic Injustice.

 

Miranda Fricker

Fricker spoke to us about epistemic injustice through the lens of the memoir of mental ill-health written by the British actor David Harewood, Maybe I Don’t Belong Here: A Memoir of Race, Identity, Breakdown and Recovery (2021). His personal story explores how experiences of racism, growing up in Britain in the seventies and as a young man in the eighties, sowed the seeds of personal fracture and psychological disconnect that later expressed themselves in psychosis.

Fricker argued that many psychiatrists and therapists see their own work as including the amelioration of precisely these forms of epistemic injustice: aiming to create a therapeutic relationship in which credibility is not withheld, and shared intelligibility of experience is cultivated, with the result that the service-user may come to express themselves without needing to truncate or restyle what they want to say. 

You can watch the recording of Miranda's talk here.

Our April talk was by Professor Lauren Freeman, who spoke to us about microaggressions and epistemic harm in medicine. This talk, which you can watch here, drew on her recently published book which has been co-authored with Heather Stewart. Lauren and Heather recently wrote a project blog for us about the aims of their book which you can read here.

 

Lauren Freeman

In May, we were joined by Dr Maru Mormina. Maru spoke to us about epistemic injustice and epistemic responsibility in evidence-informed policymaking and used expert decision-making through the Covid-19 crisis as a case study to show that scientific expertise was selectively mobilised, leading to systemic ignorance which had significant consequences for the development of policy. 

Watch Maru's talk here. 

Maru Mormina

Our final talk for the semester was given by Dr Naomi Kloosterboer on the topic of how to take people with extreme beliefs seriously. Naomi advocated for a kind of epistemic openness which allows us to acknowledge and confront how our own position distorts our understanding of others in various ways. This epistemic openness, she argued, can be useful when thinking about how clinicians should approach apparent extreme beliefs in mental health service users. 

Watch Naomi's talk here. 

Naomi Kloosterboer

Our seminar series will resume online in September, and the details of all of the upcoming talks will be published on our project website under 'events' > 'seminar series'. We are thrilled to first be welcoming Professor Richard Pettigrew, who is based in Bristol. 

Epistemic injustice in the therapeutic relationship in psychiatry

Today’s post is by Eisuke Sakakibara, who is currently a lecturer at the University of Tokyo Hospital. He is a clinical psychiatrist as well as a researcher in the field of philosophy of psychiatry. Since 2013, he has been leading a study group in Tokyo, aptly named Philosophy of Psychiatry and Psychology. 

His recent publication, “Epistemic injustice in the therapeutic relationship in psychiatry,” published in Theoretical Medicine and Bioethics, discusses the effects of epistemic injustice on the interactions between psychiatrists and their patients.

I first heard of the concept of epistemic injustice in 2019 in San Francisco. From that moment on, I intuitively knew that it is a concept suitable to highlight practical and ethical issues of communication that arise between psychiatrists and psychiatric patients. I have decided to further my research.

The psychiatrist-psychiatric patient relationship is a type of doctor-patient relationship, and furthermore, the doctor-patient relationship is a type of professional-client relationship. I have made a distinction between problems that arise specifically between psychiatrists and psychiatric patients, problems that arise within the broader doctor-patient relationship, and problems that can arise generally in the professional-client relationship. Although there are no clear boundaries to what is called professional work, in addition to the classic three professions of physician, lawyer, and clergy, one could add psychologist, pharmacist, accountant, etc. to the list of professionals.

Professionals’ work involves helping clients solve problems through paid consultation. This problem-solving process requires an “epistemic collaboration,” a shared understanding and exploration of the problem, between the professional and the client. However, a professional’s high level of expertise and their close-knit relationships with peers can sometimes hinder this collaborative process. They might unintentionally dismiss certain issues important to the client as irrelevant from a professional perspective.

Eisuke Sakakibara

The doctor-patient relationship is unique among professional-client relationships in that it seeks to solve the client's bodily problems. Thus, the client experiences the duality of being both the problem solver and the problem itself—both informant and source of information. This is where the epistemic injustice inherent in medicine can arise, since in today’s medicine, objective findings from the patient's body, such as CT scans and blood tests, tend to be more prioritized than the patient’s verbal complaints.

Finally, psychiatry deals with illnesses that may impair the patient’s rational capacities, which further creates additional difficulties in epistemic collaboration. If a patient is delusional, the psychiatrist may have to accept the patient’s utterances not as testimonials, but as sources of information that reflect the patient’s illness.

The paper identifies a variety of epistemic injustice that occurs between psychiatrist-psychiatric patients from these three perspectives and proposes possible remedies.