Workshop Report: Trust and the Affective Dimensions of Health and Healthcare

 In this post, Sofia Martellini reports back from a workshop on Trust and Affective Justice at the University of Bristol.

Source: Wellcome Collection

On June 9^th, Project EPIC and the Centre for Health, Humanities and Science co-sponsored an afternoon of guest lectures and group discussions, on the theme of Trust and the Affective Dimensions of Health and Healthcare.

While my talk highlighted one aspect of epistemic injustice in healthcare, the wide range of expertise exhibited by the other speakers brought diverse and interesting perspectives on the meaning of Trust and Affectivity.

Professor Havi Carel opened with a provocation: we walk through the world with a deep, unspoken faith in our bodies. We quietly, blindly believe that we're going to be ok and we are capable of doing what we want with our bodies. Illness has the capacity to shatter this tacit certainty, even more so in critical or end-of-life conditions, where our body becomes uncapable of the most basics of actions. She distinguished bodily doubt in everyday illness  from radical bodily doubt; the kind that sets in at the extremes of experience. Here, continuity collapses entirely, the body becomes entirely medicalized, subjectivity dropping away as the body is treated as an object from those around it. Her discussion of ICU experiences, also sourcing from her own personal experience, where passivity is total and people simply have things done to them, was particularly striking.

Dr Ross Pain then turned our attention to Indigenous healthcare in Australia, where outcomes between white and indigenous people remain deeply inequitable. Different contexts have different ways of understanding and processing pain, and Dr Pain highlighted philosophy’s tendency of overgeneralizing in order to arrive to a theoretical explanation. When philosophical concepts like epistemic injustice travel across different cultural contexts, do they actually fit? His notion of the "fittingness condition" asks us to reckon honestly with the limits of our conceptual tools.

Drawing on my time in the LeTs-Care research project, I argued that informal caregivers are victims of hermeneutical injustice, since they lack the shared concepts to make sense of, and communicate, their own experience. In Mediterranean contexts especially, there is often no culturally resonant word for "caregiver" at all; caring is only a part of family duty, invisible and unnamed. My proposed PhD aims to address this through phenomenological interviews and a broader look at how care appears across different cultures, asking whether these radically different ways of understanding care are given any epistemic recognition in the policies that are supposed to help caregivers today.

Doctoral fellow Anna Pathmanathan then brought the discussion to the clinic and the prescription pad, presenting research on antibiotic prescribing disparities across minoritized ethnic populations in primary care. Combining large-scale data with patient and prescriber interviews, her work surfaces how systemic inequity can hide in plain sight, encoded in everyday clinical decisions. The doctor-patient trust relationship varies across social status, culture and other variables, filled with prejudices and epistemic inequalities: understanding how this complex dynamic works can bring light to the issue of overmedicalization, still much present in the UK.

Finally, Cristina Ganz examined communication-based epistemic injustices in doctor-patient relations, mapping how discursive, epistemic, and affective injustices layer on top of each other in clinical interactions. Her clear framework showed how different ways of addressing patients corresponded to different kinds of epistemic injustice and separating them allows us to understand how to better direct the dialogue between doctor and patient.

The variety and depth of  different interventions showed how an apparently simple concept like trust can be conjugated in meaningful but diverse ways, tied to the notion of epistemic injustice. From the creation of a theoretical concept such as radical bodily doubt, to empirical research projects meant to show trust relationships and the issues of philosophy when applied to real cases of trust loss, epistemic injustice and trust intertwine throughout different disciplines and cases. This event made me realize even more intensely how fundamental interdisciplinarity is for better research and progress, especially in fields where theory and practice come into contact. 

Without culturally specific, in-depth empirical research, philosophers can risk falling into overgeneralization, as Dr Ross Pain showed; on the other hand, through philosophically developed concepts such as epistemic injustice, negative clinical experiences can be better understood. By sharing our experiences and projects, our collective understanding of epistemic injustice, trust and affective dimensions can grow throughout different disciplines, bringing progress and new solutions to epistemic injustice issues all over the world.

Sofia Martellini is a Philosophy PhD candidate at the University of Bristol, supervised by Professor Havi Carel and Wilhelm Dagmar. Her research sits at the intersection of epistemic injustice, phenomenology and ethics of care, with a particular focus on informal caregiving and the hermeneutical gaps that leave carers without adequate concepts to make sense of their own experience. She holds degrees in Philosophy from KU Leuven and Applied Ethics from Utrecht University and has been involved in the LeTs-Care European research project. She spoke at the CHHS & EPIC workshop in June 2026.

Loneliness: Canary in the Coalmine

In this reflection, Olivia Sagan situates her critical practice on loneliness in conversation with research on epistemic injustice.

Loneliness started getting a bad rap some time ago, accused of being the antithesis of happiness and labelled an epidemic, a public health issue and a lurking, silent killer. Two decades of research activity into this dark menace has linked loneliness to negative outcomes that run from depression to cardiovascular disease to premature death. Alarm bells clang about the rising rates of loneliness amongst the old, the young, and those in between. 

Meanwhile, governments scramble to develop policy and loneliness interventions. These appear to have dubious efficacy and in most cases pop a band aid over the deep gashes of a retreating welfare state which once provided amenities known to alleviate - if not circumvent - loneliness in the first place. I am not suggesting loneliness doesn’t exist. Given the multi-directional pressures of this quarter of the 21st century, however, my pitch is that the ‘loneliness pandemic’ is not about not having enough pals, but more a deeply discomposing existential ache: a heavy dose of Kierkegaardian anxiety, the dizziness of freedom, as we, free-floating fragmented ‘subjects’, try and make sense of multiple seismic changes to the Way Things Were. An uncertainty; a new malaise in the time of monsters, and one that we need to find new ways of negotiating. 

My main worry, meanwhile, is how alarmist discourses on loneliness may, via contagion, be nudging us to think ourselves into it. We know the stories we construct and hold on to about who and how we are become further enscripted into us, courtesy of our brain’s plasticity. In thinking ourselves into loneliness, succumbing to its vicious loop, we fall into another pathologized, medicalised, and individualised state of lack of agency. Such lack of agency and attendant anomie and torpor has alluring psychic and financial ramifications for Big Pharma, the burgeoning loneliness industry, and, as many commentators from Hannah Arendt on have grimly noted, political polarisation. 

Part of how we actually become lonely may be a feeling of not mattering - a deceptively trivial-sounding experience that has more than a bit to do with feeling unseen and unheard. An army of commentators have argued that the loss of trust in politics and a slide towards populism, a ‘thin-centred ideology’, are in part due to feeling overlooked and undervalued. At a time when it is apparently easier than ever to voice opinions, we are less likely to be heard, or to hear others. Third spaces, actual physical locations where people can convene, see, be seen, heard, matter - are in fast decline. Emerging accounts of people falling for the flattery of AI are telling – the “social sycophancy” of AI chatbots being an unanticipated offshoot of our hardwired need to be seen, recognised, and valued. 

Although not without its well-argued weaknesses, research on epistemic injustice has a role to play in constructing the uber-lonely subject in our sociopolitical moment. Testimonial injustice may indeed contribute to a sense of exclusion, thwarting the construction of a shared world: the very foundation Hannah Arendt saw as necessary for preventing loneliness. Working in tandem with hermeneutical injustice, epistemic loneliness is solidified through an inability to make one's own experiences intelligible even to oneself. 

When testimony and knowledge are discredited, we cannot establish the ‘web of human relationships’ that Arendt identified as constituting the realm of human affairs. The lonely person, like the epistemically marginalised, speaks into a void where our words cannot build shared reality, a form of ‘epistemic death’ where one's capacity to know and be known is fundamentally compromised. 

On the upside, this ‘loneliness crisis’ may help inspire us into a re-reckoning: about the essentially lonely business of being human at a particular moment of dehumanisation, which, even if we don’t fully endorse an ecological and spiritual collapse-ridden vision of, we can surely recognise. And about the need for moral transformation and overdue revisiting of human kindness. The kindness in that micro-ethic moment when we look at another human being and see them, and they speak to us and we listen and we disagree with them and we still listen. Not with epistemic justice, but with epistemic humility.

To know more: The ontological dislocation of loneliness. 

Reidpath, D. D. (2025). Decolonising epistemic injustice in global health. SocArxiv. https://doi.org/10.31235/osf.io/s2e8q_v1

Arendt, H. (1958). The Human Condition. University of Chicago Press.

Medina, J. (2013). The epistemology of resistance: Gender and racial oppression, epistemic injustice, and resistant imaginations. Oxford University Press.

Professor Sagan is Director of the Centre for Applied Social Sciences at Queen Margaret University Edinburgh, a chartered psychologist and former psychodynamic counsellor with 20 years’ experience of working with adults with long term mental health difficulties. Taking a critical perspective of the biomedical model of human distress, Olivia’s phenomenological research foregrounds explorations of autonomous strategies that people develop through which they confront, negotiate and make meaning of their conditions and experiences. Her work thus explores the resilience and creativity of the ‘ill’ – in the face of discrimination, stigma, isolation and structural inequality.

Olivia Sagan