...Section I.... it doesn't have the citations in and hasn't been proof-read... but this is how the land lies...
Section I
Miranda Fricker conceptualises epistemic injustice as a wrong done to a person in their capacity as a knower. There are two categories: testimonial injustice refers to when prejudice causes a listener to deflate the credibility of a speaker’s testimony; hermeneutical injustice occurs where ‘collective hermeneutical resources can have a lacuna where the name of a distinctive social experience should be’ (Fricker). There is injustice just if identity prejudice leads to the deflation of credibility or prejudicial marginalisation leads to the hermeneutical lacuna. In other circumstances, a person might be harmed by ‘bad luck’: they may innocently be conceived to lack credibility or the culture may innocently lack the conceptual tools required to describe a particular experience.
The two injustices - or cases of bad luck - will influence each other. For example, if my credibility (which Fricker sees as comprised of competence and sincerity) is deflated I will be in the position of having to assert the legitimacy of my experience. If I do not have the conceptual tools to explain myself competently and sincerely, my credibility will be further deflated and the lacuna remains unfilled.
BPD is one of a variety of personality disorders. BPD itself is characterised as involving considerable anger toward the self and/or others, a fragmented sense of self, extreme sensitivity and emotional volatility, difficulties with emotional regulation, problems with trusting others and with intimacy, challenging interpersonal relationships, impulsivity and recklessness. A pervasive sense of emptiness and painful aloneness appears to plague many of those diagnosed with BPD. KRYATSOUS. Another feature appears common, and is of great importance in the argument to follow: in the majority (60–90%) of cases, ‘Patients describe a painful sense of incoherence and inauthenticity; they feel as if they were only pretending to be what they are, as if they cheated others into believing them. In fact their personality often changes dramatically depending on who they are with. They seem to adopt different identities at different times, which sometimes gives these patients a chameleon-like appearance.’ FUCHS
The feelings of fragmentation and inauthenticity are not unique, though, to those with BPD. For example, as Andrea Nicki argues, they, like lack of trust and several other factors, are also a feature of those who have undergone substantial early trauma. She writes, ‘Castillo (2000) found in her research in Britain that 88 percent of women labeled with BPD whom she interviewed were adult survivors of childhood abuse (53). Because of the link with childhood abuse, feminist psychiatrist Judith Herman (1992) has argued for an alternative diagnosis of complex post-traumatic stress disorder (C-PTSD) that frames the root problem of personal difficulties as victimization instead of personality deficiency.’ Such a diagnosis would certainly reduce the stigma of a BPD diagnosis (a real concern as we shall see in the following section) and that in itself might ameliorate the possibility for effective treatment. Nicki also emphasises the gendered nature of the diagnosis, with around 75% of those diagnosed with BPD being female NICKI.
However, I will not in this essay, discuss the role of epistemic injustice in diagnosis, let alone the debate concerning the validity of the category of PD or what ‘mental illness’ may or may not be. Further, I will also not focus on the issue, well articulated in feminist literature, that in treatment (as well as diagnosis), the pathologising of emotional responses to trauma (for example, distrust, hypervigilance, anger and grief) may lead to the clinician (and wider society) blaming the victim, when the responses are understandable given the context. This is itself a form of epistemic injustice, but has been well explored elsewhere. CITATION - MARGINS
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