Thistledown

The path is strewn with feathery seeds.

And now to continue the paper in progress...

***

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 2007), by ‘hermeneutical resources’ she is speaking of the shared tools of social interpretation. There is injustice, according to Fricker, just if identity prejudice leads to a ‘deflation of credibility’ or prejudicial marginalisation leads to a hermeneutical lacuna. In other circumstances, a person might be harmed by ‘bad luck’: they may mistakenly be perceived to lack credibility (defined by Fricker as comprising competence, which may be regarded as knowledge in a particular domain, and sincerity) or the culture may innocently lack the conceptual tools required to describe a particular experience.

However, this distinction may not be as clear cut as it appears. If a particular group regularly experiences testimonial and/or hermeneutical ‘bad luck’ it could be regarded as a matter of injustice if this unequal distribution were not addressed. This will become clearer as my argument proceeds.

The two injustices influence each other. For example, if my credibility is deflated by testimonial injustice or bad luck, I will be in the position of having to assert the legitimacy of my claim. If I am not able, due to a lack of hermeneutical resources, to explain myself competently and sincerely, my credibility will be further deflated and the ‘lacuna’ remains unfilled.

While Fricker focuses upon epistemic injustice related to gender or skin-colour, writers have subsequently brought the concept to bear on medicine and notably psychiatry, ‘because of the persistent negative stereotypes that affect people with mental disorders in particular and lead to a credibility deficit’ (Crichton, Carel, and Kidd 2017).

Those with mental disorders are liable to be treated in a way that deflates their credibility. They may be regarded as unreliable witnesses purely by virtue of having a mental disorder – when they are the sole witness to the reality of their own experience (Crichton, Carel, and Kidd 2017). They may be regarded as the source of data, through which a diagnosis can be determined, and considered as a type (depressed, schizophrenic, borderline and so on) rather than responded to as experiencing individuals with their own unique perspective and their own particular combination of symptoms (Scrutton 2017).

They may also suffer because the content of their utterances, concerning the nature of their experience, does not ‘fit’ with the medical context in which they find themselves (Scrutton 2017). For example, a person hearing voices may find meaning in those voices; a person who feels that she does not have a consistent sense of self may value her multifaceted nature; a person experiencing certain altered states of consciousness may find them transformative. Unfortunately, however, her resistance to pathologizing those aspects of her experience may make her appear to lack competency among those who do not share her experience. In the first case, the Hearing Voices network offers evidence that a community which privileges the experience of its members, rather than denying them credibility, can be highly beneficial (‘Hearing Voices Network: Welcome’ n.d.). In the final case, altered states of consciousness are being researched as a possible means of enabling positive transformation (MacLean, Johnson, and Griffiths 2011), so it seems odd to deny the value of such experiences when they are endogenous. Nonetheless, that is precisely what occurs: when a person is diagnosed with a mental disorder, her positive evaluation of certain phenomenological and emotional experiences is ignored or silenced.

It is possible, of course, that people with mental disorders may not appear to be reliable witnesses, so that even a clinician open to valuing their testimony may be disinclined to grant it full legitimacy. Scrutton notes that many patients ‘do not have the education, abilities or opportunities needed to articulate their experiences’ (Scrutton 2017). In addition, those who struggle to trust others (for example, people with Complex-Post Traumatic Stress Disorder or Borderline Personality Disorder) may be unwilling to expose their innermost feelings to a stranger (Nicki 2016; Shaw and Proctor 2005). Many may have difficulty in articulating experiences for which there are few, if any, socially shared tools of communication. Matthew Ratcliffe discusses how metaphor becomes critical for those attempting to describe what he calls ‘existential feelings’, by which he means the deep and primary mood states that lead to a person experiencing the world in a particular way constrained by that mood state (Ratcliffe 2015; 2020; n.d.; 2016).

In these situations, the patient’s credibility may be deflated not by identity prejudice but by a failing of the clinician or society to overcome certain obstacles. The outcome is the same: the patients cannot enjoy epistemic justice. In some cases, it is a failure of testimonial justice; in others, of hermeneutical marginalisation. Both experiences are alienating and damaging. Rebecca Lester refers to testimonial and hermeneutical injustice or ‘bad luck’ experienced by patients with borderline personality disorder:

When a person is continuously misunderstood by others (especially those, like therapists or doctors, whose job it is to understand her), when her experiences and attempts to connect are continuously viewed as scheming or inauthentic, it is perhaps not surprising that rage and despair and feelings of emptiness become entrenched. (Lester 2013)

The ongoing experience of being misunderstood due to hermeneutical marginalisation is clearly articulated by Fricker:

When you find yourself in a situation where you seem to be the only one to feel the dissonance between received understanding and your own intimated sense of a given experience, it tends to knock your faith in your own ability to make sense of the world... (Fricker 2007)

There may also be patients who are ‘epistemologically compromised’ – in that they may have false beliefs, whether delusions or resulting from distorting thought processes (Scrutton 2017). As an example of distorting thought processes, borderline patients often have an extreme fear of abandonment and may believe that any person they are close to will ultimately abandon them. However, though their testimony is compromised by the affective force of their fears leading to distorted thought processes, it is still important to recognise that they alone can bear witness to precisely what they think or belief, and that in itself is significant.

As this section suggests, there are particular obstacles to overcome in ensuring epistemic justice in the treatment of those with mental disorders. Identity prejudice, testimonial bad luck, epistemological compromise and hermeneutical marginalisation all have to be countered to enable epistemic justice. That seems a big ask, and without suggestions of how to achieve it, the target seems a long way distant. In the following section, I shall explain the importance of epistemic justice in therapeutic relationships, which is recognised by counsellors, therapists and psychoanalysts although they do not use the same terminology.