Jaspers identifies empathic understanding as an essential tool for grasping not the mere psychic content of the condition at hand, but the lived experience of the patient. This method then serves as the basis for the phenomenological investigation into the psychiatric condition known as ‘Phenomenological Psychopathology’. In recent years, scholars in the field of phenomenological psychopathology have attempted to refine the concept of empathic understanding for its use in contemporary clinical encounters. Most notably, we have Stanghellini’s contribution of ‘second-order’ empathy (...) and Ratcliffe’s ‘radical empathy’. Through this paper, we reject the pursuit of a renewed version of ‘empathic understanding’, on the grounds that the concept is fundamentally epistemically flawed. We argue that ‘empathic understanding’ risks (1) error, leading to misdiagnosis, mistreatment and an overall misunderstanding of the experience at hand, (2) a unique form of epistemic harm that we call ‘epistemic co-opting’ and (3) epistemic objectification. To conclude, we propose that empathic understanding ought to be replaced with a phenomenological account of Fricker’s virtuous listening. (shrink)

Smartphone apps might offer a low-threshold approach to the detection of mental health conditions, such as depression. Based on the gathering of ‘passive data,’ some apps generate a user’s ‘digital phenotype,’ compare it to those of users with clinically confirmed depression and issue a warning if a depressive episode is likely. These apps can, thus, serve as epistemic tools for affected users. From an ethical perspective, it is crucial to consider epistemic injustice to promote socially responsible innovations within digital mental (...) healthcare. In cases of epistemic injustice, people are wronged specifically as epistemic agents, i.e., agents of the production and distribution of knowledge. We suggest that epistemic agency relies on different resource- and uptake-related preconditions which can be impacted by the functionality of passive self-tracking apps. We consider how this can lead to different forms of epistemic injustice (testimonial, hermeneutical, and contributory injustice) and analyze the influence of the apps’ use on epistemic practices on an individual level, in mental healthcare settings, and on the structural level. (shrink)

Those who turn to phenomenological psychopathology as an answer to problems in psychiatric healthcare may find a philosophical tradition rooted in the early-mid 20th century that has done little to adapt to modern ideas in psychiatric healthcare and psychiatric research. The Renewing Phenomenological Psychopathology project, funded by the Wellcome Trust and led by Professor Matthew Broome and Professor Giovanni Stanghellini, calls for reflection, revitalization and reconstruction of this discipline, diversifying global scholarship and working with lived experience scholars, so that it (...) can pave new paths in psychiatric understanding. The contributions of the current special issue aim to breathe new life into a vital method in psychopathology and to chart its future trajectory. (shrink)

In their article, Sedlakova and Trachsel (2023) propose a holistic, ethical, and epistemic analysis of conversational artificial intelligence (CAI) in psychotherapeutic settings. They mainly descri...

The ways in which we attempt to make sense of psychiatric illness have been slow to progress. Over the last several decades, clinicians and researchers have inherited one-size-fits-all diagnostic f...

In this article, we delve in debates around the usefulness of the notion of epistemic injustice in psychiatry to show that the concept has been misportrayed in the literature. We suggest that epistemic injustice should revolve around phenomenology and regard first and foremost the failure of mental health professionals to acquire and utilize information that service users are experts in, i.e. first-person testimony pertaining to what it is like to be them. We use this conceptualization to demonstrate the unique benefits (...) that the concept of epistemic injustice can bring to psychiatric practice, and we illustrate these through specific case studies, focusing particularly on autism. (shrink)

The current paradigm of mental health has fallen short in its promises to deliver better care and quality of life for those who lives with mental illness. Recent works have expressed the need for more comprehensive frameworks of research, in which phenomenology emerges as a fundamental tool for a new wave interdisciplinary studies with the humanities. In line with this project, this article hopes to explore the relation between education and phenomenologically oriented psychotherapy, through the work of Brazilian educator Paulo (...) Freire. First, we will briefly expose Freire’s biography and main ideas (such as the “banking model of education” and the creation of “culture circles”), showing how they can be useful during the clinical encounter. We will also highlight the importance of dialogical psychotherapy during situations of injustice and oppression. Finally, we will provide some insights that can help build a new paradigm of mental health that is based on a “praxis of freedom”, whether in research or clinical practice. We call this proposal a “Psychotherapy of the Oppressed”. (shrink)

Evaluativists hold that psychiatric disorders have a factual and evaluative dimension and recognize that psychiatric patients have an active role in shaping their symptoms, influencing the development of their disorders, and the outcome of psychiatric therapy. This is reflected in person-centered approaches that explicitly consider the role of values in psychiatric conceptualization, classification, and decision-making. In this respect, in light of the recent partnership between Fulford’s value-based practice (VBP), and Stanghellini’s phenomenological-hermeneutic-dynamical (P.H.D) psychotherapy method, this paper presents a comparative analysis (...) of two person-centered approaches to psychiatric care currently discussed within the literature. I claim that while these approaches share some core ideas, they also present important divergences concerning their axiological underpinnings, which could potentially compromise their partnership. In particular, by exploring their theoretical, practical, and ethical dimensions, I show that these models have different conceptions of what values are, which, in turn, affect their understanding of how values relate to the person and how clinicians can identify them. Finally, I argue that although Fulford’s and Stanghellini’s approaches are prima facie compatible and complementary, developing a “combined analytic-plus-phenomenological form of values-based practice” should address fundamental conceptual issues if it is to become a consistent and coherent method for psychiatric care. (shrink)

On a closed psychiatric ward, conflict and disagreement may exist between patients and psychiatrists on how to interpret the patient’s condition. This forms a complexity for implementing contemporary ideals such as shared decision making, which would require a substantial degree of epistemic flexibility from both psychiatrists and patients. Recently, authors have argued that psychiatrists are pluralistic and pragmatic in their interpretation of the patient’s condition, implying a space for this flexibility in the clinical encounter. In this article we present an (...) empirical study in which we aim to describe, understand, and explain this epistemic space and the dynamics between the psychiatrist’s and patient’s interpretation. We aim to explore and contextualize philosophical discussions through empirical research. We performed a qualitative inquiry on a closed psychiatric ward and found that both patients and psychiatrists were epistemically flexible, but epistemic negotiations were more complex and variegated than often presumed. We constructed an empirically grounded typology of different types of epistemic interaction, which shows that this interaction can only be properly understood if one acknowledges that it is shaped by different professional, societal and personal norms and values. We conclude by discussing the scope and limits of the epistemic space that we found. (shrink)

L’aide médicale à mourir (AMM) devrait être légalisée au Canada à partir de mars 2024 pour les personnes dont la seule condition médicale sous-jacente est un trouble ou une maladie mentale (AMM MM-SCMS). Dans le cadre de l’élaboration de lignes directrices visant à assurer la sécurité et la cohérence de l’AMM MM-SCMS, il convient d’accorder une attention suffisante à l’interprétation de la terminologie ambiguë de la législation actuelle et de veiller à ce que ces interprétations soient fondées sur des principes (...) éthiques acceptables. (shrink)

Multi-professional teams have become increasingly common in healthcare. Collaboration within such teams aims to enable knowledge amalgamation across specializations and to thereby improve standards of care for patients with complex health issues. However, multi-professional teamwork comes with certain challenges, as it requires successful communication across disciplinary and professional frameworks. In addition, work in multi-professional teams is often characterized by medical dominance, i.e., the perspective of physicians is prioritized over those of nurses, social workers, or other professionals. We argue that medical (...) dominance in multi-professional teams can lead to institutional epistemic injustice, which affects both providers and patients negatively. Firstly, it codifies and promotes a systematic and unfair credibility deflation of the perspectives of professionals other than physicians. Secondly, it indirectly promotes epistemic injustice towards patients via leading to institutional opacity; i.e., via creating an intransparent system of credibility norms that is difficult to navigate. To overcome these problems, multi-professional teamwork requires institutional settings that promote epistemic equity of team members. (shrink)

Silence is a byword for socially imposed harm in the burgeoning literature on epistemic injustice in psychiatry. While some silence is harmful and should be broken, this understanding of silence is untenably simplistic. Crucially, it neglects the possibility that silence can also play a constructive epistemic role in the lives of people with mental illness. This paper redresses that neglect. Engaging with first-person accounts of mania, it contends that silence constitutes a crucial form of epistemic agency to people who experience (...) mania and that the prevailing failure to recognise this may harm them. The paper proceeds as follows. After briefly examining the negative understanding of silence in the epistemic injustice literature, it outlines three epistemically agential silences: communicative silence, listening silence, and withholding silence. It then deploys these concepts to explore how the ability to perform epistemically agential silence is impaired in mania and why such silences are vital to people. The penultimate section highlights two ways that the failure to recognise the epistemic value of silence can harm people with mania. The paper concludes by drawing out implications for future research on epistemic injustice in psychiatry. (shrink)

This paper explores the philosophical concept of epistemic injustice and contends its significance and relevance to mental health nurse education and clinical practice. The term epistemic injustice may be unfamiliar to mental health nurses, yet the effects are readily visible in the dismissing, silencing, and doubting of service users’ knowledge, testimony, and interpretation. Existing professional values and clinical standards lack depth and critical exploration pertaining to epistemology and associated ethical concerns. Despite central tenets of person-centred care and valuing the service (...) users’ voice, epistemic injustice continues to occur. Epistemic injustice cannot be summed up merely by asking nurses to listen to service users. This represents an oversimplification of epistemology, ignoring the complexities of social influence and knowledge exchanges. Epistemic injustice brings something new and innovative to the nursing curriculum and fits within the principles of heutagogy. It encourages deep reflexivity surrounding the ethical issues of power inequalities and intersectionality. Inclusion in mental health nursing education allows for the social and political powers of psychiatric diagnosis as a form of silencing and stigma to be examined. Practical application is made to mental health nursing education and practice with epistemological values and ethical reflexive prompts. These can be utilised by educators and lecturers for pre-registration mental health nurse education, post-registration, and continued professional development. (shrink)

The research field of epistemic justice in healthcare has gained traction in the last decade. However, the importation of Miranda Fricker’s original philosophical framework to medicine raises several interrelated issues that have largely escaped attention. Instead of pushing forward, crafting new concepts or exploring other medical conditions, we suggest that it is time to take stock, reconsider, and articulate some fundamental issues that confront the field of epistemic injustice in healthcare. This paper articulates such fundamental issues, which we divide into (...) scientific, conceptual, and theoretical issues. Scientifically, the research field is confronted by a lack of empirical evidence. It relies on cases, making generalizations impossible and the field vulnerable to bias. Conceptually, many of the claims advanced in the literature are presented as facts but are merely hypotheses to be tested. Moreover, a criterion for applying the concept of testimonial injustice in medicine is lacking, impeding the development of a construct to empirically measure said injustices. Theoretically, many of the cases discussed in the literature do not prima facie qualify as cases of testimonial injustice, since they lack necessary components of testimonial injustice in Fricker’s framework, i.e., being unintentional and caused by identity prejudices in the hearers. If epistemic injustice is as pervasive as it is claimed in this literature, it should be of concern to us all. Addressing the issues raised here may strengthen the conceptualization of epistemic injustice in healthcare and lead to development of constructs that finally can explore its empirical basis. (shrink)

Depuis que le Canada a légalisé l’aide médicale à mourir (AMM) en 2016, il est devenu l’un des régimes les plus permissifs au monde en matière d’euthanasie et de suicide assisté. Le nombre de décès a augmenté rapidement et les catégories d’admissibilité continuent de s’élargir. Le pays est sur le point, à partir de mars 2024, d’autoriser l’AMM pour les personnes dont la seule condition sous-jacente est la maladie mentale, ce qui a suscité un débat considérable. Les défenseurs de l’AMM (...) pour les maladies mentales considèrent souvent qu’il s’agit d’une question d’égalité d’accès, mais cette extension implique des complexités considérables que l’on ne retrouve pas dans d’autres cas. Cet article examine l’AMM psychiatrique dans le contexte canadien, en s’attaquant directement aux arguments les plus pertinents des défenseurs de cette pratique. Il affirme qu’indépendamment de tout engagement préalable vis-à-vis de l’admissibilité de l’AMM en soi, il existe une nécessité éthique et juridique évidente de s’opposer à l’extension de l’AMM pour des raisons de maladie mentale si l’on suit les paramètres établis dans le cadre du régime canadien. Le document avance trois arguments : premièrement, les maladies mentales ne peuvent pas être considérées comme irrémédiables, comme l’exige la loi canadienne; deuxièmement, nous ne pouvons pas établir avec suffisamment de certitude qu’un patient atteint d’une maladie mentale a la capacité de prendre des décisions pour choisir l’AMM; et troisièmement, l’autorisation de l’AMM psychiatrique aura un impact dévastateur sur les soins et l’assistance aux malades mentaux. (shrink)