Too often, identifying practices of silencing is a seemingly impossible exercise. Here I claim that attempting to give a conceptual reading of the epistemic violence present when silencing occurs can help distinguish the different ways members of oppressed groups are silenced with respect to testimony. I offer an account of epistemic violence as the failure, owing to pernicious ignorance, of hearers to meet the vulnerabilities of speakers in linguistic exchanges. Ultimately, I illustrate that by focusing on the ways in which (...) hearers fail to meet speaker dependency in a linguistic exchange, efforts can be made to demarcate the different types of silencing people face when attempting to testify from oppressed positions in society. (shrink)

I distinguish between two senses in which feminists have argued that the knower is social: 1. situated or socially positioned and 2. interdependent. I argue that these two aspects of the knower work in cooperation with each other in a way that can produce willful hermeneutical ignorance, a type of epistemic injustice absent from Miranda Fricker's Epistemic Injustice. Analyzing the limitations of Fricker's analysis of the trial of Tom Robinson in Harper Lee's To Kill a Mockingbird with attention to the (...) way in which situatedness and interdependence work in tandem, I develop an understanding of willful hermeneutical ignorance, which occurs when dominantly situated knowers refuse to acknowledge epistemic tools developed from the experienced world of those situated marginally. Such refusals allow dominantly situated knowers to misunderstand, misinterpret, and/or ignore whole parts of the world. (shrink)

This article analyses the phenomenon of epistemic injustice within contemporary healthcare. We begin by detailing the persistent complaints patients make about their testimonial frustration and hermeneutical marginalization, and the negative impact this has on their care. We offer an epistemic analysis of this problem using Miranda Fricker's account of epistemic injustice. We detail two types of epistemic injustice, testimonial and hermeneutical, and identify the negative stereotypes and structural features of modern healthcare practices that generate them. We claim that these stereotypes (...) and structural features render ill persons especially vulnerable to these two types of epistemic injustice. We end by proposing five avenues for further work on epistemic injustice in healthcare. (shrink)

In this paper we argue that ill persons are particularly vulnerable to epistemic injustice in the sense articulated by Fricker. Ill persons are vulnerable to testimonial injustice through the presumptive attribution of characteristics like cognitive unreliability and emotional instability that downgrade the credibility of their testimonies. Ill persons are also vulnerable to hermeneutical injustice because many aspects of the experience of illness are difficult to understand and communicate and this often owes to gaps in collective hermeneutical resources. We then argue (...) that epistemic injustice arises in part owing to the epistemic privilege enjoyed by the practitioners and institutions of contemporary healthcare services—the former owing to their training, expertise, and third-person psychology, and the latter owing to their implicit privileging of certain styles of articulating and evidencing testimonies in ways that marginalise ill persons. We suggest that a phenomenological toolkit may be part of an effort to ameliorate epistemic injustice. (shrink)

When it comes to injustice, especially racial injustice, rage isn't just an acceptable response-it's crucial in order to fuel the fight for change. Anger has a bad reputation. Many people think that it is counterproductive, distracting, and destructive. It is a negative emotion, many believe, because it can lead so quickly to violence or an overwhelming fury. And coming from people of color, it takes on connotations that are even more sinister, stirring up stereotypes, making white people fear what an (...) angry other might be capable of doing, when angry, and leading them to turn to hatred or violence in turn, to squelch an anger that might upset the racial status quo. According to philosopher Myisha Cherry, anger does not deserve its bad reputation. It is powerful, but its power can be a force for good. And not only is it something we don't have to discourage, it's something we ought to cultivate actively. People fear anger because they paint it in broad strokes, but we can't dismiss all anger, especially not now. There is a form of anger that in fact is crucial in the anti-racist struggle today. This anti-racist anger, what Cherry calls Lordean rage, can use its mighty force to challenge racism: it aims for change, motivates productive action, builds resistance, and is informed by an inclusive and liberating perspective. People can, and should, harness Lordean rage and tap into its unique anti-racist potential. We should not suppress it or seek to replace it with friendly emotions. If we want to effect change, and take down racist structures and systems, we must manage it in the sense of cultivating it, and keeping it focused and strong. Cherry makes her argument for anti-racist anger by putting Aristotle in conversation with Audre Lorde, and James Baldwin in conversation with Joseph Butler. The Case for Rage not only uses the tools of philosophy to articulate its arguments, but it sharpens them with the help of social psychology and history. The book is philosophically rich and yet highly accessible beyond philosophical spheres, issuing an urgent call to all politically and socially engaged readers looking for new, deeply effective tools for changing the world. Its message will resonate with the enraged and those witnessing such anger, wondering whether it can help or harm. Above all, this book is a resource for the activist coming to grips with a seemingly everyday emotion that she may feel rising up within her and not know what to do with. It shows how to make sure anger doesn't go to waste, but instead leads to lasting, long-awaited change. (shrink)

Concern for human vulnerability seems to be at the heart of bioethical inquiry, but the concept of vulnerability is under-theorized in the bioethical literature. The aim of this article is to show why bioethics needs an adequately theorized and nuanced conception of vulnerability. We first review approaches to vulnerability in research ethics and public health ethics, and show that the bioethical literature associates vulnerability with risk of harm and exploitation, and limited capacity for autonomy. We identify some of the challenges (...) emerging from this literature: in particular, how to reconcile universal human vulnerability with a context-sensitive analysis of specific kinds and sources of vulnerability; and how to reconcile obligations to protect vulnerable persons with obligations to respect autonomy. We then briefly survey some of the theoretical resources available within the philosophical literature to address these challenges, and to assist in understanding the conceptual connections between vulnerability and related concepts such as harm, exploitation, needs, and autonomy. We also sketch out a taxonomy of sources and kinds of vulnerability. Finally, we consider the implications for policy evaluation of making vulnerability an explicit and central focus of bioethics. Our investigation is in the form of a broad survey motivating a research agenda rather than a detailed analysis. (shrink)

Our understanding of social experiences is central to our social understanding more generally. But this sphere of epistemic practice can be structurally prejudiced by unequal relations of power, so that some groups suffer a distinctive kind of epistemic injustice—hermeneutical injustice. I aim to achieve a clear conception of this epistemicethical phenomenon, so that we have a workable definition and a proper understanding of the wrong that it inflicts.

I explain the notion of contributory injustice, a kind of epistemic injustice, and argue that it occurs within psychiatric services, affecting those who hear voices. I argue that individual effort on the part of clinicians to avoid perpetrating this injustice is an insufficient response to the problem; mitigating the injustice will require open and meaningful dialogue between clinicians and service user organisations, as well as individuals. I suggest that clinicians must become familiar with and take seriously concepts and frameworks for (...) understanding mental distress developed in service user communities, such as Hearing Voices Network, and by individual service users. This is especially necessary when these concepts and frameworks explicitly conflict with medical or technical understandings of users’ experiences. I defend this proposal against three objections. (shrink)

It is often emphasised that persons diagnosed with borderline personality disorder show difficulties in understanding their own psychological states. In this article, I argue that from a phenomenological perspective, BPD can be understood as an existential modality in which the embodied self is profoundly saturated by an alienness regarding the person’s own affects and responses. However, the balance of familiarity and alienness is not static, but can be cultivated through, e.g., psychotherapy. Following this line of thought, I present the idea (...) that narrativising experiences can play an important role in processes of appropriating such embodied self-alienness. Importantly, the notion of narrative used is that of a scalar conception of narrativity as a variable quality of experience that comes in degrees. From this perspective, narrative appropriation is a process of gradually attributing the quality of narrativity to experiences, thereby familiarising the moods, affects, and responses that otherwise govern ‘from behind’. Finally, I propose that the idea of a narrative appropriation of embodied self-alienness is also relevant to the much-debated question of personal responsibility in BPD, particularly as this question plays out in psychotherapeutic contexts where a narrative self-appropriation may facilitate an increase in sense of autonomy and reduce emotions of guilt and shame. (shrink)

In this article, I provide a phenomenological exploration of the role played by narrativity in shaping affective experience. I start by surveying and identifying different ways in which linguistic and narrative expression contribute to structure and regulate emotions, and I then expand on these insights by taking into consideration the phenomenology of borderline personality disorder. Disruptions of narrative abilities have been shown to be central to the illness, and I argue that these disruptions are at the origin of a number (...) of alterations of affective experience. In particular, I suggest that due to the narrative “fragmentation” characteristic of the disorder, the emotions experienced by borderline patients are less differentiated and have a predominantly bodily and unregulated character. (shrink)

In this paper I argue that the distinction between epistemic privilege and epistemic authority is an important one for feminist epistemologists who are sympathetic to feminist standpoint theory, I argue that, while the first concept is elusive, the second is really the important one for a successful feminist standpoint project.

Louis Charland has argued that the Cluster B personality disorders, including borderline personality disorder, are primarily moral rather than clinical conditions. Part of his argument stems from reflections on effective treatment of borderline personality disorder. In the argument from treatment, he claims that successful treatment of all Cluster B personality disorders requires a positive change in a patient’s moral character. Based on this claim, he concludes (1) that these disorders are, at root, deficits in moral character, and (2) that effective (...) treatment of these disorders requires a sort of moral education rather than clinical intervention. In this paper, I evaluate the argument from treatment through a critical analysis of two psychotherapeutic interventions that have shown recent effectiveness against borderline personality disorder. I suggest that both Dialectical Behaviour Therapy and Mentalization-Based Treatment indicate that borderline personality disorder is, at root, a deficit in non-moral cognitive and emotional capacities. I suggest that these non-moral deficits obscure the expression of an otherwise intact moral character. In light of this, I conclude that effective treatment of borderline personality disorder requires primarily clinical intervention rather than moral edification. (shrink)

Many feminist researchers have been critical of the psychiatric category of borderline personality disorder 1 and have emphasized the gendered nature of the diagnosis. It is estimated that people diagnosed with BPD comprise 1 to 2 percent of the general population in the United States in a given year, and that women represent 75 percent of those diagnosed.2 Critics have argued that the diagnosis reinforces double-binds for women and pathologizes traits associated with both conventional femininity, such as emotionality, dependency, and (...) self-destructiveness, and unconventional femininity, such as rebelliousness and sexual promiscuity (Lester 2013; Potter 2009; Shaw.. (shrink)

Once common, therapeutic privilege—the practice whereby a physician withholds diagnostic or prognostic information from a patient intending to protect the patient—is now generally seen as unethical. However, instances of therapeutic privilege are common in some areas of clinical psychiatry. We describe therapeutic privilege in the context of borderline personality disorder, discuss the implications of diagnostic non-disclosure on integrated care and offer recommendations to promote diagnostic disclosure for this patient population. There are no data in this work.

The purpose of this inquiry is to explore the experience of Borderline Personality Disorder with the aim of developing a more liberating approach to its diagnosis and treatment. Eight participants diagnosed with Borderline Personality Disorder were recruited from a psychiatric hospital operated by the Surrey and Borders NHS Trust and an outpatient daycentre based in London, United Kingdom. A narrative approach to methodology was employed to collect and analyse the participants’ life-stories. Themes to emerge from the participant’s narratives were found (...) to coincide with R.D. Laing’s concept of ontological insecurity. Ontological insecurity describes a number of aspects of the participant’s distress. To conclude, some general implications of this research for psychotherapy are briefly explored. (shrink)

In this article, I argue for a reconsideration of the taxonomy of the Histrionic Personality Disorder (HPD). First, HPD does not carry the negative ethical implications of the other Cluster Bs, which are Anti-Social (ASPD), Borderline (BPD), and Narcissistic (NPD). Using Aristotelian notions of character as a heuristic device, I argue that ontologically HPD is not a personality disorder, but instead a cultural disorder, a result of attitudes toward traditionally feminine styles of interaction. This explains the confusion in the research (...) between HPD and hysteria and also the curious paucity of literature on HPD itself in contrast to the other Cluster Bs. (shrink)

Personality disorders: illegitimate subject positions The diagnosis of personality disorder is common in mental health nurse settings and is a term often used without critical consideration. In clinical practice, the term personality disorder has pejorative connotations, which arise out of the way in which these behaviours are constructed as behavioural rather than psychiatric. The discursive construction of categories of personality disorder are inculcated into clinical practice and become taken‐for‐granted by those in practice culture. The construction of some personalities as disordered (...) and, therefore, illegitimate becomes natural. This paper provides a critical analysis of the diagnosis and suggests an approach to mental health nursing care that is more legitimising for those people who receive psychiatric diagnoses. (shrink)