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)

Challenging and rewarding in equal measure, _Phenomenology of Perception_ is Merleau-Ponty's most famous work. Impressive in both scope and imagination, it uses the example of perception to return the body to the forefront of philosophy for the first time since Plato. Drawing on case studies such as brain-damaged patients from the First World War, Merleau-Ponty brilliantly shows how the body plays a crucial role not only in perception but in speech, sexuality and our relation to others.

There is one concept in medicine which is prominent, the symptom. The omnipresence of the symptom seems, however, not to be reflected by an equally prominent curiosity aimed at investigating this concept as a phenomenon. In classic, traditional or conventional medical diagnostics and treatment, the lack of distinction with respect to the symptom represents a minor problem. Faced with enigmatic conditions and their accompanying labels such as chronic fatigue syndrome, fibromyalgia, medically unexplained symptoms, and functional somatic syndromes, the contestation of (...) the symptom and its origin is immediate and obvious and calls for further exploration. Based on a description of the diagnostic framework encompassing medically unexplained conditions and a brief introduction to how such symptoms are managed both within and outside of the medical clinic, we argue on one hand how unexplained conditions invite us to reconsider and re-think the concept we call a “symptom” and on the other hand how the concept “symptom” is no longer an adequate and necessary fulcrum and must be enriched by socio-cultural, phenomenological and existential dimensions. Consequently, our main aim is to expand both our interpretative horizon and the linguistic repertoire in the face of those appearances we label medically unexplained symptoms. (shrink)

In this remarkable book Michel Foucault, one of the most influential thinkers of recent times, calls us to look critically at specific historical events in order to uncover new layers of significance.

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)

Scientific representation is a currently booming topic, both in analytical philosophy and in history and philosophy of science. The analytical inquiry attempts to come to terms with the relation between theory and world; while historians and philosophers of science aim to develop an account of the practice of model building in the sciences. This article provides a review of recent work within both traditions, and ultimately argues for a practice-based account of the means employed by scientists to effectively achieve representation (...) in the modelling sciences. (shrink)

Fricker shows that virtue epistemology provides a general epistemological idiom in which these issues can be forcefully discussed.

"The medical establishment has become a major threat to health. The disabling impact of professional control over medicine has reached the proportions of an epidemic. Iatrogenesis, the name for this new epidemic, comes from iatros, the Greek word for physician, and genesis, meaning origin. Discussion of the disease of medical progress has moved up on the agendas of medical conferences, researchers concentrate on the sick-making powers of diagnosis and therapy, and reports on paradoxical damage caused by cures for sickness take (...) up increasing space in medical dope-sheets [...] The public has been alerted to the perplexity and uncertainty of the best among its hygienic caretakers [...] This book argues that panic is out of place. Thoughtful public discussion of the iatrogenic pandemic, beginning with an insistence upon demystification of all medical matters, will not be dangerous to the commonweal."-- from Introduction. (shrink)

I argue for an intentional conception of representation in science that requires bringing scientific agents and their intentions into the picture. So the formula is: Agents (1) intend; (2) to use model, M; (3) to represent a part of the world, W; (4) for some purpose, P. This conception legitimates using similarity as the basic relationship between models and the world. Moreover, since just about anything can be used to represent anything else, there can be no unified ontology of models. (...) This whole approach is further supported by a brief exposition of some recent work in cognitive, or usage-based, linguistics. Finally, with all the above as background, I criticize the recently much discussed idea that claims involving scientific models are really fictions. (shrink)

The point of departure for this article is a review of the discussion between Twaddle and Nordenfelt on the concepts of disease, illness, and sickness, and the objective is to investigate the fruitfulness of these concepts. It is argued that disease, illness, and sickness represent different perspectives on human ailment and that they can be applied to analyze both epistemic and normative challenges to modern medicine. In particular the analysis reveals epistemic and normative differences between the concepts. Furthermore, the article (...) demonstrates, against Nordenfelt's claim, that the concepts of disease, illness, and sickness can exist without a general theory of health. Additionally, the complexity of different perspectives on human ailment also explains why it is so difficult to give strict definitions of basic concepts within modern health care. (shrink)

The art of interpretation has traditionally been an integral part of medical practice, but little attention has been devoted to its theory. Hermeneutics or the study of interpretation has grown as a methodological interest primarily within the humanities. Borrowing from the medieval fourfold sense of scripture, which organizes interpretive activity both logically and comprehensively, I propose a hermeneutical model of clinical decision-making. According to the model, a patient is analogous to a literary text which may be interpreted on four levels: (...) (1) the literal facts of the patient's body and the literal story told by the patient, (2) the diagnostic meaning of the literal data, (3) the praxis (prognosis and therapeutic decisions) emanating from the diagnosis, and (4) the change effected by the clinical encounter in both the patient's and clinician's life-worlds. The model is illustrated through application to a medical case. (shrink)

Drawing freely and expertly from Continental and analytic traditions, Richard Bernstein examines a number of debates and controversies exemplified in the works of Gadamer, Habermas, Rorty, and Arendt. He argues that a "new conversation" is emerging about human rationality—a new understanding that emphasizes its practical character and has important ramifications both for thought and action.

Havi Carel uses phenomenology to explore how illness modifies the ill person's body, values, and world. Carel argues that illness has received little philosophical attention. Phenomenology of Illness develops a phenomenological framework for illness and a systematic understanding of illness as a philosophical tool.

As is made plain in the critical apparatus and editorial matter appended to the original German publication of Hussed's Ideas II, I this is a text with a history. It underwent revision after revision, spanning almost 20 years in one of the most fertile periods of the philosopher's life. The book owes its form to the work of many hands, and its unity is one that has been imposed on it. Yet there is nothing here that cannot be traced back (...) to Hussed himself. Indeed, the final" clean copy" for publication, prepared by an assistant, was completely reviewed by the master three times and emended by him in detail on each occasion. Nevertheless, in the end the work was in fact not submitted for publication, and after Hussed's pen last touched the manuscript in 1928 it was set aside until posthumously edited and published by the Hussed-Archives in 1952. The story of the composition of Ideas II begins with the "pencil manuscript" of 1912. This is the ultimate textual source for both Ideas II and Ideas III. 2 It has been preserved as a folio of 84 sheets in very dense shorthand of the Gabelsberger system, written mostly with a pencil. It was composed by Hussed "in one stroke" immediately after the completion of I Edmund Husser!: Ideen zu einer reinen Phiinomenologie und phiinomenologischen Philosophie. Zweites Buch: Phiinomenologische Untersuchungen zur Konstitution. Edited by Marly Biemel. The Hague: Martinus NijhofT, 1952 (Husserliana IV). (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)

This paper demonstrates how the problematic kinds of epistemic power that physicians have can diminish the epistemic privilege that pregnant women have over their bodies and can put them in a state of epistemic powerlessness. This result, I argue, constitutes an epistemic injustice for many pregnant women. A reconsideration of how we understand and care for pregnant women and of the physician–patient relationship can provide us with a valuable context and starting point for helping to alleviate the knowledge/power problems that (...) are symptomatic of the current system and structure of medicine. I suggest that we can begin to confront this kind of injustice if medicine adopts a more phenomenological understanding of bodies and if physicians and patients—in this case, pregnant women—become what I call “epistemic peers.”. (shrink)

A psychiatric diagnosis today is asked to serve many functions—clinical, research, medicolegal, delimiting insurance coverage, service planning, defining eligibility for state benefits , as well as providing rallying points for pressure groups and charities. These contexts require different notions of diagnosis to tackle the particular problem such a designation is meant to solve. In a number of instances, a ‘status’ definition is employed to tackle what is more appropriately seen as requiring a ‘functional’ approach . In these instances, a diagnosis (...) may play only a subsidiary role. Some examples are discussed: the criteria for involuntary treatment; the determination of criminal responsibility; and, assessing entitlements to state benefits. I suggest that the distinction between ‘status’ versus ‘function’ has not been given sufficient weight in discussions of diagnosis. It is in the functional domain that some of the problematic relationships between clinical psychiatry and the social institutions with which it rubs shoulders are played out. A status, signified by a diagnosis, has often been encumbered with demands for which it is poorly equipped. It is a reductive way of solving problems of management, allocation or disposal for which a functional approach should be given greater weight. (shrink)

The purpose of this paper is to show through the concrete example of epileptic seizure anticipation how neuro-dynamic analysis and “pheno-dynamic” analysis may guide and determine each other. We will show that this dynamic approach to epileptic seizure makes it possible to consolidate the foundations of a cognitive non pharmacological therapy of epilepsy. We will also show through this example how the neuro-phenomenological co-determination could shed new light on the difficult problem of the “gap” which separates subjective experience from neurophysiological (...) activity. (shrink)

The relevance of the Aristotelian concept ofphronesis – practical wisdom – for medicine and medical ethics has been much debated during the last two decades. This paper attempts to show how Aristotle’s practical philosophy was of central importance toHans-Georg Gadamer and to the development of his philosophical hermeneutics, and how,accordingly, the concept of phronesiswill be central to a Gadamerian hermeneutics of medicine. If medical practice is conceived of as an interpretative meeting between doctor and patient with the aim of restoring (...) the health of the latter, then phronesis is the mark of the good physician, who through interpretation comes to know the best thing todo for this particular patient at this particular time. The potential fruitfulness of this hermeneutical appropriation of phronesis for the field of medical ethics is also discussed. The concept can be (and has been) used in critiques of the conceptualization of bioethics as the application of principle-based theory to clinical situations, since Aristotle’s point is exactly that problems of praxis cannot be approached in this way. It can also point theway for alternative forms of medical ethics, such as virtue ethics or a phenomenological andhermeneutical ethics. The latter alternative would have to address the phenomena of healthand the good life as issues for medical practice. It would also have to map out in detail the terrain of the medical meeting and the acts of interpretation through which phronesis is exercised. (shrink)

The moral authority for professional ethics in medicine customarily rests in some source external to medicine, i.e., a pre-existing philosophical system of ethics or some form of social construction, like consensus or dialogue. Rather, internal morality is grounded in the phenomena of medicine, i.e., in the nature of the clinical encounter between physician and patient. From this, a philosophy of medicine is derived which gives moral force to the duties, virtues and obligations of physicians qua physicians. Similarly, an ethic specific (...) to the other healing professions, law, teaching or ministry, can be derived from the specific ends to telos of each of these professions, which like medicine, are focused on a special type of human relationship. (shrink)

This article presents an interview method which enables us to bring a person, who may not even have been trained, to become aware of his or her subjective experience, and describe it with great precision. It is focused on the difficulties of becoming aware of one’s subjective experience and describing it, and on the processes used by this interview technique to overcome each of these difficulties. The article ends with a discussion of the criteria governing the validity of the descriptions (...) obtained, and then with a brief review of the functions of these descriptions. (shrink)

Trust is central to the therapeutic relationship, but the epistemic asymmetries between the expert healthcare provider and the patient make the patient, the trustor, vulnerable to the provider, the trustee. The narratives of pain sufferers provide helpful insights into the experience of pain at the juncture of trust, expert knowledge, and the therapeutic relationship. While stories of pain sufferers having their testimonies dismissed are well documented, pain sufferers continue to experience their testimonies as being epistemically downgraded. This kind of epistemic (...) injustice has received limited treatment in bioethics. In this paper, we examine how a climate of distrust in pain management may facilitate what Fricker calls epistemic injustice. We critically interrogate the processes through which pain sufferers are vulnerable to specific kinds of epistemic injustice, such as testimonial injustice. We also examine how healthcare institutions and practices privilege some kinds of evidence and ways of knowing while excluding certain patient testimonies from epistemic consideration. We argue that providers ought to avoid epistemic injustice in pain management by striving toward epistemic humility. Epistemic humility, as a form of epistemic justice, may be the kind disposition required to correct the harmful prejudices that may arise through testimonial exchange in chronic pain management. (shrink)

This paper describes a method for analyzing a corpus of descriptions collected through micro-phenomenological interviews. This analysis aims at identifying the structure of the singular experiences which have been described, and in particular their diachronic structure, while unfolding generic experiential structures through an iterative approach. After summarizing the principles of the micro-phenomenological interview, and then describing the process of preparation of the verbatim, the article presents on the one hand, the principles and conceptual devices of the analysis method and on (...) the other hand several dimensions of the analysis process: the modes of structural unfolding of generic structures, the mutual guidance of the processes of structural and experiential unfolding, the tracking of analysis processes, and finally the assessment of analysis results. (shrink)

In this essay, I argue that certain injustices faced by mentally disabled persons are epistemic injustices by drawing upon epistemic injustice literature, especially as it is developed by Miranda Fricker. First, I explain the terminology and arguments developed by Fricker, Gaile Pohlhaus, Jr., and Kristie Dotson that are useful in theorizing epistemic injustices against mentally disabled people. Second, I consider some specific cases of epistemic injustice to which mentally disabled persons are subject. Third, I turn to a discussion of severely (...) mentally disabled persons who, because they are unable to share information or develop interpretations of shared social experiences, may fall outside Fricker’s discussion of epistemic injustice. Fourth and finally, following arguments given by Kristie Dotson and Christopher Hookway, I define and explain a type of epistemic injustice: intimate hermeneutical injustice that I believe supplements other discussions of epistemic injustice. (shrink)

The purpose of this paper is to show through the concrete example of epileptic seizure anticipation how neuro-dynamic analysis and “pheno-dynamic” analysis may guide and determine each other. We will show that this dynamic approach to epileptic seizure makes it possible to consolidate the foundations of a cognitive non pharmacological therapy of epilepsy. We will also show through this example how the neuro-phenomenological co-determination could shed new light on the difficult problem of the “gap” which separates subjective experience from neurophysiological (...) activity. (shrink)

ONE of the most important and central claims in Hans-George Gadamer's philosophical hermeneutics is that all understanding involves not only interpretation, but also application. Against an older tradition that divided up hermeneutics into subtilitas intelligendi, subtilitas explicandi, and subtilitas applicandi, a primary thesis of Truth and Method is that these are not three independent activities to be relegated to different sub-disciplines, but rather they are internally related. They are all moments of the single process of understanding. I want to explore (...) this integration of the moment of application into hermeneutic understanding which Gadamer calls the "rediscovery of the fundamental hermeneutic problem." For it not only takes us to the heart of what is distinctive about philosophical hermeneutics but it reveals some of the deep problems and tensions implicit in hermeneutics. First, I want to note some of the central features of what Gadamer means by philosophical hermeneutics. Then I can specify the problem that he is confronting when dealing with application. This will enable us to see what Gadamer seeks to appropriate from Aristotle, and especially from Aristotle's analysis of phronesis in book VI of the Nicomachean Ethics, in elucidating the sense in which all understanding involves application. Gadamer certainly realizes that "Aristotle is not concerned with the hermeneutical problem and certainly not with its historical dimension, but with the right estimation of the role that reason has to play in moral action", and yet Gadamer claims that "if we relate Aristotle's description of the ethical phenomenon and especially the virtue of moral knowledge to our own investigation, we find Aristotle's analysis is in fact a kind of model of the problems of hermeneutics". But Gadamer's own understanding, interpretation, and appropriation of Aristotle has much richer consequences. It is itself a model of what he means by hermeneutical understanding. It is an exemplar of effective-historical consciousness, the fusion of horizons, the positive role of temporal distance, how understanding is part of the process of the coming into being of meaning, the way in which tradition "speaks to us" and makes a "claim to truth" upon us, and what it means to say that "the interpreter dealing with a traditional text seeks to apply it to himself." Furthermore, when we see how Gadamer appropriates Aristotle's text, we gain a deeper understanding of why the Geisteswissenschaften are moral-practical disciplines in the sense in which the Ethics and the Politics are practical disciplines, and why Gadamer thinks that "hermeneutic philosophy is the heir of the older tradition of practical philosophy" whose chief task is to "justify this way of reason and defend practical and political reason against the domination of technology based on science." Gadamer's own understanding of philosophical hermeneutics can itself be interpreted as a series of footnotes and reflections on his decisive intellectual encounter with Aristotle, an encounter to which he frequently refers and which was initiated by his participation in Heidegger's seminar on the Nicomachean Ethics. (shrink)

It is generally accepted that the therapeutic relationship between professionals and patients is one of trust. Nonetheless, some patient groups carry certain social vulnerabilities that can be exacerbated when they extend trust to health-care professionals. In exploring the epistemic and ethical implications of expert status, this paper examines how calls to trust may increase epistemic oppression and perpetuate the vulnerability of people with impairments. It critically evaluates the processes through which epistemic communities are formed or determined, and examines the institutional (...) structure and power relations that contribute to or sustain such self-affirming ideological communities. It also argues for a two-way collaborative approach between professionals and people with impairments that recognizes the role of local knowledge in enhancing professionals’ own understanding of their theoretical framework and promoting responsive practices and policies. (shrink)

Scientific representation is a booming field nowadays within the philosophy of science, with many papers published regularly on the topic every year, and several yearly conferences and workshops held on related topics. Historically, the topic originates in two different strands in 20th-century philosophy of science. One strand begins in the 1950s, with philosophical interest in the nature of scientific theories. As the received or “syntactic” view gave way to a “semantic” or “structural” conception, representation progressively gained the center stage. Yet, (...) there is another, older, strand that links representation to fin de siècle modeling debates, particularly in the emerging Bildtheorie of Boltzmann and Hertz, and to the ensuing discussion among philosophers thereafter. Both strands feed into present-day philosophical work on scientific representation. There are a number of different orthogonal questions that philosophers ask regarding representation. One set of questions concerns the nature of the representational relation between theories or models, on the one hand, and the real-world systems they purportedly represent. Such questions lie at the more metaphysical and abstract end of the spectrum—and they are often addressed with the abstract tools of the analytical metaphysician. They constitute what we may refer to as the “analytical inquiry” into representation. On the other hand there are questions regarding the use that scientists put some representations to in practice—these are questions that are best addressed by means of some of the favorite tools of the philosopher of science, including descriptive analysis, illustration by means of case studies, induction, exemplification, inference from practice, etc., and are best referred to as the “practical inquiry” into representation. The notion of representation invoked in such inquiries may be “deflationary” or “substantive”—depending on whether it construes representation as a primitive notion, or as susceptible to further reduction or analysis in terms of something else. (shrink)

Many critics of medicalization express concern that the process privileges individualised, biologically grounded interpretations of medicalized phenomena, inhibiting understanding and communication of aspects of those phenomena that are less relevant to their biomedical modelling. I suggest that this line of critique views medicalization as a hermeneutical injustice—a form of epistemic injustice that prevents people having the hermeneutical resources available to interpret and communicate significant areas of their experience. Interpreting the critiques in this fashion shows they frequently fail because they: neglect (...) the ways in which medicalization may not obscure, but rather illuminate, individuals’ experiences; and neglect the testimony of those experiencing first-hand medicalized problems, thus may be guilty of perpetrating testimonial injustice. However, I suggest that such arguments are valuable insofar as they highlight the unwarranted epistemic privilege frequently afforded to medical institutions and medicalized models of phenomena, and a consequent need for greater epistemic humility on the part of health workers and researchers. (shrink)

I argue that clinical medicine can best be understood not as a purified science but as a hermeneutical enterprise: that is, as involved with the interpretation of texts. The literary critic reading a novel, the judge asked to apply a law, must arrive at a coherent reading of their respective texts. Similarly, the physician interprets the text of the ill person: clinical signs and symptoms are read to ferret out their meaning, the underlying disease. However, I suggest that the hermeneutics (...) of medicine is rendered uniquely complex by its wide variety of textual forms. I discuss four in turn: the experiential text of illness as lived out by the patient; the narrative text constituted during history-taking; the physical text of the patient's body as objectively examined; the instrumental text constructed by diagnostic technologies. I further suggest that certain flaws in modern medicine arise from its refusal of a hermeneutic self-understanding. In seeking to escape all interpretive subjectivity, medicine has threatened to expunge its primary subject — the living, experiencing patient. (shrink)