Chronic fatigue syndrome or myalgic encephalomyelitis remains a controversial illness category. This paper surveys the state of knowledge and attitudes about this illness and proposes that epistemic concerns about the testimonial credibility of patients can be articulated using Miranda Fricker’s concept of epistemic injustice. While there is consensus within mainstream medical guidelines that there is no known cause of CFS/ME, there is continued debate about how best to conceive of CFS/ME, including disagreement about how to interpret clinical studies of treatments. (...) Against this background, robust qualitative and quantitative research from a range of countries has found that many doctors display uncertainty about whether CFS/ME is real, which may result in delays in diagnosis and treatment for patients. Strikingly, qualitative research evinces that patients with CFS/ME often experience suspicion by health professionals, and many patients vocally oppose the effectiveness, and the conceptualization, of their illness as psychologically treatable. We address the intersection of these issues and healthcare ethics, and claim that this state of affairs can be explained as a case of epistemic injustice. We find evidence that healthcare consultations are fora where patients with CFS/ME may be particularly vulnerable to epistemic injustice. We argue that the marginalization of many patients is a professional failure that may lead to further ethical and practical consequences both for progressive research into CFS/ME, and for ethical care and delivery of current treatments among individuals suffering from this debilitating illness. (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)

Epistemic injustice is a harm done to a person in their capacity as an epistemic subject by undermining her capacity to engage in epistemic practices such as giving knowledge to others or making sense of one’s experiences. It has been argued that those who suffer from medical conditions are more vulnerable to epistemic injustice than the healthy. This paper claims that people with mental disorders are even more vulnerable to epistemic injustice than those with somatic illnesses. Two kinds of contributory (...) factors for epistemic injustice in psychiatric patients are outlined: global and specific. Some suggestions are made to counteract the effects of these contributory factors, for instance we suggest that physicians should participate in groups where the subjective experience of patients is explored, and learn to become more aware of their own unconscious prejudices towards psychiatric patients. (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)

Much recent philosophical work argues that power constrains speech—pornography silences women, testimonial injustice thwarts a speaker’s transmission of knowledge, bias distorts the performative force of subordinated speech. Though the constraints that power places on speech are serious, power also enables some speech. Power doesn’t just keep us from speaking—it also makes us speak. In this paper I explore how power produces, rather than constrains, speech. I discuss a kind of speech I call extracted speech: speech that is unjustly elicited from (...) an agent. I discuss examples of coerced confession, intimidated “consent,” and mandatory self-disclosure as instances of extracted speech, and theorize a bit about what significance this speech has more generally for philosophy of language and political philosophy. (shrink)

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)

This paper defends a contextualist approach to epistemic injustice according to which instances of such injustice should be looked at as temporally extended phenomena (having developmental and historical trajectories) and socially extended phenomena (being rooted in patterns of social relations). Within this contextualist framework, credibility excesses appear as a form of undeserved epistemic privilege that is crucially relevant for matters of testimonial justice. While drawing on Miranda Fricker's proportional view of epistemic justice, I take issue with its lack of attention (...) to the role that credibility excesses play in testimonial injustices. I depart from Fricker's view of the relation between credibility excesses and credibility deficits, and I offer an alternative account of the contributions that undeserved epistemic privileges make to epistemic injustices. Then, through the detailed analysis of To kill a mockingbird, I elucidate the crucial role played by the social imaginary in creating and sustaining epistemic injustices, developing an analysis of the kind of social blindness produced by an oppressive social imaginary that establishes unjust patterns of credibility excesses and deficits. (shrink)

Testimony is an invaluable source of knowledge. We rely on the reports of those around us for everything from the ingredients in our food and medicine to the identity of our family members. Recent years have seen an explosion of interest in the epistemology of testimony. Despite the multitude of views offered, a single thesis is nearly universally accepted: testimonial knowledge is acquired through the process of transmission from speaker to hearer. In this book, Jennifer Lackey shows that this thesis (...) is false and, hence, that the literature on testimony has been shaped at its core by a view that is fundamentally misguided. She then defends a detailed alternative to this conception of testimony: whereas the views currently dominant focus on the epistemic status of what speakers believe, Lackey advances a theory that instead centers on what speakers say. The upshot is that, strictly speaking, we do not learn from one another's beliefs - we learn from one another's words. Once this shift in focus is in place, Lackey goes on to argue that, though positive reasons are necessary for testimonial knowledge, testimony itself is an irreducible epistemic source. This leads to the development of a theory that gives proper credence to testimony's epistemologically dual nature: both the speaker and the hearer must make a positive epistemic contribution to testimonial knowledge. The resulting view not only reveals that testimony has the capacity to generate knowledge, but it also gives appropriate weight to our nature as both socially indebted and individually rational creatures. The approach found in this book will, then, represent a radical departure from the views currently dominating the epistemology of testimony, and thus is intended to reshape our understanding of the deep and ubiquitous reliance we have on the testimony of those around us. (shrink)

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

Despite contemporary moral philosophers' renewed attention to the moral significance of emotions, the attitudinal repertoire with which they equip the mature moral agent remains stunted. One attitude moral philosophers neglect (if not disown) is contempt. While acknowledging the nastiness of contempt, I here correct the neglect by providing an account of the moral psychology of contempt. In the process, I defend the moral propriety of certain tokens of properly person-focused contempt against some prominent objections -- among them, objections stemming from (...) Kantian worries that contempt is incompatible with the respect we owe to persons as such. (shrink)

Miranda Fricker’s influential concept of epistemic injustice has recently seen application to many areas of interest, with an increasing body of healthcare research using the concept of epistemic injustice in order to develop both general frameworks and accounts of specific medical conditions and patient groups. This paper illuminates tensions that arise between taking steps to protect against committing epistemic injustice in healthcare, and taking steps to understand the complexity of one’s predicament and treat it accordingly. Work on epistemic injustice is (...) therefore at risk of obfuscating legitimate and potentially fruitful inquiry. This paper uses Chronic Fatigue Syndrome/Myalgic Encephalomyelitis as a case study, but I suggest that the key problems identified could apply to other cases within healthcare, such as those classed as Medically Unexplained Illnesses, Functional Neurological Disorders and Psychiatric Disorders. Future work on epistemic injustice in healthcare must recognise and attend to this tension to protect against unsatisfactory attempts to correct epistemic injustice. (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)

This paper argues that underlying social biases are able to affect the processes underlying linguistic interpretation. The result is a series of harms systematically inflicted on marginalised speakers. It is also argued that the role of biases and stereotypes in interpretation complicates Miranda Fricker's proposed solution to epistemic injustice.

Philosophical suspicions about the place of shame in the psychology of the mature moral agent are in tension with the commonplace assumption that to call a person shameless purports to mark a fault, arguably a moral fault. I shift philosophical suspicions away from shame and toward its absence in the shameless by focusing attention on phenomena of shamelessness. In redirecting our attention, I clarify the nature of the failing to which ascriptions of shamelessness might refer and defend the thought that, (...) as an evasion of moral self-censure, shamelessness can be morally pernicious. Far from foregoing shame, I conclude, we should be mindful of its moral importance and unapologetic in its defense. (shrink)

Miranda Fricker maintains that testimonial injustice is a matter of credibility deficit, not excess. In this article, I argue that this restricted characterization of testimonial injustice is too narrow. I introduce a type of identity-prejudicial credibility excess that harms its targets qua knowers and transmitters of knowledge. I show how positive stereotyping and prejudicially inflated credibility assessments contribute to the continued epistemic oppression of marginalized knowers. In particular, I examine harms such as typecasting, compulsory representation, and epistemic exploitation and consider (...) what hearers are obligated to do in response to these injustices. I argue that because epistemic harms to marginalized knowers also arise from prejudicially inflated assessments of their credibility, the virtue of testimonial justice must be revised to remedy them. (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)