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)

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)

In this paper we propose that our understanding of pathocentric epistemic injustices can be enriched if they are theorised in terms of predicaments. These are the wider socially scaffolded structures of epistemic challenges, dangers, needs, and threats experienced by ill persons due to their particular emplacement within material, social, and epistemic structures. In previous work we have described certain aspects of these predicaments - pathocentric epistemic injustices, pathophobia, and so on. We argue that thinking predicamentally helps us integrate the various (...) social, epistemic, and practical obstacles experienced by ill persons and also unify the many concepts available for theorising them (microaggessions, epistemic injustices, and so on). (shrink)

In August 2021, Froese et al. published survey data collected from 2,543 respondents on their subjective experiences living under imposed social distancing measures during COVID-19 (1). The questionnaire was issued to respondents in the UK, Japan, and Mexico. By combining the authors’ expertise in phenomenological philosophy, phenomenological psychopathology, and enactive cognitive science, the questions were carefully phrased to prompt reports that would be useful to phenomenological investigation and theorizing (2–4). These questions reflected the various author’s research interests (e.g., technology, grief, (...) time). Between April 7th and July 31st, 2021, a second questionnaire with the same question set was issued to respondents of the original who had agreed to do a follow-up. This was intended to capture subjective reports of life under social distancing measures a year after the initial survey. By this time–depending on their country of residence and health status–respondents had potentially lived with repeated and prolonged lockdowns and a variety of other restrictions on their social lives. When taken together, Survey I and Survey II provide a cross-cultural and longitudinal dataset that allows for analysis of longer-term impacts of imposed social distancing measures on people’s experiences. For researchers working in diverse disciplines, this dataset offers a rich resource that reflects people’s reactions to the imposition of different social restrictions in different countries and over different time periods. (shrink)

Ill persons suffer from a variety of epistemically-inflected harms and wrongs. Many of these are interpretable as specific forms of what we dub pathocentric epistemic injustices, these being ones that target and track ill persons. We sketch the general forms of pathocentric testimonial and hermeneutical injustice, each of which are pervasive within the experiences of ill persons during their encounters in healthcare contexts and the social world. What’s epistemically unjust might not be only agents, communities and institutions, but the theoretical (...) conceptions of health that structure our responses to illness. Thus, we suggest that although such pathocentric epistemic injustices have a variety of interpersonal and structural causes, they are also sustained by a deeper naturalistic conception of the nature of illness. (shrink)

In this paper, we argue that certain theoretical conceptions of health, particularly those described as ‘biomedical’ or ‘naturalistic’, are viciously epistemically unjust. Drawing on some recent work in vice epistemology, we identity three ways that abstract objects (such as theoretical conceptions, doctrines, or stances) can be legitimately described as epistemically vicious. If this is right, then robust reform of individuals, social systems, and institutions would not be enough to secure epistemic justice: we must reform the deeper conceptions of health that (...) underlie them. (shrink)

In this chapter we suggest that many experiences of suffering can be further illuminated as forms of transformative experience, using the term coined by L.A. Paul. Such suffering experiences arise from the vulnerability, dependence, and affliction intrinsic to the human condition. Such features can create a variety of positively, negatively, and ambivalently valanced forms of epistemically and personally transformative experiences, as we detail here. We argue that the productive element of suffering experiences can be articulated as transformative, although suffering experiences (...) are not the type mostly discussed in the transformative experience literature. We correct for this here by developing a taxonomy of negatively valenced transformative experiences. We suggest three features that make such experiences ones of suffering, following Michael Brady’s definition: intensity, novelty, and attentional focus. Finally, we suggest that one possible explanation for the edifying capacity of suffering comes from it requiring more transformation than positive experiences. (shrink)

This paper offers an overview of the philosophical work on epistemic injustices as it relates to psychiatry. After describing the development of epistemic injustice studies, we survey the existing literature on its application to psychiatry. We describe how the concept of epistemic injustice has been taken up into a range of debates in philosophy of psychiatry, including the nature of psychiatric conditions, psychiatric practices and research, and ameliorative projects. The final section of the paper indicates future directions for philosophical research (...) of epistemic injustices and psychiatry, concerning neurocognitive disorders, identity prejudices in psychiatric illness, concepts of epistemic privilege in psychiatry, and the prospects for combining phenomenological psychopathology and epistemic justice. We argue that much remains to be done in the conceptualization of these epistemic injustices and suggest that this future work should be multidisciplinary in character and sensitive to the phenomenology of psychiatric conditions. (shrink)

Carel Fabritius left behind few but important works of art. We are concerned here with the View in Delft, and attempt to make two points about it. The first is that this small painting manages to break away from the classical perception of perspective, an endeavor informed mostly by new findings in the field of optics of the time. The second point, theoretically related to the first, stresses compositional elements that would bring View in Delft closer to a meditation (...) on the fleetingness of life, making it a "town-scape" vanitas. (shrink)

An essay review of Havi Carel, 'Phenomenology of Illness' (OUP 2015).

What is it like to be a bat? What is it like to be sick? These two questions are much closer to one another than has hitherto been acknowledged. Indeed, both raise a number of related, albeit very complex, philosophical problems. In recent years, the phenomenology of health and disease has become a major topic in bioethics and the philosophy of medicine, owing much to the work of Havi Carel (2007, 2011, 2018). Surprisingly little attention, however, has been given (...) to the phenomenology of animal health and suffering. This omission shall be remedied here, laying the groundwork for the phenomenological evaluation of animal health and suffering. (shrink)

We introduce two concepts—social certainty and social doubt—that help to articulate a variety of experiences of the social world, such as shyness, self-consciousness, culture shock, and anxiety. Following Carel's (2013) analysis of bodily doubt, which explores how a person's tacit confidence in the workings of their body can be disrupted and undermined in illness, we consider how an individual's faith in themselves as a social agent, too, can be compromised or lost, thus altering their experience of what is afforded (...) by the social environment. We highlight how a loss of bodily or social certainty can be shaped and sustained by the environments in which one finds oneself. As such, we show how certain individuals might be more vulnerable to experiences of bodily and social doubt than others. (shrink)

This article aims to provide a response to the problem of suffering through an explication of a new theodicy termed the Exemplarist Theodicy. This specific theodicy will be formulated in light of the moral theory provided by Linda Zagzebski, termed the Exemplarist Moral Theory, the notion of transformative experience, as explicated by L.A. Paul, Havi Carel and Ian James Kidd, and the virtue-theoretic approach to suffering proposed by Michael Brady, which, in combination with some further precisifying philosophical concepts—namely, compensation, (...) total empathy, and infinitely valuable connections—will provide us with a possible, morally sufficient reason for why God allows individuals to experience suffering. (shrink)

Within the last decade, epistemic injustice has been a valuable framework for those working on exposing oppressive practices within the healthcare system. As this work has evolved, new terminology has been added to the epistemic injustice literature to bring to light previously obscured epistemic harms in healthcare practices. This paper aims to explore an important concept that has not received the attention it deserves: epistemic isolation. By developing Ian Kidd and Havi Carel’s concept of epistemic isolation, a new range (...) of epistemic harms are brought to the fore, as some of the most marginalised in our society are forced to operate from positions of ignorance. In the words of Kidd and Carel, epistemic isolation occurs in ‘situations where a person or group lacks the knowledge of, or means of access to, particular information; for instance, if they live within a politically repressive society which forbids access to the necessary sources of information in order to protect the government’s hegemony’ (183–184). This paper will demonstrate that such epistemic isolation is uniquely devastating for those with psychiatric illness, exacerbating their already challenging circumstances. (shrink)

In this paper, I consider practical strategies for resolving the epistemic injustice that ill persons face when seeking medical treatment. My arguments will expand upon those initially made by Havi Carel and Ian James Kidd in “Epistemic Injustice in Healthcare: A Philosophical Analysis.” My approach to this problem is twofold. First, I will demonstrate how the phenomenological toolkit, as it currently stands, emphasizes the patient’s experience and leaves the doctor’s experience unadjusted. After this, I will explain how the toolkit (...) can be improved to include the doctor’s perspective. (shrink)

I introduce the concept pathophobia, to capture the range of morally objectionable forms of treatment to which somatically ill persons are subjected. After distinguishing this concept from sanism and ableism, I argue that the moral wrongs of pathophobia are best analysed using a framework of vice ethics. To that end I describe five clusters of pathophobic vices and failings, illustrating each with examples from three influential illness narratives.