Search

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. [ABSTRACT FROM AUTHOR]

Epistemic injustices within diagnostic practices in health care have increasingly been the object of research in recent years. However, most accounts focus on either under- or misdiagnosis resulting from epistemic injustices and have largely neglected the issue of overdiagnosis. This paper explicates what overdiagnosis entails in psychiatry and outline several structural problems within diagnostic practices that enable overdiagnosis. Afterwards, it is argued that overdiagnosis constitutes an instance of hermeneutical injustice. The overdiagnosed are wronged by being classified, perceived, and treated as sick by themselves, healthcare, and society due to problematic diagnostic practices within psychiatry, though their distress might be non-pathological, or they do not stand to benefit from medical treatment. Consequently, the overdiagnosed experience difficulties in being understood, making themselves understood, and understanding themselves, which leads to cognitive disablement and hermeneutical marginalization. Such epistemic injustices indicate the need for less diagnose-centric healthcare systems where help and recognition does not hinge on the ascription of labels. [ABSTRACT FROM AUTHOR]

The concept of epistemic injustice provides a theoretical framework for considering the ethical issues arising in interpersonal communication. This article proposes the concept of implicational injustice as a novel type of epistemic injustice. An implicature is a message that a speaker does not explicitly state, but that is implicitly communicated by an utterance. Since the speaker does not explicitly state the implicature, it may be overlooked by the hearer. This oversight of implicature is likely to occur when the hearer prematurely terminates the search for relevance or when there is informational inequality between speaker and hearer. If premature termination or information inequality is caused by the hearer’s prejudice against the speaker or by the undue ignorance of the speaker, the oversight of implicature is deemed an implicational injustice. This article offers several examples of the oversight of implicature and implicational injustice in doctor-patient communication in which patients’ attempts to convey psychosocial messages to their physicians are often overlooked. Implicational injustice can be considered as a novel subtype of epistemic injustice that differs from other subtypes, such as silencing, testimonial injustice, and interpretative injustice. Implicational injustice prevents the sufferer’s full participation in epistemic collaboration and can inflict secondary harm, such as negative effects on clinical decision making. [ABSTRACT FROM AUTHOR]

When diagnosing psychological disorders, doctors are expected to take the mental anguish of patients and offer fast and accurate explanations. The pressure that comes with this often leaves doctors in need of epistemic shortcuts for faster diagnoses. One such epistemic shortcut is to lean on statistical data when offering a diagnosis. When used justly, doctors consider a patient’s testimony, exhibited symptoms and statistical data relating to the general features of the patient such as age, weight and sex to determine if a patient has a given disorder or illness. Practices such as this have the capacity to yield good results at a quick pace, however, such practices may also be abused. With a focus on gender statistics and psychological diagnoses, I argue that systematic practices of epistemic injustice may occur when the statistical data becomes over-valued and the epistemic privilege of patients to be able to assert their own bodily and mental experiences is ignored. This places patients at risk of misdiagnosis, long-term damage and pain, or even death. It also produces patient mistrust both of themselves and of the medical community, which can carry further repercussions for public health. [ABSTRACT FROM AUTHOR]

In this article, we examine why academics and practitioners researching inequalities choose to collaborate and to what extent such collaborations have the potential to address knowledge inequalities in the research process. We maintain that the mere act of collaboration does not inherently lead to the tackling of knowledge inequalities and that the motivations for collaboration matter. We argue that although in single collaborations partners can create equitable relationships where the knowledge of both academic and practitioner partners are valued, transforming the dominant epistemological hierarchies within academia and policymaking will require time and structural change. We end by considering how such change will be difficult to achieve but is not impossible. [ABSTRACT FROM AUTHOR]

Abstract\nPoints of interestUsers of Augmentative and Alternative Communication (AAC) have been historically left out of research. Within knowledge production, we see a prioritisation of the spoken voice in a hierarchy that at worst excludes, and at best subjugates, mediated voices. This scoping review sought studies involving AAC users as research participants, to identify practical lessons that could help inform data collection strategies to address this gap. We identified several common logistical and ethical considerations, organising them into three ­overarching themes that require additional attention from researchers working with AAC users, specifically: timescales, communication partners, and personal agency. In documenting that AAC-friendly methods are missing from the literature, we relocate the problem of AAC users’ exclusion from qualitative research from the inability of individuals with complex communication needs to participate in research, to individual and institutional inability or unwillingness to design and fund data collection practices that suit the needs of AAC users.A search for English-language studies documenting the involvement of AAC users in qualitative research produced only 32 articles, highlighting the dearth of published research that includes this group.Common logistical concerns discussed by these scholars centre on the different timescales on which AAC users operate, highlighting the need for AAC-specific research designs and adaptive institutional structures to support them.Scholars also highlighted both the value and tension of involving communication partners, or proxies, in interviews with AAC users, identifying an epistemological dilemma that requires further attention.Ethical concerns about the impact of research design on the personal agency of AAC users were also common to many of the studies reviewed, indicating a need for dedicated focus on epistemic justice when working with AAC users.A search for English-language studies documenting the involvement of AAC users in qualitative research produced only 32 articles, highlighting the dearth of published research that includes this group.Common logistical concerns discussed by these scholars centre on the different timescales on which AAC users operate, highlighting the need for AAC-specific research designs and adaptive institutional structures to support them.Scholars also highlighted both the value and tension of involving communication partners, or proxies, in interviews with AAC users, identifying an epistemological dilemma that requires further attention.Ethical concerns about the impact of research design on the personal agency of AAC users were also common to many of the studies reviewed, indicating a need for dedicated focus on epistemic justice when working with AAC users. [ABSTRACT FROM AUTHOR]

AbstractThis article highlights a paradox. On the one hand, the Independent Living (IL) movement has achieved a resounding success through the widespread ratification of the United Nations Convention on the Rights of Persons with Disabilities (CRPD). Yet on the other hand, the mainstreaming of the CRPD has witnessed proliferating misappropriations of IL. This has forced IL activists to fight on two fronts, continuing the older fight for implementing IL policies, while also engaging in a newer fight against misinterpretations of IL. Two recent examples of this newer epistemic struggle are discussed, drawing on the work of the European Network on Independent Living – fighting against representations of continuing institutionalisation as ‘community inclusion’, and fighting against representations of home care as ‘personal assistance’. The analysis concludes with an appeal to power holders to take the knowledge of IL activists seriously to help realise IL, while enabling epistemic justice. [ABSTRACT FROM AUTHOR]

The article "Metacognition and epistemic injustice in schizophrenia" explores the relationship between first-person authority (FPA) and metacognition in the context of schizophrenia treatment. It discusses how integrating metacognition into therapy can address challenges faced by individuals with schizophrenia, such as impaired metacognitive abilities and social functioning. The article also highlights the importance of respecting FPA in therapy to avoid epistemic injustice while acknowledging the need for medical oversight to ensure effective treatment strategies. The research emphasizes the role of metacognitive therapies in reshaping schizophrenia treatment by balancing patient experiences with evidence-based guidance. [Extracted from the article]

Background: Being able to measure informed choice represents a mechanism for service evaluation to monitor whether informed choice is achieved in practice. Approaches to measuring informed choice to date have been based in the biomedical hegemony. Overlooked is the effect of epistemic positioning, that is, how people are positioned as credible knowers in relation to knowledge tested as being relevant for informed choice. Aims: To identify and describe studies that have measured informed choice in the context of prenatal screening and to describe epistemic positioning of pregnant people in these studies. Methods: Online databases to identify papers published from 2005 to 2021. The PRISMA-ScR checklist guided data collection, analysis and reporting. Secondary analysis that considered hermeneutics (e.g., knowledge that was tested, study design) and testimony (e.g., population descriptors) developed a priori. Findings: Twenty-nine studies explored the measurement of informed choice. None reported that pregnant people were involved in the design of the study. Two studies reported pregnant people had some involvement in the design of the measurement. Knowledge tested for informed choice included technical aspects of screening, conditions screened and mathematical concepts. Twenty-seven studies attributed informed choice to population descriptors (e.g., race/ethnicity, age, education). Population descriptors were reified as characteristics of epistemic credibility for informed choice obtained. For example, when compared to a high school qualification, a tertiary qualification was a statistically significant characteristic of informed choice. When compared by race, white people were found to be significantly more likely to make an informed choice. Additional demographic descriptors such as age, language spoken, faith and previous pregnancies were used to further explain differences for informed choice obtained. Explanations about underlying assumptions of population descriptors were infrequent. Conclusion: Using population descriptors in the biomedical hegemony as explanatory variables for informed choice can position (groups of) people as more, or less, epistemically credible. Such positioning could perpetuate epistemic injustices in practice leading to inequitable access to healthcare. To better uphold (pregnant) people as credible knowers population descriptors should instead be contextual (and contextualising) variables. For example, as indicators of social privilege. Further, making room for ways of knowing that go beyond the biomedical hegemony requires the development of epistemically just 'measures' through intentional, inclusive design. [ABSTRACT FROM AUTHOR]

The testimonies of victims of the sexual violence perpetrated by Argentine state terrorism still face obstacles to its acknowledgement. In this article I argue that, from an intersectional and contextualized feminist approach, it is possible to accommodate these denunciations and understand this violence as a specific, political and gender-based discipline. In this case, the treatment of gender as an analytical category and as performativity (Scott, Butler) enables us to see the subversion of normative mandates as activists yesterday and as witnesses of crimes against humanity today. By analyzing the epistemic injustice (Fricker, Medina) and reverse empiricism (Alcoff) affecting those who report sexual violence, particularly in the context of concentration camps, I present the multiple difficulties involved in the perception and attribution of credibility to the victims' stories. Finally, I suggest that these testimonies and memories deserve to be included in what Ciriza calls our situated feminist genealogies. [ABSTRACT FROM AUTHOR]

It is well-established that algorithms can be instruments of injustice. It is less frequently discussed, however, how current modes of AI deployment often make the very discovery of injustice difficult, if not impossible. In this article, we focus on the effects of algorithmic profiling on epistemic agency. We show how algorithmic profiling can give rise to epistemic injustice through the depletion of epistemic resources that are needed to interpret and evaluate certain experiences. By doing so, we not only demonstrate how the philosophical conceptual framework of epistemic injustice can help pinpoint potential, systematic harms from algorithmic profiling, but we also identify a novel source of hermeneutical injustice that to date has received little attention in the relevant literature, what we call epistemic fragmentation. As we detail in this paper, epistemic fragmentation is a structural characteristic of algorithmically-mediated environments that isolate individuals, making it more difficult to develop, uptake and apply new epistemic resources, thus making it more difficult to identify and conceptualise emerging harms in these environments. We thus trace the occurrence of hermeneutical injustice back to the fragmentation of the epistemic experiences of individuals, who are left more vulnerable by the inability to share, compare and learn from shared experiences. [ABSTRACT FROM AUTHOR]

The primary objective of this paper is to nuance our understanding of how a knowledge-centred injustice can manifest in planning. To do so, the paper draws upon the concept of "epistemic injustice" from the field of social epistemology. Epistemic injustice occurs when certain voices are unjustly discredited and/or systemically marginalised. Recognising and addressing epistemic injustice is crucial as it can generate unjust harms in planning decision-making, as well as perpetuate institutionalised prejudice. The paper seeks to enhance our understanding of "epistemic injustice" by presenting a framework for identifying: (1) the conditions to be met for it to manifest; (2) how meeting different conditions generates different degrees of harm; and (3) detailing how meeting certain conditions may help to perpetuate institutionalised prejudice. The paper references a case of planning conflict in an informal settlement in Iran to illustrate the workings of this framework. The benefits and limitations of the framework are discussed. Suggestions for further research are identified. This paper contributes to the field by providing a framework for refining our theoretical understanding of epistemic injustice in planning and offering a practical illustration of the framework's use in a context that is comparatively underrepresented in planning research. [ABSTRACT FROM AUTHOR]

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". [ABSTRACT FROM AUTHOR]

Epistemic injustices are wrongs done concerning a person's capacity as a knower. These actions are usually caused by prejudice and involve the distortion and neglect of certain marginalized groups' opinions and ways of knowing. A type of epistemic injustice is hermeneutical injustice, which occurs when a person cannot effectively communicate or understand their experience, since it is excluded in scholarship, journalism, and discourse within their community. Indigenous Peoples (IPs) are especially vulnerable to hermeneutical injustice because their way of life is unfamiliar or inaccessible to others. This leads to the exclusion of their ideas from public discourse, especially those important for human and societal development. This phenomenon is particularly evident in instances related to IP education. José Medina claims that there are cases of hermeneutical injustice which hinders the ability of people to share and make meaning, or simply, hermeneutical death. Ben Kotzee, on the other hand, identifies the specific educational dimension of epistemic injustice. Using both of these frameworks and citing the results of local studies on indigenous education as illustrative points, we attempt to show instances and scope of hermeneutical injustice in the education of IPs in the Philippines. [ABSTRACT FROM AUTHOR]

This article brings a philosophical perspective to bear on issues of research ethics governance as it is practiced and organized in Canada. Insofar as the processes and procedures that constitute research oversight are meant to ensure the ethical conduct of research, they are based on ideas or beliefs about what ethical research entails and about which processes will ensure the ethical conduct of research. These ideas and beliefs make up an epistemic infrastructure underlying Canada's system of research ethics governance, but, we argue, extensive efforts by community members to fill gaps in that system suggest that these ideas may be deficient. Our aim is to make these deficiencies explicit through critical analysis by briefly introducing the philosophical literature on epistemic injustice and ignorance, and by drawing on this literature and empirical evidence to examine how injustice and ignorance show up across three levels of research ethics governance: research ethics boards, regulations, and training. Following this critique, and drawing on insights from the same philosophical tradition, we highlight the work that communities across Canada have done to rewrite and rework how research ethics as a site of epistemic resistance is practiced. [ABSTRACT FROM AUTHOR]

Epistemic injustice is often thought of as a form of exclusion. In the same way in which there are different forms and degrees of exclusion, there are different forms and degrees of injustice. In this paper, I argue that a fundamental tool to struggle against their most robust cases is listening, i.e. having a disposition to be affected by other persons. The main idea is that listening has a collective dimension and depends on restructuring social relations. To support this, I briefly examine some of the most classic ways of conceiving hermeneutic injustice. Then I show its relation to different ways of exclusion, which leads me to propose the notion of architectural hermeneutic injustice. I show that struggling against it requires more than inclusion mechanisms and I suggest some other struggle paths, such as the promotion of a listening culture which involves the transformation of our social structures. [ABSTRACT FROM AUTHOR]

Many philosophers hold there are genuine cases of culpable ignorance. This paper argues that there are conditions that can render knowledge epistemically culpable too. First, we contrast culpable ignorance with morally culpable knowledge. Second, we examine the nature of epistemically culpable knowledge using a key example. We then highlight empirical support for the claim that there are real-world conditions that make epistemically culpable knowledge possible. Next, we survey three kinds of epistemic culpability fostered by culpable knowledge. Finally, we address the benefits objection and argue that it fails. [ABSTRACT FROM AUTHOR]

Coercion is still highly prevalent in contemporary psychiatry. Qualitative research indicates, however, that patients and psychiatric staff have different understandings of what they mean by ‘coercion’. Psychiatric staff primarily employ the concept as referring to instances of formal coercion regulated by law, such as involuntary hospital admission or treatment. Patients, on the other hand, use a broader concept, which also understands many instances of informal psychological pressure as coercive. We point out that the predominance of a narrow concept of coercion in psychiatry can have negative consequences for patients, and argue that this difference in how the concept ‘coercion’ is used is both grounded in epistemic oppression and reinforces such oppression. Epistemic oppression, as defined by Dotson, refers to the persistent epistemic exclusion of members of marginalized groups from participation in practices of knowledge production. We first demonstrate how patients may experience inferential inertia when communicating their experiences of coercion. We then show that the resulting predominance of a narrow concept of coercion in psychiatry can be described as a case of hermeneutical injustice in a context shaped by institutional hermeneutical ignorance. We argue for a change in institutional practices in psychiatry that allows for the adequate consideration of patients’ perspectives on coercion. [ABSTRACT FROM AUTHOR]

Breast cancer patients' experiences of epistemic injustice in healthcare is a well-established fact. However, the significant role that gender plays in deciding the nature of epistemic injustice encountered by male and female breast cancer patients is still underexplored. Through a comparative analysis of Alan F. Herbert's The Pink Unicorns of Male Breast Cancer (2016) and Nina Riggs' The Bright Hour: A Memoir of Living and Dying (2017), we explore how male and female breast cancer patients distinctly experience vitiated testimonial dynamics and hermeneutical marginalisation. Breast cancer patients can negotiate credibility deficit, identity crisis, and existential crisis caused by epistemic injustice through narrating. Taking from Fricker's epistemic injustice, later contextualised in formal healthcare by Kidd and Carel, this study considers both the male and the female points of view to identify subtle instances of injustice and ways to overcome it. This article also articulates the need to overcome the stigma of considering breast cancer 'a woman's disease' so that male breast cancer patients' testimonies are equally prioritised along with female breast cancer patients. This comparative study highlights the ignorance inside institutional healthcare by foregrounding insensitivity toward all breast cancer patients and especially a lack of awareness of male breast cancer. Therefore, reading and writing such memoirs might secure future epistemic justice to all breast cancer patients irrespective of their gender. [ABSTRACT FROM AUTHOR]

The notion of decolonizing the curriculum is currently gaining momentum in Higher Education Institutions (HEI) across the world and in the United Kingdom (UK). Fuelled by the movements #RhodesMustFall, 'Why is my curriculum White?', and critical incidents such as the killing of George Floyd and the #BlackLivesMatter protests, campaigners for decolonizing the curriculum have all questioned the omission of other perspectives from dominant Eurocentric White curricula at universities around the world, including social work education. This paper reports the findings of a qualitative study that involved 20 in-depth interviews with social work academics, social work students and practice educators (field instructors) in an English HEI social work department about their perspective on decolonizing the curriculum in social work education. The concepts of epistemic injustice and cultural humility were used to examine the data. Findings suggest that social work education is not immune to the centering of a Eurocentric curriculum and White middle-class values and needs to change to embrace other epistemology. The paper concludes by arguing that the concepts of epistemic injustices and cultural humility are especially relevant for understanding why and how social work curricula might be decolonized. [ABSTRACT FROM AUTHOR]

Long Covid (LC) has been called the greatest mass-disabling event in human history. For patients, LC not only has implications for quality of life but also for meaning in life: how one's life and the world are understood and what is seen as valuable in one's life. This qualitative empirical study used a Constructivist Grounded Theory approach to investigate the meaning in life of people struggling with LC through ten patient interviews. This study shows that patients lose their prior understanding of life and come to a changed meaning in life, in part due to the experienced (social) isolation and loss of (both physical and cognitive) abilities caused by LC. Moreover, patients struggled with acceptance, uncertainty, and the inherent incomprehensibility and uncontrollability that living with LC entails, though this simultaneously co-existed with hope, optimism and acceptance. Additionally, dimensions of meaning intersect; a patient having some understanding of their illness (dimension of meaning: comprehension) required an understanding Other (dimension of meaning: connection). Emerging from lockdown brought the challenge and isolation of adjusting to chronic illness in society as usual (albeit divided about COVID-19 measures). This study thus offers novel insights regarding changed, present, and sought meaning in life for LC patients. [ABSTRACT FROM AUTHOR]

If global higher education is truly committed to decolonization, there will have to be some radical changes. A decolonized university would increase the freedom of students and staff through undoing the legacy of the past, a past which was exclusive and homogenous. In order for this to materialize, universities must adopt a different consciousness. They must move away from the current culture that has privileged global north epistemic and pedagogical frameworks that serve to alienate the student from the global south. For universities to be able to undo the effects of the epistemic injustice that indigenous students have faced, the academy must approach education with a new mindfulness of whom it is that it is designed to serve. When we approach higher education with a consciousness of decolonization and a recognition of the identity of whom the education system is meant to serve, then management systems and epistemic and pedagogical frameworks in our universities cannot remain abstract in nature. Rather they must be fully cognizant of the students' backgrounds, their social needs, and their academic needs. These cannot be mere considerations but must be the information which directs what is taught and how it is taught, for a just education system is not and can never be decontextualized. As Afro-communitarianism prescribes, decontextualization disregards the necessity of, and integral relationships to, others and the world. Any just pedagogical system must acknowledge the legitimacy of, and draw from, contributions in culture, knowledge, and perspective that come from the students themselves—both as individuals and as insiders of a particular class, culture, and indigenous group. It is in this symbiotic relationship where both the student and the educator can begin to be humanized again. [ABSTRACT FROM AUTHOR]

This article examines biases in digital mental health and their impact on technical, social, and political systems. Rising health expenditures and the politics of public health have increased individuals' responsibility for managing their own health. Global e-health initiatives promise mental health metrics through digital technologies. However, obstacles such as neo-colonial workings of the global economy, embedded biases in technology, and exclusion of psychological therapeutic approaches hinder the digital shift in mental health. This article analyzes the ecosystem of digital mental health technologies, challenging assumptions about psychological normality and algorithmic bias. It explores issues in individualized digital healthcare, cultural biases in psychological assessments, and disciplinary biases in psychology and psychotherapy integrated into digital health tools. By exposing biases and power dynamics, the article emphasizes the need for ethical considerations and offers insights into the potentials and limitations of mental health technologies. [ABSTRACT FROM AUTHOR]

In this article, I explore the potential of reciprocal relations of recognition of epistemic agency to respond to calls to transform pedagogical practice in the South African academy and, in particular, to disrupt ongoing epistemic injustice in the academy. First, I put forward a picture of recognition as a practice underpinned by an attitude of playful self-discipline and spend some time elucidating what this attitude involves. Second, I turn to a description of epistemic agents as socially and historically situated knowers with normative status. Third, I bring these discussions together to speak about the practice of recognising our own and one another's epistemic agency. And, finally, I explore how intentionally engaging in this practice might serve to respond to calls to transform pedagogical practice and address epistemic injustice in the academy. [ABSTRACT FROM AUTHOR]

This article provides original insight into women's experiences of adulthood diagnoses of attention deficit hyperactivity disorder (ADHD) and autism. Research exploring experiences of adulthood diagnoses of these conditions is emerging. Yet, there is no research about the gendered experiences of an adulthood combined ADHD and autism (AuDHD) diagnosis. This article addresses this gap through interpretative phenomenological analysis of email interviews with six late-diagnosed AuDHD women revealing the complex interplay between late diagnosis, being a woman, and combined diagnoses of ADHD and autism. It underscores how gender norms and stereotypes contribute to the oversight and dismissal of women's neurodivergence. Interpretative phenomenological analysis reveals the inextricability of femininity and neurotypicality, the gendered burden, discomfort, and adverse consequences of masking, along with the adverse outcomes of insufficient masking. Being an undiagnosed AuDHD woman is a confusing and traumatising experience with profound and enduring repercussions. The impact of female hormones exacerbated participants' struggles with (peri)menopause often being a catalyst for seeking diagnosis after decades of trauma. The epistemic injustice of not knowing they were neurodivergent compounded this trauma. Diagnosis enabled participants to overcome epistemic injustice and moved them into a feminist standpoint from which they challenge gendered inequalities relating to neurodiversity. This article aims to increase understanding and representation of late-diagnosed AuDHD women's lived experiences. The findings advocate for trauma-informed pre- and post-diagnosis support which addresses the gendered dimension of women's experiences of being missed and dismissed as neurodivergent. There needs to be better clinical and public understanding of how AuDHD presents in women to prevent epistemic injustice. [ABSTRACT FROM AUTHOR]

Deepfakes and other forms of synthetic media are widely regarded as serious threats to our knowledge of the world. Various technological responses to these threats have been proposed. The reactive approach proposes to use artificial intelligence to identify synthetic media. The proactive approach proposes to use blockchain and related technologies to create immutable records of verified media content. I argue that both approaches, but especially the reactive approach, are vulnerable to a problem analogous to the ancient problem of the criterion—a line of argument with skeptical implications. I argue that, while the proactive approach is relatively resistant to this objection, it faces its own serious challenges. In short, the proactive approach would place a heavy burden on users to verify their own content, a burden that is exacerbated by and is likely to exacerbate existing inequalities. [ABSTRACT FROM AUTHOR]

Epistemic trust—trust in the relevance and utility of social learning—is central to helping processes between clients and workers in helping services. Yet, due to their experiences, clients may adaptively develop predispositions toward stances of epistemic mistrust or epistemic credulity. From an AMBIT (adaptive mentalization-based integrative treatment) perspective, this article argues that epistemic mistrust and credulity are both caused by social injustice and generate further social injustice. Helping services commonly respond in ways that fail to acknowledge this social injustice and, perversely, deliver further injustice still. Our primary focus is how these issues relate to work with clients, but we argue that they are present in work within AMBIT's other foci, too: in teams, multiagency networks, and learning. We conclude that workers and helping services have a moral duty to recognize and attend to the multiple social injustices associated with epistemic mistrust and credulity. [ABSTRACT FROM AUTHOR]

Copyright of Tijdschrift voor Geschiedenis is the property of Amsterdam University Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: The non-availability of indoor piped water and electricity results in alternate forms of personal care and domestic tasks in resource-constrained rural settings. This article examines the applicability of existing measures for the contextual assessment of basic and instrumental Activities of Daily Living (bADLs and iADLs) in these settings. Method: An integrative review guided by the approach of Lübbe et al. (2020) was conducted. Structured database searches of CIN AHL, Scopus and Sabinet identified published articles which were subjected to eligibility criteria. Microsoft Excel was used to synthesize data. Results: The search strategy yielded 591 articles that met the inclusion criteria, from which 187 ADL instruments were identified. Three instruments suited to resource-constrained rural settings were identified. Conclusion: Occupational therapists should consider that existing ADL frameworks and instruments appear silent on the impact of limited access to household amenities in resource-constrained settings. This constitutes epistemic injustice as many rural households globally do not have potable water or adequate household energy supply. Global South occupational therapy curricula must include contextually relevant ADL frameworks and development of contextually relevant instruments should be [ABSTRACT FROM AUTHOR]

The use of memes has become increasingly widespread in political discourse. However, there is a dearth of philosophical discussion on memes and their impact on political discourse. This paper addresses this gap in the literature and bridges the divide between the empirical and philosophical work on memes by offering a functionalist account which allows for a more in-depth analysis of the role memes play in political discourse. We offer a taxonomy of the eight key characteristics of memes: 1. humor; 2. fostering in-group identity; 3. caricatures; 4. replicability; 5. context collapse; 6. hermeneutical resources; 7. low reputational cost; 8. signaling. On the positive side, the propensity memes have to foster in-group identity and to function as a hermeneutical tool for people to make sense of their own experiences are a boon especially to marginalized communities. On the flipside, the creation of an in-group/out-group dynamic can also be exploited by sinister political actors, especially since the low reputational cost of circulating memes allows for plausible deniability. We use the analysis in this paper to jumpstart a discussion of how we should understand memes and debate which norms should govern the novel speech act of posting a meme given its impact on political discourse. Based on our findings, we end with a call to adopt stricter norms for the act of posting a meme. [ABSTRACT FROM AUTHOR]

In recent years, we have witnessed increased interest in alternatives to the dominant corporate social media sites, such as Facebook, Twitter (now X), and TikTok. Tired of disinformation, harassment, privacy violations, and the general degradation of platforms, users and technologists have looked for non-corporate alternatives. Not-for-profit social media platforms emerging from free/libre and open-source software (FLOSS) communities based on non-centralized infrastructure have emerged as promising alternatives. For applied epistemology of the internet, these alternative social media platforms present an opportunity to study different ways of producing knowledge together online. This paper evaluates the epistemic potential for such alternative, non-corporate social media. I present an epistemological framework for analyzing the epistemic promises and perils of alternative social media. Then I apply this framework to the case of Mastodon, a federated, open-source microblogging platform. Mastodon's structure and culture of openness present opportunities to avoid many of the epistemic perils of biased and untrustworthy large corporate platforms. However, Mastodon's risks include techno-elitism, white ignorance, and isolated, epistemically toxic communities. [ABSTRACT FROM AUTHOR]

In typical instances of epistemic injustice, the victims and perpetrators are distinct across social groups – as marginally or dominantly situated. When epistemic injustice happens, the dominantly situated typically rely on prejudicial stereotypes to prevent the marginally situated from participating in epistemic activities. This is a manifestation/ exercise of their social power. However, with anonymity on the internet, a marginally situated person can effectively pose as a dominantly situated person and vice versa. When this happens, we cannot always tell who is behind a post. Consequently, relying on differential power relations, as in typical cases of epistemic injustice, might be ineffective online. In this paper, I argue for three ways that anonymity might complicate instances of epistemic injustice online. [ABSTRACT FROM AUTHOR]

This paper identifies and analyses a novel species of hermeneutical epistemic injustice (HI). Fricker's traditional account analyses HI in terms of a collective conceptual gap. (Epistemic injustice: power and the ethics of knowing, Oxford University Press, Oxford, 2007). Building on this, Simion's analysis (in: Bondy P, Carter JA (eds) Well-founded belief: new essays on the epistemic basing relation. Routledge, New York, 2019) suggests the phenomenon is broader, and thus more ubiquitous: specifically, that agents who have been hermeneutically marginalised can be susceptible to HI through failing to ground their social experience in conceptual resources that are already available. This paper advances the literature further and presents a novel strand of the phenomena, where agents both have, and base, their experience on available concepts but are still subject to HI. I argue that this is an important species of HI that should be investigated and accounted for, and I suggest that in virtue of being hermeneutically marginalised, often agents only have available to them defective or oppressive concepts. I further provide a case study of what this can look like online and new concerns social media presents for this kind of HI. CW: Mentions of transphobia, racism, sexism, rape. [ABSTRACT FROM AUTHOR]

This article examines the phenomenon of epistemic injustice within the global social media landscape, using Southeast Asia as a case study. It explores how X (formerly known as Twitter) holds the potential to cultivate a digital public sphere that embodies justice and equitable dialogue, compared with major platforms like Facebook, Instagram, and TikTok. Beginning with an introduction to epistemic injustice, the article contextualizes its significance in Southeast Asia, highlighting the region's digital challenges and opportunities. It then proposes characteristics necessary for ideal social media platforms, drawing on Habermas's public sphere and Rawls's justice principles to advocate for spaces that promote inclusive and rational discourse. The core analysis centers on X, suggesting that its features could make it a superior choice for fostering a just digital environment globally. The article recommends specific improvements for X to evolve into an ideal social platform, addressing challenges such as cyberbullying, echo chambers, and misinformation. The conclusion emphasizes the importance of prioritizing epistemic justice in social media platforms to achieve a more inclusive and fairer digital public sphere, with Southeast Asia serving as a representative example of a less-than-ideal environment where such platforms could thrive. [ABSTRACT FROM AUTHOR]

What exactly is gaslighting and how does it play out in the gendered context of women's entrepreneurship? We contribute to Stern's three-stage model of gaslighting by presenting a contextualised perspective through a 'twisted path' of gaslighting that maps out gaslighting interactions and consequences, reflecting how our findings coincide with, depart from and enrich this model; meanwhile identifying primary and subsequent (secondary and tertiary) gaslighting interactions. By examining gaslighting through the lens of epistemic injustice and testimonial injustice, we explain why some women entrepreneurs succumb to gaslighting, while others strategically employ testimonial smothering and infrapolitics as an empowered agential strategy rather than a disenfranchised consequence. Considering the lack of research on gaslighting in entrepreneurship, our geopolitical context emphasises the role of spatial position and identity within multiple systems of injustice, such as occupation and patriarchy, adding novel insights theorised and grounded in lived experiences. In doing so, we disrupt the influence of western feminism by embracing a postcolonial feminist perspective and promoting social justice through centring the voices of 40 internally displaced Palestinian women entrepreneurs. Policy implications underscore the need to raise awareness of gaslighting, facilitate its identification and promote preventive measures to hold gaslighters accountable. [ABSTRACT FROM AUTHOR]

Being dismissed or disparaged by medical professionals can be shocking and demoralizing for patients, leading to unnecessary harms (e.g., avoidance of medical treatment; depression; shame). This difficulty is further compounded when patients are also the target of wide-ranging stigmatization due to the nature of the medical and behavioral diagnoses they carry, and/or the social identities attributed to them by medical providers. Incorporating both clinical psychology and medical ethics perspectives, two clinical cases are presented demonstrating the insidious nature of the harms incurred to patients from traumatic medical experiences like those described above. Both cases are shown to illustrate the role that a particular form of gaslighting– medical gaslighting– plays in creating the conditions that result in a form of medical trauma. The term "medical gaslighting" currently lacks a clear and stable definition in the larger literature; the authors develop and establish a definition here. The case of Alex is offered, illustrating a standard form of medical trauma recognized in the literature, and the significance of epistemic injustice in preparing the grounds for medical gaslighting. Next, the case of Kiara is considered, in order to demonstrate how medical gaslighting becomes the vehicle for a more subtle form of medical trauma, not currently captured in standard diagnostic criteria. The claims presented here are testable, and the authors suggest that further work expanding the conceptual reach of medical trauma, and incorporating the concept of medical gaslighting into standard practice, is warranted. [ABSTRACT FROM AUTHOR]

In this paper I identify a distinct form of epistemic injustice and oppression which I call 'hermeneutical sabotage'. Hermeneutical sabotage occurs when dominantly situated knowers actively maintain or worsen the dominant hermeneutical resources for understanding the experiences or identities of marginalised groups. They do this through actively distorting the resistant hermeneutical resources developed by marginalised groups, and by introducing new, prejudiced hermeneutical resources. I develop a taxonomy of four forms hermeneutical sabotage can take, giving an example of each, and explain the difference between 'hermeneutical sabotage' and other types of epistemic injustice. I demonstrate the importance of having the concept of hermeneutical sabotage for recognising how it can be used, intentionally or unintentionally, to further the aims of harmful political movements. I give examples of hermeneutical sabotage which furthers the aims of transphobic, racist, and anti-immigrant political movements. [ABSTRACT FROM AUTHOR]

Abstract There has been a rising call to decolonize global health so that it more fully includes the concerns, knowledge, and research from people all over the world. This endeavor can only succeed, we argue, if we also recognize that much of established global health doctrine is rooted in Euro-American beliefs, values, and practice rather than being culturally neutral. This paper examines the cultural biases of child feeding recommendations as a case in point. We argue that the global promotion of Responsive Feeding—a set of allegedly best practices for child feeding promulgated by the WHO and others—is based on a tacit conviction that certain Western middle-class feeding practices are universally best, along with a promise that future evidence will demonstrate their superiority. These recommendations denounce feeding practices that diverge from this style as Non-Responsive Feeding, thereby pathologizing the many valued ways of feeding children in communities all over the world without sound scientific evidence. Drawing on ethnographic research, we show that there is a wide variety in feeding practices around the world and these are closely interlinked with the understandings and priorities of caregivers, as well as with favored forms of relationships and ways of maintaining them. For global health nutrition interventions to be justified and effective, they would need to be based on more pertinent, culturally responsive research than they currently are. We suggest the use of ethnographic research as an important tool in building empirically grounded, epistemically inclusive, and locally meaningful approaches to improving nutritional support for children in communities around the world and to global health efforts more broadly.

Abstract Background Being able to measure informed choice represents a mechanism for service evaluation to monitor whether informed choice is achieved in practice. Approaches to measuring informed choice to date have been based in the biomedical hegemony. Overlooked is the effect of epistemic positioning, that is, how people are positioned as credible knowers in relation to knowledge tested as being relevant for informed choice. Aims To identify and describe studies that have measured informed choice in the context of prenatal screening and to describe epistemic positioning of pregnant people in these studies. Methods Online databases to identify papers published from 2005 to 2021. The PRISMA-ScR checklist guided data collection, analysis and reporting. Secondary analysis that considered hermeneutics (e.g., knowledge that was tested, study design) and testimony (e.g., population descriptors) developed a priori. Findings Twenty-nine studies explored the measurement of informed choice. None reported that pregnant people were involved in the design of the study. Two studies reported pregnant people had some involvement in the design of the measurement. Knowledge tested for informed choice included technical aspects of screening, conditions screened and mathematical concepts. Twenty-seven studies attributed informed choice to population descriptors (e.g., race/ethnicity, age, education). Population descriptors were reified as characteristics of epistemic credibility for informed choice obtained. For example, when compared to a high school qualification, a tertiary qualification was a statistically significant characteristic of informed choice. When compared by race, white people were found to be significantly more likely to make an informed choice. Additional demographic descriptors such as age, language spoken, faith and previous pregnancies were used to further explain differences for informed choice obtained. Explanations about underlying assumptions of population descriptors were infrequent. Conclusion Using population descriptors in the biomedical hegemony as explanatory variables for informed choice can position (groups of) people as more, or less, epistemically credible. Such positioning could perpetuate epistemic injustices in practice leading to inequitable access to healthcare. To better uphold (pregnant) people as credible knowers population descriptors should instead be contextual (and contextualising) variables. For example, as indicators of social privilege. Further, making room for ways of knowing that go beyond the biomedical hegemony requires the development of epistemically just ‘measures’ through intentional, inclusive design.

The subject of the article is the analysis of the moral dimension of moral panic. The current research on moral panic is led by two approaches, processual and attributional. However, the moral dimension of moral panic is addressed in both only marginally. We intend to show that analyzing this concept in isolation from its moral dimension gives an incorrect impression that its cognitive and normative aspects may be treated as separate. We believe that the concept of moral panic when abstracted from the language of valuation, loses its theoretical potential. When analyzed across the full spectrum of its actual contexts and from the perspective of moral vocabulary, moral panic retains its theoretical relevance. Since each new form of political hegemony, violence, and other oppressive actions against the subaltern groups often resort to instigating moral panic, the concept can be usefully applied to their analysis and critique.

In his discussion of “marginalized bodies,” Leder maintains that members of oppressed social groups encounter not just discriminatory treatment and limited access to societal resources, but also “embodied injustice”. Such injustice occurs when an “inferior group” is not only identified with the body as such, but also labeled as “having the wrong kind of body”. This devaluation of certain kinds of bodies results in an alteration of people’s embodied ways of feeling, perceiving, and acting in the world. Both in injury or illness and in cases of embodied injustice, there is often (a) a constriction of lived space, (b) a disruption of lived time, and (c) isolation. To illustrate how these distressing disruptions to the body-world relation are caused largely by social factors, Leder turns to incarcerated persons (Chap. 6) and elders (Chap. 7) as case studies. Building upon this discussion, I argue that depression is both an illness that involves the sorts of alterations to the body schema that Leder outlines, and also the result of various socially caused harms. Just as the restrictions imposed by illness and incarceration can become mutually reinforcing, so, too, can the restrictions imposed by depression and the social stigmatization that often accompanies it. This has some important implications for healing and treatment.

Abstract Background Multidrug-resistant tuberculosis (MDR/RR-TB) is a major global health challenge, disproportionately affecting low- and lower-middle-income countries (LLMICs). The World Health Organization (WHO) generates guidance to address the problem. Here, we explore the extent to which guidance and related knowledge are generated by experts living in the most-affected countries and consider the results in the context of the movement to decolonize global health. Methods We examined the composition of World Health Organization (WHO) MDR/RR-TB treatment Guideline Development Groups (GDGs) from 2016 to 2022. We classified GDG members according to the MDR/RR-TB burden and World Bank income level of the country of their institutional affiliation. We also searched PubMed to identify peer-reviewed publications from 2016 to 2023 which emanated from individual-patient-data meta-analysis like those done for Guideline review, and classified the publication authors according to the same indicators. Results There were 33 high-burden MDR/RR-TB countries during the time period. Of these, 72.1% were LLMICs and none was high-income. In contrast, only 30.3% of WHO GDG members and 10.4% of peer-reviewed publication authors were from LLMICs. Representatives from high-MDR/RR-TB-burden countries comprised 34.3% of WHO GDG members and 14.7% of authors of guideline-related publications. Conclusions The important imbalance between the geographical distribution of lived experience with MDR/RR-TB and the distribution of individuals generating knowledge and guidance on treatment of MDR/RR-TB can have clinical and resource implications. Countries may reject or defer guideline adoption because of a mismatch between that guidance and local disease epidemiology. Funding conditioned on compliance with guidelines can exacerbate health inequalities. The movement to decolonize global health considers representation disparities as epistemic injustice, that is unfair treatment in the process of generating, sharing, or receiving knowledge. Reform is possible in many of the institutions involved in generation of global health knowledge, such as: meaningful participation of LLMICs in projects as a requirement for research funding, improved attention to the epistemic and geographical location of journal editorial staff, and broader inclusion in guidelines committees. Better alignment of participation in knowledge generation with burden of disease holds potential for reducing inequality and improving relevance of guidance for the lived experience with MDR/RR-TB.

Borderline personality disorder (BPD) has been a controversial diagnosis for over 40 years. It was to be removed from the latest version of the ICD, only to be reintroduced as a trait qualifier as a result of last-minute lobbying. Retaining BPD as a de facto diagnosis keeps us stuck at a deadlock that undermines the voices of patients who have persistently told us this label adds ‘insult to injury’. Miranda Fricker's concept of epistemic injustice helps illuminate how this affects subjectivity and speech, hermeneutically sealing patients in ways of thinking that are not evidence-based, resulting in testimonial smothering (altering or withholding one's narratives) and testimonial quieting (dismissing a speaker's capacity to provide worthy testimony) that prevent more affirmative explanations.

Although there is now a substantial body of literature exploring the effects of language diversity in international management contexts, little attention has been paid to the ethical dimensions of language diversity at work. This conceptual paper draws on the concept of epistemic injustice in order to explore how language, and in particular corporate language policies, may act as a source of epistemic injustice within the workplace. It demonstrates how language competence affects credibility judgements about a speaker, and also considers how corporate language policies can create situations of hermeneutic injustice, in which marginalised groups are denied the vocabularies to understand their own experiences. Finally, ways in which such epistemic harms can be reduced are discussed, and the possibilities for management education to create epistemically responsible managers are highlighted. [ABSTRACT FROM AUTHOR]