Contributory injustice in psychiatry

Abstract

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

Recovery Mentors as continuing professional development trainers for better recognition of the epistemic value of the experiential knowledge and improved access to recovery-oriented practices

“…Indeed, as suggested by Miller Tate (2019) the term “contributory injustice” marks out a typical feature of the epistemic inequity where the marginalized are unable to contribute equally to the collective understanding of their experiences because their contributions are systematically dismissed [48]. This closely relates to Fricker's concept of hermeneutical injustice, but while hermeneutical injustice refers to cases where both the marginalized and dominant groups share a lack of epistemic resources needed to express or understand the former's experiences, contributory injustice picks out cases where relevant resources have been developed and used by the marginalized group, but not taken up by the dominant group [49].…”

The value of doing philosophy in mental health contexts

“…We recognise that the factors which account for epistemic injustice in mental health are deeply entrenched, and many strategies are required to restore justice (Crichton et al 2017 ; Sanati and Kyratsous 2015 ; Wardrope 2015 ; Kurs and Grinshpoon 2018 ; Miller Tate 2018 ). As such, we propose that philosophy groups constitute a modest, but potentially significant, strategy for change to use in conjunction with existing strategies.…”

“…There is also hermeneutic injustice, in which marginalised groups have fewer resources for understanding aspects of their social experiences in comparison to groups with greater social and cultural power. Multiple authors have investigated how people in mental distress are at risk of epistemic injustice in both medical and social encounters (Carel and Kidd 2014 ; Sanati and Kyratsous 2015 ; Wardrope 2015 ; Crichton et al 2017 ; Kurs and Grinshpoon 2018 ; Miller Tate 2018 ). Richard Lakeman ( 2010 ), a mental health professional, gives an account of personal experience of epistemic injustice, in which he noticed a marked difference in how his testimony was received by colleagues during a period of mental distress as compared to before that period.…”

Perspective: Decolonizing postmodernist approaches to mental health discourse toward promoting epistemic justice

“…One of the consequences of this split has manifested in mainstream psychiatry's broad dismissal of, or its self-preservation facing, the otherwise lively and impactful discussion surrounding post-modernity (2,3). However, the widening preoccupation with epistemic in/justice in psychiatry and psychiatric epidemiology journals [e.g., (4)(5)(6)(7)], signified also in the initiative to dedicate a distinct Research Topic thereto in Frontiers, marks an opportunity for identifying some of its notional origins and engaging in contemplation on the nuances of incorporating them into mental health discourse and practice.…”