Exclusion of the Psychopathologized and Hermeneutical Ignorance Threaten Objectivity

Abstract

This article brings together considerations from philosophical work on standpoint epistemology, feminist philosophy of science, and epistemic injustice to examine a particular problem facing contemporary psychiatry: the conflict between the conceptual resources of psychiatric medicine and alternative conceptualizations like those of the neurodiversity movement and psychiatric abolitionism. I argue that resistance to fully considering such alternative conceptualizations in processes such as the revision of the Diagnostic and Statistical Manual of Mental Disorders emerges in part from a particular form of epistemic injustice (hermeneutical ignorance) leveled against a particular social group (which I call the "psychopathologized"). Further, insofar as the objectivity which psychiatry should aspire to is a kind of "social objectivity" which requires incorporation of various normative perspectives, this particular form of epistemic injustice threatens to undermine its scientific objectivity. Although many questions regarding implementation remain, this implies that psychiatry must grapple substantively with radical reconceptualizations of its domain if it is to achieve legitimate scientific objectivity.

The Institutional Definition of Psychiatric Condition and the Role of Well-Being in Psychiatry

“…I do not think the understanding of collective well-being that ought to guide psychiatry can be reached purely from the philosophical armchair, but rather must emerge from a process of productive dialogue among those who will be impacted by it. I suggest that such a process be carried out for psychiatry using the framework of “social objectivity,” which has been suggested both as a way to effectively deal with the role that values inevitably play in psychiatry (Gagné-Julien 2021a, 2021b; Knox 2022), as well as a way for scientific investigation of well-being to be objective (Alexandrova 2017, 2018).…”

Epistemic justice is an essential component of good psychiatric care

“…This is especially so when we consider that the implications of hermeneutical justice are far more radical for psychiatric practice than testimonial justice, and these implications have recently been productively theorized and debated in the philosophy of psychiatry community (e.g. Aftab, 2022;Knox, 2022;Ritunnano, 2022). Kious et al show a remarkable discrepancy between how they approach matters of epistemic justice when it comes to psychiatric patients v. how they approach instances of epistemic injustice centered around gender or race.…”

“…This is especially so when we consider that the implications of hermeneutical justice are far more radical for psychiatric practice than testimonial justice, and these implications have recently been productively theorized and debated in the philosophy of psychiatry community (e.g. Aftab, 2022; Knox, 2022; Ritunnano, 2022).…”