The clinical encounter begins with presentation of an illness experience; but throughout that encounter, something else is constructed from it – a symptom. The symptom is a particular interpretation of that experience, useful for certain purposes in particular contexts. The hermeneutics of medicine – the study of the interpretation of human experience in medical terms – has largely taken the process of symptom-construction to be transparent, focussing instead on how constellations of symptoms are interpreted as representative of particular conditions. This (...) paper examines the hermeneutical activity of symptom-construction more closely. I propose a fourfold account of the clinical function of symptoms: as theoretical entities; as tools for communication; as guides to palliative intervention; and as candidates for medical explanation or intervention. I also highlight roles they might play in illness experience. I use this framework to discuss four potential failures of symptom-interpretation: failure of symptom-type and symptom-token recognition; loss of the complete picture of illness experience through overwhelming emphasis on its symptomatic interpretation; and intersubjective feedback effects of symptom description altering the ill person’s own perceptions of their phenomenal experience. I conclude with some suggestions of potential remedies for failures in the process of symptom-construction. (shrink)

Augmentative and Alternative Communication Technology [AAC Tech] is a relatively young, multidisciplinary field aimed at developing technologies for people who are unable to use their natural speaking voice due to congenital or acquired disability. In this paper, we take a look at the role of AAC Tech in promoting an ‘empathic turn’ in the perception of non-speaking autistic persons. By the empathic turn we mean the turn towards a recognition of non-speaking autistic people as persons whose ways of engaging the (...) world and expressing themselves are indicative of psychologically rich and intrinsically meaningful experiential lives. We first identify two ways in which AAC Tech contributes positively to this development. We then discuss how AAC Tech can simultaneously undermine genuine empathic communication between autistic persons and typically developed communicators (or neurotypicals). To mitigate this concern, we suggest the AAC field should incorporate philosophical insights from Design for Emotions and enactive embodied cognitive science into its R&D practices. To make our proposal concrete, we home in on stimming as an autistic form of bodily expressivity that can play an important role in empathic communicative exchanges between autistic persons and neurotypicals and that could be facilitated in AAC Tech designed for autistic people. (shrink)

Intellectually disabled students face particular barriers to epistemic participation within schooling contexts. While negative forms of bias against intellectually disabled people play an important role in creating these barriers, this paper suggests that it is often because of the best intentions of educators and peers that intellectually disabled students are vulnerable to forms of epistemic injustice. The author outlines a form of epistemic injustice that operates through an educational practice widely regarded as serving the interests of intellectually disabled students. ‘Epistemic (...) ability profiling’ involves the identification of the epistemic consequences of disability in the service of promoting students’ best interests, or to create opportunities for their participation in epistemic communities. Epistemic ability profiling is a double-edged sword: it is important that educators understand and attend to the ways in which differences in ability shape students’ epistemic agency, and yet epistemic ability profiling operates against the background of a conceptually ableist conceptual terrain. As a result, epistemic ability profiling runs the risk of legitimating structural forms of injustice against intellectually disabled people. (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)

Menschen mit psychischer Erkrankung sterben statistisch gesehen früher als die Allgemeinbevölkerung. Ein Grund hierfür ist, dass sie eine schlechtere somatische Gesundheitsversorgung erhalten. Wir argumentieren, dass ableistische Netzwerke sozialer Bedeutung zu einer Abwertung der epistemischen Kompetenz von Menschen mit psychischer Erkrankung führen. Diese Abwertung kann mit dem Konzept der testimonialen Ungerechtigkeit erfasst werden. Testimoniale Ungerechtigkeit bezeichnet das ungerechtfertigte Herabstufen der Glaubwürdigkeit einer*s Sprecher*in aufgrund eines Vorurteils gegen ihre*seine soziale Identität. Wir analysieren ethische und epistemische Folgen testimonialer Ungerechtigkeit als wichtige Ursachen der (...) schlechteren Gesundheitsversorgung von Menschen mit psychischer Erkrankung. Testimoniale Ungerechtigkeit kann zu medizinischen Behandlungsfehlern führen und für Betroffene schwerwiegende gesundheitliche Folgen nach sich ziehen. Zudem kann sie zu einem Vertrauensverlust von Menschen mit psychischer Erkrankung in das Gesundheitssystem führen. Daher trägt testimoniale Ungerechtigkeit zur strukturellen Diskriminierung von Menschen mit psychischer Erkrankung bei. Vor diesem Hintergrund diskutieren wir, wie die somatische Gesundheitsversorgung unter ethischen Gesichtspunkten verbessert werden kann. (shrink)

This paper examines epistemic injustice in knowledge production concerning autism. Its aim is to further our understanding of the distinctive shapes of the kinds of epistemic injustices against autists. The paper shows how Ian Hacking’s work on autistic autobiography brings into view a form of hermeneutical injustice that autists endure with respect to their firsthand accounts of their experiences of autism. It explores how understanding the distinctive shape of this hermeneutical injustice can help us further appreciate dangers and harms of (...) using interpretive frameworks for autistic experience that neglect autists’ own contributions to the formation of words and concepts for capturing their experiences. In particular, the paper argues that even when autists are included in knowledge production concerning autistic experience, they remain vulnerable to forms of hermeneutical marginalization that can stifle the coming into being of autistic experience. (shrink)

Human beings as objects, and we are objects inter alia, offer information, even knowledge. And yet, in a society marked by pervasive identity prejudice, even objects do not offer neutral facts. Here, I argue that the harms imposed on those who suffer testimonial injustices cannot be sufficiently understood through the ethical lens of objectification. Such persons are not simply objectified, not simply treated as mere sources of information rather than as informants. Even as objects (not mere objects), they are often (...) unable to testify on their own behalf or testify to true facts of the matter. Rather than follow Miranda Fricker’s argument that testimonial injustices are acts of objectification, I argue that they are better understood as acts of what Ann Cahill calls derivatization. A re-examination of Fricker’s account of the wrong of testimonial injustice as derivatizing rather than objectifying clarifies the wrong of epistemic injustice, reinforces the mutuality of testimonial exchanges where both the speaker and listener are actively engaged and obligated to participate well to succeed, and opens up a discussion of how even when being treated as a source of information, informants can be mistreated. (shrink)

The historical relationship between health care professionals and people with disabilities is fraught, a fact all the more troubling in light of the distinctive roles clinicians play in both establishing and responding to that which is considered normal or abnormal by society at large. Those who wish to improve their clinical practice might struggle, however, to keep up with developments across numerous disability communities as well as the ever-growing body of disability studies scholarship. To assist with this goal, I offer (...) an overview of recent disability theory, outline a set of responsibilities clinicians have to disability communities, and provide recommendations for clinicians who hope to justly treat patients with disabilities and improve their care and health outcomes. (shrink)