Bringing theoretical conceptions in psychiatry to epistemic justice.

内容摘要

Pathocentric epistemic injustice is a form of epistemic injustice that affects ill persons. In this paper I deal with pathocentric epistemic injustice in psychiatry that impacts persons with psychiatric conditions. There are several sources of such epistemic injustice, ranging from the agential level to the structural, institutional and even to the theoretical level of healthcare and medicine. In this paper I explore theoretical conceptions as sources of pathocentric epistemic injustice in psychiatry. Specifically, I focus on the notion that the naturalistic conception of health is an epistemically unjust theoretical conception when it exclusively privileges the epistemic resources of biomedical sciences. Supposing this claim is correct, this paper tries to offer a way of ameliorating the pathocentric epistemic injustice caused by the naturalistic conception of health. I argue that the first step of the ameliorative project lies in emphasis and acknowledgement of the concepts that embody the patient perspective, such as harm, well-being and suffering. While these concepts are found in the theoretical sphere of psychiatry, they are underdeveloped and lack proper attention. Furthermore, while elaborating on these concepts is necessary, it is not sufficient for epistemic justice in psychiatry. Thus, I introduce the idea of epistemic pillars of psychiatry - scientific research, clinical work and patient's perspective. Epistemic justice in psychiatry does not rely on any one these elements, rather it rests on the collaboration, compromise and mutual recognition of these spheres. It lies in harmony of the three pillars of psychiatry, rather than in either element being the dominant one.