I will talk us through some types of epistemic injustice, principally: ‘testimonial
injustice’, ‘pre-emptive testimonial injustice’, and ‘hermeneutical injustice’ which
I defined in earlier work; and ‘testimonial smothering’ as defined by Kristie Dotson.
I’ll explain these phenomena largely by way of examples from a memoir of mental ill-health
written by the British actor David Harewood, Maybe I Don’t belong Here: A Memoir of
Race, Identity, Breakdown and Recovery (2021). His personal story explores how experiences
of racism, growing up in Britain in the seventies and as a young man in the eighties,
sowed the seeds of personal fracture and psychological disconnect that later expressed
themselves in psychosis.
I will also reflect that many psychiatrists and therapists effectively see their own
work as including the amelioration of precisely these forms of epistemic injustice:
aiming to create a therapeutic relationship in which credibility is not withheld,
and shared intelligibility of experience is cultivated, with the result that the service-user
may come to express themselves without needing to truncate or restyle what they want
to say. This may be an impossible ideal, given that healthcare professionals must
equally be diagnostically alert to fantasy, projection, and delusion, among other
phenomena of epistemic disturbance, but impossible ideals can nonetheless be useful
guiding ideals, playing a helpful informal self-regulatory role in one’s professional
practice. If so, then perhaps the explicitly epistemic framing of this particular
guiding ideal may make for a useful tool in the therapeutic toolbox?
