{"id":633,"date":"2023-10-16T08:05:07","date_gmt":"2023-10-16T08:05:07","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmjleader\/?p=633"},"modified":"2023-10-11T15:15:33","modified_gmt":"2023-10-11T15:15:33","slug":"epistemological-relevance-in-social-justice-a-justified-belief-or-pinion-by-dr-nagina-khan-and-professor-kam-bhui","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmjleader\/2023\/10\/16\/epistemological-relevance-in-social-justice-a-justified-belief-or-pinion-by-dr-nagina-khan-and-professor-kam-bhui\/","title":{"rendered":"Healthcare Inequalities and Social Justice Blog Series: Epistemological relevance in social justice: a justified belief or pinion? By Dr. Nagina Khan and Professor Kam Bhui"},"content":{"rendered":"

Miranda Fricker is a critical philosopher, who identified a particular form of social injustice which she named epistemic injustice which occurs when a person is wronged as a knower.1<\/sup> Fricker explained that the harm this can do and identified there is instant injury when not believed and to be rejected or discredited on a deeper level – \u201cto be wronged as a knower, or speaker\u2019 is to be wronged in a capacity essential to human value\u201d (p. 44). Sadly, epistemic injustice has become a popular concept in healthcare. In healthcare and psychiatric practice, epistemic injustice is concerned with the negative socio-epistemic experiences constantly described by individuals with psychiatric conditions and correspondingly there is a parallel with the preoccupation of scholars within healthcare studies who endorse discourses of equality, diversity, and inclusion (EDI) on the one hand, yet ignore racism and the epistemic injustice suffered by Black and ethnic minority populations and scholars alike? See table. 1 below for the snapshot of evidence related to this.<\/p>\n

Table. 1 Existing evidence of inequality in healthcare <\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n
Study <\/strong><\/td>\nFinding <\/strong><\/td>\n<\/tr>\n
Mental health care for Asian, black and white patients with non-affective psychoses: Pathways to the psychiatric hospital, in-patient and after-care<\/a>.<\/td>\nEvidence exists that Black patients had more-complex pathways to specialist services.<\/td>\n<\/tr>\n
The first contact of patients with schizophrenia with psychiatric services: Social factors and pathways to care in a multi-ethnic population<\/a>.<\/td>\nCompared with White and South Asian patients who visited their general practitioner (GP), Black people were less likely to be referred to specialist services.<\/td>\n<\/tr>\n
Mental health care for Asian, black and white patients with non-affective psychoses: Pathways to the psychiatric hospital, in-patient and after-care<\/a>.<\/p>\n

The first contact of patients with schizophrenia with psychiatric services: Social factors and pathways to care in a multi-ethnic population<\/a>.<\/td>\n

Police were more likely to be involved in admissions or readmissions of Black people.<\/td>\n<\/tr>\n
Early manifestations, personality traits and pathways into care for Asian and white first-onset cases of schizophrenia<\/a>.<\/p>\n

The first contact of patients with schizophrenia with psychiatric services: Social factors and pathways to care in a multi-ethnic population<\/a>.<\/td>\n

In West London, specialist referral following primary care assessments appeared to be equally common among White and South Asian patients, but hospital admission was more likely among South Asians following a domiciliary visit.<\/td>\n<\/tr>\n
Access to mental health care in an inner-city health district. I: Pathways into and within specialist psychiatric services.<\/a><\/td>\nIn Birmingham South Asians had the highest community rates of mental disorder, were the most frequent consulters in primary care and were less likely than White people to have their mental disorder recognised.<\/td>\n<\/tr>\n
Ethnic inequalities in the incidence of diagnosis of severe mental illness in England: a systematic review and new meta-analyses for non-affective and affective psychoses.<\/a><\/td>\nThe risk for a diagnosis of non-affective and affective psychoses is particularly elevated for Black ethnic groups and is higher for all ethnic minority groups. Including those previously not assessed through meta-analyses (White Other, Mixed Ethnicity).<\/td>\n<\/tr>\n
Department of Health<\/a>. The independent review of the Mental Health Act.<\/td>\nFinal report sets out recommendations covering 4 principles that the review believes should underpin the reformed Act:<\/p>\n
    \n
  • choice and autonomy \u2013 ensuring service users\u2019 views and choices are respected<\/li>\n
  • least restriction \u2013 ensuring the Act\u2019s powers are used in the least restrictive way<\/li>\n
  • therapeutic benefit \u2013 ensuring patients are supported to get better, so they can be discharged from the Act<\/li>\n
  • people as individuals \u2013 ensuring patients are viewed and treated as rounded individuals.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
Understanding ethnic inequalities in mental healthcare in the UK: A meta-ethnography<\/a>.<\/td>\nFound that the delivery of safe and equitable person-centred care requires a model of mental health that is responsive to the lived experiences of people in ethnic minority groups.<\/p>\n

Highlighting that this requires better alignment of mental health services with social and anti-racist models of care.<\/td>\n<\/tr>\n

Power and the Ethics of Knowing. Epistemic Injustice: Power and the Ethics of Knowing<\/a><\/p>\n

The Emperor Has No Clothes: Rewriting \u201cRace in Organizations.<\/a>\u201d<\/p>\n

Epistemic injustice and hegemonic ordeal in management and organization studies: Advancing Black scholarship<\/a>.<\/td>\n

Penelope Muzanenhamo writes, that, rather than deter me, I believe my socially powerless identity has inspired my participation in the struggle for epistemic justice with other Black (female) scholars with the goal to advance Black scholarship. By Black scholarship, I denote epistemological approaches grounded in the social realities of Black (and Brown) individuals and communities, that are adopted by non-White bodies such as myself.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Fricker stated, \u201cin contexts of oppression the powerful will be sure to undermine the powerless in just that capacity, for it provides a direct route to undermining them in their very humanity<\/em>\u201d (p. 44).1<\/sup> Furthermore, Muzanenhamo, P., suggested, this is because the capacity to reason and to give knowledge to others is fundamental to being human and so to be insulted or ignored in this capacity is deeply wounding.2<\/sup> Hence, perhaps why we can identify with Capponi (2003) who identifies as Mad and a service user of the Canadian Mental health system, she has written numerous prevailing autobiographies authenticating her personal knowledge and the experiences of others. She says, every individual is different, despite comparable circumstances and diagnoses, in terms of potential, character, awareness, welfares and capabilities. \u201cThese differences might be obscured by labels and behaviours, by homelessness and poverty, but they are there. And they need to be expressed for us to find out what makes us special, what makes us unique. The failure to see us as people, not as pathologies, continues to wear us down\u201d (p. 150).3<\/sup> \u00a0This picture of her involvement in the mental health system and experience of epistemic injustice reverberates with Fricker\u2019s account of the deep wounding and harm through, weakening personal testimony or failure to provide a respectful platform. This oversight can destabilise independence, autonomy and an individual\u2019s route to civilisation, humanity, and mortality.<\/p>\n

Scholars have identified two main co-operating notions for epistemic injustice:<\/p>\n

    \n
  1. Testimonial injustice occurs when a speaker is denied credibility and is degraded, ignored, or dismissed as a reliable knower.<\/em>1<\/sup>
    \nAnd<\/li>\n<\/ol>\n
      \n
    1. Hermeneutic injustice is an injustice of meaning-making where a particular experience is not only not part of the collective knowledge resource but has perhaps not even been named and conceptualised.<\/em><\/li>\n<\/ol>\n

       <\/p>\n

      Not being heard – not feeling heard<\/u><\/p>\n