Papers by Lucienne J Spencer
Social Epistemology , 2024
Within the last decade, epistemic injustice has been a valuable framework for those working on ex... more Within the last decade, epistemic injustice has been a valuable framework for those working on exposing oppressive practices within the healthcare system. As this work has evolved, new terminology has been added to the epistemic injustice literature to bring to light previously obscured epistemic harms in healthcare practices. This paper aims to explore an important concept that has not received the attention it deserves: epistemic isolation. By developing Ian Kidd and Havi Carel's concept of epistemic isolation, a new range of epistemic harms are brought to the fore, as some of the most marginalised in our society are forced to operate from positions of ignorance. In the words of Kidd and Carel, epistemic isolation occurs in 'situations where a person or group lacks the knowledge of, or means of access to, particular information; for instance, if they live within a politically repressive society which forbids access to the necessary sources of information in order to protect the government's hegemony' (183-184). This paper will demonstrate that such epistemic isolation is uniquely devastating for those with psychiatric illness, exacerbating their already challenging circumstances.
Epistemic Injustice and Violence: Exploring Knowledge, Power, and Participation in Philosophy and Beyond, 2024
Reports of the intent to kill oneself are not always met with the credibility they deserve, with ... more Reports of the intent to kill oneself are not always met with the credibility they deserve, with potentially fatal results. We recognise this as testimonial injustice, whereby a person’s testimony is not taken seriously due to a pervasive identity prejudice attached to the speaker (Fricker 2007). To meet the government’s ‘zero suicide ambition’ for mental health patients, we need to adopt epistemically just methods of evaluating suicide claims.
Philosophical Psychology, 2024
Those who turn to phenomenological psychopathology as an
answer to problems in psychiatric heal... more Those who turn to phenomenological psychopathology as an
answer to problems in psychiatric healthcare may find a philosophical
tradition rooted in the early-mid 20th century that has done little to adapt
to modern ideas in psychiatric healthcare and psychiatric research. The
Renewing Phenomenological Psychopathology project, funded by the
Wellcome Trust and led by Professor Matthew Broome and Professor
Giovanni Stanghellini, calls for reflection, revitalization and reconstruction
of this discipline, diversifying global scholarship and working with lived
experience scholars, so that it can pave new paths in psychiatric understanding. The contributions of the current special issue aim to breathe new life into a vital method in psychopathology and to chart its future trajectory
Royal Institute of Philosophy Supplements , Volume 94: Lived Experience and Co-Production in Philosophy and Mental Health , Cambridge University Press, 2023
The co-production of meaning' is a phrase that has become entrenched in the field of public menta... more The co-production of meaning' is a phrase that has become entrenched in the field of public mental health, adopted almost as a slogan within the literature. But what does it actually mean? Current definitions gesture toward the very broad idea that co-production involves a collaboration between 'service users' and healthcare professionals, each contributing their knowledge to better understand and treat mental health problems. Yet, terms such as 'equal' 'reciprocal', and 'partnership' fail to clarify the nature of this 'co-production', and how it can be achieved. To better understand the co-production of meaning, we shall attempt to develop an account of co-production through phenomenological psychopathology. Through Hans Georg Gadamer's remarks on 'the hermeneutic problem of psychiatry' two key obstacles to 'co-production' emerge: 1) contingent problems, and 2) intrinsic problems. In calling attention to these obstacles, we problematise the concept of 'co-production' in public mental health, revealing it to be more complex than originally thought. We conclude by arguing that new developments in phenomenological psychopathology can be used to overcome the limitations of 'co-production'.
Phenomenology and the Cognitive Sciences, 2023
Jaspers identifies empathic understanding as an essential tool for grasping not the mere psychic ... more Jaspers identifies empathic understanding as an essential tool for grasping not the mere psychic content of the condition at hand, but the lived experience of the patient. This method then serves as the basis for the phenomenological investigation into the psychiatric condition known as 'Phenomenological Psychopathology'. In recent years, scholars in the field of phenomenological psychopathology have attempted to refine the concept of empathic understanding for its use in contemporary clinical encounters. Most notably, we have Stanghellini's contribution of 'second-order' empathy and Ratcliffe's 'radical empathy'. Through this paper, we reject the pursuit of a renewed version of 'empathic understanding', on the grounds that the concept is fundamentally epistemically flawed. We argue that 'empathic understanding' risks (1) error, leading to misdiagnosis, mistreatment and an overall misunderstanding of the experience at hand, (2) a unique form of epistemic harm that we call 'epistemic co-opting' and (3) epistemic objectification. To conclude, we propose that empathic understanding ought to be replaced with a phenomenological account of Fricker's virtuous listening.
Philosophy of Medicine, 2023
The relevance of epistemic injustice to psychiatry has generated a lively literature, and only a ... more The relevance of epistemic injustice to psychiatry has generated a lively literature, and only a few critical pushbacks, a recent example being an article by Brent M. Kious, Benjamin R. Lewis, and Scott Y.H. Kim (2023). They question the usefulness of the concept of epistemic injustice to psychiatry. We would like to offer the following responses. We worry that the authors operate with a too-narrow conception of epistemic injustice, which they define as "unfairly discriminating against a person with respect to their ability to know things." At best, this includes the paradigmatic forms of what philosophers call discriminative epistemic injustice. However, this omits other importantly different kinds, such as distributive epistemic injustices, the wrongs of which involve injustices in the distribution of epistemic goods, such as credibility, which need not involve specific acts of discrimination. If we are to assess the relevance of the concept of epistemic injustice, we need a proper view of the richness of the concept. This should include acknowledging the diversity of kinds of epistemic injustice and avoiding a narrowly moral framing of their wrongs. Kious, Lewis, and Kim (2023) also complain that "allegations of psychiatric EI [epistemic injustice]" are too focused on single cases that are insufficient to motivate a generalized pessimism about psychiatric practice. A handful of isolated cases would not, of course, justify broader claims about the ubiquity of epistemic injustices. Moreover, not all negative epistemic experiences will be cases of epistemic injustice, and we, too, worry about the indiscriminate use of the concept. However, an abundance of such evidence exists insofar as there is an enormous literature testifying to negative epistemic experiences that are often interpretable as epistemic injustices-a recent survey, for example, can be found in an article by Ian James Kidd, Lucienne Spencer, and Havi Carel (2022). In addition, Kious, Lewis, and Kim overlook the complex nature of the examples they draw upon, such as Abdi Sanati and Michalis Kyratsous's case study of "J.N." (2015), whose fears about her husband's fidelity were wrongly assumed to be the product of delusion. Kious, Lewis, and Kim question whether this can be understood as ethically problematic, rather than just as a simple mistake. However, they fail to highlight the epistemic power imbalances and
Child and Adolescent Mental Health., 2023
Most mental health research largely ignores or minimises gender and age differences in depression... more Most mental health research largely ignores or minimises gender and age differences in depression. In 'Don't mind the gap: Why do we not care about the gender gap in mental health?', Patalay and Demkowicz identify a dearth of research on the causal factors of depression in young women. They attribute this to an overreliance on biological accounts of gender differences in depression. Patalay and Demkowicz conclude that a person-centred approach that meaningfully engages with the reports of young women with depression is more likely to expose the social drivers of depression that impact this group. This commentary focuses on Patalay and Demkowicz's call to examine the patient's lived experience. We argue that there is an urgent need to reflect upon the methodologies involved in examining lived experience and how they can be best utilised. Ultimately, we advocate for an approach known as 'phenomenological psychopathology', through a phenomenological investigation of depression in young women, we can go some way towards closing the gender gap. Key Practitioner Message • Most mental health research largely ignores or minimises gender and age differences in depression • We risk falling back on a gender and age-neutral account of depression, thus obstructing psychiatric knowledge and undermining the validity of the diagnostic criteria • Patalay and Demkowicz attempt to address this research gap by appealing to the 'lived experience' of young people with depression • We caution against a general methodology of 'lived experience' and instead advocate for phenomenological psychopathology
Philosophical Psychology, 2023
The rich literature in phenomenological psychopathology regards the communicative difficulties ac... more The rich literature in phenomenological psychopathology regards the communicative difficulties accompanying psy-chiatric illness as a product of ‘unworlding‘: the experience of a drastic change in one’s habitual field of experience. This paper argues that the relationship between speech expres-sion and unworlding in psychiatric illness is more complex than previously assumed. Not only does unworlding cause a breakdown in speech expression, but a breakdown in speech expression can perpetuate, and even exacerbate, the experience of unworlding characteristic of psychiatric illness. In other words, I identify a two-way relationship between unworlding and the communication breakdown in psychiatric illness. Merleau-Ponty’s phenomenology of speech expression is drawn upon to demonstrate how her-meneutical injustice in psychiatric healthcare can elicit unworlding for the person with a psychiatric illness.
Epistemic Injustice in Psychiatric Research and Practice, 2022
This paper offers an overview of the philosophical work on epistemic injustices as it relates to ... more 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.
Social Epistemology , 2022
The literature on epistemic injustice has thus far confined the concept of testimonial injustice ... more The literature on epistemic injustice has thus far confined the concept of testimonial injustice to speech expressions such as 'inquiring, questioning, discussing, speculating', 'deliberating', and, above all, 'telling' (Wanderer, 2017: 32) (Fricker, 2007: 60). I propose that it is time to broaden the horizons of testimonial injustice to include a wider range of expressions. Controversially, the form of communication I have in mind is non-verbal expression. Non-verbal expression is a vital, though often overlooked, form of communication, particularly for people who have certain neurocognitive disorders. Dependency upon nonverbal expression is a common feature of some forms of neurocognitive disorders such as 'intellectual disabilities', autism and late-stage dementia. According to the narrow definition of testimonial injustice currently championed in the literature, people who express nonverbally are exempt from testimonial injustice. However, when we consider cases where meaningful communications from non-verbal people are dismissed or ignored in virtue of identity prejudice, there seems to be a distinct testimonial harm at play. Using late-stage dementia as a case study, I argue that the definition of testimonial injustice should be expanded to include all communicative practices, whether verbal or non-verbal, to encompass the epistemic harms inflicted upon some of the most marginalised in our society.
Philosophy of Medicine , 2021
This article develops the concept of wrongful depathologization, in which a psychiatric disorder ... more This article develops the concept of wrongful depathologization, in which a psychiatric disorder is simultaneously stigmatized (because of sanist attitudes towards mental illness) and trivialized (as it is not considered a “proper” illness). We use OCD as a case study to argue that cumulatively these two effects generate a profound epistemic injustice to OCD sufferers, and possibly to those with other mental disorders. We show that even seemingly positive stereotypes attached to mental disorders give rise to both testimonial injustice and wilful hermeneutical ignorance. We thus expose an insidious form of epistemic harm that has been overlooked in the literature.
Thesis Chapters by Lucienne J Spencer
In the introduction to Madness and Civilisation, Foucault sets out his project as follows:
In th... more In the introduction to Madness and Civilisation, Foucault sets out his project as follows:
In the serene world of mental illness, modern man no longer communicates with the madman…The language of psychiatry, which is a monologue of reason about madness, has been established on the basis of such a silence. I have not tried to write the history of that language, but the archaeology of that silence (Foucault, 2001: xii).
Through this dissertation, I excavate the archaeology of that silence a little more, uncovering its distinctly epistemic foundation. Drawing on the emerging field of epistemic injustice, I develop an underexplored form of epistemic silencing that I dub ‘hermeneutical silencing’. In a case of hermeneutical silencing, the oppressed individual is silenced by a lack of language to describe their marginalised experiences. I then proceed to demonstrate the true breadth and depth of the harm produced by hermeneutical silencing. The hermeneutically silenced individual not only suffers a cognitive disadvantage due to an inability to articulate their experiences; with recourse to Merleau-Ponty’s phenomenology of speech expression, I argue that they suffer a profound disruption to their embodied experience in the world.
When the concept of ‘hermeneutical silencing’ is applied to the domain of psychiatry, a more complete picture of the ‘archaeology of that silence’ unfolds. Although an experience of alienation from the world is characteristic of psychiatric illness, the concept of hermeneutical silencing demonstrates how this experience can be exacerbated and perpetuated by gaps in the interpretive framework where words to describe the patient’s experience ought to be. If we hope to amplify such marginalised voices in the future, we must first address the unequal hermeneutical practices that stifle them.
Blogs by Lucienne J Spencer
In the search for alternative approaches to psychiatry, there has been a reignited interest in ph... more In the search for alternative approaches to psychiatry, there has been a reignited interest in phenomenological psychopathology: an approach that uses the phenomenological method to highlight the lived experience of the person with mental ill-health1 and invites a personcentred approach to diagnosis and treatment. Phenomenological psychopathology has its roots in Karl Jaspers' seminal work General Psychopathology (1913), which surpassed the limited scope of pre-structured interviews and diagnostic criteria by examining the patient's life-world. After a long period during which phenomenological psychopathology fell into obscurity, new work in the field and amplification of the patient's voice through mad-pride activism have led to a resurgence of the approach, giving it a valued place amongst once more dominant methodologies.
Last week my friend Maria was finally given a diagnosis of autism at 28 years old. Maria has alwa... more Last week my friend Maria was finally given a diagnosis of autism at 28 years old. Maria has always been painfully aware that there was something different about her. She engaged with mental health services for many years but for a long time she received no diagnosis. She read different accounts of psychiatric disorders in the hope to better understand herself, but nothing seemed to fit. It wasn't until she encountered a book on the experience of female autism that she had an 'Aha!' moment. The book identified unique traits that are more likely to be displayed by autistic females compared to autistic males. The first-person reports collated by the author reflected Maria's own experiences-and everything clicked into place.
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Papers by Lucienne J Spencer
answer to problems in psychiatric healthcare may find a philosophical
tradition rooted in the early-mid 20th century that has done little to adapt
to modern ideas in psychiatric healthcare and psychiatric research. The
Renewing Phenomenological Psychopathology project, funded by the
Wellcome Trust and led by Professor Matthew Broome and Professor
Giovanni Stanghellini, calls for reflection, revitalization and reconstruction
of this discipline, diversifying global scholarship and working with lived
experience scholars, so that it can pave new paths in psychiatric understanding. The contributions of the current special issue aim to breathe new life into a vital method in psychopathology and to chart its future trajectory
Thesis Chapters by Lucienne J Spencer
In the serene world of mental illness, modern man no longer communicates with the madman…The language of psychiatry, which is a monologue of reason about madness, has been established on the basis of such a silence. I have not tried to write the history of that language, but the archaeology of that silence (Foucault, 2001: xii).
Through this dissertation, I excavate the archaeology of that silence a little more, uncovering its distinctly epistemic foundation. Drawing on the emerging field of epistemic injustice, I develop an underexplored form of epistemic silencing that I dub ‘hermeneutical silencing’. In a case of hermeneutical silencing, the oppressed individual is silenced by a lack of language to describe their marginalised experiences. I then proceed to demonstrate the true breadth and depth of the harm produced by hermeneutical silencing. The hermeneutically silenced individual not only suffers a cognitive disadvantage due to an inability to articulate their experiences; with recourse to Merleau-Ponty’s phenomenology of speech expression, I argue that they suffer a profound disruption to their embodied experience in the world.
When the concept of ‘hermeneutical silencing’ is applied to the domain of psychiatry, a more complete picture of the ‘archaeology of that silence’ unfolds. Although an experience of alienation from the world is characteristic of psychiatric illness, the concept of hermeneutical silencing demonstrates how this experience can be exacerbated and perpetuated by gaps in the interpretive framework where words to describe the patient’s experience ought to be. If we hope to amplify such marginalised voices in the future, we must first address the unequal hermeneutical practices that stifle them.
Blogs by Lucienne J Spencer
answer to problems in psychiatric healthcare may find a philosophical
tradition rooted in the early-mid 20th century that has done little to adapt
to modern ideas in psychiatric healthcare and psychiatric research. The
Renewing Phenomenological Psychopathology project, funded by the
Wellcome Trust and led by Professor Matthew Broome and Professor
Giovanni Stanghellini, calls for reflection, revitalization and reconstruction
of this discipline, diversifying global scholarship and working with lived
experience scholars, so that it can pave new paths in psychiatric understanding. The contributions of the current special issue aim to breathe new life into a vital method in psychopathology and to chart its future trajectory
In the serene world of mental illness, modern man no longer communicates with the madman…The language of psychiatry, which is a monologue of reason about madness, has been established on the basis of such a silence. I have not tried to write the history of that language, but the archaeology of that silence (Foucault, 2001: xii).
Through this dissertation, I excavate the archaeology of that silence a little more, uncovering its distinctly epistemic foundation. Drawing on the emerging field of epistemic injustice, I develop an underexplored form of epistemic silencing that I dub ‘hermeneutical silencing’. In a case of hermeneutical silencing, the oppressed individual is silenced by a lack of language to describe their marginalised experiences. I then proceed to demonstrate the true breadth and depth of the harm produced by hermeneutical silencing. The hermeneutically silenced individual not only suffers a cognitive disadvantage due to an inability to articulate their experiences; with recourse to Merleau-Ponty’s phenomenology of speech expression, I argue that they suffer a profound disruption to their embodied experience in the world.
When the concept of ‘hermeneutical silencing’ is applied to the domain of psychiatry, a more complete picture of the ‘archaeology of that silence’ unfolds. Although an experience of alienation from the world is characteristic of psychiatric illness, the concept of hermeneutical silencing demonstrates how this experience can be exacerbated and perpetuated by gaps in the interpretive framework where words to describe the patient’s experience ought to be. If we hope to amplify such marginalised voices in the future, we must first address the unequal hermeneutical practices that stifle them.