Exploring epistemic injustice amongst non-clinical and clinical groups with unusual experiences

Khan, Aneela (2024). Exploring epistemic injustice amongst non-clinical and clinical groups with unusual experiences. University of Birmingham. Ph.D.

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Abstract

Current literature on the philosophical concept of epistemic injustice, the notion that marginalised individuals are dismissed as credible in their capacity as a knower, suggests that this occurs within healthcare settings, perpetrated against those with a diagnosis surrounding poor mental health. However, much of the literature in this field is theoretical, with limited empirical research on this concept in relation to mental health. Whilst the case has been made for why those with psychosis may be likely to face epistemic injustice i.e. due to their perceived identity as a mentally ill patient and subsequent lack of credibility based on unusual experiences e.g. delusions, this has yet to be explored empirically. The present thesis aims to bridge this gap by exploring incidences of epistemic injustice amongst those with unusual experiences and those with a diagnosis of a schizophrenia spectrum disorder, in order to understand any factors between the groups that may contribute to this injustice.

Firstly, to add to the theoretical literature reviewed, the thesis examines whether occurrences of epistemic injustice exists across the relevant qualitative literature through the use of a meta-ethnography. In order to operationalise the philosophical concept of epistemic injustice, the thesis then utilises an interpretative phenomenological approach to explore frameworks of understanding and meaning-making processes in people with unusual experiences, but without a medical diagnosis (non-clinical group). Relationships with others pre- and post-the experience are also investigated. Following this, the same line of exploration is then repeated with individuals who have been diagnosed with a schizophrenia spectrum disorder (clinical group). Finally, the thesis uses a multiperspectival approach to compare the findings of the non-clinical and clinical groups, identifying conceptual overlaps or conflicts of perspectives between group experiential themes. Similarities and differences regarding the sense-making process as well as perceived treatment of others were examined between participants, in an effort to bring to light any incidences of hermeneutical injustice and testimonial injustice.

The analyses highlight hermeneutical injustices occur within the clinical group through poor timeliness and information-sharing surrounding the diagnosis, as well as dismissal of religious and cultural interpretations. In addition, testimonial injustices were also understood to occur through perceived changes in identity and subsequent lack of credibility afforded to clinical participants, leading to dismissal of testimony. The present thesis offers empirical support for the occurrence of epistemic injustice amongst individuals with psychosis in comparison to undiagnosed individuals with unusual experiences, suggesting that the injustice occurs in relation to diagnosis and perceived identity.

Type of Work:

Thesis (Doctorates > Ph.D.)

Award Type:

Doctorates > Ph.D.

Supervisor(s):