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Hermeneutical injustice, clinical imagination and patient discontent in mental healthcare
Neil Armstrong (Oxford University)
Edward Harcourt (University of Oxford)
Magdalen Daubeny
Start time:
20 September, 2018 at 9:00 (UTC+0)
Session slots:

Short abstract:

This panel combines philosophical work on hermeneutical injustice and the imagination with empirically informed anthropological work on mental healthcare and patient health experiences to investigate mental healthcare patients' claims to be misunderstood by clinicians.

Long abstract:

For decades in mental healthcare there has been talk of improving services through patient-centred care, personalisation, the recovery movement, service-user empowerment, and the co-production of meaning. Yet patients continue to express discontent. They are widely reported to feel misunderstood, even stigmatised and disempowered, by contact with mental healthcare. Our interdisciplinary panel will seek to investigate this puzzling mismatch. We start from the thought that at least some patient discontent arises out of epistemic problems. One clue as to why might be found in Miranda Fricker's notion of 'hermeneutical injustice.' This refers to gaps or absences in collective hermeneutical resources that leave certain kinds of experience without appropriate means of expression. For Fricker, populations can suffer from hermeneutical marginalisation, such that a lack of expressive resources means they are unable to participate equally in discursive settings that are important to them. This might suggest that it is gaps in the social imaginary that create barriers to service reform. We will explore how philosophical work on epistemic injustice and the imagination connects with empirically rich anthropological understandings of mental healthcare and patient experience. Might patient discontent arise out of hermeneutical marginalization? Does clinical language create expressive lacunae leaving patients unable to communicate or even make sense of their experiences? How do the reported imaginative failures of clinicians relate to their training and professional expertise or the institutional setting and requirements of bureaucratic accountability?