Accepted Paper:

has pdf download Mistaking the map for the territory: biomedical ontology and hermeneutical injustice  


Alistair Wardrope (University of Sheffield/Sheffield University Hospitals NHSFT)

Paper short abstract:

I argue that hermeneutical marginalisation of non-medicalised perspectives on mental health arises from unjustified reification of medical models of mental illness that are only intended to serve certain limited purposes and are not exclusive of alternative perspectives on the same phenomena.

Paper long abstract:

"On Prozac, Sisyphus might well push the boulder back up the mountain with more enthusiasm and creativity. I do not want to deny the benefits of psychoactive medication [… But to] see him as a patient with a mental health problem is to ignore certain larger aspects of his predicament connected to boulders, mountains, and eternity." So writes Carl Elliott in Better than Well. But why should it be the case that considering Sisyphus to have a mental health problem results in neglect of boulders or eternity? While such concepts do not easily find a home in the biomedical ontology, to assume they are thereby rendered impotent is to imagine that medicine says everything there is to say about the experience in question. If medical descriptions are taken to 'carve nature at the joints', and describe an underlying reality without remainder, such assumption might be valid; but if they are instead - as ubiquitous throughout the sciences - models of phenomena that are able to serve specific explanatory, predictive or interventional purposes, then this does not exclude interpreting those phenomena in different ways to serve different purposes.

I will argue that biomedical models in mental health are intended in the latter sense - as models - but that by treating them in the former sense, misappropriating their application to realms beyond the medical, we produce hermeneutical marginalisation of other, complementary, approaches that may produce epistemic injustice. Responding to this injustice requires interrogation of the social processes driving such misappropriation.

Panel Med06
Hermeneutical injustice, clinical imagination and patient discontent in mental healthcare