Okay, thank you so much for coming for this
afternoon's session. Our next speakers are
Laura Delgado and Claudia Picazo.
Laura is a PhD student in UNED, more or less.
Claudia Picazo is an associate professor in
UNED as well, in the best department in
the world, Department of Logic, History and
Philosophy of Science. And Laura's research is
focused more on philosophy of psychiatry and
philosophy of medicine. Claudia's work is mainly
in philosophy of language, philosophy of mind,
some research on epistemic injustice, and many other things.
And they are going to talk today
about hermeneutical injustice and psychiatry. So thank you so much.
Okay, thank you, Christian.
Thank you for the organizers, especially Agatha.
We are going to talk about hermeneutical injustice and psychiatry.
Okay, some diagnostic categories used in
psychiatry have been criticized from different points of view.
For instance, from feminist
criticism of borderline personality disorder,
it has been said that BPD is the latest
manifestation of historical attempts to explain
away the strategies with some women used to
survive and resist oppression and abuse by
describing these strategies as symptomatic
of a disturbed personality disorder.
From anti-racist critics to oppositional
defiant disorder, it has been argued that ODD is
overdiagnosis, perpetuates this legacy's
normalization of racial oppression, pathologizing
of resistance, and behavioral control as intervention,
rather than advocacy against racial violence.
So these critics point out that there may be
certain biases in these categories that obscure
our understanding of the reality that they are
intended to describe. However, we think that
these criticisms are too coarse-grained in the
sense that in what sense these categories are
effective or what kinds of harm they are causing.
Okay, our aim in this talk is to offer a taxonomy
of different conceptual harms that can illuminate
the ways in which diagnostic categories can be
defective and harmful. To this aim, we use the
tools developed in the literature of hermeneutical
injustice, but ultimately we put forward a broader
notion that goes beyond purely epistemic harms.
So we propose the notion of conceptual harms.
Okay, this is the plan of the talk.
First, I present some problems with diagnostic categories.
Second, Claudia presents the main approaches
of hermeneutical injustice. Then, we present
the idea of conceptual harms and a provisional
taxonomy of these harms is a work in progress.
And finally, we apply this framework to some examples in psychiatry.
Some examples in which diagnostic categories seem
to be problematic. The first example concerns
feminist criticism on BPD. BPD is a personality
disorder defined by the DSM as a pervasive pattern
of instability in interpersonal relationships,
self-image, and affects, as well as marked impulsivity.
It is important to note that about 75%
of people diagnosed as BPD are women,
and 70% of whom have suffered abuse.
Okay, feminist criticism has argued that BPD is a
gender-based diagnosis that pathologizes women's
behavior by placing them in a double-binding
situation by which women may be pathologized
for complying with and for failing to comply
with contradictory social expectations of female behavior.
The validity of some diagnostic symptoms
such as the inappropriate anger or sexual
promiscuity has been also a question.
It has been argued that BPD, rather than an
individual mental disorder, is the consequence
of social problems such as child abuse or a
sexist environment. And some critics, as Lester,
argued that BPD is an adaptive strategy to an oppressive environment.
Okay, other diagnostic categories that have
been criticized from anti-racist approaches
is the case of opposite defiant disorder.
Following also the DSM, ODD is a childhood
disruptive impulsive control and conduct
disorder characterized by anger or irritability,
argumentativeness or defiance and vindictiveness.
Research in the US has found that ODD diagnoses
are 35% more prevalent in black children than in white children.
Lega argues that this disparity stems not
from a hindering behavioral differences
but racialized biases of defiance.
She argues that adults are more likely to perceive black
children as stronger, more adult-like, less
innocent and less deserving of attention than white children.
And this adultification biases
impact especially in racially minoritized girls.
Negative stereotypes of black women
being angry, aggressive and hypersexual
leads adults to treat black girls inappropriately, punishing them for
subjected infractions like disruption or disobedience that they face.
So rather than a mental disorder, it has been
argued that the behaviors considered symptoms in
DDD are actually reactions to racism.
Lega points out that ODD diagnoses become racist when applied
indiscriminately to racially minoritized children
as a bad kid level, placing blame of them for
these unwanted behaviors. Doing so is especially
problematic when these behaviors serve
as reactions or adaptations to racism.
This misattribution can incite adverse outcomes,
including mistreatment, opportunities for
misdiagnosis, failure to protect against racism,
and harsher disciplinary practices.
So from these anti-racist approaches, it is
argued that ODD diagnosis is not helpful,
neither a good explanation of these behaviors,
but a stigmatizing level that overlooks
daily experiences of racism, sexual abuse, and difficult environments.
So according to this criticism, BPD and ODD,
it seems that some diagnostic categories hide
structural realities and obscure rather than
illuminate some experiences and behaviors.
Also according to this criticism, the application
of the categories can be biased, which further
obscures the experiences and identities of
those to whom the category is currently applied.
The third criticism we present was posted by
Tzatmar and Karel. It concerns the neurotypical
notion of good life and its repercussions
for neurodivergent modes of flourishing.
They argue that the dominant conception of
good life relies on species-typical intuitions
about what is good and desirable, and
this is problematic when accounting for
neurodivergent modes of flourishing that
may be based on atypical intuitions.
This entails that autism and other cognitive
variations are excluded of the possibility
of real flourishing life, and neurotypical ideas
about flourishing life exclude alternative ones from neurodivergent.
Okay, so we've seen that there are some
criticisms concerning diagnostic categories,
and what I'm going to do now is to
present the tools that we have from the
literature on the discussion of hermeneutical injustice.
So the idea in these criticisms is
that we have some notions or some concepts,
some diagnostic categories, which are concepts
that are either biased or are wrongly applied
or have some defect. And these defects that
these categories have are obscuring our
understanding of certain behaviours,
certain experiences, the way we understand other
people, the way we understand ourselves as well,
and so we think it's useful to use the notions
that have or tools that have been developed
in the literature on hermeneutical injustice to
make more precise what the problems with these categories are.
So hermeneutical injustice is about
concepts and how the concepts we have or don't have
are problematic for our epistemic lives.
So concepts are usually thought to be the
building blocks of thoughts, and this is important
because we use concepts for categorisation,
inference, memory, learning, and decision making.
So we use concepts to make sense of our experiences,
of the world around us, to make choices, and so
on. And so many people, starting with Friker,
have pointed out how they play crucial roles in
our epistemic lives and beyond, of course, and
how when they are problematic, then we
have problems in our epistemic lives.
So the idea that we find in the literature on
hermeneutical injustice is that our conceptual
repertoires or the conceptual resources that we
have in our societies can be dysfunctional or defective.
Friker introduced this idea that
sometimes the problem with the conceptual resources
that we have in a given society is that there
should be some concepts, but in fact these
concepts are lacking. I will explain more in detail later.
There is another kind of defect
in the conceptual repertoire, which would be
that sometimes we do have concepts but they are
difficult to apply. And also we have cases where
the concepts that we have are defective but in a wrongful way.
So it's not just that we don't have
the means to create good concepts, but rather that
because we have prejudice and so on, we end up
going in concepts that are wrongfully defective.
And the problem is that whenever this happens, our
experiences can be obscured. So instead of using
these concepts to make sense, to make intelligible,
to understand our experiences, ourselves,
other people, in the end what we have is a
situation where we don't understand or everything
is a bit obscured. It's important to highlight
here that for this literature what is important
is that this defectiveness can be related to
the existence of some form of marginalization,
hermeneutical marginalization in particular,
and/or the presence of prejudiced stereotypes.
So we have these problems with the conceptual
repertoires because we have identity prejudices,
for example, or because we don't allow all
groups in the society to contribute to the
creation of meanings, social meanings, or
concepts more generally. So all this discussion on
hermeneutical injustice started with Friker's work
and she introduced this idea that hermeneutical
injustice occurs when subjects are unable to
make some significant experience intelligible to
themselves and to others because they are
hermeneutically marginalized. So she was interested
in the situations where we have an epistemic harm,
in particular the harm is that there is a cognitive
deficiency and intelligibility of a significant experience.
We have an experience we don't
understand because there is a lacuna in
the collective hermeneutical resource.
And it's also a situation where there is some wrong.
So it's not just that there is no concept, it's that
there is no concept because some group, so the group
who is having this experience, is hermeneutically marginalized.
This means that the group is not
being allowed to participate in the creation of concepts.
Well, in her framework the epistemic
harm tends to cause other harms which can be
also epistemic but also practical.
So she introduces two paradigmatic examples of this situation.
One is that of sexual harassment and the other is postpartum depression.
So imagine, well, imagine, sorry, she picks testimonies
from this time. So before the notion of sexual
harassment was introduced there was of course
sexual harassment. So women were suffering
sexual harassment. However, what we find is that
many women didn't understand exactly what was going on.
Of course they had some idea but they
didn't have like a full developed notion or like
a clear understanding of what they were going through.
So this kind of situation would constitute
a hermeneutical injustice because there was a
significant experience that they could not make
intelligible or they couldn't make sense of the
experience precisely because there was no notion,
there was no concept that would describe
appropriately the experience. And the reason
why there was no concept is that women were not
allowed to develop these legal notions.
They were not lawyers at that time and so on.
And more generally their perspectives were not being
taken into account or they were not taken as
seriously as men's perspective who could describe
the same situation in different terms like "I was
just flirting" or so on. Another example would be
postpartum depression which before it was
identified as such many women suffered.
So there are testimonies of women feeling that they were
just bad mothers and so on. But then now we have
a notion that can explain or make sense
of the experiences that they were having.
So these are cases where there are some significant experiences
that would be in our interest to understand but
because of the social asymmetries in
our societies we have no concepts for.
In this sense we can say that in these situations
of hermeneutical injustice the collective
hermeneutical resources are dysfunctional because
there is a gap where there should be a concept
or a word and this is causing an epistemic harm
that is an incapacity to make sense or understand
more generally an experience. This is Freaker's
original definition but in the last 20 years in
the literature we find many other situations
that could be also classified as hermeneutical
injustices and we have also other cases
that involve some form of conceptual harms.
And so our idea is that we need to go
beyond Freaker's definition to understand
what is going on with this criticism in diagnostic categories.
And we need to go beyond Freaker's
definition into directions. First there are other
ways in which hermeneutical resources can be
dysfunctional and also there are other conceptual harms.
So conceptual harms as the harms caused by
our concepts that are not really restricted to
our epistemic lives or to this idea that we cannot
make sense of an experience. And what I'm going
to do now is to present some ways in which the
hermeneutical repertoire can be dysfunctional
and also some other conceptual harms.
And then we will try to understand the
criticisms to the diagnostic categories that
Laura presented using this conceptual framework.
So beyond conceptual gaps we also have problems of application.
And here for example Falvo talks
about what she calls positive hermeneutical
injustice which could be the kind of hermeneutical
injustice that results from the presence of
oppressive and distorting concepts which crowd
out, defeat or preempt the application of an
available and more accurate concept. And the point
here is that sometimes the problem is not that we
don't have a concept but rather that we cannot
apply the adequate concept to an experience.
Why? Because we have some other concept or some
cultural narrative that distorts or blocks the application.
Well there are different examples
here but there's this for example Jenkins talks
about rape myths. So if one endorses rape myths
then even though we have a good notion of rape
in some countries let's say, it can be the case
that we are unable to apply the notion of rape
to an experience that we've had precisely because
we believe the rape myths and that prevents us from
applying the accurate concept. Falvo speaks of
hermeneutical clashes and she has this idea that
sometimes we can have concepts that are associated
with different stereotypes such that conceptualising
something as an example of this stereotype prevents
us from applying the other concept. So her example
is suppose we have the notion of a golden boy and
this comes with a certain stereotype.
When we also have the notion of a rapist with different
stereotypes like a stranger, a monster,
her idea is that it can happen that when
we conceptualise someone as a golden boy
that prevents us from conceptualising that person as a rapist.
She's talking about a case about someone, I
don't remember whose name, but it was like a
young man who was described by the press as a
golden boy and nobody could believe that he had
raped a girl and the problem according to Falvo
was that because you're talking about him as a
golden boy then if you imagine that a rapist is
a stranger, a monster and so on, then of course
you cannot believe that this person is a rapist
but the problem is these stereotypes that you have.
So then that's a problem of application.
We have good concepts but we can't apply them.
Then there's also another way in which our
resources can be dysfunctional which is
by the presence of defective concepts.
Here the idea is that sometimes we have concepts that
seem to provide some intelligibility but
actually they don't because they are defective.
Here we have introduced this notion of an imposter
concept which could be an imposter concept as we
understand it would be a concept that provides
some form of intelligibility but it's delusive.
So the experience actually remains obscured.
An imposter concept is a concept that emerges
from authority as we understand it, for example medical authority,
and which is that is coined in the context of a
practice that is wrongful. So it's not a case of
epistemic bad luck but rather the result of
marginalization or the presence of prejudice
stereotypes and biases and so on.
Here the example that I usually use is a drapetomania.
Maybe you've heard, probably you've heard about
this because I always use this example.
So the drapetomania was supposed to be a mania affecting
slaves in the 19th century manifested by an
uncontrollable impulse to wander or run away
from their white masters and this was coined by a doctor.
The idea here is that well if you are a
slave and you have a desire to run away that must
mean that you are crazy and this doctor coined
this notion drapetomania which was supposed to
explain or make sense or make intelligible certain
experiences in this case of a desire to run away.
This concept was not successful. It was not used
like on a general basis but it would be the kind
of thing that we have in mind when we talk about
imposter concepts like there's an authority in
this case medical authority introducing or pointing a concept.
The concept is biased. It's a result of
prejudice and it's supposed to make intelligible
an experience but actually it's obscuring some
reality in this case slavery. We introduced, so
this is a paper I have with Laura Delgado and we
introduced imposter concepts as concepts that
take the place of more adequate concepts and
we were using it for cases where there
was a genuine experience to be described.
So in the case of drapetomania slaves had this desire to
run away we can suppose. However we could have
these more extreme cases where there is not
even an experience to make sense of or to make
intelligible still we coined some concept for
strategic purposes for example. That would be
the case of an empty imposter concept and we can
think here of sluggish schizophrenia.
How do you, I don't know how to say this in English.
I don't know if you've heard about this. I don't know much.
Maybe Laura knows better but apparently in the
Soviet Union they had this diagnostic category
and it was used for people who was expressing
opposition to the communist regime. But the thing
is that it was supposed to be a kind of
schizophrenia that didn't, so that in the
beginning was associated with no symptom but that
would develop at some point. So people were being
diagnosed with no clear clinical criteria and so
the idea here is that we can in the most extreme
case we could have concepts that don't
even refer or try to capture an experience.
But anyway this is a way in which the
conceptual resources can be dysfunctional.
Then we can have cases of misuses and abuses of
adequate concepts and here we also introduced
this idea of imposter uses. So sometimes the
problem is not so much that we don't have
so that the concept is defective but rather that
we are using it in a wrongful way. And here we can
think of these cases where men describe sexual
harassment as flirting. The concept of flirting
is okay, there's nothing wrong with it.
The problem is that it's being misapplied.
So some people as Droz Bitsan, I never
know how to read his name, Grodniewicz, JP.
Okay thank you.
And so they also speak of rigid uses of
diagnostic categories in psychotherapy that
will also be a misuse or an abuse but
I'm not going to enter into this here.
So these are all the ways in which our
conceptual resources can be dysfunctional
so that goes beyond Pricker's original definition.
But we also think that there are
harms beyond the epistemic. So we start with the
epistemic harm and this is the idea Pricker has
that some situations are harming us as epistemic
agents and in the hermeneutical case the problem
is that we don't have the means to understand
or to make sense of some significant experience.
So the problem here could be understanding.
We can't understand our experiences, we can't
understand ourselves or oneself or we can't
think about our identity in the correct way
and this would create some situation of cognitive
hermeneutical injustice as some people call it.
But of course there are other harms for example
communicative harms. This is something that Medina
has and other people has highlighted.
Sometimes we disadvantaged groups do have adequate conceptual
resources but the problem is that these resources
are not shared so that even though they understand
their experiences they are unable to communicate them to others.
This would constitute what some
people call a communicative hermeneutical injustice.
But this is communicative in nature,
not really epistemic. I think we could also speak
of ethical harms. I'm not sure ethical is the right word here.
Christian mentioned that we have
problems with values. Well I have problems
with how to call these kind of things
that refer to interpersonal relations.
So the idea here is that it's so suppose we are in
this situation where we understand an experience
that we have, we understand our identity but there
are other people in our society or most people in
our society don't have the concept that we have
because it's not shared. Well in that situation
there is a communicative harm because if we try
to communicate how we feel to others there will
be a communicative disruption. We will not be successful.
But I think there's also a harm in
not being understood by others more generally
even if we don't try to communicate to them.
I mean I think it can be a harm in being
conceptualized in the wrong way by other
people in our society. And think for example of
a very sexist society where people think that
women are only happy when they are married and have children.
And we have this woman who is single
and is perfectly fine and feels happy but like
putting aside the communicative problems that
the situation would create I think there's also
something wrong in this society which is unable
to understand the identity of this woman and
her experiences. So this would be similar to a
hermeneutical injustice but not really the canonical
case that Fricker has in mind. And there are some
people who talk about existential harms or
epistemic existential injustice and here there is
Ayala's work on how insufficient conceptual
resources can prevent us from having a certain
experiences and building our identities in certain ways.
And so she has this idea that not having
certain concepts like non-binary gender or lesbian
can prevent us from conceptualizing our effects
in this case in some way but also in developing
certain identities. So we don't and in developing
some certain desires. So it goes beyond understanding.
It's related to understanding
but it's not only that we don't understand
our experiences it's also that because
we don't have those concepts we don't
build our identities in certain ways.
So our idea here is that if we really want to
understand what's wrong with the diagnostic
categories we started with we need we can use
tools from hermeneutical injustice but in the end
we need a broader framework and this is what we
are trying to do here very briefly because this is
very work in progress. So we think that we need
this broader notion of conceptual harm that captures
different ways in which the hermeneutical
resources can be dysfunctional and different harms.
And our proposal is to understand this as an
impairment suffered by an individual in some
significant dimension of her identity such
as self-understanding or understanding some
significant experiences being understood by
other members of one's community or buildings one identity.
Were this discussed by the state of the
collective conceptual repertoire in her community
or how it is used. As always in this debate this
can be a harm but this can also constitute an
injustice when it's related to marginalization or
prejudice stereotypes. And so what I've tried to
present in this discussion about different types
of hermeneutical injustice is the different harms
that we can have and the different ways in which
the conceptual tools can be defective.
So we have epistemic communicative ethical and existential
harms and we have these defects in concepts
when there is a lack of concept but also when
there is a distortion or a hermeneutical clash
when the concepts are defective and when they are wrongly used.
And now Laura is going to apply this framework to psychiatry.
So we think that criticism on diagnostic
categories presented in section one as well
as the problem detected by Tzadman and Karet can
be understood more precisely with the terminology introduced.
With this framework we can understand
what kind of defect the category has for instance
if it is applied or if it is defective and the
harms it may cause to the individual to whom it's applied.
So in the example of autism and
fluorescent life Tzadman and Karet argue that this
is a case of hermeneutical injustice.
This case of hermeneutical injustice arises from a conceptual
lacuna but probably the kind of hermeneutical
injustice here can be better explained as a
hermeneutical clash between the concept of autism
and the fluorescent life. There is an association
between conflicting stereotypes which result in
conceptualizing someone as autistic preventing
him from also being conceptualized as someone
who has a fluorescent life. These conflicting
stereotypes operate as follows. If autism and
other cognitive disabilities in general are
considered objectively bad and something that
to be treated as a personal tragedy for both the
individual and her family regardless of levels of
subjective happiness, this negative stereotyped
concept of autism conflicts with neurotypical
concepts of fluorescent life preventing autistic
people from being conceptualized as being capable
of having a fluorescent life but also a neurotypical
idea of fluorescent life excludes alternative
or neurodivergent ways of fluorescent.
The harms this hermeneutical clash may cause
present this taxonomy by Claudia are epistemic
harms in the sense that individuals who think of
themselves as autistic not applying to themselves
properties as a fluorescent or having a good life,
communicative because individuals who think of
themselves as autistic not being able to communicate
to others how they feel, there is an ethical or
interpersonal harm by which neurotypical having
a distorted understanding of neurodivergent.
It is also an existential harm in the sense that
there are restrictions in how to build one's identity.
Regarding ODD, we can understand
the critics presented as suggesting that ODD
is an imposter concept because it provides a
distorted understanding of certain behaviors.
From these critics it may be considered an
imposter concept because it emerges from an
authority, medical or psychiatric, it provides a
delusive intelligibility, experience and behaviors
are understood as a mental disorder but the target
experience remains obscure, the understandable
and adaptive reactions to racism, marginalization
or other debased forms of oppression.
The harms that an imposter concept may cause are epistemic harms as
Claudia presented, it provides a delusive
understanding of significant experiences
and one's identity, there is an ethical
interpersonal harm because others also
misunderstand one's experiences and identity,
there is an existential harm in the sense that
there is also a restriction in how to build
one's identity and in this case there are not
communicative harms in the sense that a person
diagnosed with ODD can share this with others but
as I said this concept provides a delusive understanding.
According to anti-racist approaches, ODD diagnosis
is argued that ODD diagnosis should be revised
and changed by creating an alternative
nomenclature and replacing terms such as
defiant and opposite and the inclusion of a trauma
specifier for this diagnosis and other factors
such as poverty, difficult health environments
and systemic racist structures. So from these
critics there is a problem with the term
and also with the content in this diagnosis.
In relation to BPD, some feminist critics argue
in favor of maintaining this diagnostic level
because sometimes it's helpful for understanding
and making intelligible some experiences
but sometimes they focus on behaviors that
not fulfill social expectations about women,
take precedence over the trauma experiences.
So these behaviors are viewed as a consequence
of distort or pathological personality rather than responses to trauma.
In this sense we can understand the feminist
criticisms as suggesting that there are imposter
uses of BPD that mask the traumatic experiences
by focusing on the unexpected or unwanted
woman's behavior. The imposter use of BPD may
provide the illusion description of the situation
in the sense that the situation, the behaviors
are seen as a personality disorder, an individual
problem rather than a consequence of trauma or a sexual abuse.
In these cases, a post-traumatic
stress disorder may be a better description but
this relation between some women behaviors like
anger or impulsivity and BPD tends to pathologize
women for these behaviors rather than view them
as understandable reactions to trauma.
The harms that imposter uses may cause are similar to the
imposter concept in the sense that there is
epistemic harm, this delusive understanding
of significant experience and one's identity, an
interpersonal or ethical harm that others also
misunderstand, one's experience as an identity,
an existential harm by this restriction in how
to build one's identity and the concept may
be shared as well as the imposter concept.
So, in summary, our conclusions, we have argued
that some diagnostic categories have been
criticized for contributing to sexism, racism, and ableism.
They may obscure rather than illuminate
social and individual realities, blocking
understanding and promoting a distorted
image of those to whom they are applied.
We have presented different ways in which diagnostic
categories can be defective and expanded this
notion of hermeneutical injustice to capture
one conceptual harm and other conceptual harms.
We hope that the framework of conceptual harms
we have introduced is useful to identify
and understand defects in psychiatric levels
as well as the harms they may cause. Thank you.
>> Thank you so much, Claudia.
We have 15 minutes for Q&A. There is someone in the room
who would like to ask something.
Of course, you can use the language you want to use,
Spanish or English. Victor.
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