Antonia Smyth (MA in Philosophy, 2021) ‘Epistemic Injustice in Cases of Compulsory Psychiatric Treatment‘
There is a growing body of philosophical research into epistemic injustice in the psychiatric context; this thesis examines the impact of this distinct form of injustice on people in compulsory psychiatric treatment specifically, that is, on people receiving treatment without their consent. Epistemic injustice poses an intrinsic harm to those who experience it, but it can result in secondary practical consequences. In the case of compulsory psychiatric treatment, these consequences can be severe, including the infringement of peoples’ rights to liberty and autonomy.
I begin with a focus on testimonial injustice, as described by Miranda Fricker. I will show that compulsory treatment cases provide fertile ground for this form of injustice, and explore the idea that testimonial injustice functions at an institutional level in this context. To demonstrate this I use a case study, the Victorian Mental Health Act 2014, focusing particularly on the role of capacity assessments, which I will argue constitute a formal credibility judgment. Fricker’s proposed remedy for testimonial injustice is the cultivation of the virtue of testimonial justice, however, I argue that on its own, this will not be sufficient for combatting institutional testimonial injustice. Examining solutions to this problem, I argue for structural solutions in the form of proposals for legislative and policy changes.
This will require the incorporation of epistemic resources that challenge the dominant clinical perspective, which I hold can and have been developed and disseminated through liberation movements. To that end, I examine the history of Mad Pride and some of the barriers and objections to its aims. Mad activism promotes the view that experiences commonly taken to be illness or disorder under the socially dominant set of epistemic resources are, in fact, grounds for culture and identity, and ought not to be pathologised. I seek to demonstrate not only that the alternative epistemic resources presented by Mad positive activists are valid, but that while it fails to take seriously alternative epistemic resources developed by consumers, survivors, and ex-patients, psychiatry as a discipline cannot properly engage in the democratic discussion required for objective inquiry. I ultimately contend that this will not be possible while compulsory treatment remains a reality, providing an epistemic argument for its elimination.
Supervisor: Associate Professor Karen Jones