Epistemic injustice refers to harms that relate specifically to our status as epistemic agents, whereby our status as knowers, interpreters, and providers of information, is unduly diminished or stifled in a way that undermines the agent’s agency and dignity. The concept was defined by Miranda Fricker (2007), who identifies two key forms of epistemic injustice. The first is testimonial injustice, which refers to cases where testimony is unduly dismissed because of prejudiced beliefs regarding minority groups. Hermeneutical injustice refers to cases where a community’s shared vocabularies have been structured in a way that unfairly distorts or stifles understanding for, and of, a minority group. In each case, there is an instance of people being harmed specifically in their capacity as knowers: individuals capable of knowing or providing knowledge.

Much work on epistemic injustice has identified the operation of negative stereotypes relating to gender and race; for instance, when someone’s testimony is dismissed, doubted, or accorded low credibility due to racist or sexist prejudices on the part of the listener (Dotson, 2011; Fricker, 2007; Kidd et al., 2017; Medina, 2013). But in recent years research has drawn attention to epistemic injustice in healthcare generally, and more specifically within psychiatry, pediatrics, and among people with disabilities (Blease et al., 2016; Carel & Kidd, 2014; Crichton et al., 2016; Kidd & Carel, 2016, 2019; Potter, 2015). What has been revealed is the systematic stifling of the voices and interpretive tools available to both ill and disabled persons: in particular, their information providing, testimonies, and interpretations. These types of epistemic injustice have been associated with the medical deficit model that dominates much of medical and psychiatric discourse (Kidd & Carel, 2018, 2019). Moreover, physically disabled persons’ claims that they are happy and living good lives have also been dismissed due to prejudices about the possibility of living well whilst disabled (Blease et al., 2016; Carel, 2016, ch. 6).

Neurodiversity, epistemic injustice, and the good human life – Chapman – 2022 – Journal of Social Philosophy – Wiley Online Library

We’ve suggested that autistic individuals encounter testimonial injustice, when they claim to be happy or living good lives, and hermeneutical injustice, seen in the exclusion of neurodivergent modes of flourishing. But it is also vital to consider how these forms of injustice combine and interlock in practice. In day-to-day life, prejudiced stereotypes regarding autistic flourishing and wellbeing culminate in autistic individuals encountering a “catch-22”-like framing, whereby the possibility of being both autistic and living a good life is, to varying extents, unthinkable for many.

Neurodiversity, epistemic injustice, and the good human life – Chapman – 2022 – Journal of Social Philosophy – Wiley Online Library

The central message I wish to convey is that the epistemic justice is an essential component of good psychiatric practice and there is no reason for the attitude of psychiatrists toward this framework to be one of antagonism. Medicine and psychiatry, practiced virtuously, are on the side of epistemic justice.

Epistemic justice is not something that is outside of good clinical care. Good clinical care is inclusive of our best ethical practices; just as good clinical care cannot be racist or sexist, good clinical care cannot be epistemically unjust. We cannot appeal to good clinical care to justify ignoring epistemic justice because epistemic justice clarifies a vital aspect of what good clinical care ought to be.

Epistemic justice is an essential component of good psychiatric care | Psychological Medicine | Cambridge Core

Epistemic injustice pervades autism research in a way that only ever marginalizes autistic people in knowledge creation while providing an almost all-encompassing blanket of protection for non-autistic researchers—non-autistic people have an assumed objectivity that means they do not have to defend their involvement in the creation of knowledge.

Frontiers | Academic, Activist, or Advocate? Angry, Entangled, and Emerging: A Critical Reflection on Autism Knowledge Production

I lean into my emotions because they inform my values, keep me tied to the autistic community, generate my sense of epistemic responsibility to the community I come from. I am open because when autistic students (whether undergraduate or postgraduate) approach me to ask how I handle the experience of feeling and living these accounts, they express a loneliness that silence only serves. I now have a policy of honesty and I tell them: I feel angry.

Frontiers | Academic, Activist, or Advocate? Angry, Entangled, and Emerging: A Critical Reflection on Autism Knowledge Production

Autism has never been free from the people who created it, or who continue to create it. The people who delineated us from any other constitution, or patterns of behaviors by grouping us together based on our behavior and communication, have a routine history of perpetuating the stereotypes that limit us, degrade us, and form the basis of some degree of our oppression. This includes denying us any epistemic authority to give meaning to what it means to be autistic (Frith and Happe, 1999; Frith, 2004) so as to remove access to challenging the constant barrage of deficit and disease framings. Another autistic academic said it best: “autism discourse and I are co-constituted” (de Hooge, 2019). As an autistic I feel the reverberations of the scientific discourse into my personal life—it radiates into social media, informs stereotypes, creates discourses, and ideas of autism that comes to grow amongst our families, friends, colleagues, community, and the strangers we encounter.

Frontiers | Academic, Activist, or Advocate? Angry, Entangled, and Emerging: A Critical Reflection on Autism Knowledge Production