Epistemic injustice, children and mental illness

J Med Ethics. 2021 Nov;47(11):729-735. doi: 10.1136/medethics-2021-107329. Epub 2021 Jun 25.


The concept of epistemic (specifically testimonial) injustice is the latest philosophical tool with which to try to theorise what goes wrong when mental health service users are not listened to by clinicians, and what goes right when they are. Is the tool adequate to the task? It is argued that, to be applicable at all, the concept needs some adjustment so that being disbelieved as a result of prejudice is one of a family of alternative necessary conditions for its application, rather than a necessary condition all on its own. It is then argued that even once adjusted in this way, the concept does not fit well in the area where the biggest efforts have been made to apply it so far, namely the highly sensitive case of adult patients suffering from delusions. Indeed it does not serve the interests of service users struggling for recognition to try to apply it in this context, because there is so much more to being listened to than simply being believed. However, the concept is found to apply smoothly in many cases where the service users are children, for example, in relation to children's testimony on the efficacy of treatment. It is suggested that further research would demonstrate the usefulness of the concept in adult cases of a similar kind.

Keywords: children; concept of mental health; ethics; moral psychology; psychiatry.

MeSH terms

  • Child
  • Humans
  • Mental Disorders* / therapy
  • Mental Health Services*
  • Prejudice