Critical Phenomenology and Hermeneutical Injustice in Mental Health

Today's post is by Rosa Ritunnano (University of Birmingham and Melbourne), consultant psychiatrist and PhD candidate at the Institute for Mental Health, Birmingham, UK. Here she talks her recent paper which has been awarded the 2021 Wolfe Mays Essay Prize for Early Career Researchers by The British Society for Phenomenology (BSP) and the Journal of the British Society for Phenomenology (JBSP). 

Rosa Ritunnano

In this paper, I argue that the adoption of a critical phenomenological stance may improve conditions of hermeneutical marginalisation as experienced by individuals who have attracted a diagnosis of psychosis (although I believe that the suggested approach can be transferrable to other conditions).

In cases of hermeneutical injustice, one is unable to understand their own experience or effectively communicate it to others because they lack an adequate conceptual framework for making sense of this experience. The classic example used in the literature on hermeneutical injustice is women’s inability to adequately understand or describe experiences of sexual harassment before the concept ‘sexual harassment’ was coined and entered popular usage.

In mental healthcare, hermeneutical marginalisation may occur for different reasons. On the one hand, the person may start from a position of disadvantage when it comes to having adequate interpretive tools at their disposal. This is because they may already belong to a (environmentally, economically, socially) disadvantaged group whose access to hermeneutic resources is limited, or because their interpretations are (systemically or individually) dismissed. In the latter situation, individuals may have developed their own hermeneutical tools or equipment to make sense of a certain experience but, despite such understanding, their perspective is not given uptake by the listener(s). This is what philosopher Kristie Dotson has called ‘contributory injustice’. To illustrate, contributory injustice in psychiatry can be found in reports of service users who hear voices, where clinicians (for varied reasons) may refuse to acknowledge alternative ‘non-disease’ ways of understanding these experiences, such as those that draw on spiritual or religious narratives.

In either case, the clinical encounter (i.e, the consultation between mental healthcare professionals and patients) can become a “hermeneutical hotspot”. That is a location in social life “where a group’s unequal hermeneutical participation will tend to show up in a localised manner” (Fricker, p. 152). In this situation, rather than thinking about clinician and patient as two separate epistemic agents, I suggest that we also look at the role of the relational context (and the communicative dynamics) in mitigating or amplifying the hermeneutical hotspot created over time by certain cultural and clinical practices.

I suggest that correcting for hermeneutical injustice requires that both clinicians and patients engage in a form of hermeneutical humility and sincere attentiveness towards the person’s own subjectivity and situated meaning-making processes. As well as paying attention to psychopathological experiences linked with a certain mental health condition, clinicians should be alert to the ways in which contingent historical, autobiographical and social structures (such as colonialism, anti-Black racism, and heteropatriarchy) may shape the lived experience and meaning of such a condition.

I argue that critical phenomenology, intended as a praxis of freedom in seeking a deep transformative societal change, may help address hermeneutical marginalisation even within the limited confines of the clinical encounter. Adopting this stance requires the ability, on the part of the listener, to perceive the other as an expressive and trustworthy epistemic agent, even when their experiential world differs in fundamental ways from their reality (as in the case of psychosis). In these circumstances, rather than trying to avoid the epistemic asymmetry by labelling it as a “problem to be treated”, it may be more helpful to actively navigate and manage it with care, empathy and respect.