Psychiatric diagnosis and hermeneutical injustice: the impact of biomedical diagnoses on personal narratives

Users of mental health services are at risk of becoming victims of epistemic injustice, as described by Miranda Fricker. In this thesis, I claim that they can be victims specifically of hermeneutical injustice, which can occur due to the diagnosis they receive. A psychiatric diagnosis is often taken to represent some kind of discrete disease, as if it connotes a natural kind of disease entity. I argue that many physical diseases can be understood as natural kinds in medical science. However, most psychiatric diagnostic categories cannot be so understood. They do not offer any explanation for the patient’s condition. Much of modern psychiatry is based on the biomedical model of diseases. This model seeks the causes of patients’ illnesses in biological abnormalities in the body. Accordingly, the receipt of a psychiatric diagnosis can convey a biomedical narrative about the nature of the patient’s condition, one that tends to locate the cause of the condition in abnormal brain processes of some kind. The effect of this can be understood in terms of the self-narratives that individuals construct for themselves. I discuss several accounts of narrativity which explain how individuals gain meaning in their lives through their self-narratives. These narratives can be changed by the person’s social circumstances and by extraneous events. Receiving a psychiatric diagnosis is one such event in some people’s lives which can change the recipient’s self-narrative about their life and their difficulties. The medicalization implicit in psychiatric diagnoses conveys a biomedical narrative which may conflict with or diminish the recipient’s previous self- narratives at a time when they will be experiencing significant emotional distress and disturbance. As such, the recipient’s own hermeneutical resources for making sense of their experiences can become marginalised. This can result in the recipients of psychiatric diagnoses becoming victims of hermeneutical injustice.