Psychological Medicine cambridge.org/psm Editorial Cite this article: Kious BM, Lewis BR, Kim SYH (2023). Epistemic injustice and the psychiatrist. Psychological Medicine 53,1–5. https://doi.org/ 10.1017/S0033291722003804 Received: 28 July 2022 Revised: 5 October 2022 Accepted: 29 November 2022 First published online: 5 January 2023 Keywords: Epistemic injustice; psychiatry; clinical ethics Author for correspondence: Brent M. Kious, E-mail: brent.kious@hsc.utah.edu © The Author(s), 2023. Published by Cambridge University Press Epistemic injustice and the psychiatrist Brent M. Kious 1 , Benjamin R. Lewis 1 and Scott Y. H. Kim 2 1 Department of Psychiatry, University of Utah, 501 Chipeta Way, Salt Lake City, UT 84108, USA and 2 Department of Bioethics, National Institutes of Health, 10 Center Drive, Bethesda, MD 20814, USA Abstract Background. Psychiatrists depend on their patients for clinical information and are obligated to regard them as trustworthy, except in special circumstances. Nevertheless, some critics of psychiatry have argued that psychiatrists frequently perpetrate epistemic injustice against patients. Epistemic injustice is a moral wrong that involves unfairly discriminating against a person with respect to their ability to know things because of personal characteristics like gender or psychiatric diagnosis. Methods. We review the concept of epistemic injustice and several claims that psychiatric practice is epistemically unjust. Results. While acknowledging the risk of epistemic injustice in psychiatry and other medical fields, we argue that most concerns that psychiatric practice is epistemically unjust are unfounded. Conclusions. The concept of epistemic injustice does not add significantly to existing stan- dards of good clinical practice, and that it could produce changes in practice that would be deleterious. Psychiatrists should resist calls for changes to clinical practice based on this type of criticism. Introduction Practicing psychiatrists balance many considerations when evaluating information provided by their patients: a general need to believe what patients say, a recognition that any person’s account of events can be mistaken, and the importance of maintaining a solid therapeutic rela- tionship. Recently, commentators from within and outside of psychiatry have tried to compli- cate this balance by arguing that psychiatrists should strive to avoid epistemic injustice in their interactions with their patients, but that they are frequently guilty of perpetrating it (Bueter, 2019; Crichton, Carel, & Kidd, 2017; Drożdżowicz, 2021; Gagné-Julien, 2021; Harcourt, 2021; Kurs & Grinshpoon, 2018; Sanati & Kyratsous, 2015). Epistemic injustice (EI) involves unfairly discriminating against a person with respect to their ability to know things. The concept was developed by the philosopher Miranda Fricker to articulate how persons in minoritized groups can be further marginalized in the public and private exchange of information (Fricker, 2007). But this is not merely a philosoph- ical debate. The concept has been utilized in multiple domains to advocate for social change, including in medicine. Calls for epistemic justice in psychiatry have appeared in practice-oriented journals (Crichton et al., 2017), been touted as a foundation for clinical reform (Zisman-Ilani, Roth, & Mistler, 2021), and are closely allied with other efforts to revamp traditional approaches to care (Carrotte, Hartup, Lee-Bates, & Blanchard, 2021; Daya, Maylea, Raven, Hamilton, & Jureidini, 2020; Groot, Haveman, & Abma, 2020; Harcourt, 2021; Tate, 2019). We think EI is illuminating in some domains, and are sympathetic to the concerns that presumably motivate those applying it to psychiatry: there is much our field has done poorly, and more it could do better. In what follows, however, we hope to persuade readers that, as a way of regulating practice, EI adds little to ordinary standards of good clinical care, while too much emphasis on it could entail serious harm to patients, providers, and their relationships. Are psychiatrists epistemically unjust? Fricker identifies two kinds of EI. Testimonial injustice arises when an individual’s factual report about some issue is ignored or taken to be unreliable because of individual character- istics that are not related to her epistemic (knowledge-having) ability (Fricker, 2007). A patient who reports that she is in pain but who is disregarded because of her race or gender would be a victim of testimonial injustice, since her race and gender have nothing to do with her knowl- edge. The second is hermeneutic injustice. There, an individual’s knowledgeable reports fail to receive adequate attention because she, her listeners, or society as a whole lack the conceptual resources to interpret them. Fricker gives the compelling example of sexual harassment: prior to the development of the concept, women’s concerns about certain kinds of sexually oriented https://doi.org/10.1017/S0033291722003804 Published online by Cambridge University Press