<p>This paper analyzes the conception of objectivity in psychiatry as a structural factor that may promote epistemically unjust clinical practices. It argues that because psychiatry primarily relies on patients’ reports of mental symptoms and clinicians’ observations of behavior, it has had to develop ways to address these in a standardized, objective manner. Standardized instruments provide reliability and – presumably – validity in psychiatric assessment and diagnosis. However, by their very nature, they must set aside patients’ perspectives and idiosyncrasies. Understanding objectivity as standardization, this paper argues, promotes treating patients as mere informants or, worse, as sources of information – which may underpin various forms of epistemic injustice, such as hermeneutical or contributory injustice. This paper also addresses recent proposals to include patients’ perspectives in the DSM revision processes, arguing that while this represents a step towards social and epistemic justice, as well as an improvement in diagnostic classification, it remains insufficient for achieving epistemic justice due to the constraints inherent in standardization. The conclusion is that rethinking objectivity beyond standardization is necessary to achieve epistemic justice in psychiatry.</p>

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Objectivity, standardization, and epistemic injustice in psychiatry

  • Virginia Ballesteros

摘要

This paper analyzes the conception of objectivity in psychiatry as a structural factor that may promote epistemically unjust clinical practices. It argues that because psychiatry primarily relies on patients’ reports of mental symptoms and clinicians’ observations of behavior, it has had to develop ways to address these in a standardized, objective manner. Standardized instruments provide reliability and – presumably – validity in psychiatric assessment and diagnosis. However, by their very nature, they must set aside patients’ perspectives and idiosyncrasies. Understanding objectivity as standardization, this paper argues, promotes treating patients as mere informants or, worse, as sources of information – which may underpin various forms of epistemic injustice, such as hermeneutical or contributory injustice. This paper also addresses recent proposals to include patients’ perspectives in the DSM revision processes, arguing that while this represents a step towards social and epistemic justice, as well as an improvement in diagnostic classification, it remains insufficient for achieving epistemic justice due to the constraints inherent in standardization. The conclusion is that rethinking objectivity beyond standardization is necessary to achieve epistemic justice in psychiatry.