This chapter examines how particular ways of knowing become regimes of truth in mental health and addiction services. Using Bhaskar’s critique of the epistemic fallacy and Fricker’s epistemic injustice, I show how measurement is mistaken for reality, and how lived knowledge is discounted as unreliable. Risk tools, symptom scales, and diagnostic codes acquire authority, while narrative meaning becomes administratively inaudible. I track how these epistemologies shape what is recorded, who is believed, and whose pain is converted into “non-engagement.” The chapter calls for epistemological pluralism, bringing lifeworld testimony, practitioner judgment, and community knowledge alongside clinical evidence, so pain is legible on its own terms.