Kyratsous Michalis, Sanati Abdi
South London and Maudsley NHS Foundation Trust & Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.
North East London NHS Foundation Trust, Ilford, UK.
J Eval Clin Pract. 2017 Oct;23(5):974-980. doi: 10.1111/jep.12609. Epub 2016 Aug 4.
Miranda Fricker's concept of epistemic injustice has been quite a novel idea in epistemology. It brings something new to the fields of epistemology and ethics. Fricker draws our attention to a distinctive species of injustice, the epistemic injustice, in which someone is specifically wronged in his capacity as a knower. There has been a significant amount of work done in epistemic injustice, both in race and gender studies. The application of the concept in the context of mental health is less explored. Here, we aim to apply the concept of epistemic injustice in attributing responsibility to patients with borderline personality disorder. Attributing responsibility involves holding someone accountable for his presumed wrongdoings, making judgments on whether the agent has control on his action, on whether is aware of its consequences. It is generally agreed that in order to be morally responsible for an action the person should be worthy of praise or blame for it. Following Aristotle, we focus on epistemic condition in attribution of responsibility. We will discuss the role of epistemic injustice in assessment of epistemic condition of responsibility. We will show that we can misinterpret the agent's intentions because of the presence of systematic prejudices. We will focus on patients suffering from borderline personality disorder. We provide a case vignette to show a tendency in the professionals in holding these patients responsible for their action when it can be argued otherwise. We argue that prejudice against the patient with borderline personality disorder where the person is seen as manipulative plays a significant role in the process of epistemic injustice. The suggested manipulative nature of patients with borderline personality disorder leads to professionals to ascribe agency and knowledge where it is not due.
米兰达·弗里克的认知不公正概念在认识论中是一个相当新颖的观点。它给认识论和伦理学领域带来了新的东西。弗里克让我们注意到一种独特的不公正形式，即认知不公正，在这种不公正中，某人作为认知者的能力受到了特别的伤害。在种族和性别研究中，已经有大量关于认知不公正的研究工作。该概念在心理健康背景下的应用较少被探讨。在这里，我们旨在将认知不公正的概念应用于边缘型人格障碍患者的责任归因。责任归因涉及让某人对其假定的不当行为负责，判断行为者是否对其行为有控制权，是否意识到其后果。人们普遍认为，为了对一个行为负有道德责任，这个人应该因其行为而值得赞扬或受到责备。遵循亚里士多德的观点，我们将重点放在责任归因中的认知条件上。我们将讨论认知不公正在责任认知条件评估中的作用。我们将表明，由于系统性偏见的存在，我们可能会误解行为者的意图。我们将关注边缘型人格障碍患者。我们提供了一个案例 vignette，以展示专业人员在可以有其他观点的情况下，倾向于让这些患者对自己的行为负责。我们认为，对边缘型人格障碍患者的偏见，即认为他们具有操纵性，在认知不公正的过程中起着重要作用。边缘型人格障碍患者所谓的操纵性导致专业人员在不应归因的地方归因能动性和知识。
