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“相信我,只有我知道自己的感受。” 一项关于精神卫生保健中认知不公正经历的自我民族志叙述。

"Believe me, only I know how I feel." An autoethnographic account of experiences of epistemic injustice in mental health care.

作者信息

Hultman Lill, Hultman Maya

机构信息

Department of Social Sciences, Marie Cederschiöld University, Stockholm, Sweden.

Independent Researcher, Stockholm, Sweden.

出版信息

Front Psychiatry. 2023 Feb 23;14:1058422. doi: 10.3389/fpsyt.2023.1058422. eCollection 2023.

Abstract

In Sweden, support and service for people with disabilities is provided under the Swedish disability legislation, which has a clear focus on the individual's right to a life like that of any other citizen and on promoting equality and participation in society. Nevertheless, having a physical impairment makes it clear that equal mental health care is not provided in practice. This becomes particularly salient when there is a need for mental health in-patient care. In this article, the aim is to explore our own experiences of epistemic injustice in relation to mental health care provision in a situation where one of us has a mobility impairment that require the presence of personal assistants in everyday life. Critical personal narrative is applied to highlight the different, but intertwined experiences of a young female mental health user with a physical disability and her mother. Diary entrances, shared discussions and extracts from health care records are used to illustrate how epistemic injustice may occur in health care practices. In the analysis, we use Fricker's concepts that relate to different aspects of epistemic injustice, to show how power is exerted. Healthcare professionals' inability to value and integrate patients experience-based knowledge into practice where the lack of a holistic perspective visualizes what happens when people do not fit into predefined categories. Instead of strengthening patients' rights, health care professionals discredit patients' and family members knowledge, and thereby giving themselves epistemic privilege. People with the combined experience of both disabilities and mental health issues are vulnerable to epistemic injustice and epistemic harm since they are commonly denied both epistemic credibility and authority. Our results highlight the importance of counteracting resilient structures of social privilege and power and identifying and, in as far as possible, removing the mechanisms that exclude the epistemic resources of people with disabilities and their family members from being part of shared epistemic resources.

摘要

在瑞典,根据瑞典残疾立法为残疾人提供支持和服务,该立法明确侧重于个人享有与其他公民一样生活的权利以及促进平等和社会参与。然而,身体有损伤清楚地表明,实际上并未提供平等的心理健康护理。当需要心理健康住院护理时,这一点变得尤为突出。在本文中,目的是探讨在我们其中一人有行动障碍且日常生活需要个人助理在场的情况下,我们自身在心理健康护理提供方面遭遇认知不公正的经历。运用批判性个人叙事来突出一位有身体残疾的年轻女性心理健康服务使用者及其母亲不同但相互交织的经历。日记记录、共同讨论以及医疗记录摘录被用于说明认知不公正如何可能在医疗实践中发生。在分析中,我们使用弗里克与认知不公正不同方面相关的概念,以展示权力是如何施加的。医疗保健专业人员无法重视并将患者基于经验的知识融入实践,在这种情况下,缺乏整体视角使人们不符合预定义类别时所发生的情况显现出来。医疗保健专业人员不是增强患者权利,而是诋毁患者及其家庭成员的知识,从而赋予自己认知特权。同时有残疾和心理健康问题的人容易遭受认知不公正和认知伤害,因为他们通常既被剥夺认知可信度又被剥夺认知权威。我们的结果凸显了抵制社会特权和权力的顽固结构以及识别并尽可能消除那些将残疾人和其家庭成员的认知资源排除在共享认知资源之外的机制的重要性。

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本文引用的文献

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Medicalization and epistemic injustice.医学化与认知不公。
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Still a health issue.仍是一个健康问题。
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Convention on the Rights of Persons with Disabilities.《残疾人权利公约》
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