Department of Philosophy, University of Sheffield, Sheffield, England.
J Eval Clin Pract. 2024 Aug;30(5):848-854. doi: 10.1111/jep.13971. Epub 2024 Feb 20.
When one is seriously ill, the diagnosis given can generate questions about what it means and how to make sense of it. This is particularly the case for psychiatric diagnoses which can convey a biomedical narrative of the sufferer's condition. Making sense of one's diagnosis in such cases can involve changing one's self-narrative in such a way as to incorporate the belief that one has developed a disease with an unknown cause. To demonstrate the importance of self-narratives, I outline key themes in narrative theory which have been explored in various ways by philosophers and some psychologists. These theorists emphasise the importance of self-narratives in creating meaning for their authors. The biomedical narrative associated with a psychiatric diagnosis may conflict with the recipient's previous self-narratives. This may reduce the recipient's sense of self-efficacy and induce feelings of hopelessness about recovery. I argue that those receiving a psychiatric diagnosis may consequently be vulnerable to epistemic injustice. In particular, this includes hermeneutical injustice, where individuals lack the ability to understand or articulate their experiences in ways that make sense to them, due to their hermeneutical resources being marginalised by the dominant narrative in a medicalized environment. I consider two possible objections to my claim and offer answers to these.
当一个人病重时，医生给出的诊断结果可能会引发很多疑问，比如这个结果意味着什么，以及应该如何理解。对于精神科诊断来说尤其如此，因为这类诊断可能传达了一种关于患者病情的生物医学叙述。在这种情况下，要理解自己的诊断，可能需要改变自己的自我叙述，从而接受自己患上了一种病因不明的疾病这一信念。为了说明自我叙述的重要性，我概述了叙事理论中的一些关键主题，哲学家和一些心理学家以不同的方式对这些主题进行了探讨。这些理论家强调了自我叙述在为作者创造意义方面的重要性。与精神科诊断相关的生物医学叙述可能与接受者之前的自我叙述相冲突。这可能会降低接受者的自我效能感，并导致他们对康复感到绝望。我认为，那些接受精神科诊断的人可能因此容易受到认知不公正的影响。特别是，这包括解释性不公正，由于在一个医学化的环境中，占主导地位的叙事使个体的解释性资源边缘化，因此他们可能缺乏以对自己有意义的方式理解或表达自己的经验的能力。我考虑了对我观点的两个可能的反对意见，并对这些意见进行了回答。
