Degerman Dan
Department of Philosophy, University of Bristol, Bristol, UK.
Med Health Care Philos. 2025 Jun;28(2):247-259. doi: 10.1007/s11019-025-10256-9. Epub 2025 Jan 29.
Silence is a byword for socially imposed harm in the burgeoning literature on epistemic injustice in psychiatry. While some silence is harmful and should be broken, this understanding of silence is untenably simplistic. Crucially, it neglects the possibility that silence can also play a constructive epistemic role in the lives of people with mental illness. This paper redresses that neglect. Engaging with first-person accounts of mania, it contends that silence constitutes a crucial form of epistemic agency to people who experience mania and that the prevailing failure to recognise this may harm them. The paper proceeds as follows. After briefly examining the negative understanding of silence in the epistemic injustice literature, it outlines three epistemically agential silences: communicative silence, listening silence, and withholding silence. It then deploys these concepts to explore how the ability to perform epistemically agential silence is impaired in mania and why such silences are vital to people. The penultimate section highlights two ways that the failure to recognise the epistemic value of silence can harm people with mania. The paper concludes by drawing out implications for future research on epistemic injustice in psychiatry.
在精神病学领域关于认知不公正的新兴文献中，沉默是社会施加伤害的代名词。虽然有些沉默是有害的，应该被打破，但这种对沉默的理解过于简单化，难以成立。至关重要的是，它忽略了沉默在精神疾病患者生活中也能发挥建设性认知作用的可能性。本文纠正了这一疏忽。通过结合对躁狂症的第一人称叙述，本文认为沉默对经历躁狂症的人来说是一种关键的认知能动性形式，而目前普遍未能认识到这一点可能会对他们造成伤害。本文内容如下。在简要审视了认知不公正文献中对沉默的负面理解之后，本文概述了三种具有认知能动性的沉默：交流性沉默、倾听性沉默和保留性沉默。然后，本文运用这些概念来探讨在躁狂症中进行具有认知能动性沉默的能力是如何受损的，以及为什么这种沉默对人们至关重要。倒数第二部分强调了未能认识到沉默的认知价值可能伤害躁狂症患者的两种方式。本文最后阐述了对精神病学中认知不公正未来研究的启示。
