LAUSR

I’m grateful to the commentators for their thoughtful and thoughtprovoking replies. Psychiatric serviceusers often feel disempowered relative to a profession (psychiatry) and so sometimes enlist the aid of another profession (philosophy) to redress the balance. All well and good, but it is vital in this context not to set one’s critical faculties on one side. Although Dr Kious thinks that is just what I have done, what I was trying to do was to call a halt to the uncritical use of a piece of philosophy, the concept of testimonial injustice. It is a fine tool in many contexts, it is the newest tool in the alliance between psychiatric serviceusers and philosophers, but to think it is apt to address every problem in the complex ethics of the clinician– serviceuser relationship is like insisting there must be a way to fix a problem with the tool you have, whatever the problem and whatever the tool. This isn’t good philosophy, and (I argued) won’t help serviceusers either. It is proper in philosophy to do the best one can for one’s opponent. So, rather than dismissing the concept of testimonial injustice as inapplicable in psychiatric contexts on the basis of the letter of Fricker’s book, I try out various adjustments in the spirit of the original. This is the principle of charity, not ‘stretching’ an ‘accepted’ concept, still less assuming that if you think you have been wronged then you have been. As the CYP examples show (though I stressed that we need more evidence, and I’m grateful to Pham et al for contributing theirs), it looks as if it sometimes does apply in psychiatric contexts, though contexts very different from those described by Sanati and Kyratsous. But if, stretched as far as sympathetically possible, the tool still doesn’t do the job, it is time to look for other tools. That’s the main conclusion of the paper: a concept that is about what can go wrong in believing people won’t get a grip on utterances—like delusional utterances— whose primary goal is not to secure belief. Dr Kious points out that psychiatrists don’t think that is their goal, but that’s fine by me: my disagreement was with overenthusiastic philosophers, not with psychiatrists. At no point in the paper did I say or imply that psychiatrists are not committed to listening attentively to their patients. Indeed I cite evidence that attentive listening is therapeutically valuable: why would I think that if I believed it never happened? I also readily acknowledge— as I did not in the paper—that clinicians make decisions in situations of considerable pressure and uncertainty. However, if a certain sort of mistaken judgment is made under pressure, that doesn’t vindicate the judgment but tends rather to excuse it. I gave no opinion as to how ‘seriously wrong’ such misjudgments are. My interest was in analysing them: testimonial injustice or not? In some cases, yes, but in others it helps neither philosophy nor serviceuser advocacy to insist that it is.