Objectivity Isn’t Neutral: How Standardization in Psychiatry Can Undermine Epistemic Justice
by Samantha Lily (on Mad in America)
Since there are no biological markers or lab tests for most psychiatric conditions, psychiatry has turned to standardization—checklists, psychiatric interviews, and Likert scales—to bring order to what would otherwise be subjective and variable presentations. However, Ballesteros argues that these tools simplify complexity and impose a framework that often excludes what patients themselves consider most significant. They transform narratives into data points and patients into information providers, undermining the possibility of authentic epistemic engagement.
Ballesteros’s analysis builds on the concept of epistemic injustice, a term coined by philosopher Miranda Fricker to describe harms that occur when people are undermined in their capacity as knowers. In the context of psychiatry, Ballesteros argues, this happens when patients are disbelieved, denied the tools to make sense of their own suffering, or excluded from shaping the frameworks that define their experiences.
She identifies three specific forms of epistemic injustice embedded in psychiatric practice:
Testimonial injustice: When a patient’s account is dismissed or not taken seriously.
Hermeneutical injustice: When a patient lacks access to the language or frameworks needed to interpret their suffering.
Contributory injustice: When patient-developed insights or concepts are ignored by clinicians and institutions.
