Overcoming Epistemic Injustice: Social and Psychological Perspectives 1786607050, 1786607069, 9781786607058, 9781786607072

Citation preview

Overcoming Epistemic Injustice

Collective Studies in Knowledge and Society Series Editor: James H. Collier is Associate Professor of Science and Technology in Society at Virginia Tech This is an interdisciplinary series published in collaboration with the Social Epistemology Review and Reply Collective. It addresses questions arising from understanding knowledge as constituted by, and constitutive of, existing, dynamic, and governable social relations. Titles in the Series The Future of Social Epistemology: A Collective Vision, edited by James H. Collier Social Epistemology and Technology: Toward Public Self-Awareness Regarding Technological Mediation, edited by Frank Scalambrino Socrates Tenured: The Institutions of 21st-Century Philosophy, Robert Frodeman and Adam Briggle Social Epistemology and Epistemic Agency, edited by Patrick J. Reider Democratic Problem-Solving: Dialogues in Social Epistemology, Justin Cruickshank and Raphael Sassower The Kuhnian Image of Science: Time for a Decisive Transformation?, edited by Moti Mizrahi Taking Conspiracy Theories Seriously, edited by M. R. X. Dentith Overcoming Epistemic Injustice: Social and Psychological Perspectives, edited by Benjamin R. Sherman and Stacey Goguen Heraclitus Redux: Technological Infrastructures and Scientific Change, Joseph C. Pitt (forthcoming) Minority Report: Dissent and Diversity in Science, William T. Lynch (forthcoming)

Overcoming Epistemic Injustice Social and Psychological Perspectives Edited by Benjamin R. Sherman and Stacey Goguen

London • New York

Published by Rowman & Littlefield International, Ltd. 6 Tinworth Street, London SE11 5AL www.rowmaninternational.com Rowman & Littlefield International, Ltd. is an affiliate of Rowman & Littlefield 4501 Forbes Boulevard, Suite 200, Lanham, Maryland 20706, USA With additional offices in Boulder, New York, Toronto (Canada), and London (UK) www.rowman.com Copyright © 2019 by Benjamin R. Sherman and Stacey Goguen Copyright in individual chapters is held by the respective chapter authors. All rights reserved. No part of this book may be reproduced in any form or by any electronic or mechanical means, including information storage and retrieval systems, without written permission from the publisher, except by a reviewer who may quote passages in a review. British Library Cataloguing in Publication Information A catalogue record for this book is available from the British Library ISBN: HB 978-1-78660-705-8 ISBN: PB 978-1-78660-706-5 Library of Congress Cataloging-in-Publication Data Available ISBN: 978-1-78660-705-8 (cloth : alk. paper) ISBN: 978-1-78660-706-5 (pbk. : alk. paper) ISBN: 978-1-78660-707-2 (electronic) TM The paper used in this publication meets the minimum requirements of American National Standard for Information Sciences—Permanence of Paper for Printed Library Materials, ANSI/NISO Z39.48-1992.

Contents

Acknowledgments

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Introduction

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I: Managing Psychological Tendencies 1 Negative Epistemic Exemplars Emily Sullivan and Mark Alfano 2 Positive Stereotypes: Unexpected Allies or Devil’s Bargain? Stacey Goguen 3 Conceptualizing Consent: Hermeneutical Injustice and Epistemic Resources Audrey Yap 4 Structural Thinking and Epistemic Injustice Nadya Vasilyeva and Saray Ayala-López 5 The Inevitability of Aiming for Virtue Alex Madva 6 Can Epistemic Virtues Help Combat Epistemologies of Ignorance? Emily McWilliams II: Curing Epistemic Injustice in Healthcare 7 Epistemic Microaggressions and Epistemic Injustices in Clinical Medicine Lauren Freeman and Heather Stewart 8 Returning to the “There Is”: PTSD, Phenomenology, and Systems of Knowing MaryCatherine McDonald v

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Contents

9 Pathocentric Epistemic Injustice and Conceptions of Health Ian James Kidd and Havi Carel 10 Uncovering Prejudice and Where It Lives: Stereotype Mapping in Professional Domains Elianna Fetterolf 11 Epistemic Injustice in Careers: Insights from a Study with Women Surgeons Katrina Hutchison III: Arresting Epistemic Injustice in the Legal and Correctional Systems 12 The Episteme, Epistemic Injustice, and the Limits of White Sensibility Lissa Skitolsky 13 Carceral Medicine and Prison Abolition: Trust and TruthTelling in Correctional Healthcare Andrea J. Pitts 14 Epistemic Injustice and Medical Neglect in Ontario Jails: The Case of Pregnant Women Harry Critchley IV: Learning to Overcoming Epistemic Injustice in Academia, Education, and Sports 15 Teaching as Epistemic Care Casey Rebecca Johnson 16 When Testimony Isn’t Enough: Implicit Bias Research as Epistemic Exclusion Lacey J. Davidson 17 Gaslighting as Epistemic Violence : “Allies,” Mobbing, and Complex Posttraumatic Stress Disorder, Including a Case Study of Harassment of Transgender Women in Sport Rachel McKinnon

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Afterword Miranda Fricker

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Index

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About the Contributors

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Acknowledgments

The editors would like to thank Jim Collier for his support and inspiration in getting this volume started; Isobel Cowper-Coles for seeing it through its approval; Natalie Linh Bolderston for her help and guidance in getting it completed; and all of our contributors for their fantastic work. Ben Sherman would like to thank Miranda Fricker for inspiring him to look at ethics, epistemology, and prejudice in new ways; Sally Haslanger and the MIT Workshop on Gender and Philosophy for encouraging early work in this direction; Mark Alfano, Lacey Davison, Daniel Kelly, and Natalia Washington for being early commentators and suggesting exciting new directions; the Brandeis University Department of Philosophy for their continuing support; and Stacey Goguen for her advice, guidance, insight, hard work, and providing most of the knowledge capital in this project.

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Introduction

The chapters collected in this book share a common motivation: all respond to certain kinds of injustice, and, more specifically, kinds of injustice that unfairly and unreasonably prevent the insights and intellectual abilities of vulnerable and stigmatized groups from being given their due recognition. These kinds of injustice are, of course, very old, even if their specific forms change over time, and talk in terms of “epistemic injustice” is new. The problems that many now easily recognize as epistemic injustice— unjust credibility deficits, active ignorances, unequal power to label and describe the world, and so on—have been investigated and theorized by a wide variety of scholars in previous decades. We find these investigations in the countless discussions of silencing as a tactic of oppression, in W. E. B. Du Bois’s discussion of “the veil” and “double consciousness” ([1903] 1994), in Foucault’s discussion of labeling as an expression of power (e.g., [1963] 1994 and [1977] 1990), in Frantz Fanon’s articulation of “psychic alienation” (1967), in Marilyn Frye’s notion of “arrogant perception” (1983), in Maria Lugones’s articulation of the refusal of the privileged to worldtravel (1987), in Gayatri Spivak’s discussion of “epistemic violence” (1988), in Sandra Bartky’s discussion of “psychological oppression” (1990), in Patricia Hill Collins’s discussion of stereotypes as unjustly controlling images (1991), and in innumerable other conversations. Discussions at the intersection of ethics and epistemology more broadly have also have a longer history in analytic philosophy than some have realized. At least since W. K. Clifford’s essay “The Ethics of Belief” ([1877] 1999) such philosophers have noted that it can be immoral to fail to seek out evidence that could overturn incorrect beliefs, and at least since Lorraine Code’s Epistemic Responsibility (1987) it has been clear that effective truth-seeking requires a whole network of ethical commitments. 1

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Miranda Fricker began using the term “epistemic injustice” in print in her 1998 paper “Rational Authority and Social Power: Towards a Truly Social Epistemology,” and the term gained much wider use after the publication of her celebrated 2007 book Epistemic Injustice: Power and the Ethics of Knowing. It has caught on in part because it helps to succinctly name kinds of wrongdoing that have become more evident since we—as a society and an academic discipline—have become increasingly concerned about identity prejudices, and the harms they cause. Epistemic injustices are simultaneously ethically wrong and epistemically unreasonable, and Fricker’s term helps to highlight the close interrelation between the ethical and the epistemic, in at least the two following ways: 1. While injustices typically involve harming someone’s interests in some way or other, epistemic injustices more specifically involve harming people in their capacities as knowers. Identity prejudices frequently lead to marginalized people being treated as less credible than they really are. This leads to a range of unjust harms—people marginalized this way are likely to receive lower pay, receive less social prestige and the power that goes with it, and may face structural legal disadvantages. But, in a more direct and fundamental way, underestimating someone’s credibility denies them the intellectual authority they deserve. It interferes with the credit they are given in the knowledge economy, however it might affect their participation in the financial economy. And, to the extent that it undermines individuals’ trust in their own judgment and reasoning, it can diminish their sense of intellectual agency. 2. While unreasonable thinking can produce injustices in various ways, identity prejudices tend to have the additional effect of making the irrationality less likely to be corrected. Fricker characterized epistemic injustice as a kind of misjudgment—identity prejudices lead to incorrect assessments of others’ credibility. And, when people are systematically misjudged and underestimated, that makes it all the less likely that they will be believed if they point out the error. If we think of epistemic injustices as a kind of misjudgment, as Fricker initially did, then, strictly speaking, it would be impossible for someone to knowingly and intentionally commit epistemic injustices. In the discussion of epistemic injustice that has followed Fricker, many have embraced a wider use of the term, so that it can include, for instance, knowing slander, malicious exclusion, intentional gaslighting, and the like. But even in this wider use, epistemic injustice still has the effect of protecting collective errors from being corrected. When marginalized groups’ insights are undervalued, or they are prevented from participating in collective conversation, or even taught to undervalue their intellectual powers so they are less inclined to participate in inquiry and argument, dominant groups miss opportunities to swap error for truth. And, when certain kinds of

Introduction

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error tend to maintain the privileges of dominant groups, the results tend to be self-perpetuating. Fricker was by no means the first to note the vicious circle where identity prejudices lead to marginalized people’s insights being neglected, and this neglect being one factor maintaining the power of identity prejudices. This vicious circle has been discussed by a wide range of scholars and activists, especially in feminist and antiracist circles. But Fricker’s work has played a major role in framing discussion of these issues in the analytic philosophical tradition. The vocabulary, argumentation, and insight she has contributed to the subject has attracted new attention to the subject, and set the terms of the discussion. TYPES OF EPISTEMIC INJUSTICE Fricker’s book, Epistemic Injustice, defines two important types of epistemic injustice. She does not claim that these are the only two types, and other thinkers have suggested additional forms of epistemic injustices that do not fall under Fricker’s definitions. Here we will introduce four widely discussed kinds of epistemic injustice. These should not be taken as an exhaustive list, but they cover the varieties that are most discussed in this volume. A. Testimonial Injustice The first form of epistemic injustice Fricker defines is the most familiar. Even those with a very simplistic understanding of racism or sexism can readily grasp the basic concept, though Fricker’s discussions add considerable complexity and nuance. Her initial definition runs as follows: Testimonial injustice occurs when a prejudice causes a hearer to give a deflated level of credibility to a speaker’s word (2007, 1). Put a little more plainly, we commit a testimonial injustice when we don’t trust what someone says as much as we should, because prejudice makes us underestimate them. Though this basic idea is easy enough to explain, there are layers of complexity that Fricker teases out. To mention a few: First, someone who commits a testimonial injustice makes a mistake, but it is not simply an “innocent error”; there is something ethically culpable in the way they make this mistake. It involves not only a kind of intellectual carelessness, but also harmful and immoral attitudes (21–22). Second, while Fricker recognizes that there are various marginal cases that might arguably be called testimonial injustices, the cases she takes to be central and paradigmatic involve systematic prejudices, “specifically those prejudices that track the subject through different dimensions of social activity—economic, educational, professional, sexual, legal, political, religious,

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and so on” (27). While people can have individual grudges, professional dogmas, and even idiosyncratic stereotypes about entire groups, these are not systematic prejudices in Fricker’s sense unless they are widely shared enough to have broad-based impacts on someone’s life. Third, she takes testimonial injustice to involve deflated credibility judgments—and not inflated credibility judgments—because she takes epistemic injustice to cause harm in a specific kind of way. There are certainly situations where someone’s interests can be harmed because others overrate their credibility, and unusual situations where someone’s interests are served by being underestimated (18–20). But Fricker takes these kinds of effects to be incidental, whereas she draws attention to “a distinctively epistemic injustice . . . a kind of injustice in which someone is wronged specifically in her capacity as a knower,” which would paradigmatically “undermine, insult, or otherwise withhold a proper respect for the speaker qua subject of knowledge” (20). Fourth, though both terms admit a range of interpretations, Fricker clarifies that she does not take all stereotypes—not even all credibility stereotypes—to be prejudicial. She takes stereotypes to be “widely held associations between a given social group and one or more attributes” (30). By this definition, pretty much all stereotypes have the potential to be incorrect sometimes, so they all carry some epistemic risk, but they are also indispensible for navigating the social world. When we assume (pending evidence to the contrary) that drivers will stop at stoplights, we are employing stereotypes, and would have trouble crossing the street without doing so. A prejudice, on the other hand, she takes to be “a pre-judgement, where this is most naturally interpreted . . . as a judgement made or maintained without proper regard to the evidence” (33). Finally, Fricker notes that epistemic bad luck can play a role in epistemic injustice, and the degree of epistemic bad luck someone encounters helps define the boundary between epistemic injustice and innocent errors. Someone’s life experiences can present them with a sufficiently misleading body of evidence that false identity stereotypes are not irrational at all, but completely justified. In a case like this, Fricker would argue the individual does not, strictly speaking, commit an epistemic injustice when these stereotypes influence their credibility judgments, even if those misjudged are harmed in their capacities as knowers (33–34). But it is probably relatively rare that someone can claim this extent of epistemic bad luck. Much more often, prevailing beliefs and socially highlighted evidence make it easy to accept prejudicial stereotypes, and difficult to see through them . . . but people could see through them by being more rational and intellectually careful. When someone would need to exert much greater effort than we would normally demand in order to see through widespread prejudices, Fricker proposes that there might be cases in which testimonial injustices are not strictly blame-

Introduction

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worthy (101–06). In such cases, she suggests a more appropriate attitude might be “a certain resentment of disappointment” (106). B. Hermeneutical Injustice If we focus strictly on individual errors, as Fricker does with testimonial injustice, we find that some harms are innocent mistakes or nonblameworthy failures to go above and beyond what is normally expected. But Fricker defines another kind of epistemic injustice where the wrongdoing is clearly collective and structural. At this level, individual culpability is harder to discern, and it becomes clear that correcting the problem must be a collective endeavor. Her initial definition runs as follows: hermeneutical injustice occurs . . . when a gap in collective interpretive resources puts someone at an unfair disadvantage when it comes to making sense of their social experiences. (2007, 1)

Fricker illustrates this kind of injustice with the concept “sexual harassment.” Before this term was coined, she notes, many women had experiences of a certain kind of bad treatment, but lacked resources to explain to others what was wrong with the treatment. If it fell short of physical assault, the treatment they experienced would often be interpreted as compliments or flirting. Many women struggled to understand what it was in their experience that was bad and harmful. The introduction of the term “sexual harassment” helped to give a name to widespread and systematically harmful experiences women (and others) had shared, and enabled them to make their grievances better known and understood. As with testimonial injustice, Fricker notes that not all harmful gaps are unjust. If conceptual gaps are the result of entirely novel situations, discoveries, or technologies, it may be inevitable that our shared conceptual vocabulary will take a little while to catch up. (The first time someone was doxxed online, the fact that “doxxing” was not yet a shared concept was not a hermeneutical injustice.) But sexual harassment was hardly a new phenomenon when the term was popularized in the 1960s and 1970s. The fact that this widely shared experience had not been named pointed to a deeper problem. Women had been, collectively and systematically, excluded from the cultural processes that develop shared concepts and understandings. This exclusion was sometimes more stringent and sometimes less, and it took many different forms. It could survive some number of women playing important and highly visible roles in society. And, because it involved shared conceptual resources, it was a problem that no individual could hope to overcome. Many people collectively would need to be aware of certain experiences and have a shared way of understanding them—a collective change was needed.

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Part of the nature of hermeneutical injustice is that it will be hard for people—especially those with more privileged social identities—to notice where there are gaps in their collective understanding. Rather, the basis for this injustice is exclusion of marginalized groups from the collective meaning-making process. Wherever groups are denied the opportunity to articulate their experiences, be heard by others, and reach new collective understandings, the situation is ripe for hermeneutical injustice. C. White Ignorance, Male Ignorance, and Other Epistemologies of Ignorance Around the time Fricker was first using the term “epistemic injustice” in print, Charles Mills discussed what he called a racial “epistemology of ignorance” in his book The Racial Contract (1997, 17–19). The idea gained popularity over roughly the same span of years as Fricker’s idea of epistemic injustice, and Mills fleshed out his idea further in the essay “White Ignorance,” in the 2007 collection Race and Epistemologies of Ignorance (Sullivan and Tuana 2007). We join many others in taking the scope of white ignorance to at least sometimes constitute a form of epistemic injustice, and to be distinct from both testimonial injustice and hermeneutic injustice. Mills recognizes that ignorance is frequently innocent; there are indefinitely many truths that are difficult or currently impossible for us to know, and so these forms of ignorance are not blameworthy. But white ignorance he formulates as something distinct from just truths that white people (among many others) innocently fail to know. Rather, the idea of white ignorance is “the idea of an ignorance, a non-knowing, that is not contingent, but in which race—white racism and/or white racial domination and their ramifications— plays a crucial causal role” (Mills 2007, 20). Within a system of white domination, he proposes, There is an understanding about what counts as a correct, objective interpretation of the world, and for agreeing to this view, one is (“contractually”) granted full cognitive standing in the polity, the official epistemic community. But . . . in a racial polity . . . officially sanctioned reality is divergent from actual reality. So here, it could be said, one has an agreement to misinterpret the world. One has to see the world wrongly, but with the assurance that this set of mistaken perceptions will be validated by white epistemic authority, whether religious or secular. (17–18)

Whereas testimonial injustice involves credibility judgments, white ignorance will often involve a failure to even entertain a proposition, notice a state of affairs, or remember an uncomfortable fact that has been learned. In some cases it may be maintained through suspension of judgment, or other ways of having no opinion at all on a matter. It can often be the result of morally

Introduction

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objectionable attitudes, such as when lack of concern for police violence against black citizens is due to a lack of concern for the well-being of those citizens. But it can also be the result of racial privilege; white people may lack knowledge, or even opinions, about various matters that they have little personal need or incentive to know about. White ignorance of residential segregation, for instance, may not be driven by approval of nonwhite people being excluded; it may simply not be noticed, since white tenants and homebuyers do not encounter problems moving where they like. Nonwhite citizens, and especially black citizens, will often not have the luxury of failing to notice residential segregation. It is open to interpretation whether white ignorance is always a form of epistemic injustice. We venture that sometimes it is not; ignorance about some injustices (e.g., about straightforward harms and deprivations) may be unjust, yet not qualify as epistemic injustices, when the harms have little to do with harming people in their capacity as knowers. But a large portion of the time, white ignorance involves a failure to recognize and appreciate what nonwhite people know, and a failure to attend to facts that support the credibility of nonwhite people. Mills notes that white ignorance is not the only form of ignorance driven by supremacy and privilege. The specific details of white ignorance will differ from parallel forms of ignorance because the specific history and circumstances of each form of privilege is different. He mentions male ignorance as one clear instance. But also, as different regions and nations have somewhat different axes of privilege and domination, the specific forms of ignorance will differ between them. As Mills notes, the U.S. one-drop rule does not apply in Jamaica. So in my native country I am not black, but brown, a member of the relatively privileged intermediate social group who, with independence, take over the reins of government, even if the white minority continue to have differential economic power and influence. . . . So if I have written about “white ignorance” in my work in reference to the United States, I have to confess that I have in my own time been guilty of a “brown ignorance” in my own country, as a member of a group categorized by some strains of Jamaican black nationalism in the 1960s as complicit with the white elite occupying the peak of the Jamaican white/brown/black social pyramid. (Mills 2016, 102–03)

D. Willful Hermeneutical Ignorance The last distinct form of epistemic injustice we will discuss here combines elements of hermeneutical injustice and privileged ignorance. In Fricker’s account of hermeneutical injustice, she concentrates on situations where marginalized individuals are denied the opportunity to develop the conceptual

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resources needed to make sense of their own experience. Her key examples (concepts like “sexual harassment” and “postpartum depression”) are drawn from the history of sexist oppression, and one feature of that kind of oppression (at least as practiced in the white middle and upper classes of the Eurocolonial world) was that women were frequently not only marginalized, but separated from each other, and given little opportunity to develop mutual understandings with others who shared their experience. But, as Gaile Pohlhaus Jr. points out, some forms of oppression—such as racial segregation— leave members of the oppressed group with opportunities to talk with each other and develop concepts that help them express and understand their experiences of oppression (Pohlhaus 2012, 724). Cases like these can be quite unlike the cases Fricker describes as hermeneutical injustice. The oppressed are often perfectly well able to express and conceptualize their experiences. But the privileged will often ignore or disparage new concepts and understandings developed by the oppressed. If the privileged are confused by what they hear, and decide not to try to understand novel concepts, or not to think through them well enough to reach more than a surface level comprehension, then the privileged commit a form of epistemic injustice that Pohlhaus terms “willful hermeneutical ignorance” (Pohlhaus 2012). In such cases, the privileged take part in creating situations where they are unable to understand the experiences of the marginalized, through earlier patterns of derision, neglect, or uncharitable responses. THE AIM OF THIS VOLUME: FIGURING OUT HOW TO DO BETTER Epistemic injustice has attracted considerable scholarly attention in recent years. This is not the first volume of chapters, or even original papers, to be published on the topic. Rather, this volume is organized about two concerns that are already widespread in the literature, but are not always a focus. First, the chapters in this volume are interested in how we can do better. We imagine that most thinkers who discuss epistemic injustice care about this on one level or another. But the subject of epistemic injustice raises various conceptual and metaphysical questions, and sometimes these are what draw in scholarly attention. We do not deny that these are interesting and important questions, and sometimes research along these lines produces insights important for overcoming epistemic injustice. But we were motivated by a more direct interest: we want to do better, and we solicited chapters that offer suggestions on how. Second, the chapters in this volume deal, at some level or another, with empirical research, to better understand what goes wrong, and how to improve. The reason for this focus is that we think it is not always obvious how

Introduction

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to avoid committing epistemic injustices. People of good will can oppose epistemic injustice and still not be sure how to proceed, or can try to do better and yet employ counterproductive strategies. When epistemic injustices are intentional, of course, a first step is obvious: don’t intentionally commit them. But most forms of epistemic injustice are at least sometimes unintentional. (Even willful hermeneutical ignorance may not involve any intent to misunderstand others, but only a lack of will to do the work required to understand what they mean. This can then lead to entirely unintentional confusion.) Some kinds of epistemic injustice, like testimonial injustice in Fricker’s sense, are arguably unintentional by definition. The idea for this volume grew out of a series of replies and responses 1 to a paper Ben Sherman published in Social Epistemology (Sherman 2015a). His paper was largely critical of what (Sherman takes to be) Fricker’s proposal for overcoming testimonial injustice (at least in her 2007 book). Fricker’s position is grounded in a virtue theory of ethics, and she proposes that the way to do better is to try to develop a virtue that either prevents or corrects for testimonial injustices: the virtue of testimonial justice. She proposes we develop this virtue by cultivating good habits: when we have underestimated someone’s credibility, we should reflate our credibility judgments. Sherman mentioned several doubts about this remedy. Some of these were not novel. For instance, many (e.g., Anderson 2012) have questioned whether Fricker’s proposed solutions to testimonial injustice are unduly individualistic. It may be that individuals simply cannot monitor their own injustice, and motivate their own efforts to be just, as well as others can. If we are better at calling out others’ mistakes than we are at catching our own, it would be better to form mutual-improvement partnerships than to try to become individually virtuous. Moreover, there are grounds for skepticism about virtue theories in general, both old and new. Old critiques of virtue theory (think Machiavelli or Mandeville) point out that sometimes we can get better results by harnessing nonvirtuous motivations and tendencies than we would get by trying to make full-blown virtue more common. Sometimes the perfect is the enemy of the good. If cultivating testimonial justice will rarely succeed, there may be other interventions that will reduce harm to marginalized groups by means of baser motives and means. (For instance, if improving company appreciation of diverse people’s contributions helps the bottom line, greed might produce more change than exhorting individuals to be fair-minded. If people are motivated by social ambition to note and call out each other’s injustices, this could produce aggregate improvements, even 1. Replies and responses appeared in the Social Epistemology Review and Reply Collective. See Alfano (2015), Davidson and Kelly (2015), Washington (2016), and Sherman (2015b, 2016).

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if individuals are motivated primarily by spite toward rivals.) New critiques of virtue theory have a more empirical basis. Virtue theory (at least in most forms) takes it as a ground-level assumption that people (either do or can) have consistent character traits that do not vary significantly across different situations—this is what distinguishes a virtue from a mere set of good acts. But a number of thinkers, most notably John Doris (2002) and Mark Alfano (2013), have argued that empirical evidence seriously undermines this assumption. Their position—known as situationism—holds that ethically irrelevant details of various situations have a significant enough impact on people’s behavior that either there are no virtues consistent across situations, or they are quite rare. While many virtue theorists would happily accept the conclusion that virtues are rare, this option poses serious problems for those who propose the development of virtues is a practical solution to pressing social problems. Some of Sherman’s worries were more particular to Fricker’s specific recommendations for developing the virtue of testimonial justice. First, there are problems of practical epistemology. In order to notice our unjust credibility judgments and reflate them (especially very quickly, as Fricker seems to propose), we must be very good at seeing the gap between what we think is correct and what is actually correct. Probably most of us are good at noticing and correcting some kinds of errors, and perhaps there are other errors that we can train ourselves to spot quickly and well. But it is worth remembering that usually, when we misjudge, it is because the wrong answer seems right to us. If it seems to us that p, and then, in hopes of avoiding mistakes, we ask ourselves again whether p, we should not be too surprised if the same bundle of critical faculties with roughly the same background knowledge returns the same answer much of the time. This seems especially true when we are considering questions with imprecise answers, unclear standards, and perhaps an unavoidable appeal to intuition and common sense. Credibility judgments often meet the latter description. Moreover, many of us, when we introspect, do not find ourselves to be prejudiced, or at least not much, and not much of the time. If we think about our estimates of others’ credibility, and those estimates seem right to us, then are we in a good position to think we have achieved the virtue of testimonial justice? This will not sound very plausible to those of us who think people should err more on the side of epistemic humility. We think people who believe they have achieved testimonial justice are more likely to be wrong than right. And this raises a worry about making testimonial justice the goal: is it a dangerous mistake to try to reach a state where we (proudly!) no longer notice ourselves making errors? Sherman also raised concerns about whether the empirical evidence favors something like Fricker’s direct approach of watching for prejudice and correcting it. While he cited particular studies raising concerns that this might be counterproductive (e.g., work on rebound effects and moral creden-

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tialing), the general point is more important than the particular findings. Around the time Fricker and Mills started their respective work, social psychology work on unconscious prejudices began a new golden era. Mahzarin Banaji and Anthony Grenwald began making use of the Implicit Association Test to provide new evidence on how implicit bias influences people’s attitudes toward others (for an overview, see Banaji and Greewald 2013), and Claude Steele’s experiments on stereotype threat cast new light on how awareness of negative stereotypes can affect the targets of those stereotypes, even without their knowing (for an overview, see Steele 2010). There has been a vast increase in exploration of these topics in recent years. Particular findings should be treated with caution; while these research paradigms have held up pretty well overall, the recent replication crisis (“Repligate”) has led to many specific studies being overturned and has exposed the ways that social science results often go underscrutinized. Still, the work in recent years seems to at least support a certain kind of skepticism and humility: a great deal of our important mental activity goes on outside of our conscious awareness, and in spite of our conscious intentions. So, at the very least, it is an empirical question whether intentionally and introspectively trying to spot unjust judgments and correct them is fruitful, or inadequate, or even counterproductive. In light of these concerns, we invited the authors in this volume to tie their ethical and epistemic arguments to empirical work and case studies. The chapters in this volume draw from a range of disciplines, often engaging with social psychology, but also drawing from other social sciences. We should remain aware that new findings (and failures to replicate old findings) might unseat some proposals here, and suggest others in their place. But these chapters take the important step of observing the ways that empirical findings about how prejudice works cannot be ignored when we think about implementing our ethical and epistemological theories. OVERVIEW OF THE CHAPTERS COLLECTED The chapters brought together in part I consider strategies for trying to overcome epistemic injustices in our own thinking. Whereas traditional virtue theories suggest that we become better by emulating exemplars of virtue, Emily Sullivan and Mark Alfano argue that we might be better off adopting a competitive mindset about epistemic justice, or making use of negative exemplars. Stacey Goguen surveys some competing conceptions of stereotypes, and considers the pros and cons of trying to harness stereotypes for just causes. Audrey Yap argues that sometimes hermeneutical injustices result, not from a lack of appropriate concepts, but from a tendency to conflate important concepts. This problem is especially pronounced, she suggests,

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with concepts like “sexual assault,” “consensual sex,” and “justified sex.” Nadya Vasilyeva and Saray Ayala-López consider the way our minds are prone to grouping beings into kinds, and associating common (or highly salient) traits with those kinds. They argue that it is probably futile to try to stop ourselves from forming these associations, but that these associations are rendered less harmful if we introduce structural explanations of the traits. Alex Madva argues that, while Fricker does not appeal much to empirical research when she proposes developing the virtue of epistemic justice, a suitably charitable interpretation of Fricker’s proposals is compatible with, and even supported by, empirical evidence on how to reduce individual prejudices. Finally, Emily McWilliams argues that traditional epistemological theories (like reliablism and evidentialism) lack the resources to address the kind of epistemologies of ignorance that Mills discusses. She argues that this constitutes a reason to favor virtue theories of epistemology, which are better equipped to offer guidance on how we should go about seeking new information. Parts II–IV examine particular institutional structures that make epistemic injustices both likely and dangerous. Part II looks at the way that clinical institutions create power dynamics that make epistemic injustice a concern. Lauren Freeman and Heather Stewart address the ways that epistemic microaggressions play a role in undervaluing patients’ testimony about their own experiences. They propose that increased attention to patients’ phenomenological experience would help to remedy this situation. MaryCatherine McDonald takes a similar line in examining the devaluation of patients’ experiences in mental health, and especially in the treatment of PTSD. Ian James Kidd and Havi Carel argue that the root of problems like these may be a biomedical conception of health that, at some level, insinuates that medical knowledge of health and disease is the only respectable form of knowledge, and ought to be categorically prioritized over patients’ experiential knowledge. Noting Kidd and Carel’s insights that there are certain kinds of stereotypes and biases targeted toward patients qua patients, Elianna Fetterolf argues that there is important work to be done in mapping what kinds of stereotypes operate in medical contexts, and to what extent; she notes that these stereotypes of patients, or of certain kinds of conditions, intersect in complex ways with stereotypes regarding gender, race, and other identity categories. Finally, Katrina Hutchison presents original qualitative research examining the ways that stereotypes affect the way patients treat doctors, concentrating on patterns of sexism apparent in patients’ reactions to women surgeons. Part III considers the ways that epistemic injustice operates in the criminal justice system. Lissa Skitolsky argues that it is fruitful to think of white people’s perceptual capacities as being in the grip of what Foucault and Butler might call a white racist episteme, preventing white people from giv-

Introduction

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ing proper respect to the testimony of black witnesses. She argues that we are not likely to be able to overcome these effects through attempts to be more objective, but that it would be more fruitful for white Americans to disrupt their settled sensibilities by exposing themselves to antiracist art, especially underground hip-hop. Andrea J. Pitts argues that the conditions of prison medical care prevent inmates from being able to trust their medical providers in the ways required for adequate medical care. As a result, they argue, there is an important respect in which the very structure of prisons makes it virtually inevitable that epistemic injustice will undermine minimal acceptable standards of care. Harry Critchley argues that the opacity of prison administration creates an epistemology of ignorance with respect to inmates, and especially medical care for inmates. Focusing on the treatment and epistemic marginalization of pregnant women inmates in the Canadian prison system, Critchley argues that addressing the problem requires questioning the assumption that prisons are necessary, inevitable, or justifiable. Part IV looks at institutions that are supposed to uphold standards of fairness, promote knowledge, and reward excellence—but can fall short in ways that are epistemically unjust. Casey Rebecca Johnson argues that teaching is a form of epistemic care work, and that—like other forms of care work—it is systematically undervalued in a way that aligns with sexist prejudices. There is a strong correspondence between the ways that teaching is viewed as a feminine profession, and the ways it is undervalued. Lacey J. Davidson argues that philosophical research that is intended to fight epistemic injustice, particularly philosophy work on implicit bias, runs a high risk of being epistemically unjust itself. And Rachel McKinnon considers the ways that those who mean to be allies are likely to unwittingly participate in the gaslighting of marginalized groups. Focusing on the case of trans women in sports, she argues that “allies”—taken to be relatively passive well-wishers—should instead aspire to be accomplices instead, or at the very least to offer sanity-checks in instances of gaslighting. The volume concludes with an afterward from Miranda Fricker, presenting thoughts on our prospects, individual or collective, for overcoming epistemic injustice. REFERENCES Alfano, Mark. 2013. Character as Moral Fiction. Cambridge: Cambridge University Press. ———. 2015. “Becoming Less Unreasonable: A Reply to Sherman.” Social Epistemology Review and Reply Collective 4 (7): 59–62. Anderson, Elizabeth. 2012. “Epistemic Justice as a Virtue of Social Institutions.” Social Epistemology 26 (2): 163–73. Banaji, Mahzarin R., and Anthony Greenwald. 2013. Blindspot: Hidden Biases of Good People. New York: Bantam.

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Bartky, Sandra. 1990. Femininity and Domination: Studies in the Phenomenology of Oppression. New York: Routledge. Clifford, William K. (1877) 1999. “The Ethics of Belief.” In The Ethics of Belief and Other Essays. Amherst, NY: Prometheus Books. Code, Lorraine. 1987. Epistemic Responsibility. Hanover, NH: University Press of New England. Collins, Patricia Hill. 1991. Black Feminist Thought: Knowledge, Consciousness, and the Politics of Empowerment. New York: Routledge. Davidson, Lacey J., and Daniel R. Kelly. 2015. “Intuition, Judgment, and the Space Between: A Reply to Sherman.” Social Epistemology Review and Reply Collective 4 (11): 15–20. Doris, John. 2002. Lack of Character: Personality and Moral Behavior. New York: Cambridge University Press. Du Bois, W. E. B. (1903) 1994. The Souls of Black Folk. New York: Dover. Fanon, Frantz. 1967. Black Skin, White Masks. New York: Grove Press. Fricker, Miranda. 1998. “Rational Authority and Social Power: Towards a Truly Social Epistemology.” Proceedings of the Aristotelians Society 98: 159–77. ———. 2007. Epistemic Injustice: Power and the Ethics of Knowing. New York: Oxford University Press. Foucault, Michel. (1963) 1994. The Birth of the Clinic. Translated by Alan Sheridan Smith. New York: Vintage Books. ———. (1977) 1990. The History of Sexuality, vol. 1. Translated by Robert Hurley. New York: Vintage Books. Frye, Marilyn. 1983. The Politics of Reality: Essays in Feminist Theory. Berkeley, CA: Crossing Press. Lugones, María. 1987. “Playfulness, ‘World’ Traveling, and Loving Perception.” Hypatia 2 (2): 3–21. Mills, Charles W. 1997. The Racial Contract. Ithaca, NY: Cornell University Press. ——. 2007. “White Ignorance.” In Race and Epistemologies of Ignorance, edited by Shannon Sullivan and Nancy Tuana. Albany: State University of New York Press. ——. 2016. “The Red and the Black” (Dewey Lecture). Proceedings and Addresses of the American Philosophical Association 90: 90–113. Pohlhaus, Gaile, Jr. 2012. “Relational Knowing and Epistemic Injustice: Toward a Theory of Willful Hermeneutical Ignorance.” Hypatia 27 (4): 715–35. Sherman, Benjamin. 2015a. “There’s No (Testimonial) Justice: Why Pursuit of a Virtue Is Not the Solution to Epistemic Injustice.” Social Epistemology 30 (3): 229–50. ———. 2015b. “(Less Un-)Attainable Virtues: A Reply to Alfano.” Social Epistemology Review and Reply Collective 4 (10): 14–18. ———. 2016. “Learning How to Think Better: A Response to Davidson and Kelly.” Social Epistemology Review and Reply Collective 5 (3): 48–53. Spivak, Gyatri Charavorty. 1988. “Can the Subaltern Speak?” In Marxism and the Interpretation of Culture, edited by Cary Nelson and Lawrence Grossberg, 271–316. Urbana: University of Illinois Press. Steele, Claude M. 2010. Whistling Vivaldi: How Stereotypes Affect Us and What We Can Do. New York: Norton. Sullivan, Shannon, and Nancy Tuana, editors and introduction. 2007. Race and Epistemologies of Ignorance. Albany: State University of New York Press. Washington, Natalia. 2016. “I Don’t Want to Change Your Mind: A Reply to Sherman.” Social Epistemology Review and Reply Collective 5 (3): 10–14.

I

Managing Psychological Tendencies

Chapter One

Negative Epistemic Exemplars Emily Sullivan and Mark Alfano

Miranda Fricker (2007) defines epistemic injustices as harms people suffer specifically in their capacity as (potential) knowers. 1 While recognizing that distributive epistemic injustice is rampant, insofar as members of disadvantaged groups tend to receive worse educations, in this chapter we are especially interested in addressing what Fricker calls testimonial epistemic injustice, which occurs when someone’s assertoric speech acts are systematically met with either too little or too much credence by a biased audience. 2 The bias in question could be explicit or implicit (or both). In either case, a society in which testimonial epistemic injustices are commonplace is one in which some people’s assertions are unjustifiably ignored, met with excessive skepticism, or never solicited, while other people’s assertions are solicited even when they have nothing valuable to add, echoed and amplified without warrant, and accepted without the application of sufficient critical scrutiny. Various epistemic harms are likely to be endemic to such a society, afflicting not just those whose testimony is quashed but also audiences (and audiences of audiences) that fail to learn as much and as well as they otherwise could— not to mention the difficulty of reality-testing when surrounded by yes-men (sometimes referred to in popular culture as a symptom of “affluenza”). Fricker recommends a virtue-theoretic response to the problem of testimonial epistemic injustice: people who do not suffer from biases should try to maintain their disposition toward naive testimonial justice, and those who 1. This publication was supported by a subaward agreement from the University of Connecticut with funds provided by Grant No. 58942 from John Templeton Foundation. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of UConn or John Templeton Foundation. 2. Medina (2013) and Yap (2017) have convincingly argued that, while credibility deficits may be more obviously problematic, credibility excesses deserve a place in the epistemic rogues gallery.

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find themselves already biased should cultivate corrective testimonial justice by systematically adjusting their credence in testimony up or down depending on whether they are hearing from someone whom they may be biased against or in favor of. The hard question is how one cultivates such a corrective virtue, if it is even possible. For example, Benjamin Sherman (2015) casts doubt that a virtue-theoretical approach is the right starting point. He argues that there is no generalizable corrective virtue for rooting out prejudices. If I believe that I’m putting too little credence in what you have to say, I’ll already have adjusted my credences, and if I think I’m putting just the right amount of credence in what you have to say, I’ll regard any adjustment as epistemically unwarranted. On the other hand, Linda Zagzebski’s (2017) epistemic exemplarism is less bleak. On her account, one can build corrective dispositions by identifying exemplars through admiration and emulation. This approach moves away from a purely individualized virtue-theoretic response to a community-based response to epistemic injustice. Epistemic agents look to their broader epistemic community to find those who are worthy of admiration and cultivate dispositions and virtues through emulation. In this chapter, we further explore community-based responses to testimonial injustice by examining the role that exemplars might play in a comprehensive response to epistemic injustice. 3 In particular, we argue that while reliance on the admiration-emulation model is problematic, learning from negative exemplars has potential. We introduce two negative exemplar frameworks that have the potential to correct for testimonial injustice. We argue that a multimodel approach that includes negative exemplars brings us closer to a virtue-theoretic response to testimonial injustice. Here is the plan for this chapter: in section 1, we first sketch Zagzebski’s exemplarist framework, the admiration-emulation model, and show that this model has serious flaws. We propose that learning from negative exemplars might overcome some of these issues. In section 2, we introduce our first negative exemplar framework: the envy-agonism model. Then, in section 3, we articulate the (mutually compatible) ambivalence-avoidance model. We conclude by discussing how a multimodel approach that includes negative emotions and negative exemplars brings us closer to a virtue-theoretic response to testimonial injustice, and discuss future research directions.

3. A comprehensive approach would, among other things, evaluate and modify the structure of social epistemic networks with an eye to amplifying messages that need to be heard and dampening testimonial sources that are unreliable or otherwise objectionable (Alfano and Skorburg 2018).

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THE ADMIRATION-EMULATION MODEL Exemplarism has a long history in both Christian philosophy (emerging especially in Augustine, on which see Kondoleon 1970) and Chinese philosophy (most notably in Confucianism, on which see Olberding 2012). In both traditions, the basic idea is to start not with abstract principles that guide the cultivation and expression of virtue, but with admired individuals, whom one imitates or emulates. In the Christian tradition on which Zagzebski’s (2004) exemplarism is based, the prime exemplar is God or Jesus Christ. The WWJD meme has its origins in the Bishop of Hippo. In this model, one begins by admiring the exemplar. Admiration, if it survives reflective scrutiny, motivates the admirer to both understand better the psychic economy of the exemplar and to emulate the exemplar’s (inner and outer) life. In her more recent work, Zagzebski (2017) expands the range of exemplars worth emulating to include nondivine and non-Christian individuals, laying out a taxonomy of three types: the saint (who exemplifies compassion), the sage (who exemplifies wisdom), and the hero (who exemplifies courage). It is not a straightforward task to translate this taxonomy to the epistemic realm. Is someone who practices epistemic justice a saint? Intuitively not, since the saint goes beyond what justice demands. But practicing epistemic justice does not seem to be a matter of heroism either. Zagzebski briefly notes that an epistemic exemplar might be a genius. However, even geniuses do not necessarily exemplify the dispositions associated with testimonial justice. Their epistemic excellences are, in the first instance, self-regarding rather than other-regarding: the genius excels at creativity and discovery, which furnish the genius herself with epistemic goods (though these could be subsequently conferred on others as well). Someone who embodies testimonial justice, by contrast, manages to refrain from harming others in their capacity as knowers. Thus, it seems that sages are the best candidates for epistemic exemplars on Zagzebski’s taxonomy. Presumably, wise individuals can be other-regarding and are able to weigh testimonial evidence in a way sensitive to justice. However, there are problems here too. Wise individuals need not concern themselves with acting in accordance with testimonial justice, even if they know what testimonial justice is and recognize when they are being unjust. 4 What would an exemplar of testimonial justice look like? Fricker (2007) distinguishes two types of testimonial justice: naive and corrective. The exemplar of naive testimonial justice would be someone uncorrupted by sexist, racist, and other prejudices that lead people to place too little epistemic trust in women and minorities while lending too much weight to the utterances of 4. For example, Whitcomb (2010) argues that wisdom does not entail living well and that wise people can in fact be evil.

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white men. Such a person might resemble Prince Myshkin in Dostoyevsky’s The Idiot ([1874] 2004). In any event, there is an essential difficulty in emulating or imitating such an epistemic naif: once innocence is lost, it cannot be regained. We cannot return from our postlapsarian world to epistemic Eden, no matter how much we might admire those who never tasted the forbidden apple. Fricker (2007) recognizes this problem and suggests that, rather than trying to restore our epistemic innocence, we should selfconsciously aim to correct the biases that we know we embody. In the admiration-emulation model, this translates to identifying—through the sentiment of admiration—people who have gained wisdom in part by managing to corral their biases, then following in their footsteps. However, the admiration-emulation model faces five problems. First, exemplars of corrective testimonial justice are likely to be invisible. Second, visible exemplars—if they are too close to perfection—are liable to provoke resentment rather than admiration. Third, admiration may be unreliable, especially in this context. Fourth, the admiration-emulation model seems to be a recipe for the (epistemically) poor getting poorer, which seems contrary to the ideal of epistemic justice. Finally, the admiration-emulation model only makes use of a small fraction of one’s social network. Exemplars of corrective testimonial justice are likely to be invisible for two reasons. First, recognizing exemplars that are actively adjusting their credences and engaging in corrective epistemic justice is difficult. Someone who signals—either explicitly or through their facial expression and body language—that they are making an effort to take an interlocutor seriously thereby fails to live up to the standards of corrective testimonial justice. Ostentatiously signaling that you’re making an effort to believe someone against whom you harbor prejudices (either implicitly or explicitly) is not a good way to treat them with the epistemic respect that is their due as a knower. If this is right, then exemplars of corrective testimonial justice will tend to be self-effacing about their corrective strategies. Doing so protects the people against whom they have biases, but it also makes them less detectable and difficult to emulate. Thus, it is hard to recognize those who are actively practicing corrective testimonial justice and overcoming bias. Second, it is difficult to simply pick out those who engage in testimonial just acts, let alone whether they are engaging in corrective strategies. In general, humans are better at noticing and attending to deviations from norms than consistency with them (Rozin and Royzman 2001). If testimonial justice is commonplace, then someone whose behavior and credence-fixing accords with the norm of justice is therefore unlikely to catch enough attention to become the object of admiration. On the other hand, if testimonial justice is rare, admiration is not the likely attitude that surfaces. As Florien Cramwinckel and her colleagues (2015, 2016) have shown, role models are admired only when they don’t deviate too much from social norms. Especially

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virtuous exemplars of corrective testimonial justice are therefore as likely to be derogated as admired. This point relates to the third problem: despite Zagzebski’s insistence to the contrary, there is ample reason to doubt the reliability of admiration. It seems to suffer both from systematic false negatives and systematic false positives. False negatives crop up when too-perfect exemplars provoke resentment and derogation rather than admiration. Zagzebski does mention this possibility, but she is not sufficiently perturbed by it. Indeed, it is striking how many of the exemplars listed in her book (e.g., Jesus, Gandhi, the Trappist monks of Tibhurine) met violent ends. False positives may be even more problematic. Admiration has a tendency to spread from a single aspect to the whole person, leading people to ignore or even imitate serious flaws in those they admire (Thomas, Archer, and Engelen 2019; la Caze 2019). The fourth and fifth problems are related. Virtuous exemplars are neither prevalent nor evenly distributed (Alfano 2017). This means that any given person is likely to have direct access to just a few exemplars, and that people in more epistemically just communities are likely to have access to many more exemplars than those who find themselves in deeply epistemically unjust communities. The uneven distribution of exemplars means that those who stand most in need of corrective epistemic justice are the least likely to have role models worth emulating, while those who are already relatively well-off enjoy an abundance of exemplars ready-to-hand. In addition, epistemically vicious people in epistemically vicious communities are especially liable to respond in problematic ways to exemplars. As Alessandra Tanesini argues, people who are the furthest away from intellectual virtue are precisely those who are less likely to pay attention. Exposure to exemplars might work only if it stimulates emulation. It is counterproductive if it leads to demoralisation or if it fans an already inflated conception of the self. Sadly, those [. . .] who have developed non virtuous habits are most likely to react to models in precisely these ways. (2016, 524)

This is not, in itself, an objection against the admiration-emulation model; maybe life is just unfair. However, in order to make progress on addressing testimonial injustice, we should make an effort to find additional models that can be of use to those already in bad epistemic (or moral) environments. Doing so requires us to find ways to learn from flawed exemplars, and increasing the proportion of one’s social network that one benefits from. If there are ways to cultivate epistemic justice that employ emotions other than admiration (even negative emotions) and exemplars other than saints, sages, heroes, and geniuses, we would all benefit from knowing about them. If our arguments in this section are on the right track, then admirationemulation exemplarism is unlikely to be much help to those wishing to

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cultivate testimonial justice. In the next two sections, we spell out alternative models that both involve negative exemplars, and as such do not suffer from the drawbacks of the admiration-emulation model. THE ENVY-AGONISM MODEL In this section, we explore our first alternative to admiration-emulation exemplarism: the envy-agonism model. Whereas, in the admiration-emulation model, the admired exemplar is evaluated with a wholly positive emotion, in this alternative framework the crucial emotion is envy. Like admiration, envy is a socially upward-looking emotion; to admire or envy someone you must see them as superior on some valued dimension or as possessing a good that you lack. It borders on absurdity to contemplate either admiring or envying oneself (at least, one’s current self). As Sara Protasi (2016, 2017, 2019) has argued, envy differs from admiration on a number of further dimensions. First, whereas admiration is pleasant, envy is painful. Second, admiration is affiliative; it tends to be accompanied by identification with the admired. Envy, by contrast, is competitive; it carries no affiliative sentiments and may even sunder people who were previously connected. Third, admiration tends to motivate either passivity or emulation of the admired, while envy is more multifarious. Protasi (2019) helpfully distinguishes four types of envy depending on whether the envied good is perceived as obtainable and whether the envier focuses primarily on the good itself or the envied individual, as indicated in Table 1.1. We are especially interested in what Protasi calls emulative envy, though we prefer to call it agonistic (competitive) envy for reasons that will become clear below. What first comes to mind when one thinks of envy is most likely one of the other varieties. Protasi argues that aggressive envy may motivate the envier to steal, while spiteful envy motivates her to spoil and inert envy motivates her to sulk. Agonistic envy, by contrast, tends to motivate competition and leveling up (or one-upmanship) rather than leveling down. While painful, agonistic envy leads the envier to think (and to try to show), “I can do better than that.” Agonistic envy thus makes sense only in some axiological contexts involving infinite or fungible goods. If I envy your possession of a nonfungible good (e.g., a painting or a child), then the only way for me to obtain it is to Table 1.1. Protasi’s Taxonomy of Envy focus on the good

focus on the individual

good is obtainable

emulative envy

aggressive envy

good is unobtainable

inert envy

spiteful envy

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take it from you, while the only way for me to become your equal is to destroy or ruin the good. However, if I envy your achievements, honors, skills, or virtues, it is possible for me to do as well as you (or even better) without you losing anything other than relative rank or position. Indeed, oneupping someone by tearing them down is hardly sporting, and in agonistic cultures such underhanded methods are frowned upon (Burckhardt [1872] 1999). The point of the agon, in other words, is to establish the conditions for the possibility of demonstrations of excellence. Exemplars serve, in this context, as milestones to surpass worthy competitors. Besting an unworthy opponent is not a cause for celebration but its own form of humiliation. If this is right, then resentment is inconsistent with agonistic envy. This may seem like an ugly portrait of the development of virtue, calling to mind Freudian ([1913] 1990) patricide and Harold Bloom’s (1973) “anxiety of influence.” In addition, contemporary philosophers are squeamish about competitive notions of virtue (Annas 2015, 16). Perhaps the clearest articulation of the agonistic model occurs in the writings of Friedrich Nietzsche (Alfano 2018). As Anthony Jensen (2016, 145) has shown, in the second Untimely Meditation, Uses and Disadvantages of History for Life (Nietzsche [1874] 1997), Nietzsche argues for an agonistic approach to historical exemplars in which history is a “selective construction out of only that which in the past was [epistemically] ‘justly’ judged worthy to serve as an . . . [other] which, by its opposition, can sharpen and strengthen the qualities in the reader that best serve life.” Jensen calls this approach to historical exemplars affirmative (as opposed to the monumental, antiquarian, and critical approaches Nietzsche criticizes in this work), suggesting that it is about “neither recognition nor emulation, but both legislation and competition” (2016, 146). In this way, affirmative history serves life better than monumental history, which closely aligns with the admiration-emulation model, and which tends to erect idols that shout, “Here and no further!” In an agonistic setting, even the highest exemplars are not perfect and can, in principle, be outdone. While Uses and Disadvantages of History for Life is an early and flawed work, Nietzsche continued to theorize about the value and use of envy in his middle works. For instance, in Human, All Too Human ([1880]) 1986) section 170, he argues that Hesiod’s good Eris, ambition [Ehrgeiz], gave [Greek artists’] genius its wings. Now this ambition demands above all that their work should preserve the highest excellence in their own eyes, as they understand excellence, that is to say, without reference to a dominating taste or the general opinion as to what constitutes excellence[. . . .] It is thus they aspire to victory over their competitors as they understand victory, a victory before their own seat of judgment, they want actually to be more excellent; then they exact agreement from others as to their own assessment of themselves.

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It should be clear that someone who competes with exemplars in this fashion will not partake of aggressive or spiteful envy, let alone inert envy, since none of these would lead them to actually be more excellent than the exemplars with whom they compete. Nietzsche continues his reflections on Eris in section 29 of “The Wanderer and His Shadow,” which was appended to Human, All Too Human in 1880. In this section, titled “Envy and its nobler brother,” he writes, “The envious man is conscious of every aspect in which the man he envies exceeds the common measure and desires to push him down to it—or to raise himself up to the height of the other: out of which there arise two different modes of action which Hesiod designated as the evil and the good Eris.” This distinction maps directly onto Protasi’s taxonomy. What Nietzsche here calls “good Eris” is emulative or agonistic envy, which prompts the envier to rise to or above the height of the envied. Finally, in Daybreak section 38 ([1881] 1997), Nietzsche observes that the older Greeks felt differently about envy from the way we do; Hesiod counted it among the effects of the good, beneficent Eris, and there was nothing offensive in attributing to the gods something of envy: which is comprehensible under a condition of things the soul of which was contest; contest, however, was evaluated and determined as good.

Such contests could be staged between the living and the dead, as Nietzsche envisions in his discussion of historical exemplars in Uses and Disadvantages of History for Life. Direct competition may be more effective, however, since both (or all) competitors can dynamically interact—treating one another as exemplars to be surpassed. Such ongoing interactive feedback loops have been hypothesized to build and extend character traits into social networks (Alfano 2016; Alfano and Skorburg 2017). Alas, the rich-get-richer problem mentioned above may only be exacerbated by such feedback loops. As Nietzsche notes, the envy-agonism model works best in a culture that values contests and victories, in which striving to excel and wanting to be recognized as excellent are not considered shameful motives. In such a culture, exemplars are highly visible rather than invisible. Moreover, such a culture would not automatically frown upon bragging or induce its members to engage in paradoxical humble-bragging (Alfano and Robinson 2014). Such a culture provides the infrastructure for agonistic competition; it establishes what we called above the conditions for the possibility of demonstrations of excellence, which, to be effective, must reliably signal both when someone has demonstrated excellence on some valued dimension and when they have not. We doubt whether many contemporary communities celebrate excellence in epistemic justice in this way. However, surely there are instances where this sort of excellence is celebrated, and it is worth exploring whether actively constructing such a community would be desirable.

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Two additional concerns with the envy-agonism model relate to rightreason criteria and the modal robustness (or not) of envy. Many, perhaps most, virtue theorists agree that an act only counts as fully virtuous if it is done for the right reason. One might wonder whether envy-based reasons ever satisfy this condition. Our aim in this section has been to establish that, while many stereotypical cases of envy (e.g., aggressive, spiteful, and inert envy) are clearly problematic, agonistic envy is not. If this partial rehabilitation of envy succeeds, then acting out of agonistic envy does not violate the right-reason criterion. Regarding modal robustness, one might worry that someone who practices epistemic justice out of agonistic envy would easily cease to do so in nearby possible worlds where they no longer felt envious. There are multiple ways that envy might be obliterated. For example, the target of envy could turn out not to be so impressive after all; or the target of envy could develop vicious epistemic habits; or the target of envy could be decisively bested. Whatever the reason, someone who no longer felt envious would no longer be spurred to better themselves. We recognize this is a serious concern, and that it emphasizes the need for the sorts of ongoing interactive feedback loops mentioned above. In the meantime, it would be helpful to have a different negative exemplarist model. In the next section, we articulate one: the ambivalence-avoidance model. THE AMBIVALENCE-AVOIDANCE MODEL The envy-agonism model involves a negative emotion that motivates an agent to act in a similar way to an exemplar in the community. On the ambivalence-avoidance model a negative emotion motivates an agent to act in a dissimilar way to the exemplar. Ambivalence is uniquely characterized as an agent having incompatible desires, unable to decide which of these desires she ultimately should act or settle on. There is a particularly negative aspect to ambivalence that is not present with other mixed emotions. To illustrate, Table 1.2 outlines Amélie Oksenberg Rorty’s (2014) helpful distinctions between ambivalence and other mixed emotions, such as uncertainty. Agents can resolve some of these emotions by seeking out new evidence, or getting clear on how they themselves rank certain preferences. The ambivalent agent has no clear way of reconciling the emotion because of the strong desire for incompatible goods. One desire will always be frustrated. Most notably, Harry Frankfurt (2001) argues that ambivalence can keep individuals away from the ethical ideal of wholeheartedness and threatens the very nature of autonomy. We argue that despite the negativity of ambivalence (and indeed in virtue of its negativity), when the emotion is directed toward individuals, not toward what to do, the

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emotion can help identify negative epistemic exemplars and build corrective habits. We saw that one of the central problems with the admiration-emulation model is that exemplars worthy of admiring are invisible. One reason they remain invisible is because it is easier for humans to notice and attend to deviations from norms than consistency with them. The ambivalence-avoidance model takes this tendency as a starting point. Agents look to exemplars that engage in practices that are off-putting and actively avoid those behaviors. It is not simply that one sees an off-putting behavior, but that the agent has a mixed feeling toward the exemplar because of this behavior. The agent takes the exemplar as embodying valuable epistemic qualities, and at the same time embodying epistemic qualities that are undesirable. In order to resolve the attitude of ambivalence the agent avoids the undesirable epistemic behavior, while at the same time holding on to the things the exemplar does well. To see how this model works, first consider a nonepistemic case of learning how to become a better public speaker. One approach is to seek out the best speakers and emulate them. However, starting from zero, this is not necessarily a winning strategy. It is not very easy to tell exactly what a good public speaker does to make the speech enjoyable. It is also not very helpful to see a terrible public speaker either. Since there are many things that are going wrong with the speech, it is hard to pinpoint exactly what to avoid. On the other hand, someone can learn more directly what to avoid from a speaker that has both good and bad qualities. It is much more telling why it is important to give eye contact to an audience by seeing a speaker who looks down the whole time, but is generally OK, than it is to see a seasoned speaker. It is the attitude of ambivalence someone has toward the speaker that allows the speaker to serve as a negative exemplar helping that person build desirable habits. Now turn to a case of testimonial injustice. The emotion of ambivalence can identify negative exemplars that, while having good epistemic attributes, fail to live up to corrective testimonial justice. After the exemplar is identified, one begins to avoid the behavior of the negative exemplar that gave Table 1.2. Rorty’s Taxonomy of Mixed Emotions Attitude/Emotion

Internal Logic

Why the Attitude Arises

Uncertainty

Neither/Nor

Lack of evidence

Indecisiveness

Maybe this/Maybe that

Unclear ordering of preferences

Vacillation

Now this/Now that

Erratic shifting of preferences

Ambivalence

Both/And

Endorsing all options and thinking them incompatible

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rise to the ambivalence. Consider a commonplace example of epistemic injustice in the workplace. In many professions, meetings offer a platform— through testimony—for individuals to show their value to the company and their epistemic merit more generally. One all-too-common phenomenon is that women’s ideas are ignored or coopted by male colleagues as their own idea. On the ambivalence-avoidance model this male colleague can serve as a negative exemplar. First, the “idea stealer” presumably has epistemic strong suits that many in the company recognize. Second, a woman whose idea was coopted will have a negative emotional reaction to the unjust act, leaving her in a state of ambivalence toward the male colleague. She will then seek to avoid this type of behavior as a way of correcting her own biases toward others. This is possible even if no one else rightly recognizes the act as a case of injustice. Progress can be made even in epistemically parasitic environments. The recognition of testimonial injustice through ambivalence can also occur on a collective level. For example, women on President Obama’s staff, feeling ambivalent toward the male-dominated environment, engaged in the practice of amplification. Whenever a woman made a valuable point the other women repeated it, giving credit to its author. This served as a method to prevent others from engaging in testimonial injustice through ignoring or coopting the ideas of others (Hatch 2016). The women sought to avoid the behavior of coopting ideas and in the processes identified a corrective strategy that would help others who were the victim of such testimonial injustice. In this sense, corrective testimonial justice can lead to collectives adopting burdened virtues (Tessman 2005) that otherwise would not be formed if they lived in an already epistemically just community. Those on the receiving end of epistemic injustice are more likely to recognize the injustice through ambivalence. However, it is not restricted to those cases. Interestingly, on the ambivalence-avoidance model, an agent could believe that her practices surrounding testimony are appropriate, and have these beliefs shaken by a negative exemplar. The salient feature of ambivalence is that it is an active attitude. When a reflective agent sees a negative exemplar engage in a practice similar to what she would have done, and yet feels ambivalence toward the exemplar as a result, change is possible. For example, seeing someone else commit acts of testimonial injustice to another creates the space needed to begin reflective engagement. What is it that this negative exemplar did that left me feeling ambivalent? What behavior should I avoid to resolve this feeling? A reflective agent can then begin to realize that there are certain behaviors she had best avoid in hearing and weighting testimony from others. Notice that the space for this kind of reflection is not present with admiration. Admiration is a more passive attitude. There is nothing about admiration qua admiration that compels an agent to resolve the emotion. Furthermore, given the positive valence of admiration, it

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does not invite critical scrutiny or reflection in the way that ambivalence does. As a result, the ambivalence-avoidance model can start to address Sherman’s (2015) worry that virtue theoretic response to testimonial injustice fails in part due to near impossibility of someone changing their credences once they feel epistemically warranted. Of course, it is not a sure thing. Uptake can be slow, and feelings of ambivalence can be misdirected, just like any emotion. Despite this, there are clear advantages to the ambivalenceavoidance model. Some of the problems plagued by the admiration-emulation model are not present in the ambivalence-avoidance model. First, it helps with the poorgetting-poorer problem. Agents can draw on a larger network of possible exemplars, besides geniuses, saints, sages, or heroes. Exemplars do not need to be those who engage in the epistemic supererogatory. Exemplars can be those who fail. Second, ambivalence does not spread like admiration. Negative exemplars aren’t seen through rose-colored glasses. One possible worry is that doubt and skepticism spreads. Once you start to doubt some aspects of the agent, then you start to doubt all aspects of the agent, even the good aspects. However, this attitude is no longer ambivalence. There is no longer an incompatible attitude directed toward the epistemic life of the exemplar. Instead, the attitude is closer to uncertainty. You begin to doubt the exemplar and resolve the doubt by seeking more evidence about whether these are epistemically good or bad behaviors. Ambivalence, on the other hand, is the mixed feeling that endorses incompatible aspects of a thing; in this case one is endorsing that the exemplar has both bad and good epistemic qualities. Thus, unlike the admiration-emulation model, you are not taking the individual as a whole package, avoiding all of their behaviors. Instead, you have ambivalent feelings regarding who they are as an epistemic agent. There are attributes about the person that you like, but have mixed feelings about them precisely due to problematic epistemic behaviors that they engage in. Lastly, even though the ambivalence-avoidance model relies on negative exemplars that the agent comes to recognize through a negative emotion, it nevertheless satisfies the right-reason criterion. Presumably, the virtuous person would feel ambivalent toward individuals that embody some aspects of a virtue, while still falling short in other ways. Moreover, avoidance is done, not through the consideration of the vicious action, but through a desire of obtaining a positive virtue: corrective testimonial justice. CONCLUSION In this chapter we made three central claims. First, we suggested that a virtue-theoretic account of corrective testimonial justice is possible so long as it is based in a community-level approach. Epistemic agents do not simply

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look inward to correct credences, but look to exemplars within their broader epistemic community to cultivate corrective behaviors. Second, we argued that the leading account of epistemic exemplarism, the admiration-emulation model, faces serious problems including the invisibility of exemplars, the reliability of admiration, and the small number of possible exemplars. As an alternative we outlined two additional models where agents can learn from negative exemplars. The envy-agonism model and the ambivalence-avoidance model most straightforwardly help with broadening one’s epistemic community to more than a few individuals, allowing the epistemic poor to become better off. Those who are entrenched in an epistemic community with few epistemically virtuous agents can still learn through negative exemplars. That said, there are still a few lingering worries with the approaches on offer. First, the visibility problem still remains to those who are already thoroughly epistemically unjust. Second, envy and ambivalence can be unreliable and misdirected, like admiration. Lastly, it is not clear that negative attitudes like envy or ambivalence are epistemically robust enough to sustain corrective habits in line with virtuous behavior. We addressed some of these worries throughout the chapter, but there is a more general theme worth highlighting. It is important to note that the exemplar models we outlined are not mutually exclusive. It is unlikely that a single exemparist model will establish a surefire route to correct for testimonial injustice or cultivate epistemic virtues more generally. We take it that these models are best used in tandem so that the agent can reach a sort of reflective equilibrium by cycling through several emotions and taking an emotional perspectivism on one’s epistemic behaviors. Zagzebski herself advocates for this kind of approach to avoid problems of reliability (2017, 42). However, Zagzebski falls short of providing examples of other emotions that could possibly figure into this reflective equilibrium. Instead, she focuses on the single emotion of admiration. We have shown that relying on admiration alone is quite problematic. As an alternative, we broadened the emotional spectrum for exemplarism. Precisely by including negative emotions an agent will have a rich tapestry to be reflective in a way that achieves perspectivism and an awareness of the kind of biases that lead to epistemic injustice. With a more diverse set of exemplars, admiration can still play a role in exemplarism so long as its negative effects are curtailed by other exemplarist emotions, such as envy and ambivalence. If what we have said here is on the right track, there is a new promising research opportunity. What other emotions could help to identify exemplars, both positive and negative? How is it that agents should weigh these different exemplarist models in becoming better epistemic agents to ensure reliability and robustness? We have only scratched the surface.

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REFERENCES Alfano, Mark. 2016. “Friendship and the Structure of Trust.” In From Personality to Virtue: Essays in the Psychology and Ethics of Character, edited by Alberto Masala and Jonathan Webber, 186–206. Oxford: Oxford University Press. ———. 2017. “Epistemic Situationism: An Extended Prolepsis.” In Epistemic Situationism, edited by Abrol Fairweather and Mark Alfano, 44–61. Oxford: Oxford University Press. ———. 2018. “Nietzsche’s Polychrome Exemplarism.” Ethics and Politics 2: 45–64. Alfano, Mark, and Brian Robinson. 2014. “Bragging.” Thought 3 (4): 263–72. Alfano, Mark, and Joshua August Skorburg. 2017. “The Embedded and Extended Character Hypotheses.” In The Routledge Handbook of Philosophy of the Social Mind, edited by Julian Kiverstein, 465–78. London: Routledge. ———. 2018. “Extended Knowledge, the Recognition Heuristic, and Epistemic Injustice.” In Extended Epistemology, edited by J. Adam Carter, Andy Clark, Jesper Kallestrup, S. Orestis Palermos, and Duncan Pritchard, 239–65. Oxford: Oxford University Press. Annas, Julia. 2015. “Virtue and Heroism.” Lindley Lecture. The University of Kansas. October 23. http://hdl.handle.net/1808/19868. Bloom, Harold. 1973. The Anxiety of Influence: A Theory of Poetry. Oxford: Oxford University Press. Burckhardt, Jacob. (1872) 1999. The Greeks and Greek Civilization. Edited by Oswyn Murray. Translated by Sheila Stern. New York: St. Martin’s Griffin. Cramwinckel, Florien M., Kees Van den Bos, and Eric Van Dijk. 2015. “Reactions to Morally Motivated Deviance.” Current Opinion in Psychology 6: 150–56. Cramwinckel, Florien M., Kees Van den Bos, Eric Van Dijk, and Marijke Schut. 2016. “Derogating Benevolent Behavior of Deviant In-Group Members: Group Processes within a RealLife Sample of Heterosexual Christians.” Social Influence 11 (1): 75–86. Dostoyevsky, Fyodor. (1874) 2004. The Idiot. Translated by David McDuff. London: Penguin. Frankfurt, Harry. 2001. “The Dear Self.” Philosophers’ Imprint 1: 1–14. Freud, Sigmund. (1913) 1990. Totem and Taboo. Translated by James Strachey. London: Norton. Fricker, Miranda. 2007. Epistemic Injustice: Power and the Ethics of Knowing. Oxford: Oxford University Press. Hatch, Jenavieve. 2016. “How the Women on Obama’s Staff Made Sure Their Voices Were Heard.” HuffPost News, September 15. https://www.huffingtonpost.com/entry/how-thewomen-on-obamas-staff-made-sure-their-voices-were-heard_us_57d94d9fe4b0aa4b722 d79fe. Jensen, Anthony K. 2016. An Interpretation of Nietzsche’s On the Uses and Disadvantages of History for Life. New York: Routledge. Kondoleon, Theodore. 1970. “Divine Exemplarism in Augustine.” Augustinian Studies 1: 181–95. La Caze, Marguerite. 2019. “Judging in Times of Crisis: Wonder, Admiration, and Emulation.” In The Moral Psychology of Admiration, edited by Alfred Archer and André Grahle, 129–47. Lanham, MD: Rowman & Littlefield. Medina, José. 2013. The Epistemology of Resistance: Gender and Racial Oppression, Epistemic Injustice, and Resistant Imaginations. Oxford: Oxford University Press. Nietzsche, Friedrich. (1874) 1997. Untimely Meditations. Edited by Daniel Breazeale. Translated by R. J. Hollingdale. Cambridge: Cambridge University Press. ———. (1881) 1997. Daybreak. Edited by Maudmarie Clark and Brian Leiter. Translated by R. J. Hollingdale. Cambridge: Cambridge University Press. ———. (1880) 1986. Human, All Too Human. Translated by R. J. Hollingdale. Cambridge: Cambridge University Press. Olberding, Amy. 2012. Moral Exemplars in the Analects: The Good Person Is That. New York: Routledge. Protasi, Sara. 2016. “Varieties of Envy.” Philosophical Psychology 29 (4): 535–49. ———. 2017. “Invideo et Amo: On Envying the Beloved.” Philosophia 45 (4): 1765–84.

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———. 2019. “Happy Self-Surrender and Unhappy Self-Assertion: A Comparison between Admiration and Emulative Envy.” In The Moral Psychology of Admiration, edited by Alfred Archer and André Grahle, 45–60. Lanham, MD: Rowman & Littlefield. Rorty, Amélie Oksenberg. 2014. “The Ethics of Collaborative Ambivalence.” Journal of Ethics 18 (4): 391–403. Rozin, Paul, and Edward B. Royzman. 2001. “Negativity Bias, Negativity Dominance, and Contagion.” Personality and Social Psychology 5 (4): 296–320. Sherman, Benjamin. 2015. “There’s No (Testimonial) Justice: Why Pursuit of a Virtue Is Not the Solution to Epistemic Injustice.” Social Epistemology 30 (3): 229–50. Tanesini, Alessandra. 2016. “Teaching Virtue: Changing Attitudes.” Logos & Episteme 7 (4): 503–27. Tessman, Lisa. 2005. Burdened Virtues: Virtue Ethics for Liberatory Struggles. Oxford: Oxford University Press. Thomas, Alan, Alfred Archer, and Bart Engelen. 2019. “How Admiring Moral Exemplars Can Ruin Your Life: The Case of Conrad’s Lord Jim.” In The Moral Psychology of Admiration, edited by Alfred Archer and André Grahle, 233–48. Lanham, MD: Rowman & Littlefield. Turri, John, Mark Alfano, and John Greco. 2017. “Virtue Epistemology.” Stanford Encyclopedia of Philosophy. https://plato.stanford.edu/entries/epistemology-virtue/. Whitcomb, Denis. 2010. “Wisdom.” In The Routledge Companion to Epistemology, edited by Sven Bernecker and Duncan Pritchard, 121–32. New York: Routledge. Yap, Audrey. 2017. “Credibility Excess and the Social Imaginary in Cases of Sexual Assault.” Feminist Philosophical Quarterly 3 (4): 1. Zagzebski, Linda. 2004. Divine Motivation Theory. Cambridge: Cambridge University Press. ———. 2017. Exemplarist Moral Theory. Oxford: Oxford University Press.

Chapter Two

Positive Stereotypes Unexpected Allies or Devil’s Bargain? Stacey Goguen

If asked whether stereotypes about people have the potential to help overcome injustice, I suspect that many would think there is a clear-cut answer to this question, and that answer is “no.” If indeed stereotypes are nothing but crude generalizations (Leslie 2017), essentializing falsehoods (Blum 2004), or controlling images (Collins 2000), then this answer is right. Furthermore, many stereotypes do have harmful effects, from the blatantly dehumanizing (Livingstone Smith 2014) to the more subtly disruptive, as experienced via phenomena such as stereotype threat (Goguen 2016; Saul 2017). Reasonably then, a common attitude toward stereotypes is that they are at best shallow, superficial assumptions, and at worst degrading and hurtful vehicles of oppression. I will argue, however, that stereotypes suffer from, well, a sort of stereotype about them. 1 Of course, stereotypes can indeed be vehicles of oppression or grossly misleading assumptions, and often are such things. But on a broad account of stereotypes, this is not is not an inherent feature of them nor a foregone conclusion about them. Stereotypes are cognitive tools, and as such, they can be used for a variety of ends. Whether or not they contribute to injustice or help push back against it depends, in part, on how they are used. If there are in fact some stereotypes that can help push back against injustice,

1. Many thanks to the people who helped me think through this project, including John Casey, Tyler Zimmer, Sophia Mihic, Valerie Williams, B. R. George, Emily McWilliams, and participants of the 2018 Prindle Institute Applied Epistemology Research Retreat, Erin Beeghly, Nathifa Greene, Richard Christopher McCammon, Travis Ford, and my friend D.

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there’s a good chance that group will include, or consist of, positive stereotypes, because they posit positive, valued group features. 2 First, what does it mean to be a stereotype? Not all philosophers agree on this. Larry Blum (2004) argues that all stereotypes are, by definition, misleading generalizations that wrongly essentialize a group and are overly resistant to counterevidence. For Blum, any generalization that does not meet these criteria does not deserve the label of “stereotype.” Blum’s account likely resonates with many people who suspect that there are serious moral harms embedded in all stereotypes. Erin Beeghly (2015) rejects Blum’s narrower account, however, and defends a broader one. She wants an account of stereotype that picks out the same set of objects that psychologists study, and argues that Blum’s account does not fit this bill. Beeghly also cautions that we might not want to confine the label “stereotype” to a subset of generalizations that are morally wrong and misleading. She notes that Walter Lippman, the first person to talk about psychological stereotypes (as opposed to the literal metal plates used in printing), acknowledged that stereotypes are simply cognitive shortcuts. He claimed that “the abandonment of all stereotypes for a wholly innocent approach to experience would impoverish human life” (Lippman 1922, 88). Therefore, Beeghly argues for a “descriptive view” of stereotypes, by which they are, essentially, expectations about individuals based on group membership (Beeghly 2015, 679). Beeghly is right that some of the generalizations and associations studied by psychologists under the label “stereotypes” will not fit Blum’s criteria. Blum’s account, however, does reveal important features about at least some stereotypes. So Blum and Beeghly’s disagreement may mostly be about terminology: on Beeghly’s account, Blum is discussing a certain subset of essentializing stereotypes. On Blum’s account, Beeghly is talking about a group of things that include stereotypes and other sorts of generalizations. For this discussion here, I will use a broader sense of stereotype, closer to Beeghly’s account and following how the word is used in everyday conversations and in social psychology research. I will not rely on Beeghly’s specific

2. It is beyond the scope of this chapter to offer a full analysis of positive and negative stereotypes. Such a project could include the following: the positive effects of negative stereotypes for privileged groups (thanks to Maureen Erber for this suggestion), the negative effects of positive stereotypes for marginalized groups (see Devarajan 2018), the negative effects of positive stereotypes for privileged group members who are counterstereotypical, and using negative stereotypes to “punch-up” against privileged groups (thanks to Ben Sherman for this suggestion).

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account however, because I do not think I need to for this discussion, and it may be a bit too broad. 3 For this discussion, stereotypes are generalizations about social groups that attempt to pick out consistent or stable features about those groups: women are empathetic; men are aggressive; gamers are lazy; jocks are stupid; Midwesterners are nice; 4 New Yorkers are rude; autistic people are antisocial; indigenous people are wise; Asian people are good at math. 5 I will also focus on stereotypes that have a “positive” valence: women are empathetic; Midwesterners are nice; indigenous people are wise; Asian people are good at math. Many such positive stereotypes can still be harmful and disrespectful. They can make it easier to create or access negative stereotypes, they can create unfair expectations, they can “box people in” to a certain identity, and they can reduce people’s willingness to acknowledge merit and effort when someone succeeds at something they are positively stereotyped about (Devarajan 2018). This is grist for the mill of thinking that all stereotypes, negative or positive, are epistemically and morally harmful. There are, however, some instances where positive stereotypes seem capable of pushing back against other, more degrading stereotypes. That is, they can sometimes have concrete, positive effects, at least in the moment. Could it be that some positive stereotypes can serve as unexpected allies in our struggles against epistemic injustice? Maybe not—these positive effects could prove to be illusory. Or if not illusory, they could be outweighed by harms they create. Positive stereotypes could be, not akin to an unexpected ally, but rather a devil’s bargain: a deal that looks worthwhile when one is desperate, but ultimately costs much more than it is worth. Investigating this question through the lens of epistemic injustice reveals that positive stereotypes have the potential to play both roles. They do not have one set role to play, but rather are a tool (a dangerous tool no doubt) that can be used for good or ill.

3. Beeghly claims that, “When we ask, ‘What’s wrong with stereotyping?’ we are asking primarily, ‘What’s wrong with forming expectations of individuals based on group membership and structuring our interactions accordingly?’” (Beeghly 2015, 679). The primary feature of stereotypes (and the primary facet of their wrongdoing), however, may not be forming expectations of individuals based on group membership (i.e., the correlation of group membership to expected behavior). Stereotypes may also imply that a particular group membership is especially salient for understanding and explaining that individual’s behavior (i.e., a causal link between group membership and behavior). As Blum puts it, stereotypes “essentialize.” 4. “Midwesterners are nice” is a generalization that Blum specifically rejects as (usually) being a stereotype (Blum 2004, 264). 5. See Leslie (2017) for a further discussion about stereotypes and “striking property generics.”

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POSITIVE STEREOTYPES AS UNEXPECTED ALLIES AGAINST EPISTEMIC INJUSTICE Do some positive stereotypes have the potential to be resources for resisting epistemic injustice? At the very least, are there some situations where positive stereotypes might grant an individual some epistemic benefit without causing serious (epistemic or moral) harm? I will focus on two ways that positive stereotypes can potentially help alleviate epistemic injustice (broadly conceived): they can help create epistemic friction, and they can help build self-trust. Epistemic Friction José Medina (2017) argues that one important tool for dealing with epistemic injustice is “hermeneutical resistance,” which names the ways that people are exerting “epistemic friction against the normative expectations of established interpretative frameworks and aiding dissonant voices in the formation of alternative meanings, interpretations, and expressive styles” (Medina 2017, 48). As background, Medina argues that “communicative contexts are always polyphonic,” which means that there are always different epistemic norms and practices being performed and advocated for. Thus, there is always the potential for epistemic friction—for presenting alternatives or challenges or questions to dominant norms, frameworks, and assumptions. Positive stereotypes can be an easy source of epistemic friction against harsher, negative stereotypes. Positive stereotypes not only deny the negative stereotype, but also supply an alternative narrative or schema to replace it. For example, a positive stereotype can deny that a certain social group has a particular vice, and instead claim that they have a particular virtue (e.g., immigrants aren’t lazy—they’re hardworking; women aren’t flighty— they’re practical and better at adulting; indigenous groups aren’t backward and ignorant—they’re wise and retain generational knowledge). On Medina’s account of epistemic injustice, it looks like positive stereotypes could play a role in helping to resist unfair “hermeneutical climates” (Medina 2017, 48), even if they are not perfect or ideal epistemic tools. In some contexts, the point of creating epistemic friction may be to directly challenge an idea, claim, or ideology, because it is harmful or oppressive. But another benefit of creating epistemic friction is that it can open up epistemic space for imagining alternatives—perhaps creating the opposite of a “controlling image,” as theorized by Patricia Hill Collins. Collins (2000) argues that certain stereotypes and tropes are not just insulting or degrading, but that they also help control an oppressed population by justifying their social subordination. These images help “keep oppressed people in their place.”

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Her examples regarding black women are the tropes of the mammy, the matriarch, the welfare mother, and the jezebel. To focus on one, the “welfare mother” as a stereotype cannot engage in responsible family planning, will have more children that she can afford, and thus will perpetually be in need of welfare (Collins 2000, 270). This image portrays black women as people who cannot be trusted to engage responsibly with the welfare system, and thus society is justified in encroaching on their autonomy by taking away their reproductive rights, and denying the black community (which black women are held responsible for) a robust social safety net. Other controlling images exist for women, too, as well as other groups. For example, one could think of the image of the bitchy boss, who is only good at her job insofar as she is terrible at being a woman (that is, nice and nurturing). Thus, it is fine if many supposedly aggressive industries do not have women in leadership roles and if women are passed up for promotion, because they are either naturally unfit to be leaders or they are a rare, unnatural “exception” to their gender. Can we use positive stereotypes to help create epistemic friction against some of these controlling images? Some have tried this, though with limited success. Melissa Harris-Perry analyzes the image of the “strong black woman,” an image that was in part created by and for black women to help push back against controlling images of themselves. The concept of the Strong Black Woman attempts to take the vices of too much aggressiveness, sexual autonomy, and independence and flip them into a set of virtues. Strong Black Women “are motivated, hardworking breadwinners who suppress their emotional needs while anticipating those of others. Their irrepressible spirit is unbroken by the legacy of oppression, poverty, and rejection” (Harris-Perry 2011, 184). However, Harris-Perry argues that the Strong Black Woman trope can end up doing its own sort of damage. This image implies that black women’s virtues are superhuman, and thus, others do not need to show them empathy, care, and concern—because they are “strong” and can handle it (Harris-Perry 2011, 185–86). One example of this fallout is that black women’s pain is often not taken as seriously as others’, they are presumed to be able to tolerate pain better than others, and they are often underprescribed pain medicine. 6

6. There is currently not much large-scale research about pain biases against black women in particular, but there are documented biases against both black patients and women more broadly in this regard, so black women are subject to at least two separate biases, and I suspect that the intersection of those biases may even amplify each other. See Hoffman and Tarzian (2001); Jamison (2014); and Fassler (2015) for discussions of biases against women’s pain, and Tamayo-Sarver et al. (2003); Hoffman et al. (2016); and Singhal et al. (2016) for discussions of biases against black patients’ pain.

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Here we witness one of the pitfalls of using positive stereotypes: they too can create a calcified image of a group of people. Even if the stereotypes accurately portray common group features or aspirational qualities, the stereotype implies that these features and qualities are completely stable and fixed. As Harris-Perry notes, “What begins as empowering self-definition can quickly become a prison” (2011, 185). The Strong Black Woman is always strong and never vulnerable; the independent woman is always independent and never needs help, and so on. All stereotypes may have this quality of boxing a group into a certain role or trope that does not do justice to each human’s dynamic self. Thus, certainly in the long run, positive stereotypes run the risk of calcifying one’s self-image, both to others and oneself. But what about as a more temporary measure? After all, some individuals have found positive stereotypes like the Strong Black Woman, or the bitchwho-gets-things-done, helpful at times. Harris-Perry herself even notes, The strong black woman serves as a constructive role model because black women draw encouragement and self-assurance from an icon able to overcome great obstacles. She offers hope to people who often face difficult circumstances. Independence and self-reliance can be crucial to building and maintaining a positive image of blackness in a society that often seeks to negate and vilify it. (Harris-Perry 2011, 184)

Used temporarily, these positive tropes can help “pry loose” our thinking from the grips of a negative stereotype or narrative. It can help us imagine different possibilities for ourselves and offer hope and motivation to make an alternative to the dominant understanding a reality. It could, even if just for a brief moment, be a freeing image. The key, perhaps, is to know when to drop the stereotype before it begins to calcify your self-image. Some might object that there are better tools for creating epistemic friction that do not come with the sorts of costs that stereotypes carry. I would be happy to hear of them, and to have others explain how we can use them instead of stereotypes. I suspect, however, that positive stereotypes may be one of the easiest and most accessible tools in our arsenal, especially in the spur of the moment if someone raises the specter of a negative stereotype. This chapter is not arguing that positive stereotypes are the best tool for the job, or a solution that comes without collateral damage. It is merely making the case that not all uses of stereotypes are epistemically and morally worthless. Self-Trust The second way that positive stereotypes can contribute to epistemic justice is by helping individuals build or restore epistemic self-trust. Since self-trust

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plays a central role in our function as general knowers (Jones 2012), an excess of self-distrust may be a byproduct of many forms of epistemic injustice. It certainly can be a sign of epistemic dysfunction in a community— which Gaile Pohlhaus Jr. (2017) argues is a core feature of epistemic injustice. I have argued elsewhere that at least some negative stereotypes can contribute to self-doubt and erode self-trust (Goguen 2016). For instance, if there is a culturally widespread stereotype that your social group is irrational, overly emotional, primitive, impulsive, delusional, or not as logical or analytical as other groups, this could lead stereotyped individuals to doubt their own epistemic agency. They may worry that their thoughts and experiences are not reliable or trustworthy, compared to others’. This has happened to me personally. One instance (of the many instances I can think of) is that in college, I once asked a professor about what exactly Plato’s forms were supposed to be, after we had read the Republic in class, because I had trouble wrapping my head around what exactly the form of a horse was—a cognitive schema, a mind-independent essence, what. Obviously, I did not use those words at age nineteen, so I probably phrased it as, “What exactly are the forms because I don’t get them?” Somewhere in that conversation, the professor mused about whether women’s brains were not structured to naturally think in terms of logical categories as men’s brains were. The unspoken implication in that conversation was perhaps there was something about my brain that would help explain why the forms did not make immediate sense to me. This conversation led me to lay awake for some nights, wondering what it meant to have a brain that was not naturally inclined to think in terms of logical categories, and whether I should distrust my thoughts about things if I might have such an illogical brain. 7 First, I want to reject one reading of this sort of self-doubt that I think is implied in lots of everyday and academic discussions of the topic. The reading is that this sort of internalized self-doubt is a form of “internalized oppression” and as such, it is thought of as either a kind of moral/emotional damage to ourselves, or an epistemic slip-up on the part of the oppressed. Either (as oppressed) we are cudgeled into feeling uncertain about our own capabilities on a brute emotional level (the mechanism here is not often spelled out), or we are somehow duped into believing a wrong conclusion about our own capabilities (whereas nonoppressed people have accurate assessments of their capabilities). 7. I also obsessed over the question of how one could investigate this sort of claim, and determine whether one’s own brain was as logically inclined as other people’s brains; and whether having heard this suspicion, I should consider it a live possibility until such time as I had found compelling evidence that it was not true of my brain—though I struggled to imagine what such evidence would look like. With hindsight, I appreciate the irony of me having a rather (perhaps overly) rational response to the suggestion that I was not fully rational.

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On this reading, to acknowledge that you have self-doubt from internalized oppression means that you are admitting to making a mistake (believing a badly argued or evidenced conclusion about yourself) or you are admitting to being emotionally and psychologically susceptible to what the oppressors want you to feel and think about yourself (i.e., uncertain; not believing in yourself.) To restate, self-doubters doubt themselves because they have either wrongly assessed their epistemic abilities, or they have given too much weight to the “negative feelings” created in them by their oppressive environment. In either case, to admit to having this sort of self-doubt is then to admit to having a flaw—you are admitting to being too irrational or too gullible or not having enough confidence in yourself when you should. Here I am going to speak for myself. This often-implicit reading of internalized self-doubt does not fit my own experience of self-doubt stemming from sexist stereotypes. I also find this reading of the situation incredibly silencing when trying to discuss this phenomenon. I find that people sometimes start pitying me or trying to correct me when I discuss my experience of self-doubt, I think because they interpret me as admitting to failures in my own logical faculties (a big no-no for someone training to be a professional philosopher). Or, people sometimes start worrying that I am saying that others who have experienced self-doubt have flawed logical and psychological faculties. In fact, I think the opposite is true. I use here a different reading wherein excessive self-doubt in a dysfunctional epistemic system is not always a sign that self-doubters are messing up or failing to recognize that the system is duping them. Self-doubters are sometimes self-doubting because they are good (or even exceptional) epistemic agents, but are receiving lots of flawed evidence from the bad sources that the larger system/community has failed to identify and label as such. In these situations where someone is presented with a negative stereotype about their group being irrational, a good epistemic agent may simply not yet know about the existence of pervasive and systemic oppression, or the role stereotypes play in such oppression, or that professors who are really smart about some topics may be very ignorant about other topics—and not be self-aware enough to realize it. But if all signs in your epistemic community point toward someone being a reliable source of information and hypotheses about the world, then good epistemic agents will take what that person says seriously, even if that leads to a discomforting conclusion about themselves. Good epistemic agents are open-minded, humble, don’t immediately discount hypotheses that don’t make them look good, seek independent assessments of their own epistemic reliability, and seek out further evidence for important claims they are unsure about. For good epistemic agents, self-trust does not form in a vacuum, independent of what the rest of the world is telling them about themselves. The smartest person in the world (should such a thing exist) still needs other people to check their math. On this reading,

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what oppressed self-doubters need is not something to improve their own cognitive processes, but simply something to challenge the dysfunction in the oppressive system that is leading these good epistemic agents to inaccurate conclusions about themselves. Positive stereotypes are one of the things that could do this sort of challenging. One way they could do this is that, in the absence of evidence that would debunk the negative stereotype once and for all, positive stereotypes can serve as a counterweight to negative stereotypes. Many stereotypes psychologically function as suspicions or hypotheses wherein every mention or activation of the stereotype makes the corresponding hypothesis more live, or more potentially salient. Positive stereotypes will not “disprove” a negative one, but they can provide some epistemic friction by presenting an opposing hypothesis as just as live as the one suggested by the negative stereotype. This could work as a stopgap measure if one does not have access to the information (neurology, etc.) that would confirm or disprove the negative stereotype. For example, if I told a friend of mine about what my professor said about women’s brains, and she thought that was bullshit, but did not have a whole argument or body of evidence at her fingertips, she could at least for the time being present me with a countervailing positive stereotype: “I don’t think women’s brains are naturally disinclined to logic because I’ve seen lots of women manage complex logistics in situations where the men were way crappier at organizing. So there might even be some situations where women’s brains are better organized and quicker than men’s.” This would play into the positive stereotype that women are better at adulting and daily organization than men are. One might object here that it’s better to discuss counterstereotypical examples, instead of countervailing stereotypes. For instance, the friend could mention all the brilliant women she knows in philosophy and science. The problem is that, after a little bit of research, she and I would realize that women only make up 10 to 30 percent of those fields, which raises the specter of the negative stereotype again. So, I would say that when it works, definitely turn to counterstereotypical facts and examples. But I suspect that in some cases, a few counterstereotypical exemplars will not be enough to make a negative stereotype less live of a hypothesis, because a few exceptions do not disprove a general rule. A second use for positive stereotypes is that they could help scaffold embodied practices and embodied knowledge, which could then help build self-trust. 8 For example, I experience lots of self-doubt about writing philosophy. Whenever I try to write a philosophy paper (including this chapter!) I am inundated with self-doubt, and it is hard to write when the writing process 8. See Shotwell (2017) for a discussion of embodied knowledge and epistemic injustice.

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is associated with lots of negative emotions and I have essentially created a habit of dredging up lots of worries and negative thoughts about myself while writing. A friend once suggested to me that I should find some positive mantra and cling to that, even if it’s something like, “I have a PhD; I have smart things to say; I can do this.” At first I balked at this idea, because it sounded like I would be clinging to a positive stereotype about people with PhDs, and stereotypes are bad. But as I heard her out, I realized that I was a bit desperate and willing to try things I didn’t even have much faith in. So I tried it, and whenever I would start worrying that I would never have anything smart or original to say, I would stop myself and think, “I have a freakin’ PhD; I can write a minimally competent paper.” What I realized is that the positive stereotype served as a stepping-stone to inject some positive associations into the writing process. Then, with this jump-start in motivation and bolstered resistance to quitting, I could more easily spend more time writing, and thus gain more knowledge of writing— more knowledge about how a paragraph that seems stupid one day can look rather insightful the next, or how, when I feel the most hopeless, I’m usually on the edge of a breakthrough. Some of this was embodied knowledge—the feeling of typing furiously at the keyboard when I had a moment of insight; the feeling of dread in my stomach that I learned I had to push through; the feeling of confusion that meant I probably hit on a deeper question than I had realized. We do not normally think of writing as a physical activity, but as I’ve become more practiced with it and more confident in my writing abilities, the more I’ve noticed the embodied aspects of it. There are ways that I am guided not by deliberate knowledge but rather by the feelings and associations and hunches that stem from certain actions. When you drive, you learn how it feels when you take too sharp of a corner; when you paint, you learn how it feels to make properly proportioned leaves with your fan brush; and when I write, I’ve learned how it feels to spit out two pages of writing in a flurry of energy that is on to something, but that will probably need to be edited down to 10 percent of its current length. Even if one does not grant me the claim that writing incorporated embodied knowledge, the larger point is that once one achieves a certain level of competence or mastery with an embodied skill, going through the motions of that skill can instill feelings of self-confidence that spur on further activity, creating a positive feedback loop. Eventually, the hope goes, I can just sit down at my computer and enjoy positive associations with the writing process, because I have built up embodied self-trust. But to get to that point where one is practiced enough to have competence with a skill, some people will benefit from the strategy of “fake it till you make it.” Positive stereotypes may help up fake (or really, jump-start) confidence and motivation until embodied habits can take over that role. Though again, this warrants

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only a temporary role for positive stereotypes, and if there is something else that can do the job equally well, it might be all the better to use those alternative means. 9 POSITIVE STEREOTYPES AS DEVIL’S BARGAINS AND MASTER’S TOOLS Positive stereotypes are not without risks and harms. But it is far from obvious that all positive stereotypes carry the same risks and the same harms. Here is where we can return to Beeghly and Blum’s disagreement, with additional context from Collins. It may be that certain basic psychological processes are the same for all stereotypes, broadly conceived as group generalizations. For example, research on stereotype threat suggests that marginalized and dominant groups can both experience certain negative effects from negative stereotypes about their group being emphasized or made salient (Inzlicht and Schmader 2011). This is in line with Beeghly’s account of stereotypes. But Collins points out that certain stereotypes have a specific use or function in certain social contexts. In the United States, certain stereotypes about black women serve as controlling images that justify their oppression and create additional epistemic labor for black women to push against them. These are essentializing stereotypes as Blum describes them. What this means is that some positive stereotypes may be riskier to use than others. It might be less risky or less damaging to use a stereotype about Midwesterners to boost your confidence than using a stereotype about your gender or race. Similarly, it might be riskier to use a stereotype about a privileged identity than a more socially neutral identity. For instance, if one faces stereotype threat or self-doubt regarding being a woman in a masculinized field, it is risky to appeal to one’s prestigious college training or family of academics as a psychological Band-Aid here. So too with my writing— relying on my PhD for confidence probably came with some costs. What makes some of these potential costs especially worrying is that the people benefitting from employing these stereotypes may not be the people paying the price for doing so. For example, if a white man semiregularly employs the stereotype that members of his social group are intelligent and rational, the costs to him might be minimal—because although he may be making himself more susceptible to negative stereotypes about white men, there are currently no oppressive stereotypes about this social group. But the costs to those that he is implicitly denigrating—women and people of color, 9. For instance, one might be able to use knowledge about their PhD in a nonstereotypical way, telling themselves that “lots of people without PhDs can write awesome philosophy papers, so with one, the chances of me writing a good philosophy paper are probably high.” The problem might be that such a pep talk fails to inspire the confidence it was aiming for.

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are significantly more severe. So too with the positive stereotype about PhDs I used and stereotypes about different classes in US society. An interesting question is whether this sort of cost also appears in positive stereotypes about a stigmatized group. For instance, the positive stereotype that women are nurturing has been used to argue that women are not cut out for certain nonnurturing roles, such as being in the military or cut-throat politics. Thus, a similar calculus could apply to a middle-class white woman who is a stay-at-home-mom, if she employs the stereotype of women as nurturing to her own benefit, but that may carry costs to the less privileged women in her life who are trying to hack it in politics. If this analysis is right, then Audre Lorde’s (1983) well-known warning about the master’s tools is an apt description of the dangers of using positive stereotypes in this way. Lorde argues, For the master’s tools will never dismantle the master’s house. They may allow us temporarily to beat him at his own game, but they will never enable us to bring about genuine change. And this fact is only threatening to those women who still define the master’s house as their only source of support. (Lorde 1983)

Lorde makes this initial observation about white feminists who reproduce hierarchies of marginalization (and white ignorance, if I am reading her correctly) against women of color and queer women. Their institutional practices use many of the same “moves” that more privileged groups use, and thus, although they might be able to move themselves up a bit in the relevant social hierarchies, they are not doing enough to undermine the hierarchy as a whole. Similarly, using certain positive stereotypes might allow one to temporarily maneuver oneself within a social hierarchy, but does nothing to help those further down the relevant set of hierarchies. Furthermore, if one makes it a habit of boosting one’s sense of self-worth with positive stereotypes, one might tie one’s self-esteem to a system of social hierarchy, to the point where one might become psychologically defensive of those systems. In this way, one might become those who “still define the master’s house,” that is, the social hierarchy, as their primary source of self-worth. Pushing back against epistemic injustice is then not just about mitigating the effects of stereotypes on their direct targets, since the true costs of using a stereotype might not be felt by the person employing it on themselves. Instead, overcoming unjust stereotypes is about dismantling unjust hierarchies from our institutions and our thinking. This has implications for research on stereotype threat, a phenomenon where the mere mention of a negative stereotype can cause targeted individuals to lose focus, motivation, and confidence—which is often measured

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through performance. Some suggest that individuals can use positive stereotypes to overcome the performance effects of stereotype threat—and this seems like an accurate prediction. However, individual performance is not everything, and positive stereotypes might have larger and longer-term consequences than one realizes. 10 CONCLUSION Where does this leave us? Positive stereotypes can have positive effects in certain circumstances. There are instances where they may be an individual’s best shot at mitigating the negative effects of negative stereotypes, or the most available tool for resisting epistemic injustice. The takeaway is that stereotypes are versatile (if crude) cognitive tools, which can be used for many purposes. Because of this, a blanket moral condemnation of all things stereotype-like in all situations is too broad a principle. However, many positive stereotypes may be conceptually and psychologically joined to a contrasting negative, degrading stereotype. In many cases, we might only be able to lift our own self-image at the cost of lowering the image of others, knowingly or not. Because of this danger, we should focus on investigating the different effects that different stereotypes have. I suggest that we could divide effects into different levels: the individual, the stereotyped group, and the institutional/cultural. In some cases, stereotypes may have an impact on an individual or local community, but no significant impact at the societal level (e.g., “The Lopez family are hard workers”; “People from Leominster are snobs”). In other cases, using a certain stereotype may benefit you the individual, but not the stereotyped group as a whole. Stereotypes are cognitive shortcuts and hypotheses about patterns of human behavior. They are indeed vehicles for epistemic injustice in many instances, but they can also sometimes be used to push back in reverse and provide momentum for resisting injustice. They are a tool with many uses, so we always want to be asking, what is this tool being used for, and what is its actual effects? Is this stereotype a coping strategy for an individual to mitigate the effects of injustice on themselves? Is it a counterhegemonic stopgap that applies friction against a dominant narrative? Is it one of the many epistemic weapons we use to keep marginalized groups in their place? Stereotypes are all that, and more. They are both unexpected allies and a devil’s bargain at times.

10. See Goguen (2016) for further discussion about stereotype threat, performance, and epistemic injustice.

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REFERENCES Beeghly, Erin. 2015. “What Is a Stereotype? What Is Stereotyping?” Hypatia 30 (4): 675–91. Blum, Larry. 2004. “Stereotypes and Stereotyping: A Moral Analysis.” Philosophical Papers 33 (3): 251–89. Collins, Patricia Hill. (1990) 2000. Black Feminist Thought: Knowledge, Consciousness, and the Politics of Empowerment. Second edition. New York: Routledge. Citations are from the second edition. Devarajan, Kumari. 2018. “‘Strong’ Black Woman? ‘Smart’ Asian Man? The Downside to Positive Stereotypes.” NPR: Codeswitch, February 17, 2018. https://www.npr.org/sections/ codeswitch/2018/02/17/586181350/strong-black-woman-smart-asian-man-the-downside-topositive-stereotypes. Fassler, Joe. 2015. “How Doctors Take Women’s Pain Less Seriously.” The Atlantic, October 15. https://www.theatlantic.com/health/archive/2015/10/emergency-room-wait-times-sex ism/410515/. Fricker, Miranda. 2017. “Evolving Concepts of Epistemic Injustice.” In The Routledge Handbook of Epistemic Injustice, edited by Ian James Kidd, José Medina, and Gaile Pohlhaus Jr., 53–60. New York: Routledge. Goguen, Stacey. 2016. “Stereotype Threat, Epistemic Injustice, and Rationality.” In Implicit Bias & Philosophy, volume 1, edited by Michael Brownstein and Jennifer Saul, 216–37. Oxford: Oxford University Press. Harris-Perry, Melissa. 2011. Sister Citizen: Shame, Stereotypes, and Black Women in America. New Haven, CT: Yale University Press. Hoffman, Diane, and Anita Tarzian. 2001. “The Girl Who Cried Pain: A Bias against Women in the Treatment of Pain.” Journal of Law, Medicine, & Ethics 29: 13–27. Hoffman, Kelly, Sophie Trawalter, Jordan Axt, and M. Norman Oliver. 2016. “Racial Bias in Pain Assessment and Treatment Recommendations, and False Beliefs about Biological Differences between Blacks and Whites.” Proceedings of the National Academy of Sciences of the United States of America 113 (16): 4296–301. Inzlicht, Michael, and Toni Schmader, eds. 2011. Stereotype Threat: Theory, Process, and Application. Oxford: Oxford University Press. Jamison, Leslie. 2014. “Grand Unified Theory of Female Pain.” Virginia Quarterly Review, Spring 2014. https://www.vqronline.org/essays-articles/2014/04/grand-unified-theory-fe male-pain. Jones, Karen. 2012. “The Politics of Intellectual Self-Trust.” Social Epistemology 26 (2): 237–51. Leslie, Sarah-Jane. 2017. “The Original Sin of Cognition: Fear, Prejudice, and Generalization.” Journal of Philosophy 114 (8): 393–421. Lippman, Walter. 1922. Public Opinion. New York: Harcourt, Brace, and Company. Livingstone Smith, David. 2014. “Dehumanization, Essentialism, and Moral Psychology.” Philosophy Compass 9 (11): 814–24. Lorde, Audre. 1983. “The Master’s Tools Will Never Dismantle the Master’s House.” In This Bridge Called My Back: Writings by Radical Women of Color, edited by Cherrie Moraga and Gloria Anzaldua, 94–101. New York: Kitchen Table Press. Medina, José. 2017. “Varieties of Hermeneutical Injustice.” In The Routledge Handbook of Epistemic Injustice, edited by Ian James Kidd, José Medina, and Gaile Pohlhaus Jr., 41–52. New York: Routledge. Pohlhaus, Gaile, Jr. 2017. “Varieties of Epistemic Injustice.” In The Routledge Handbook of Epistemic Injustice, edited by Ian James Kidd, José Medina, and Gaile Pohlahus Jr., 13–26. New York: Routledge. Saul, Jennifer. 2017. “Implicit Bias, Stereotype Threat, and Epistemic Injustice.” In The Routledge Handbook of Epistemic Injustice, edited by Ian James Kidd, José Medina, and Gaile Pohlhaus Jr., 235–42. New York: Routledge. Shotwell, Alexis. 2017. “Forms of Knowing and Epistemic Resources.” In The Routledge Handbook of Epistemic Injustice, edited by Ian James Kidd, José Medina, and Gaile Pohlhaus Jr., 79–88. New York: Routledge.

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Singhal, Astha, Yu-Yu Tien, and Renee Hsia. 2016. “Racial-Ethnic Disparities in Opioid Prescriptions at Emergency Department Visits for Conditions Commonly Associated with Prescription Drug Abuse.” PLoS ONE 11 (8): e0159224. https://doi.org/10.1371/journal. pone.0159224. Tamayo-Sarver, Susan Hinze, Rita Cydulka, and David Baker. 2003. “Racial and Ethnic Disparities in Emergency Department Analgesic Prescription.” American Journal of Public Health 93 (12): 2067–73.

Chapter Three

Conceptualizing Consent Hermeneutical Injustice and Epistemic Resources Audrey Yap

The legal difference between sex and sexual assault is located in the presence or absence of consent. In the Canadian legal system (for example), not much is said to demarcate the exact bounds of consent, though it is lacking in cases of physical force, threats, or other types of explicit coercion. The question of consent becomes complicated in many ordinary situations, for instance in which there are significant power-over relationships. These are differences in status or institutional power between parties involved. In academia, some accused of sexual misconduct have claimed their relationships were consensual, though the other party was of significantly lower institutional status, such as their being a professor and a student. My argument in this chapter is that hermeneutical injustices can affect our understanding of consent, thereby disadvantaging those with less social power. “Hermeneutical injustice” is a term used to describe cases in which an individual is failed by the collective hermeneutical resources that are available (Fricker 2007). However, this gap in hermeneutical resources is not always symmetrical (Mason 2011). Members of marginalized groups may well have the conceptual resources with which to make sense of their lived experience; the problem may lie in a lack of uptake from those with more social power. Even in Miranda Fricker’s own example, Carmita Wood and the other women who had experienced sexual harassment were aware that something bad had been done to them by their male bosses, even if they did not have a term with which it could be pinpointed. There can even be cases in which the relevant hermeneutical resources are readily available, but only in marginalized communities. For instance, as Talia Bettcher (2013) points out, inclusive meanings of the word “woman” are easily available in trans com49

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munities. But as is the case with white ignorance (Mills 2007), those with more social power often have a vested interest in maintaining hermeneutical gaps and keeping themselves ignorant (Pohlhaus 2012). In the case of consent, we find situations in which those who are marginalized claim that they felt themselves unable to refuse advances from those with more social power. And as Gaile Pohlhaus Jr. suggests, those with more social power might have a vested interest in understanding such situations in ways in which they are not bad actors. The double bind faced by the marginalized party may result from a recognition that the person making advances might eventually play a role in their future career prospects; after all, personal recommendations and networking go a long way, and in a job market saturated with applicants, making an enemy out of a prominent figure in one’s field is a risk. But of course not all cases are the same. While some instances of harassment are obvious single cases of unwanted behavior, others are better described as a series of encounters that escalate (Weale and Bannock 2017; Want and Widener 2017). Sometimes, however, those accused of bad behavior respond that everything that took place was consensual, with the expectation that they would thereby be absolved of wrongdoing. Even assuming that such denials are made in good faith, the testimony of those who claim to be harmed would suggest that something more is going on than a simple misunderstanding or a false accusation. I argue that we can understand this in terms of hermeneutical injustice. After all, one of the problems with overcoming situations of hermeneutical injustice is its imperceptibility to those who are relatively well served by existing conceptual schemes. A simplistic concept of consent, for instance, can serve the interests of those with more power in relationships, since those with less power can often perceive themselves to be obligated or otherwise compelled to comply, without any coercion required from the other party. In the following sections, I will argue that hermeneutical injustice can apply in at least two distinct ways when it comes to the concept of consent. First, making use of a distinction between operative and manifest concepts, I will show that our operative concept of consent can, in practice, build in harmful stereotypes. This can lead to characterizing certain situations as consensual for problematic reasons. Second, I will argue that there are also situations in which, even when consent might be technically present, power dynamics render certain actions and certain relationships harmful to at least one person involved in them. These are cases in which a lack of consent is the wrong way to model what is problematic about a relationship or interaction.

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MANIFEST AND OPERATIVE CONCEPTS The distinction between our manifest and operative concepts tracks the difference between a concept as it is explicitly and publicly defined (the manifest concept) and the implicit, yet more frequently practiced concept (the operative concept) (Haslanger 1995). Not all concepts need to be distinct in such ways. My manifest and operative concept of a phone might coincide, such that there would be no cases in which they come apart. And not all situations in which our manifest and operative concepts come apart involve hermeneutical injustice. While my manifest concept of a puppy might be such that it only covers dogs under a year of age, my operative concept of a puppy might be such that I refer to and treat all dogs as puppies, regardless of age. Yet it seems unlikely that hermeneutical injustice would arise from such a practice or conceptual gap. There are, however, cases in which such a hermeneutical gap can result in significant injustice and harm. Katharine Jenkins (2017) argues that such a situation arises due to a gap between our manifest and operative concepts of sexual assault and domestic abuse. This gap can result in our failing to recognize certain cases of assault and abuse for what they are. She attributes it in part to rape myths, or inaccurate views about the nature of rape and the circumstances under which it takes place. For example, the ideas that sexual assault must always involve overwhelming physical force, that victims always employ significant physical resistance to the assault, and that assault cannot take place within the context of an existing sexual relationship, are all examples of rape myths (Anderson 2005). Juror acceptance of such myths, and the extent to which lawyers in court appeal to them, have had documented effects on assault trials, often to the detriment of the complainants (Temkin, Gray, and Barrett 2016). While it is clear from the law in a wide range of North American contexts that sexual intercourse without consent is in fact sexual assault (our manifest concept), the extent to which someone accepts rape myths such as the idea that victims always fight their attackers, can affect the extent to which they are likely to classify experiences—even their own experiences—as sexual assault (under their operative concept) (Peterson and Muehlenhard 2004). These are unusual cases of hermeneutical injustice, since they are not situations in which a concept is entirely absent and must be developed in order to account for peoples’ experiences. Rather, they are cases in which there is a perfectly serviceable concept that is widely available for use, but is not, in fact, the concept that is used in practice. Fricker’s original definition of hermeneutical injustice does not apply in the cases Jenkins discusses, since the official concept of sexual assault is not obscured by any formal mechanisms, nor is it difficult to access. Yet, because of the presence of rape myths in popular culture, many people develop faulty concepts of sexual

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assault, building in pernicious elements that are not required by the official definition, such as physical resistance on the part of the victim. As such, we can see situations in which a person genuinely does not see themselves as having been sexually assaulted because they did not physically resist, having applied their faulty operative concept of assault in order to understand their experience (Jenkins 2017, 194). Now, Jenkins’s discussion is about assault and harassment more generally and not the specific issue of consent. So I want here to consider particular ways in which injustice can result from too close a connection between our concept of sexual pleasure and our operative concept of sexual consent. More specifically, there are times when our operative concept of consent becomes conflated with our concept of sexual desire, such that if we readily believe that a sexual encounter was desirable or pleasurable, then we are more likely to view it as genuinely consensual. This can cause problems when our sexual stereotypes lead us to believe that those who are seen as “naturally” less desirable might be more grateful, or take more pleasure in sex, making it harder for us to see those people as “rapeable.” Yet according to our manifest concept of consent, it is possible to feel sexual desire for another person without consenting to sex with them. For example, someone in a monogamous relationship might feel mutual sexual desire with someone who is not their partner, but not consent to sex with that person, so as not to betray their partner’s trust. And conversely, we might also consent to sex without any accompanying feelings of sexual desire, perhaps as part of a business transaction, or to please a partner. 1 Stormy Daniels, for instance, when interviewed about her affair with Donald Trump, clearly states that she did not want to have sex with him, but notes that the sex was entirely consensual (CBS News 2018). A conflation of desire and consent is not exhausted by the problems of rape myths, though the issues do intersect. While rape myths might be particularly problematic for victims with certain social identities, this discussion focuses on how sexual stereotypes specifically related to those social identities can cause problems. The focus, then, will be on nonideal victims: those who are not readily recognized by society as being victims (Christie 1986). Recognition of victimhood (or lack thereof) is multifaceted, but includes factors such as character, and weakness relative to the perpetrator. None of these factors are sufficient by themselves, however; sexually abused women, for instance, are not always seen as ideal victims even when they are weak relative to their partners, because of a presumed antecedent relationship.

1. There are further issues of ongoing consent, and consent for different kinds of sexual activities, but those are beyond the scope of the present discussion and are discussed by others such as Rachel Bussel (2008) and Rebecca Kukla (2018).

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Two ways that a person can be seen as a nonideal victim of sexual assault are by being seen as promiscuous, or as generally undesirable. With respect to the former, studies often find people willing to attribute more blame to sexual assault victims who have had more previous sexual partners (Pollard 1992). And despite provisions such as Canada’s rape shield laws, complainants’ backgrounds nevertheless remain subject to scrutiny (Randall 2010), and there have been cases in which defense lawyers are able to circumvent these protections by successfully arguing that past sexual encounters are relevant to the case at hand (Brean 2016). With respect to the latter, data on blame attribution to victims seen as undesirable is less clear, though sometimes, victims portrayed as unattractive are seen as having somehow provoked their assaults (Pollard 1992). For instance, many fat women who have been sexually assaulted are told that they should see it as a compliment (Harding 2008). So even if an assault is recognized to have taken place, it might be seen as somehow less harmful than it would have been had a thinner woman been assaulted. I certainly do not claim, though, that the traits of perceived promiscuity and undesirability are exhaustive of the characteristics of nonideal sexual assault victims. Moreover, the same person might have both traits attributed to them. In the rest of this section, I will consider how the complexities of social identity can confound our assessments of sexual desire and sexual consent in the cases of nonideal victims more generally. 2 Conceptions of disabled people’s sexuality are complex, particularly when we consider their intersection with other aspects of identity such as race and gender. Though disability is often associated with vulnerability, disabled black men can be socially located with an identity that is portrayed as hypersexualized, but incapable of acting on those impulses. What this can easily lead to is a narrative of their sexuality in which they would be expected to receive any kind of sexual attention with gratitude. After all, black sexuality has generally been treated in the Western colonial imagination as deviant and “wild”: Through colonial eyes, the stigma of biological Blackness and the seeming primitiveness of African cultures marked the borders of extreme abnormality. For Western sciences that were mesmerized by body politics, White Western normality became constructed on the backs of Black deviance, with an imagined Black hyper-heterosexual deviance at the heart of the enterprise. (Collins 2005, 120)

This has continued in present-day views of black men as physically stronger and more aggressive than men of other races (Welch 2007; Wong, Horn, and Chen 2013). The purported aggressiveness (both sexual and otherwise) of 2. Though nonideal perpetrators pose their own set of issues (Yap 2017).

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black men has been very successful in maintaining a society in which they are demonized and subjected to mass incarceration (Ferber 2007). The image of the buck, so often deployed as a representation of black men, can then be contrasted with the wildness of colonial views of Africa. The buck, as Abby Ferber (2007, 15) points out, following Patricia Hill Collins, gives us an image of a powerful and dangerous animal only partly tamed by slavery. The point here is to see the clear extent to which the perception of black hypersexuality—particularly black male hypersexuality—becomes entrenched. When we then consider these tropes in conjunction with those about disability, we end up with a set of conflicting narratives. Stereotypes about disabled people’s sexuality tend to vary according to the nature of their disabilities. Many people who are visibly disabled are often stereotyped as asexual, or at the very least, completely lacking in sexual ability or a sexual life (Parsons, Reichl, and Pedersen 2017). But whether or not they are seen as desiring a sexual life can sometimes vary, and has, unsurprisingly, been shown to be gendered. Men with intellectual disabilities face perceptions of being driven more by sexual desire, and can even be seen as potential sexual predators by staff who work with them (Young, Gore, and McCarthy 2012, 345). Interestingly, though the very figure of a disabled black man forms the centerpiece of Fricker (2007), in discussing the testimonial injustice of the case, Tom Robinson’s disability is never brought up. Other writers dealing with epistemic injustice, such as José Medina (2013), do raise it as an issue, but even for Medina, the issue of disability plays only a cursory role. This oversight is noted by Tommy Curry (2017), who, following Shelley Tremain (2017), notes that a more complete analysis of this case must account for both racial dynamics in historical context and disability: Because the phobias surrounding Black men imply a peculiar savageness (almost super-humanism), the conceptual analysis of testimony offered by Fricker and Medina obscures the physical disadvantage and vulnerability Mr. Tom Robinson has to Mayella Ewell. [. . .] This presumption of gender vulnerability as only residing within the female body serves to reify the idea that rape is only the carnal knowledge of the (white) female body and thereby imposes a peculiar burden on Mr. Robinson to prove he did not fulfill his biological desire to rape even though he was physically incapable of such an act. Because he—as male—is assumed to be capable of rape, he is denied being considered by the reader (or the philosopher) as a (Black male) victim of rape. As such, his disability is rendered irrelevant to his credibility. Although Mr. Robinson's disability [is] obviously visible, it is disregarded because of the assumed violent and rapist nature of Black males. (Curry 2017, 338)

Here, then, we can see how sexual vulnerability ends up being constructed as a conceptual impossibility for Black male bodies, even in the face of disabil-

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ity. That this is a neglected aspect of this case might be explained both by the exclusion of considerations about disability when considering issues of race, as mentioned above, as well as by the exclusion of considerations of race in fields like disability studies (Bell 2006). A situation in which these issues became live and relatively public came about in October 2015, when Anna Stubblefield, then a philosophy professor at Rutgers, was convicted of sexually assaulting a disabled black man (referred to in court documents as DJ) who could not speak. Jeff McMahan and Peter Singer, in the Stone column for the New York Times, write about this case, arguing against the severity of Stubblefield’s sentence. Among the considerations they bring to bear is the nature of DJ’s disability. If he is incapable of understanding the concept of consent, they write, This does not exclude the possibility that he was wronged by Stubblefield, but it makes it less clear what the nature of the wrong might be. It seems reasonable to assume that the experience was pleasurable to him; for even if he is cognitively impaired, he was capable of struggling to resist, and, for reasons we will note shortly, it is implausible to suppose that Stubblefield forcibly subdued him. (McMahan and Singer 2017)

McMahan and Singer, here, do not argue that there was clear evidence of consent, but rather that it—or something else that made the encounter permissible—can be read from a lack of physical resistance and the supposition that the experience was pleasurable to him. 3 But according to the manifest concept, a lack of physical resistance on the victim’s part, and a lack of physical force on the perpetrator’s part, are not indicators of consent. After all, even people who are unconscious can be sexually assaulted, whether or not they are aware of the assault itself. Even for conscious victims, many women freeze up or remain passive when sexually assaulted (Anderson 2005, 627). And many people remain in abusive relationships, even covering up the abuse their partners perpetrate. Karen Rich (2014) outlines several stories of disabled women in abusive relationships of various kinds, several of whom downplayed or rationalized the abuses they suffered while they remained with their partners. Yet a premise of McMahan and Singer’s argument seems to be that if DJ did not resist, then he likely found the experience pleasurable. Given the aforementioned considerations about pleasure, consent, race, and disability, we ought to be wary of the extent to which our views about consent in such cases might be affected by bias. One aspect of the Stubblefield case that we 3. A complicating factor here, however, is that DJ may in fact have resisted. Daniel Engber (2015), going by Stubblefield’s recollection of events, notes that on one occasion at DJ’s house, DJ kept sitting up instead of lying down to kiss, and lowered himself onto the floor. Stubblefield claimed that DJ only said that he was feeling overwhelmed by the situation, yet that it was something that he wanted.

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have not considered, however, is the extent to which she had power over DJ, as his therapist and the person who facilitated his communication with others. Power asymmetries pose their own set of hermeneutical challenges for the concept of consent. THE INADEQUACY OF CONSENT A relatively common defense against allegations of sexual misconduct in power-over contexts is that the sexual relationships or encounters were entirely consensual. In this section, I will argue that (at the very least the legal definition of) consent is an inadequate concept in many relationships or sexual encounters when it comes to tracking whether the situation itself is just. While I am skeptical about the extent to which the concept can be revised in order to account for many of my concerns, nothing I say precludes that possibility. For the purposes of this chapter, I take consent as it is treated in the Canadian legal system, Article 265.3: For the purposes of this section, no consent is obtained where the complainant submits or does not resist by reason of (a) the application of force to the complainant or to a person other than the complainant; (b) threats or fear of the application of force to the complainant or to a person other than the complainant; (c) fraud; or (d) the exercise of authority. (Criminal Code 1985)

I will argue that, at the very least in power-over situations, a relationship might be consensual without it being fair to the party with less power. What this means in practical terms is that even if the party with more power is lacking in coercive intent also refrains from explicitly coercive actions such as threats, appeals to their institutional position, or inducements through promises of greater status or benefits, the more vulnerable party may not see themselves as entirely free to refuse—at least not without incurring negative consequences. These might, then, be cases in which the idea of consent, in the sense of agreement in the absence of coercion, is inadequate. My motivating examples here will be cases in which there are sexual relationships within institutional contexts, such as relationships between professors and their students, or advisors and their advisees. DJ, for instance, if we accept Stubblefield’s claim that he was capable of communicating consent, could nevertheless have felt obligated to consent to sex with Stubblefield, given her role as his therapist. Even when those with more power do not try to leverage their positions to secure sexual consent, we might nevertheless see such situations as unjust. In contrast, Stormy Daniels’s emphasis

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that her affair with Trump was consensual, despite her lack of sexual desire, is intended to ensure that she was not seen as a victim (CBS News 2018). The difference here is that Daniels saw herself as completely free to refuse any further sexual encounters (as she did), and saw the encounter as a kind of business deal that had the potential to provide her with some advantages, but that she could turn down without significant penalty. Taking Daniels’s word for it that she was not victimized by the encounter, we can see that the nature of the relationship makes a significant difference. It is not the presence or absence of sexual desire or pleasure that is important to its being just, but the relationship between the parties. Despite the fact that someone like Trump has significant socioeconomic power relative to someone like Daniels, this relative social privilege was the only way in which he had power over her. Institutional power-over relationships are then a special case. We can take it for granted, as per the legal definition, that if authority is exercised in order to secure agreement to a sexual encounter, then consent is not present. But that this is put in terms of the exercise of authority suggests that some kind of appeal to that authority needs to be present, or some way of making the authority salient to the other party’s decision. Institutional power that is simply part of the background context of a relationship does not seem to be authority that is actively exercised. My claim about institutional power implies that sexual or romantic relationships between professors and their students are likely unjust. Many institutions’ sexual harassment policies prohibit these; and while some see this as a positive measure, others do not. For instance, Laura Kipnis, one of the more outspoken critics of stringent university regulation of such relationships, writes that their outright prohibition infantilizes students (Kipnis 2015). Her worry is that these policies are constituting many of the students in sexual harassment cases as victims without sufficient power to refuse their harassers. My claim then, is that there is a reason why Kipnis and others (perhaps even some of the professors accused of sexually harassing their students) do not see these situations as unequal relationships to which one party has not properly consented: that our legal concept of consent fails to properly serve the interests of those with less social-institutional power, which is a kind of hermeneutical injustice. So unlike Fricker’s case of sexual harassment, we do not lack a concept of consent. And unlike the cases described above, in which stereotypes problematize our operative conception of consent, we can grant that in many of these cases, consent is present. But I argue that power dynamics in these cases can create situations in which professors believe themselves to be in a consensual romantic relationship with a student, but the student perceives the relationship as one they are unable to leave or control. That is, while they might be technically capable of turning down advances—refusals are not

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being silenced—they might believe (correctly in some cases) that such refusals might have difficult to detect negative effects on their prospective careers. There might be a question, though, of whether a person in such a situation is genuinely consenting, in that the potential for negative consequences can undermine their capacity to consent freely. I think there are many cases in which we would agree that we have the power to give (or withhold) genuine consent despite the potential for foreseeable negative consequences. For instance, we would often consider relationships to be consensual even when exiting them would result in negative social consequences for one party, such as the loss of social standing or relationships. This might become fuzzier in certain more extreme cases—for instance in a conservative community in which leaving one’s spouse might result in social ostracism and the loss of virtually all meaningful ties. In such a case, we might not be so clear that a person’s continued participation in the relationship is fully voluntary, even if the threat of ostracism remains unstated. I argue, though, that understanding what is problematic about such situations is not best captured by determining whether participation in the relationship is consensual. Rather, I consider consent to be a concept that serves us well only when background conditions of relative justice are met. In cases like our conservative community described above, the problem seems to be less a matter of an individual person’s continued agreement to participation in a relationship, than of the background conditions in the society being such that they might be placed in a double bind. A person who wants to leave their relationship in such a society has the choice between remaining in an unhappy situation or being cut off from many important sources of meaning in their lives. Their continued participation may be technically voluntary, since the option to bear the social costs of leaving remains open to them. Now, although these more rigid social contexts, as well as institutional contexts like academia, might only apply to a relatively narrow set of individuals, similar power dynamics can be seen in a variety of other, less formal situations. In November 2017, the comedian Louis CK released a statement confirming that he had engaged in sexual misconduct, and had wronged several women. His statement is revealing of the very phenomenon under discussion, however. At the time, I said to myself that what I did was okay because I never showed a woman my dick without asking first, which is also true. But what I learned later in life, too late, is that when you have power over another person, asking them to look at your dick isn’t a question. It’s a predicament for them. The power I had over these women is that they admired me. And I wielded that power irresponsibly. (Walters and Redden 2017)

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What we have are cases in which women might have agreed to what CK asked, but were in a power-over relationship such that they did not feel as though they were in a position to refuse. Agreement, then, seems inadequate as an appropriate gauge of just sexual activity. Similarly, in January 2018, the actor Aziz Ansari was the subject of a story in which a woman described a date with him in which he pushed sexual activity on her. The woman in this story describes the encounter as a violation that upset her, though the actor denied that anything nonconsensual had taken place, citing a different recollection of events (Way 2018). However, the absence of coercion does not mean the absence of any wrongdoing. To clarify this idea, Ann Cahill (2014) has discussed the category of “unjust sex,” taking it to be a relatively broad category of sexual acts including both those that count as sexual violence and those in which, for instance, “a heterosexual woman feels pressured, but not coerced, to engage sexually with her male partner” (Cahill 2014, 310). But unjust sex need not be confined to heterosexual relationships. In many relationships, one person has more power than the other. This is certainly the situation—indeed it is the presumption—behind one of our motivating cases, in which there is a sexual relationship within an institutional power-over context. Defenders of such relationships, such as Kipnis (2015, 10), sometimes claim that to forbid them, or to claim that these are in general unjust relationships, is to treat students (typically women students) as lacking in sexual agency, or as incapable of taking care of themselves and standing up for their own rights. But this neglects the extent to which the exercise of such agency, in declining unwanted advances, can be imprudent or risky for the one with less power. In philosophy, for example, the effects of prestige can be significant. For instance, the beneficial effects of a PhD from a more prestigious institution have been studied and shown to affect careers in ways that seem unlikely to be explicable solely in terms of merit (De Cruz 2018). From the perspective of a junior member of the profession, positive scholarly attention from someone more senior, well respected, and well known, could surely be a way to improve one’s chances in an extremely competitive environment, in which job applicants highly outnumber available positions. This would suggest, then, that the risks of negative evaluation from a more highly placed or better renowned member of the profession would be something relevant to anyone on the receiving end of such an individual’s romantic or sexual advances. In such cases, the problem is not one of consent or outright coercion, but rather with the expected consequences of refusal. Someone on the receiving end of unwanted romantic advances might not be coerced into acceptance by the party making such advances, but may be uncertain about the extent to which there will be negative consequences if they decline. Indeed, even the one making such advances might not know the extent to which their judgment of the individual would change upon refusal. Moreover, even if their

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advances are accepted, it is not clear that they could know whether romantic reciprocation is genuine or prudential. This means that our concept of consent, even when appropriately applied, might be the wrong concept to track the presence or absence of wrongful sex. So the injustice in this case results from the idea that consent or its absence is the gold standard for determining whether a sexual relationship or act was wrong. In order to overcome it, it seems that we would either have to broaden our conception of unjust sex, as Cahill suggests, or change our concept of consent to include the kinds of broad social factors that I have brought up here. While my concern with this latter option is not decisive, we might nevertheless think that not all injustice ought to be treated as criminal. That is, we might consider someone to have acted wrongly and unjustly if they enter into a sexual relationship with someone over whom they have significant power, but we might not want to say that their actions were illegal. CONSENT AND SOCIAL POWER With this picture in place, we can see that there can be different kinds of hermeneutical gaps, even with respect to the same concept—in this case, consent. A natural question to ask ourselves, then, is what we can do to remedy such situations. One step in the right direction is to be clear about the nature of the social structures that lead to the systematic disadvantaging of those for whom the concept of consent is misapplied or inadequate. And in fact, it may be a mistake to see the issue of hermeneutical injustice as separable from the power imbalances that lead to the conceptual problems in the first place. For instance, racism and ableism can skew our views about the relationship between sexuality, pleasure, and consent. Similarly, misogyny in Kate Manne’s (2018) sense, and entitlement to sex, are likely central factors in many power-over relationships. A better understanding of oppressive forces such as ableism, racism, and misogyny, then, can help us understand how to implement structural solutions to problems of consent, or advocate for structural solutions that are already in place. The prohibitions against faculty-student relationships that those like Kipnis deplore are one such structural solution. Rather than, as Kipnis worries, undermining the sexual agency of students, they account for the epistemic limitations of instructors. A well-meaning instructor who would like a relationship with one of their students is certainly possible. But not only does a prohibition on such relationships protect students from unwanted attention by less well-meaning instructors, it also protects the wellmeaning from their own ignorance of their students’ genuine desires. Since it is not difficult for us to mistakenly believe, through the mechanisms of hermeneutical injustice, that a relationship with significant power asymme-

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tries is just, the onus is on those with more power to avoid relying solely on the presence of consent, or a belief that it has been obtained. So while this analysis does not offer any one catch-all solution to problems of sexual injustice (after all, such a thing likely does not exist), it at least gives us some reasons for moving our thinking on the matter beyond the issue of consent, to look at the background conditions of inequality under which potentially problematic relationships might be taking place. REFERENCES Anderson, Michelle J. 2005. “All-American Rape.” St. John’s Law Review 79 (5): 625–44. Bell, Chris. 2006. “Introducing White Disability Studies: A Modest Proposal.” In The Disability Studies Reader, second edition, edited by Lennard J. Davis, 275–82. New York: Routledge. Bettcher, Talia M. 2013. “Trans Women and the Meaning of ‘Woman.’” In Philosophy of Sex: Contemporary Readings, edited by Nicholas Power, Raja Halwani, and Alan Soble, 233–50. Lanham, MD: Rowman & Littlefield. Brean, Joseph. 2016. “How Jian Ghomeshi’s Lawyer Was Able to Navigate Canada’s Rape Shield Law.” National Post, February 11. https://nationalpost.com/news/canada/how-jianghomeshis-lawyer-was-able-to-breach-canadas-rape-shield-law. Bussel, Rachel K. 2008. “Beyond Yes or No: Consent as Sexual Process.” In Yes Means Yes: Visions of Female Sexual Power and a World without Rape, edited by Jaclyn Friedman and Jessica Valenti, 43–52. Berkeley, CA: Seal Press. Cahill, Ann J. 2014. “Recognition, Desire, and Unjust Sex.” Hypatia 29 (2): 303–19. CBS News. 2018. “Stormy Daniels Describes Her Alleged Affair with Donald Trump.” CBS News, March 25. https://www.cbsnews.com/news/stormy-daniels-describes-her-alleged-af fair-with-donald-trump-60-minutes-interview/. Christie, Nils. 1986. “The Ideal Victim.” In From Crime Policy to Victim Policy, edited by E. A. Fattah, 17–30. London: Palgrave Macmillan. Collins, Patricia Hill. 2005. Black Sexual Politics: African Americans, Gender, and the New Racism. New York: Routledge. Criminal Code, R.S.C. 1985. c.46, s.265(3). Curry, Tommy. 2017. “This Nigger’s Broken: Hyper-Masculinity, the Buck, and the Role of Physical Disability in White Anxiety toward the Black Male Body.” Journal of Social Philosophy 48 (3): 321–43. De Cruz, Helen. 2018. “Prestige Bias: An Obstacle to a Just Academic Philosophy.” Ergo 5 (10): 258–87. Engber, Daniel. 2015. “The Strange Case of Anna Stubblefield.” New York Times Magazine, October. https://www.nytimes.com/2015/10/25/magazine/the-strange-case-of-anna-stubblefield.html. Ferber, Abby L. 2007. “The Construction of Black Masculinity: White Supremacy Now and Then.” Journal of Sport and Social Issues 31 (1): 11–24. Fricker, Miranda. 2007. Epistemic Injustice: Power and the Ethics of Knowing. Oxford: Oxford University Press. Harding, Kate. 2008. “How Do You Fuck a Fat Woman?” In Yes Means Yes: Visions of Female Sexual Power and a World without Rape, edited by Jaclyn Friedman and Jessica Valenti, 67–76. Berkeley, CA: Seal Press. Haslanger, Sally. 1995. “Ontology and Social Construction.” Philosophical Topics 23 (2): 95–125. Jenkins, Katharine. 2017. “Rape Myths and Domestic Abuse Myths as Hermeneutical Injustices.” Journal of Applied Philosophy 34 (2): 191–205. Kipnis, Laura. 2015. “Sexual Paranoia Strikes Academe.” The Chronicle of Higher Education, February. http://www.chronicle.com/article/Sexual-Paranoia-Strikes/190351.

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Kukla, Rebecca. 2018. “That’s What She Said: The Language of Sexual Negotiation.” Ethics 129 (1): 70–97. Manne, Kate. 2018. Down Girl: The Logic of Misogyny. Oxford: Oxford University Press. Mason, Rebecca. 2011. “Two Kinds of Unknowing.” Hypatia 26 (2): 294–307. McMahan, Jeff, and Peter Singer. 2017. “Who Is the Victim in the Anna Stubblefield Case?” New York Times, April 3. https://www.nytimes.com/2017/04/03/opinion/who-is-the-victimin-the-anna-stubblefield-case.html. Medina, José. 2013. The Epistemology of Resistance: Gender and Racial Oppression, Epistemic Injustice, and Resistant Imaginations. Oxford: Oxford University Press. Mills, Charles. 2007. “White Ignorance.” In Race and Epistemologies of Ignorance, edited by Shannon Sullivan and Nancy Tuana, 11–38. Albany: State University of New York Press. Parsons, Alexandria L., Arleigh J. Reichl, and Cory L. Pedersen. 2017. “Gendered Ableism: Media Representations and Gender Role Beliefs’ Effect on Perceptions of Disability and Sexuality.” Sexuality and Disability 35: 207–25. Peterson, Zoe D., and Charlene L. Muehlenhard. 2004. “Was It Rape? The Function of Women’s Rape Myth Acceptance and Definitions of Sex in Labeling Their Own Experiences.” Sex Roles 51 (3–4): 129–44. Pohlhaus, Gaile, Jr. 2012. “Relational Knowing and Epistemic Injustice: Toward a Theory of Willful Hermeneutical Ignorance.” Hypatia 27 (4): 715–35. Pollard, Paul. 1992. “Judgements about Victims and Attackers in Depicted Rapes: A Review.” British Journal of Social Psychology 31: 307–26. Randall, Melanie. 2010. “Sexual Assault Law, Credibility, and ‘Ideal Victims’: Consent, Resistance, and Victim Blaming.” Canadian Journal of Women and the Law 22 (2): 397–434. Rich, Karen. 2014. “‘My Body Came between Us’: Accounts of Partner-Abused Women with Physical Disabilities.” Affilia: Journal of Women and Social Work 29 (4): 418–33. Temkin, Jennifer, Jacqueline M. Gray, and Jastine Barrett. 2016. “Different Functions of Rape Myth Use in Court: Findings From a Trial Observation Study.” Feminist Criminology 13 (2): 205–26. Tremain, Shelley L. 2017. “Knowing Disability, Differently.” In The Routledge Handbook of Epistemic Injustice, edited by Ian James Kidd, José Medina, and Gaile Pohlhaus Jr., 175–83. New York: Routledge. Walters, Joanna, and Molly Redden. 2017. “Louis CK Responds to Allegations of Sexual Misconduct: ‘These Stories Are True.’” Guardian, November 10. https://www .theguardian.com/tv-and-radio/2017/nov/10/louis-ck-statement-sexual-misconduct-allegat ions-these-stories-are-true. Want, Linda, and Andrea Widener. 2017. “Confronting Sexual Harassment in Chemistry.” Chemical & Engineering News, September. https://cen.acs.org/articles/95/i37/Confrontingsexual-harassment-chemistry.html. Way, Katie. 2018. “I Went on a Date with Aziz Ansari. It Turned into the Worst Night of My Life.” Babe, January 13. https://babe.net/2018/01/13/aziz-ansari-28355. Weale, Sally, and Caroline Bannock. 2017. “‘We Felt Inferior and Degraded’: Reporting Sexual Harassment at University.” Guardian, March 5. https://www.theguardian.com/education/ 2017/mar/05/we-felt-inferior-and-degraded-reporting-sexual-harassment-at-university. Welch, Kelly. 2007. “Black Criminal Stereotypes and Racial Profiling.” Journal of Contemporary Criminal Justice 23 (3): 276–88. Wong, Y. Joel, Angela J. Horn, and Shitao Chen. 2013. “Perceived Masculinity: The Potential Influence of Race, Racial Essentialist Beliefs, and Stereotypes.” Psychology of Men and Masculinity 14 (4): 452–64. Yap, Audrey. 2017. “Credibility Excess and the Social Imaginary in Cases of Sexual Assault.” Feminist Philosophical Quarterly 3 (4): 1. Young, Rhea, Nick Gore, and Michelle McCarthy. 2012. “Staff Attitudes towards Sexuality in Relation to Gender of People with Intellectual Disability: A Qualitative Study.” Journal of Intellectual and Developmental Disability 37 (4): 343–47.

Chapter Four

Structural Thinking and Epistemic Injustice Nadya Vasilyeva and Saray Ayala-López

In response to the question “How can we fight (at least some forms of) epistemic injustice?” we propose what can be classified as a structuralpsychological approach, one that targets how people think about structural factors. We review recent empirical results suggesting that a structuralpsychological intervention is a promising way to address discriminatory behavior in general. Our proposal is driven by the growing evidence that the discriminatory behavior behind practices of epistemic injustice is strongly associated with people’s psychological tendency to form what the psychological literature calls internalist representations of social (and natural) categories. To situate our proposal in the existent literature on both epistemic injustice and the general debate about interventions on and explanations of social injustice, we start by briefly reviewing two main types of interventions, and locating them in the general debate between individualistic and structural approaches to social justice. Next, we review empirical literature on the cognitive processes that contribute to discriminatory behavior, focusing on instances of internalist thinking, such as psychological essentialism and inherence heuristic. Next, we introduce our proposal of promoting structural thinking as an intervention against discriminatory behavior in general, based on counteracting people’s tendency to represent social categories in internalist ways. Finally, we review the benefits structural thinking might bring to the fight against epistemic injustice.

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INDIVIDUALISTIC AND STRUCTURAL APPROACHES TO COUNTERACTING EPISTEMIC INJUSTICE Epistemic injustice is about an unjust distribution and management of epistemic resources. The unjust (not merely unfortunate) distribution and management of resources can be divided into three subcategories. Testimonial injustice occurs when someone does not recognize the interlocutors’ knowledge, usually via faulty attributions of credibility; hermeneutical injustice has to do with hermeneutical lacunas, gaps in collective epistemic resources that make it hard for people in different epistemic communities to conceptualize, understand, and/or communicate certain experiences (Fricker 2007); finally, contributory injustice takes place when knowers are wronged because interlocutors, due to a willful hermeneutical ignorance (Pohlhaus 2012), utilize prejudiced hermeneutical resources (Dotson 2012). Various practices of epistemic injustice often work together, forming wider patterns of unjust social dynamics. Interventions to prevent or alleviate epistemic injustice, and in particular the specific breed of testimonial injustice, often target people’s implicit biases and prejudiced beliefs that seem to drive discriminatory behaviors. Miranda Fricker’s (2007) proposal on the virtue of testimonial justice is a good example of this approach. Roughly, it works as follows: when you adopt a critical, reflective attitude and become aware of the possibility that your epistemic judgments are being affected by an identity-prejudice against a speaker, you need to neutralize its impact. Doing so implies the need to “shift intellectual gear” from the spontaneous heuristics people use when evaluating speakers (which are infused with prejudices) to an “active critical reflection” that would help people figure out how the prejudices might have distorted their judgment (Fricker 2007, 91). This intervention paradigm has received criticisms, often pointing out that enforcing the virtue of testimonial justice is not feasible and/or counterproductive to the overall goal of eliminating testimonial injustice (see, e.g., Sherman 2015). One straightforward alternative to Fricker-style proposals is to shift attention from individuals’ minds and focus on fixing the environment shaping people’s behavior. That is, instead of trying to upgrade our flawed minds, full of problematic associations between social groups and traits, we could turn to the correlations that exist in our corrupted society and are picked up by our minds as we form representations useful for navigating the world we inhabit. Let’s unpack how the two alternatives relate to each other. Fricker-style proposals locate the wrong within our minds, which make up problematic associations between social groups and traits, later used as shortcuts to reason about group members. The objective is to resist the wrong mental representations and get the social reality right. But as Sally Haslanger reminds us, many morally problematic attitudes do get the social reality

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right: “Women actually are more submissive than men; we are better caregivers than men; we are better at multi-tasking too” (Haslanger 2017, 3), and African Americans are five to eight times more likely to be imprisoned than European Americans (Roberts 2004). The key is not to deny this, but to ask why the social reality takes this shape. As part of an answer to this question, Haslanger continues: “This is not to say that this is true ‘by women’s nature’ but because of the social history of gender” (Haslanger 2017, 3); a similar comment can be made about racial inequalities in incarceration rates, appealing to the social history of race. That is, when we inquire into many of the correlations present in our social reality, we see patterns of inequalities and unjust social (structural) dynamics that constitute and cause them. This opens up a potential locus of intervention: the social dynamic that creates and maintains those correlations that our minds readily pick up on. That is, instead of intervening on the shortcuts our minds make up, let’s instead fix the environment that provides inputs to our mental machinery. Once the problematic associations disappear from the environment, relying on mental shortcuts to reason about it would not lead to discrimination and injustice anymore. In line with this approach, psychologist Gerd Gigerenzer, an advocate of the benefits of cognitive heuristics, suggests that “[T]o improve moral behavior towards a given end, changing environments can be a more successful policy than trying to change beliefs or inner virtues” (Gigerenzer 2010, 530). Heuristics are not necessarily bad, and they are certainly an important cognitive tool. These shortcuts allow us to navigate the world fast and under conditions of uncertainty. This is one way our mind copes with a complex world. The environmental intervention approach avoids the challenge of fighting basic characteristics of human psychology. Instead, it proposes to engineer the social system in a way that helps us align our judgments and actions with our explicit beliefs and available evidence. The two interventions reviewed above could be seen as reflecting the divide that we find in the philosophical debate about social justice more generally. There, it is common to find an opposition between individualistic and structural approaches. While Fricker-style interventions can be considered individualistic, the alternative environment-engineering intervention could be characterized as structural. 1 Much can be said about whether or not individualistic and structural approaches are really opposite. Recent developments acknowledge that individualistic and structural approaches are not necessarily in competition. For example, Robin Zheng (2018) merges the two approaches proposing to understand implicit biases to be a particular type of social structure, rather than ordinary individual attitudes. In turn, Lacey Dav1. We are not saying that Gigerenzer and other researchers working on heuristics endorse a structural approach to social injustice. We use Gigerenzer only to illustrate the idea that preventing cognitive shortcuts might not be the best way to go.

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idson and Dan Kelly (2018) see norms, and our capacity to detect them and follow them, as the connection between individualist and structural approaches. One could also say that individualistic and structural approaches are compatible because they actually address different questions (AyalaLópez and Vasilyeva 2015). In this chapter we combine elements of the two approaches in yet another way, by focusing on structural thinking—how individuals think about structures. It is an individualist proposal because it intervenes on individual’s psychology, although not on implicit biases. In fact, Alex Madva (2016) points out that the individualistic approach is often defined too narrowly, and it gets identified with implicit bias. This restrictive definition results in treating failures of interventions on implicit bias as a failure of the whole approach. Our proposal contains individualistic elements that do not imply intervening on implicit bias; instead, it is based on mitigating harmful internalist thinking. Our proposal can also be classified as structural, in two senses. First, it takes acknowledging the crucial role of structural factors to be the driving force for fighting injustice. Second, it can be implemented with structural-level interventions on human psychology. Before introducing the details of our proposal, we briefly review empirical literature on internalist thinking and how it contributes to discriminatory behavior. INTERNALIST THINKING AND ITS CONSEQUENCES A growing body of psychological literature has documented the tendency for internalist thinking, the tendency to look “within” categories for causes and explanations, attributing properties of category members to inherent/essential factors (Cimpian and Salomon 2014; Gelman 2003). For example, if a person learns about a correlation between being an African American and higher likelihood of incarceration in the United States, engaging in internalist thinking would lead them to attribute the property (propensity to end up in jail) to something about the category itself rather than the socioeconomic context. Just like an internalist thinker might expect that a tiger would naturally grow to be a ferocious predator with a similar set of predispositions no matter in what context it is brought up, they might expect that African Americans would achieve similar life outcomes even if they were placed in an entirely different social environment. Besides explanation, causal attribution, and intuitions about property stability, internalist thinking can manifest itself in categorization, generalization, prediction, normative expectations, and many other cognitive functions. Psychological literature identifies several psychological phenomena that we place under the umbrella term of “internalist thinking.” Although they have important theoretical differences, for the purposes of our discussion we

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focus on commonalities, and on shared psychological and behavioral consequences. One example of internalist thinking is the inherence heuristic, defined as the tendency to explain observed patterns in terms of the inherent properties of the objects that instantiate the patterns (Cimpian and Salomon 2014). For example, if girls wear pink, people might infer that it must be due to something inherent about pink (it is delicate) and/or girls (they are attracted to delicate colors), rather than considering a broader range of external, historical factors. This heuristic has been linked to a number of harmful psychological consequences, such as promoting support for the status quo (Hussak and Cimpian 2015). The inherence heuristic can be viewed as a precursor to the second phenomenon that we identify with internalist thinking, psychological essentialism, defined as the tendency to represent some natural and social categories as having underlying, deep, true natures (essences) which cause observable characteristics and ultimately make members of those categories what they are (Gelman 2003; Medin and Ortony 1989; Meyer et al. 2013; Hirschfeld 1996; Prentice and Miller 2007; Rhodes and Gelman 2008; Rothbart and Taylor 1992). It has been documented in children and adults, in reasoning about both natural and social kinds. Essentialized categories are represented as having unchanging and innate properties, and sharp and immutable boundaries, which can be problematic when reasoning about both natural categories (e.g., interfering with understanding the mechanisms of natural selection; Shtulman and Schulz 2008) and social categories (e.g., promoting unwarranted generalization of negative properties, strong normative expectations, prejudice, and contributing to the underrepresentation of women in some academic fields, such as mathematics, physics, engineering, and philosophy; Allport 1954; Haslam, Rothschild, and Ernst 2000, 2002; Keller 2005; Leslie 2017; Leslie et al. 2015). Unfortunately, preventing development of essentialist beliefs appears to be a challenge; children readily acquire them from a rich variety of subtle cues, such as generic language (Cimpian and Markman 2011; Rhodes, Leslie, and Tworek 2012); for example, statements attributing a property to a category in general, of the form “boys like X” and “girls do Y,” which have been characterized as tagging categories as essence-based and generalization-supporting (Leslie 2017). Children exposed to generic statements about an ability (even if the message is positive, such as “girls are good at X!”) may show drops in motivation, interest, and performance (Cimpian 2010; Cimpian, Mu, and Erickson 2012). The essentialist stance appears to be quite resilient to evidence and revision. Nongeneric quantified statements (“all,” “most,” “some”) and ambiguous statements (“they are good at X”) are often remembered and interpreted as generics by children and in some cases by adults (Hollander, Gelman, and Star 2002; Leslie and Gelman 2012; Meyer and Baldwin 2013; Tardif et al. 2012). Even when adults do not openly

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endorse some essentialist beliefs (e.g., that girls “essentially” prefer dolls over trucks), they may “default” to essentialist expectations when cognitively taxed (Eidson and Coley 2014). All this research paints a rather pessimistic picture for social change. Sarah-Jane Leslie (2014) is vocally skeptical about the possibility of breaking out of the loop of transmitting essentialist beliefs from generation to generation via subtle linguistic cues, where essentialist beliefs in turn shape social reality and make the essentialist beliefs true (in the sense that they reflect descriptive generalizations). Breaking out of this loop would seem to require going against deeply ingrained psychological tendencies to seek generalizable regularities and communicate about them efficiently. After all, we live in a world where boys do play with trucks; women are underrepresented in high-level academic positions in science, technology, and philosophy; and African Americans are overrepresented in prisons. It would be a heavy burden to put on people to ask them to put their capacity to learn about the environment on standby, to ignore salient statistical regularities, and to refrain from relying on their otherwise efficient cognitive tools that effectively support generalization and prediction in so many domains, such as associative learning and category-based reasoning. Fortunately, there may be an alternative that doesn’t require that people “un-see” stable correlations between categories and properties they observed in the world, or somehow discount these correlations as not meaningful. Instead, it would call for a different explanation of these connections, an explanation that would open the door for seeing these properties as not inevitable, but instead as depending on social structures. STRUCTURAL THINKING When philosophers, sociologists, psychologists, or economists talk about the important role of socioeconomic structures shaping life outcomes for individuals, they engage in structural thinking. Its hallmark is locating an object of explanation within a larger structure and identifying structural constraints that act on components of the structure to shape the distribution of outcomes for each component (Haslanger 2016). What we propose is that structural thinking is a broadly accessible cognitive skill, not restricted exclusively to trained professionals, and that promoting structural thinking in people could be an effective tool to mitigate the kind of injustice that concerns us here. When applied to reasoning about social categories, structural thinking can offer an alternative explanation for why the observed correlations exist. For example, take properties such as “underrepresented in philosophy,” “often quit their jobs after having children”—these can be reliably associated with the category “women” and taken to be true (in the sense of accurately de-

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scribing the current state of the world). But, crucially, they may be represented not as caused by an internal, core property of “women,” but as obtaining in virtue of women’s position in the current socioeconomic structure (an “office,” in Stewart Shapiro’s [1997] terms, or a “node,” in Haslanger’s terms [2016]).We refer to such properties of a category as structural properties, because they obtain in virtue of structural constraints acting on the “node” within a structure occupied by the category. Looking at structural connections as a different type of nonaccidental relationship between a property and a category brings to light an inherent ambiguity of generic statements and formal explanations (which explain a property by appealing to category membership; for example, “Why does Pazu walk over my computer keyboard while I work?—Because she is a cat”). Consider the following generics and formal explanations: “Women have trouble obtaining tenure in STEM fields,” “African American men end up in prison,” “Ly didn’t get tenure because she is a woman,” “William ended up in prison because he is African American.” On most accounts, these statements are taken to express something about inherent properties of the respective categories (e.g., Cimpian and Markman 2011; Leslie 2014; Prasada and Dillingham 2006, 2009); in contrast, we argue that it is possible to induce a nonessentialist, structural interpretation. Whereas internalist accounts represent features as characterizing the category per se, a structural account can represent features associated with a “node” or location within a structure. Consider an example of a generic statement discussed by Haslanger (2011) and Leslie (2014): “women are submissive.” This statement could be true due to external sociological factors (e.g., if the society systematically discourages women from being assertive). But, according to Leslie, this generic statement would nevertheless be interpreted as communicating that “there is something in the nature of women that makes them submissive” (Leslie 2014, 217), reinforcing essentialist beliefs about women. Leslie argues that generics are by default interpreted as expressing such “generalizations that hold because of common, inherent features of the members of the kind” (Leslie 2014, 217). The only alternative that Leslie considers is interpreting generics as describing statistical connections that do not reflect a principled relationship between a property and a category (Prasada and Dillingham 2006, 2009), along the lines of “pigeons sit on statues,” “police officers eat donuts,” and “barns are red,” on the basis of “specific worldly knowledge.” In contrast, we focus on people’s capacity to interpret generics and formal explanation structurally, by construing features of category members as products of structural constraints rather than inherent aspects of the kind or effects of causally active categorical essence. Recent empirical evidence shows that with appropriate cueing, both children and adults can construe property-category connections structurally.

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Nadya Vasilyeva, Alison Gopnik, and Tania Lombrozo (2018) taught participants novel property-category connections (“girls play Yellow-ball,” “boys play Green-ball”). Vasilyeva et al. varied the framing of the property-category connection: half of the participants were given structural cues (girls and boys were described as occupying structural positions with different affordances), and the other half of the participants were not given such cues. All participants (three- to six-year-old children and adults) read a cover story about a school where each student received one of two toys (Yellow-ball or Green-ball) to play during recess; the toy was determined by whether a pebble the student threw fell into a yellow bucket or a green bucket. In one version of the story (designed to prime a structural construal), in the girl classroom the yellow bucket was much larger than the green bucket, with the reverse in the boys’ classroom, imposing stable different structural constraints on the probability of each outcome for the girls and the boys in the story. In the other version of the story, the buckets were of the same size. Regardless of the story version, all participants received the same strong statistical evidence showing that across several days, most girls reliably played Yellow-ball, while most boys played Green-ball. Participants then completed several tasks designed to measure how they construed the newly learned connection between the category (girl) and the property (playing Yellow-ball). First, they were asked to explain the connection (“Why do girls play Yellow-ball?”); their explanations were coded as structural—that is, appealing to differential accessibility of the games for girls and boys (e.g., “Because for the girls, it is easier to get the pebble into the yellow bucket”)— or internalist—that is, appealing to category members’ liking, wanting, preferring one of the toys (e.g., “Because they like the color yellow”)—or miscellaneous. While in the absence of structural framing, most participants produced internalist responses; when structural cues were given, the internalist responses dropped with age as structural responses increased, so that by five to six years of age, the early propensity to generate mostly internalist explanations switched to generating mostly structural explanations in the structural condition. Strikingly, even the youngest group (three- to four-year-olds) was able to generate some structural explanations (about 20 percent of the children in this age range did). Second, when participants’ intuition about property stability was probed (in a scenario where a girl transfers to the boys’ classroom, and participants are asked if she would still play the Yellow-ball, even in the new context, indicating low property mutability, or switch to playing the Green-ball, reflecting high property mutability), for all age groups the structural framing of a property elicited stronger expectations that the property can change (i.e., both children and adults were significantly more likely to say that a girl would switch to playing a different game if she is no longer confined to the “girl classroom,” our equivalent of a structural

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node with its fixed affordances). In the absence of structural priming, participants expected the category members to retain the property across contexts. These findings demonstrated that structural construal of category properties can be successfully induced across development (with stronger effects for adults, but—strikingly—with detectable effects with children as young as three), and that structural construal has tangible psychological consequences for how people explain properties of category members, and for the expectations they form about stability of those properties across possible contexts. Another important finding from Vasilyeva, Gopnik, and Lombrozo (2018) was that there are tasks where the structural construal produces behavior indistinguishable from nonstructural, internalist construal—but for very different reasons. When participants in the study were asked to evaluate a formal explanation explaining a property by appealing to the category membership—for example, that Suzy plays Yellow-ball a lot at her school “because she is a girl”—participants were equally likely to endorse the explanation whether they committed to a structural or internalist construal of the property connection (as indicated by additional measures). This suggests that while both experimental groups agreed with the explanations, they meant different things by it—either that Suzy plays Yellow-ball a lot because she is a girl, and for girls Yellow-ball is more accessible whether or not they like it (the structural construal), or that Suzy plays Yellow-ball a lot because she’s a girl, and girls are inherently drawn to yellow color/this particular type of toy (the internalist construal). This finding suggests that formal explanations (and, as ongoing work suggests, generic statements) come in two “flavors,” internalist and structural, which opens up an intriguing possibility that people with radically different views can seemingly agree while in practice talking past each other (as a bigoted person and a feminist can agree that “Mary didn’t get tenure in math because she’s a woman”—explaining the connection between women and difficulty of getting tenure in math either in terms of lack of innate talent, or in terms of structural barriers). On a more optimistic note, existence of the two “flavors” of formal explanations and generics suggests that despite all the negative consequences of generic speech documented in the psychological literature, we may not have to exorcise them from our speech—but we need to make sure we induce a structural interpretation when they are used. When someone states that “African Americans are overrepresented in prisons,” they need to emphasize the role of structural factors, unless they want to leave the door open for an internalist interpretation attributing the high odds of ending up in prison to inherent, deep characteristics of what it means to be an African American. One potential benefit of structural explanations is their resilience, or the capacity to accommodate new statistical evidence about social categories without abandoning the explanation. In contrast, simply negating a property attributed to a social category may produce positive but short-lived effects, as

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new statistical information will likely serve as counterevidence to the negation. For example, if a person hears an assertion that a previously established connection between a category (“women”) and a property (“being submissive”) is false—“that’s not true, women are not submissive” 2—when a new instance of a submissive behavior on the part of a woman is encountered, it will weigh in as falsifying the assertion. Similarly, when internalist explanations are negated without offering a structural alternative, they may relapse in light of new statistical evidence. For example, imagine a girl who learns that there are few women professors in mathematics departments and asks a caretaker if that’s because women are bad at it. The caretaker confidently denies that explanation, asserting that actually, women are great at math. The girl may accept this claim, but when new evidence starts piling up (she learns that many women drop out after the first math course in college; few women receive prestigious awards in mathematics; the women she knows express little interest in math; etc.), it can function as contradictory evidence and an indication to revise her beliefs back to the same or a related internalist explanation (maybe after all women are not that good at math, and/or inherently not interested in it). In contrast, if the caretaker offered a structural explanation of the available evidence, attributing the dearth of women professors in mathematics to structural barriers women face in this discipline, then new observations may not be seen as questioning this explanation but compatible with it. At this point these claims about potential resilience of structural explanation are speculative, but one of the authors has relevant empirical studies in the works. When applied to reasoning about causal relations, structural thinking can shift attention from triggering causes to structuring causes which make it so that the relationship between the triggering cause and the effect exists in the first place (Dretske 1988; Haslanger 2016). There is nothing inherently wrong with being interested in triggering causes, but in social contexts where active structuring causes do shape problematic relationships between triggering causes and outcomes, ignoring structuring causes can be misguided. One example of focusing on a triggering cause is a 2013 popular article by Emily Yoffe telling college women to stop getting drunk since this behavior leads to sexual assault. In a response opinion piece, Louise Antony (Yoffe 2013) pointed out that that the relationship between women’s drinking (the triggering cause) and sexual assault (the outcome) exists only in a particular type of 2. Note that in light of flexible truth conditions of generics, simply adding a quantifier (“some women are submissive,” “not all women are submissive”) or specifying property prevalence numerically (“50 percent of women are submissive”) may not be enough to make the generic “women are submissive” budge in its perceived truth value (Cimpian, Brandone, and Gelman 2010). People are perfectly happy to endorse generics “lions have manes” and “ticks carry Lyme disease” while acknowledging that not all lions have manes, and only a small proportion of ticks carry Lyme disease (Leslie 2017; Tessler and Goodman 2016). We are grateful to the editors for suggesting this clarification.

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society—in other words, she identified the social structure as the structuring cause that makes it so that the relationship “drinking → assault” exists in the first place, and suggested we should focus and intervene on structuring causes instead. The relationship between drinking and sexual assault is an example of an unstable relationship, defined as a relationship that varies in strength across background circumstances (Lewis 1986; Woodward 2006, 2010). Nadya Vasilyeva, Thomas Blanchard, and Tania Lombrozo (2018) recently showed that when adults realize that a causal relationship is unstable, they are less likely to endorse causal and explanatory generalizations about them (of the form “X causes Y”), and less likely to act on the triggering cause to influence the outcome, compared to stable causal relationships. Pointing out structural causes shaping lower-level relationships between triggering causes and outcomes can make the instability of the latter salient, with tangible psychological consequences for reasoning about structurally bound agents (i.e., most agents within a social structure). For example, having a child harms women’s careers (Budig and England 2001; Kahn, Garcia-Manglano, and Bianchi 2014). Focusing on the triggering cause (having a baby) puts the responsibility on women, with the corresponding low-level solution: advise women not to have children (at least until their careers are secured). Applying structural thinking and identifying structuring causes that shape the distribution of options for agents occupying different positions within the structure is an important step toward not blaming victims making constrained choices with constrained consequences within those social structures. STRUCTURAL THINKING AND EPISTEMIC INJUSTICE How is structural thinking relevant for tackling epistemic justice? We see it as mitigating problematic processing of information about social groups that is commonly associated with epistemic injustice, in particular, stereotyping and prejudice. Essentialist beliefs, which we presented above as one element of internalist thinking, predict stereotype endorsement (Bastian and Haslam 2005) and are associated with prejudice (Allport 1954; Haslam, Rothschild, and Ernst 2002). When attributes of social groups are seen as fixed and derived from an internal core, people are likely to rely on stereotypes to navigate the social reality. As long as structural thinking takes us away from the sort of cognitive processes that lead to problematic judgments of other people, developing structural thinking has something to offer to the fight against epistemic injustice. Specifically, structural thinking can help reduce hermeneutical injustice by addressing conceptual gaps that align with larger patterns of discrimination. Structural thinking might be the missing hermeneutical tool for understanding statistical patterns in nondiscriminatory ways (e.g., offering a non-

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internalist account of why certain social groups are overrepresented or underrepresented in specific domains, without assuming inevitability and normativity of the existing patterns). It thus puts thinkers in a better position to reason about the social categories they and others belong to. This has direct consequences for testimonial and distributive injustice. When one reason a person A discounts a person B as a potential knower is because A engages in an internalist interpretation of B’s “failures” in other domains (e.g., failing to secure certain jobs or levels of income) by attributing them to an inherent lack of capacity or knowledge on part of B or a social category B belongs to—structural thinking may neutralize this chain of inferences by offering non-discriminatory ways of interpreting associations in the world (e.g., between B’s social category and low wages), with positive downstream consequences for evaluation of B’s testimony (B is perceived as nevertheless credible and trustworthy). Even if this is not sufficient to eliminate perceived credibility deficit entirely, by training A to consider noninternalist explanations of the (apparent) lack of credibility, structural thinking can provide A with the necessary conceptual tools, the hermeneutical resources required to appreciate B’s capacity to contribute knowledge. In cases when the listener lacks detailed knowledge about the speaker, structural thinking may prevent or reduce an internalist interpretation of the initial disfluency, or lack of immediate comprehension of what the speaker is saying, or more generally, the perceived trustworthiness of the speaker, by offering an alternative, noninternalist interpretation of these observations (e.g., A might think “perhaps, I don’t understand what B is saying [or B does not appear credible to me] not because B is inherently un-comprehensible, but because the mismatch in the social positions each of us occupies makes communication between us more challenging”). In this sense, thinking structurally might pave the way to a better epistemic sensibility, to the capacity to tune up to unfamiliar hermeneutical systems and unfamiliar knowers, a “Kaleidoscopic social sensibility” (Medina 2013). How does the structural thinking proposal compare to previously articulated interventions against epistemic injustice in terms of feasibility? For example, when Fricker talks about the virtue of epistemic justice, she writes that “Its possession requires the hearer to reliably neutralize prejudice in her judgments of credibility” (Fricker 2007, 92). As others have pointed out, developing and exercising the virtue of epistemic justice seems like a difficult enterprise. Fricker proposes a sort of epistemic leap of faith. That is, when we judge a knower in a faulty way, and this is due to our prejudices presenting the knower as a deficient source, then we need to resist what appears as the evidence. When our epistemic prejudices-mediated detectors are telling us to be cautious, or outright skeptical, we need to trust. The virtue of epistemic justice seems to be telling us to ignore the (apparent) evidence we are getting, and trusting that we will know how to make a correct judg-

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ment in the absence of it. At a first glance, it sounds like the opposite of epistemic responsibility, and yet we know this is something we would do out of both epistemic and moral responsibility: because we want to get the reality right in spite of the smoke curtain of prejudices distorting it. Even if not impossible, resisting the prejudice-mediated evidence sounds like a difficult thing to do. The virtue of epistemic justice also requires that we have the capacity to notice when we have made a mistaken judgment about a knower. The idea behind epistemic justice is that once we notice it, then we compensate for the mistake. As pointed out by Benjamin Sherman (2015), there are problems with committing to this capacity. From the first-person perspective, I might have the impression that I have become good at detecting faulty judgments that derive from my prejudices. However, how can I be sure about the reliability of that evidence? As Sherman explains, some errors, such as the gambler’s fallacy, can be fixed with a critical, reflective attitude. While it is easy for us to commit that fallacy, after we reflect we might recognize the mistake, and we can try to correct for it. He doubts, however, that we can identify and correct for the mistakes that have to do with our prejudiced judgments. What would count as evidence of the mistake if our perception is prejudiced in the first place? In comparison, we see structural thinking as not requiring that sort of psychological heroism apparently required by the virtue of epistemic justice. Instead of going against the apparent evidence or calling for detecting mistakes that by definition escape our radar (as they can occur at the level of implicit bias), structural thinking requires that we consider an alternative explanation for the association between the category and the properties, such as perceived lack of credibility. We can speculate that structural thinking may be easier to implement than the virtue of epistemic justice, for two reasons. It appears that the virtue of epistemic justice requires that an agent attributes the perceived lack of credibility either to some unknown cause or to the agent’s own cognitive and/or moral flaws. But we know from the psychological literature that both of these strategies may be an uphill battle. First, people have trouble reasoning about causal models with unspecified inputs, where “nothing” appears to cause “something.” For example, when people are told that a medical screening test produces false positives in 5 percent of the time (but are not told why or how), they fail to apply this knowledge when interpreting test results (Eddy 1982; Gigerenzer and Hoffrage 1995). Asking people to acknowledge the possibility that their “detectors of un-trustworthy and noncredible speakers” produce false positives may be similarly ineffective. Interestingly, giving people a concrete variable as the cause of false positives (e.g., saying that they can be caused by a benign cyst) significantly improves performance (Krynski and Tenenbaum 2007); once the concrete variable is plugged into the mental causal model as the

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cause, it is easier for people to take its effect into account, since the effect does not appear to arise “out of nothing.” But, in the case of epistemic justice virtue approach, an equivalent move hits another barrier: people tend to resist attributing negative causal influences to self (see reviews of evidence for self-serving bias: Blaine and Crocker 1993; Miller and Ross 1975; and actorobserver asymmetry: Jones and Nisbett 1971). In contrast, the structural thinking approach provides the agent with a tangible external cause of the perceived lack of credibility, without threatening the agent’s self. This, taken together with the fact that structural thinking does not require actively discarding available statistical evidence, combined with the evidence of structural thinking in children as young as three (Vasilyeva, Gopnik, and Lombrozo 2018), gives us reasons to believe that structural thinking is a psychologically plausible approach, and it may turn out to be less cognitively demanding than employing the virtue of epistemic justice. WHEN STRUCTURAL THINKING IS (UN)LIKELY TO HELP Of course, structural thinking is not a magic cure-all solution, and it is important to determine when it is and is not likely to work. One possibility is that while it succeeds in blocking overgeneralization across social contexts, it may be less resistant to overgeneralization across category members. 3 Prior research on nonstructural generics documented an asymmetry between generic truth conditions and implied prevalence: in one study (Cimpian, Brandone, and Gelman 2010, Experiment 1), participants learned that a certain percentage of novel category members had a property (e.g., “30 percent of lorches have purple feathers”) and indicated whether the corresponding generic (“lorches have purple feathers”) was true or false. On average, participants required 69 percent or more category members to have the property in order to endorse the generic as true. However, when a different group of participants was given the same generic statements and asked to estimate the percentage of category members having the property, their estimates averaged to 96 percent. This showed that generics can be endorsed based on little evidence, but have strong implications—potentially resulting in overgeneralization across individual category members. Can structural thinking help mitigate this effect? The short answer is we do not know yet (but one of the authors is currently conducting studies to evaluate the effects of structural construal on generic truth conditions and implied prevalence: Vasilyeva and Lombrozo unpublished). Depending on the psychological mechanisms giving rise to the asymmetry between the generic truth and implied prevalence judgments, structural framing of generics can prove more or less impactful. Let’s consider three possible psychological mechanisms. First, people could 3. We are grateful to the editors of this volume for encouraging us to develop this question.

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inflate prevalence estimates because they assume that a novel generic conveys a principled feature of a category (à la “dogs have tails”; Prasada and Dillingham 2006, 2009), rather than a striking or a minority characteristic (“sharks attack swimmers”; “lions have manes”; Leslie 2007, 2008); they might make this assumption if they believe that generics about principled features are the most common or prototypical (Cimpian, Brandone, and Gelman 2010). If so, then making a structural generic alternative more salient to people can help mitigate inflation of prevalence estimates in two ways: by helping them recognize that the proportion of “principled generics” is lower than they thought and by highlighting that structural generics may hold true of properties that are mutable—and thus potentially more variable across individuals (Vasilyeva, Gopnik, and Lombrozo 2018). On the other hand, if the asymmetry stems from pragmatic assumptions (the speaker’s choice not to quantify the generic with “some” may be taken to signal that all category members rather than a subset have the property, based on the Gricean maxim of quantity; Cimpian, Brandone, and Gelman 2010; Declerck 1991; Grice 1975)—then the structural framing may have little impact. As a third option, the asymmetry may stem from the previously documented discrepancy between outputs of extensional reasoning (targeting the extension of the concept, the set of items it picks out in the world) and intensional reasoning (about the abstract kind and its features), and the specific challenges of translating between the two, in either direction (Cimpian, Brandone, and Gelman 2010; Jönsson and Hampton 2006; Tversky and Kahneman 1983). If so, structural thinking might complicate the matters by requiring people to manage uncertainty over the abstract kind in question: for example, when considering the generic “women are submissive,” are we talking about “women” qua an essentialized kind, or “women” qua a structural node (Haslanger 2016)? If the two kinds disagree in prevalence estimates of submissiveness, the mere act of acknowledging the uncertainty may produce more conservative prevalence estimates, mitigating overgeneralization across individuals. Apart from the issue of erroneous (inflated) estimates of feature prevalence in a category, there is the question of moral permissibility of relying on statistically accurate estimates about social groups to guide decisions about their members. On the one hand, ignoring base rates, or prior probabilities of a person having a feature, is considered a violation of principles of rationality, which undermines prediction accuracy (Bar-Hillel 1980; Tversky and Kahneman 1974). For example, in a medical context, in order to maximize accuracy of diagnosis for a patient with a cough, a symptom compatible with both the common cold and lung cancer, doctors should take into account that there are a lot more people with the common cold than there are people with lung cancer; ignoring this information will result in dramatic deviations from

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accurate diagnosis, underdiagnosing common colds and misdiagnosing lung cancer. Likewise, social stereotypes have been conceptualized as offering useful base rate information that maximizes prediction accuracy (Krosnik, Li, and Lehman 1990; Locksley et al. 1980; Rasinski, Crocker, and Hastie 1985). However, the use of social stereotypes for prediction is not morally neutral: it can be argued to go against principles of justice and fairness, violating rights of individuals (Cao and Banaji 2016; Cao, Kleiman-Weiner, and Banaji 2018; Dworkin 2000; Rawls 2001). This idea is reflected in explicit prohibitions against using group membership and corresponding base rates in the US courts to evaluate defendants’ guilt, and to adjust health insurance premiums in Europe (Cao, Kleiman-Weiner, and Banaji 2018; Koehler 1992; European Court of Justice 2011). In recent work, Jack Cao, Max KleimanWeiner, and Mahzarin Banaji (2018) show that people can do both—behave like rational Bayesians, using base rate information to maximize accuracy of their predictions, and condemn the use of base rate information on moral grounds. For example, the same group of participants who predicted that, for example, a man who performed a surgery is more likely to be a doctor compared to a woman who performed a surgery, also judged a person making the same type of a Bayesian judgment as unfair and unjust. 4 We can speculate that structural thinking might encourage people to take into account the considerations of justice and fairness when they make decisions about how to act toward members of different social groups, by drawing their attention to the causes of the observed statistical patterns across social categories, helping them recognize the role of the stable patterns of disadvantage. Extensive psychological evidence suggests that people care deeply about the causal mechanisms, or causal models producing the observed outcomes (Griffiths and Tenenbaum 2005; Tenenbaum, Griffiths, and Kemp 2006); when they realize that several possible causal models could 4. Cao, Kleiman-Weiner, and Banaji (2018) raise a possibility that participants are not being hypocritical (essentially accusing a third person of bigotry for the very same judgment they made themselves), but instead they engage in another rational Bayesian judgment, based on participants’ estimates of base rates of sexists in our society. Consistent with our proposal about the “two flavors” of generics, internalist and structural, “both an unabashed sexist and a feminist statistician can state that a man who performed surgery is more likely to be a doctor than is a woman who performed surgery, albeit for different reasons” (Cao, Kleiman-Weiner, and Banaji 2018, 10). Thus, participants had to estimate whether the third party was a sexist or a feminist. If they believe that there are more sexists than feminists, it would be rational to assume the speaker was a sexist, and criticize them. Ultimately, the sexist is blameworthy for arriving to an accurate conclusion in a wrong way. This is another illustration of the psychological importance attributed to the different causal mechanisms, even if they lead to the same outcome. (Additionally, this suggests yet another potential effect of engaging in structural thinking: a listener who recognizes that speakers may use generics and formal explanations to convey structural meanings will be less likely to jump to the conclusion that anyone who uses generic language about gender is sexist, and will avoid false alarms classifying structural thinkers as bigots.)

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have produced the observation, even young children take steps to collect additional evidence to figure out which model was responsible (Schulz and Bonawitz 2007). When people generalize from limited observations, different explanations of the same observation produce radically different generalization behaviors (Lombrozo and Gwynne 2014; Vasilyeva and Coley 2013). Thus, we can expect structural versus internalist explanations of an observed statistical correlation between a category and a property to influence how people reason and act based on this correlation. To illustrate this idea, imagine you “hire” two teenage kids living in your neighborhood to help you deliver free lunches to some residents. It turns out that both fail to deliver about 30 percent of the lunches, but for different reasons: one is lazy, unmotivated, and distracted, so she loses lunch boxes or forgets to deliver them; the other one is regularly harrassed by neighborhood bullies, who destroy her lunch boxes when they encounter her on her delivery route. Assuming the same expected outcome in the future (30 percent loss), would you be equally likely to hire each of these kids again? Our intuition suggests that the preference might go to the second kid, with a more structural explanation of the negative outcome, rather than the first kid, with a more internalist explanation of the same outcome. Likewise, we can speculate that a CEO choosing between two candidates with the same average likelihood of underperforming may be sensitive to the underlying mechanism, making them more likely to hire the candidate whose failures arise due to structural factors (e.g., misses evening meetings due to lack of available childcare, does not pursue new projects due to lack of support from coworkers) than the candidate failing for intrinsic reasons (e.g., forgets to attend meetings due to lack of organization, does not pursue new projects due to lack of motivation). 5 In sum, if the explanatory mechanism could make a difference in how much weight is given to moral considerations of justice and fairness, then structural thinking has the potential to make a difference in how members of

5. Nonstructural explanations that merely cite external causes may be less efficient in mitigating prejudice. For example, Belief in Social Determinism (BSD), a lay theory that “a person’s essential features . . . are shaped permanently and profoundly by social factors” (Rangel and Keller 2011, 1, our emphasis), utilizes external factors to tell an “inside story” of how individuals come to be “permanently and profoundly” shaped by social factors (Plaut and Markus 2005): for example, how a woman came to be submissive. Critically, the consequences of engaging in BSD are not that different from internalist thinking: it is associated with dispositional bias, expectations of stability across situations and time, negative stereotyping, prejudice, discrimination, and hierarchy-enhancing ideologies (e.g., nationalism). Applying it to our examples, the BSD explanation would appeal to the social factors that made one of the candidates lazy, irresponsible, and unmotivated. While alleviating the potential blame, we doubt this explanation would do much in boosting the candidate’s odds of being hired.

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some social groups are treated, even if the predictive statistics do not speak in their favor. 6 Were structural thinking to prove beneficial for alleviating epistemic (and other types of) injustice, it could be promoted at several levels. At the firstperson level, it can be implemented as a means of self-improvement. It can also be promoted by encouraging others to engage in it. Just like Vasilyeva, Gopnik, and Lombrozo (2018) were able to promote structural thinking in their participants, teachers could promote structural thinking in the classroom, by engineering the kind of inquiry contexts children confront. This suggests yet another level of implementation, in the form of guidelines about how best to talk to children, especially when generic statements are involved. CONCLUSION The proposal we have outlined combines the individualist with the structural elements in a novel way: it targets how individuals think about structures. By acknowledging that both the individuals’ psychology and the structural factors contribute to producing injustice, it engages both of these elements in fighting it, in an empirically informed way. Our proposal also calls for further empirical research to evaluate effectiveness and boundary conditions of structural thinking. REFERENCES Allport, Gordon W. 1954. The Nature of Prejudice. Cambridge: Addison-Wesley. Anthony, Louise. 2013. “Advising Women against Drinking Also Sends a Dangerous Method.” New York Times, October 24. https://www.nytimes.com/roomfordebate/2013/10/23/youngwomen-drinking-and-rape/advising-women-against-drinking. Ayala-López, Saray, and Nadya Vasilyeva. 2015. “Explaining Speech Injustice: Individualistic vs. Structural Explanation.” In Proceedings of the 37th Annual Conference of the Cognitive Science Society, edited by D. C. Noelle, R. Dale, A. S. Warlaumont, J. Yoshimi, T. Matlock, C. D. Jennings, and P. P. Maglio. Austin, TX: Cognitive Science Society. Bar-Hillel, Maya. 1980. “The Base-Rate Fallacy in Probability Judgments.” Acta Psychologica 44: 211–33. Bastian, Brock, and Nick Haslam. 2005. “Psychological Essentialism and Stereotype Endorsement.” Journal of Experimental Social Psychology 42: 228–35. Blaine, Bruce, and Jennifer Crocker. 1993. “Self-Esteem and Self-Serving Biases in Reactions to Positive and Negative Events: An Integrative Review.” In Self-Esteem: The Puzzle of Low Self-Regard, edited by Roy F. Baumeister, 55–85. Boston: Springer.

6. Of course, there are limits on how powerful an explanation can be in guiding action. When a choice puts moral and social responsibility in conflict with productivity and commercial success—for example, if the choice is between a candidate likely to underperform for structural reasons and a candidate very unlikely to underperform at all—the conflict may be resolved differently, depending on the “mission” and priorities of the hiring organization. In academia, selection of graduate students or research assistants may raise similar conflicts in decision makers.

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Chapter Five

The Inevitability of Aiming for Virtue Alex Madva

What should we do to overcome epistemic injustice? 1 Miranda Fricker (2007, 2010b) argues that we as individuals ought to cultivate certain testimonial and interpretive virtues. This chapter defends and expands upon her proposals. My background motivation is to respond to two prominent objections to Fricker’s virtue-theoretic proposals. First, the situationist objection states that her account of virtue cultivation is empirically implausible, suffering both from the general limitations that (situationists argue) plague all ethical and epistemological virtue theory, as well as from more particular pitfalls facing individuals who try to overcome their own “bias blind spots” (e.g., Alfano 2015, Davidson and Kelly 2015, Sherman 2015). Second, and relatedly, the structuralist objection argues that Fricker’s prescriptions for cultivating epistemic virtue are excessively individualistic, and fail to appreciate the underlying structural factors driving epistemic oppression (Alcoff 2010, Anderson 2012, Ayala-López 2018, Dotson 2012, Langton 2010, Medina 2013, Washington 2016). I say these challenges represent the background motivations for this chapter because I won’t have the space to respond to them in depth. They have, in more general terms, been litigated extensively elsewhere (e.g., Fairweather and Alfano 2017). Instead, the brunt of this chapter will be dedicated to making the positive case that Fricker’s account is both empirically oriented and plausible—indeed, pursuing epistemic virtue in roughly the way she 1. The inception and early development of this chapter owe an immeasurable debt to Jennifer Kanyuk. Jen and I originally intended to write this together, until scheduling conflicts made that impossible. I am also grateful for insightful, rigorous, and patient feedback from Stacey Goguen and Benjamin Sherman, as well as for the audience’s questions and suggestions during a poster presentation of this material at the Bias in Context #4 conference at the University of Utah in October 2017.

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describes is inevitable for anyone who takes seriously the systemic epistemic injustices she and others have identified. According to Fricker (and numerous feminist-epistemological forerunners and commentators), the pivot away from epistemic injustice depends in part on moments of self-critical awareness, states of cognitive dissonance in which an individual realizes that she may, for example, be underestimating an interlocutor’s credibility due to stereotypes or prejudices. Fricker further advocates that individuals cultivate epistemic habits that aim to consistently neutralize the effects of such prejudices on their credibility estimates. I agree on both counts: working to cultivate such habits is an integral component of what we ought to do in the face of pervasive epistemic injustice. I sample from a range of findings from social and cognitive psychology that bear these claims out. That said, Fricker is clear that her specific proposals do not constitute the only means through which individuals and institutions should combat epistemic injustice. I therefore build on her account—drawing inspiration from several essays written after Epistemic Injustice (Fricker 2010b, 2010a, 2012, 2013)—by beginning to sketch a fuller, antiindividualistic picture of the structure of cultivating individual epistemic virtue(s). OBJECTIONS TO EPISTEMIC-JUSTICE VIRTUE THEORY Structuralists and situationists share much in common. Both claim that what’s outside individual hearts and minds is more important than what’s in them (i.e., more important than individuals’ idiosyncratic beliefs, desires, prejudices, and traits) when it comes to the main drivers of human behavior, and therefore to the perpetuation and eradication of epistemic injustice, from which it would seem to follow that philosophical and activist attention to individual vices and virtues is misplaced. Structuralists and situationists will, for example, both emphasize the power of social roles to shape behavior over and above idiosyncratic character traits (“it’s not that I have an authoritarian or evil personality, or that I harbor ill will toward members of such-and-such group . . . I was just following orders”). The difference between these objections is that situationists typically focus on normatively irrelevant or inappropriate influences on behavior, as when judges deny parole applications because it’s close to lunch and they’re hungry (Danziger, Levav, and Avnaim-Pesso 2011), whereas structuralists often focus on prima facie normatively appropriate influences on human behavior. For example, Saray AyalaLópez (2018) argues that many instances of testimonial injustice are less a matter of individuals harboring prejudices against speakers, and more about individuals simply following publicly shared norms. Very roughly, her argument locates the problem in the unfair “rules of the game” rather than in the irrationality, ignorance, or self-interest of the “players.” Structuralists also

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point to still broader societal and environmental factors like group-based segregation, wealth inequality, education-funding streams, environmental toxins, and so on, to explain the perpetuation of systemic epistemic injustices. Situationists and structuralists have identified a range of incredibly important phenomena. I disagree profoundly with the lessons they draw (Brownstein, Madva, and Gawronski under review; Madva forthcoming, 2016b, 2016a, 2017; Madva and Brownstein 2018). I cannot here catalogue all my grievances, and I will rest my response to their claims primarily on the conceptual distinctions and empirical evidence I highlight in the following sections. In order to provide some context for those claims, however, I home in on some of Benjamin Sherman’s (2015) arguments against the wisdom or feasibility of Fricker’s recommendations for taking meaningful steps to become more epistemically just. Recall that Fricker argues for the necessity of self-critical awareness, moments of cognitive dissonance in which an individual considers that his assessments of others’ credibility might be biased. She writes, “the initial step towards improved, less prejudiced forms of social perception can only be a step of critical reflection . . . the initial moves towards finding ways to neutralize the impact of prejudice in our judgements have to be self-reflective in the first instance” (Fricker 2010b, 166). Fricker argues, furthermore, that individuals should practice trying to neutralize the effects of prejudice on their credibility judgments. Sherman is dubious about these proposals. First, he argues that when individuals step back and critically reflect on their intuitive credibility judgments, they will most likely find their initial impressions to be accurate. (Sherman is, of course, not skeptical of critical reflection’s general value, but of its specific relevance to catching and correcting our own errors in assigning credibility to other speakers, through the specific methods recommended by Fricker.) For example, research on the “bias blind spot” suggests we tend to think our judgments are more objective than they really are (Pronin, Lin, and Ross 2002). As a result, Sherman writes (citing Moore’s Paradox), “your own present judgments will always seem correct to you” (2015, 11). Sherman predicts not just that Fricker-style self-critical awareness is unlikely to ameliorate testimonial injustice, but that it is more likely to reentrench our biased assessments than to undermine them. I will eventually argue in section 3 that Sherman’s predictions about what “always” happens are belied by the empirical evidence. It bears noting, however, that Fricker nowhere purports to offer an easy, fail-safe debiasing procedure. Like most moments of cognitive dissonance, reflection on our potentially biased epistemic habits and judgments can be resolved in variously vicious or virtuous ways, or simply ignored altogether. The point is instead that such moments of self-critical reflection must happen if progress is to be made. I agree. The rarity, difficulty, and potential backfiring effects of these

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self-critical moments represent just one important set of considerations; the further question is whether there is any viable alternative. Are we seriously to consider that progress toward the social-epistemic overhauls advocated by situationists and structuralists is possible without a whole bunch of currently complicit citizens of liberal democracies coming to reconsider the correctness of their epistemic judgments and then taking steps to do something about it? Can, for example, enduring racial epistemic justice be achieved without a critical mass of white Americans reassessing their skeptical impressions of the credibility of people of color who testify to, and protest against, ongoing oppression? Even if we grant that moments of self-critical awareness have an unavoidable role to play in spurring resistance against epistemic injustice, a further set of questions regards the form that resistance should take. Following other situationists and structuralists, Sherman is skeptical that our efforts should be invested in aiming for virtue. He doubts there is any such attainable ideal as individual epistemic justice and suggests that striving for such an impossible goal might be counterproductive or even incoherent. There will, he suspects, be better ways of reducing testimonial injustice than for each individual to try compensating for the role of prejudice in their epistemic assessments. Some of his concerns here are weightier than others. It is perhaps humanly impossible to shoot 100 percent from the free-throw line, or to accurately answer every trivia question on every episode of Jeopardy!, but people can practice sinking as many shots and answering as many questions as they can. Similarly, there’s clearly room to want to be, and practice being, as accurate in our testimonial uptake as we can. We have all had experiences of thinking someone was lying or misremembering only to discover they were telling the truth (it turns out we were misremembering!), or observing a disagreement about some trivial factual issue (like directions or opening hours) and being persuaded by the uber-confident, outspoken, cis able-bodied white man when it turns out that a less socially privileged person was right all along. We (can) learn from such mistakes and (should) try to do better next time. We do not always get feedback about the accuracy of our initial credibility estimates, but we get plenty, and we can be more or less diligent about absorbing it and trying to do better. Now, is there such a thing as full-blown testimonial virtue, where this refers to an actually existing earthling mammal whose responses to testimony are perfectly accurate and just? Presumably not. Although I take it to be obvious that most individuals cannot achieve perfect moral-epistemic virtue, many individuals can (and therefore should try to) get much closer to the ideals than they already are. I tend to focus on the cultivation of these virtues rather than the virtues themselves, because I follow nonideal theorists and responsibilists like Lorraine Code and Fricker in asserting that we can take

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steps in the right direction(s) despite failing to settle with full precision what the final destination is or having a detailed map for how to get there: epistemic responsibility does not come complete with a set of accompanying rules for the direction of the mind. Like many virtues, it names a precept, a principle, whose effects are diffuse, unpredictable, and open to ongoing, collaborative-contestatory deliberation. Often they do not speak for themselves but require collective processes of evaluation/negotiation. I do not spell out necessary and sufficient conditions for achieving epistemic responsibility, and for good reasons: there are none. But guidelines can be sketched: impressionistic though they may be. (Code 2017, 96)

The implausibility of context-general codification is itself a central motivation for a virtue-theoretic rather than rule-based approach (Fricker 2007, 73–76, and 171–73). (Some readings of Fricker as making unduly narrow proposals for combating epistemic injustice may fail to take seriously her emphasis on uncodifiability.) I also follow the many feminist epistemologists who take for granted that avoiding the perpetuation of epistemic oppression and the attainment of full epistemic virtue is extremely difficult, if not impossible (Dotson 2012, 24–25; Medina 2013, sec. 5.2), and yet who for precisely this reason insist on being as vigilant as possible in advancing justice and knowledge. The process of getting better is ongoing. We know enough now to make meaningful improvements. We will learn more as we go, revising our current sense of “best practices” in light of continued empirical investigation and collective-contestatory deliberation. Epistemic-virtue cultivation is necessary but not sufficient for social change. Fricker writes, for example, that “virtuous individuals working within an institutional body are obviously only part of the story” (2012, 296), because “combating epistemic injustice clearly calls for virtues of epistemic justice to be possessed by institutions as well as by individuals” (Fricker, 2007, 176). Such caveats would almost seem to go without saying (hence the terms “obviously” and “clearly” in these passages), yet many structuralists seem to attribute to Fricker the implausible claim that individual virtue is sufficient. One reason epistemic-virtue cultivation is insufficient is that it must be socially and institutionally embedded. The requisite moments of self-reflection are unlikely to burst forth ex nihilo from a social vacuum. Someone else (a parent, teacher, friend, politician), or at least some event external to your own mind (e.g., a person who is profoundly skeptical about the reality of police brutality until he personally suffers or witnesses it), likely must confront you with at least a smidgen of counterevidence (or epistemic friction) to set the relevant self-reflection in motion. For how this kind of prompting might go in practice, see David Broockman and Joshua Kalla’s (2016) study of door-to-door canvassing reducing voters’ transphobia for at least three

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months. 2 Note that it follows from the necessary embeddedness of virtue cultivation that Fricker’s occasional talk of self-critical reflection coming “first” is a mistake. Various interpersonal, situational, and structural conditions are at least conducive (and perhaps necessary) for enabling the relevant self-reflection. This point is implicitly baked into several of Fricker’s examples of individuals raised in thoroughly hierarchical and prejudiced societies (2007, sec. 4.2; see also 2012, 2013). (José Medina [2013, 18] also sometimes slips into saying that epistemic resistance “has to begin within ourselves,” although he elsewhere emphasizes all manner of social preconditions that perforce precede such introspective first steps.) The upshot is that movements toward individual and institutional virtues are interdependent. Neither comes first; neither comes second. They are irredeemably entangled in a complex set of holistic interrelations. So although I agree with more or less all of Fricker’s necessary conditions, there is, as she says, more to the story. To better capture the interdependence of individual and structural change, and to thereby do some justice to the spirit, if not the letter, of situationists’ and structuralists’ concerns, I propose augmenting our account of epistemic virtue. STRUCTURING VIRTUE CULTIVATION I highlight here two underappreciated distinctions for cultivating epistemic virtue. The first involves the cognitive architecture of the virtues themselves. The second involves what we might call the targets of virtuous attention, that is, what good epistemic agents think about and react to. First, epistemic-virtue cultivation must occur along (at least) two psychological levels (or “systems”). Discussions of epistemic virtue have focused on our self-reflective, corrective, metacognitive dispositions, such as the second-order ability (presumably necessary for open-mindedness and humility) to recognize when our first-order epistemic intuitions might be in error. This emphasis on metacognition is premised on the assumption that our firstorder, intuitive cognitive tendencies are very stubborn, if not altogether incorrigible (e.g., Alfano 2013, 147; Kahneman 2011, 417; cf. Madva 2016b, 2017), perhaps because these tendencies are hardwired from birth, or perhaps because these tendencies reflect learned prejudices and other habits of thought too deeply ingrained and socially reinforced for individuals to change. Either way, the stubbornness assumption is wrong. Epistemic-virtue cultivation can and must incorporate the direct retraining of our relatively spontaneous, unreflective (“System-1”) patterns of thinking, feeling, perceiving, and reacting to epistemic social reality (Alcoff 2006). I should note there will likely be more finely grained or alternative-but-useful ways of slicing 2. For illuminating examples of how these conversations went, see Resnick (2016).

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virtue’s cognitive-architectural pie. It might, for example, be important to demarcate the cognitive, affective, and motivational dimensions of virtue (although I tend to be skeptical of distinctions between “reason” and “passion”; Madva and Brownstein, 2018). The second distinction regards the targets of virtuous attention. Fricker’s original treatment of epistemic virtue focuses primarily on becoming a better epistemic agent in local interactions, in the form of reliably and responsibly evaluating and interpreting others’ testimony. This interactional dimension of epistemic virtue is certainly crucial. Here the conceptual and empirical questions are: what is the cognitive architecture of an epistemically debiased mind and which strategies promote it? However, the cultivation of epistemic virtue must have a multidirectional orientation, such that our attention is directed not only to the credibility and intelligibility of other individuals but also, more broadly, to the structures and institutions in which we are all embedded. Before I explain why, note that Fricker’s account of testimonial justice is not comprehensive even as an account of interactional virtue. Consider, as an extreme example, a person who reliably self-corrects his deflated estimates of oppressed speakers’ credibility, such that his assessments of testimony are perfectly accurate (thereby meeting Fricker’s central criterion for testimonial justice); yet he then turns around and intentionally tells everyone else that these oppressed speakers are less credible than he knows them to be. It would be absurd to suggest that this person was testimonially virtuous. The wrongs done in this case are not merely moral but epistemic: he is degrading others’ knowledge, he is failing to respect the oppressed speakers’ status as knowers and others’ status as acquirers of knowledge, and so on. Interactional epistemic virtue is, then, as much about telling truths as about believing them. So meeting Fricker’s criterion is necessary but not sufficient for local-interactional testimonial virtue. In this vein, Jason Kawall (2002) points out that virtue epistemologists have been preoccupied with individualistic, self-regarding epistemic virtues (the personal acquisition of truth and avoidance of error via, e.g., open-mindedness or humility) and not enough with other-regarding epistemic virtues (e.g., the dissemination of truth via, say, honesty or courage). Kawall convincingly argues that certain otherregarding dispositions are full-blooded components of epistemic virtue. We must take this insight further, such that structure-facing dispositions claim an equal place in the pantheon of epistemic virtues. Take, for example, a member of Congress who voted to forbid the Center for Disease Control from even studying the effects of gun violence, or climate scientists who know full well the harm we are doing to the planet but accept money from private industry to spread lies, fund bogus studies, sow doubt, and so on. Again, it would be absurd to suggest that such individuals who know the facts, or know how to acquire them, but take steps to prevent our community from doing so, are epistemically virtuous. Epistemic virtue requires being the

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sort of person who reliably and responsibly supports institutions that generate, disseminate, and retain knowledge. This involves taking steps to promote (or, minimally, not taking steps to impede) the creation, revision, or maintenance of just bodies of knowledge. It also requires attention to the ways that individuals’ social locations and situations inform their beliefs and other epistemic dispositions (e.g., Ayala-López and Vasilyeva, this volume; Grasswick 2017). Here the conceptual and empirical questions are: what is the cognitive architecture of an epistemically resistant mind and which strategies promote it? Cultivating epistemic virtue thus requires a multidirectional orientation, targeting both micro-interactions and macro-structures. Again, there are surely more fine-grained and illuminating ways to parse the objects of virtuous attention, as well as other objects of virtuous attention beyond these two (consider, e.g., nonsocial truths and other epistemic goods, such as scientists who must be conscientious in the management of their data). But the foregoing distinction represents a useful first pass for my purposes. Whether interactional and structure-facing epistemic virtues are “unified” in the Socratic sense is also an important question. Can a person move closer to interactional virtue without approaching structure-facing virtue, and vice versa? These are essentially empirical matters, not to be adjudicated via armchair analysis. I’ll next underscore evidence of overlap between interactional and structurefacing virtue, but it is presumably possible for them to come apart, or work cross purposes. In the nonepistemic realm, someone can be compassionate and respectful in their micro-interactions but remain politically oblivious, indifferent, or even deeply committed to the perpetuation of unjust institutions. Similar disconnects may arise in the epistemic domain. Let me also stress that the virtues are highly contextual and open-textured, and that epistemic-virtue cultivation must be tailored to specific embodied minds occupying specific social locations operating in specific political conditions. For one very crude example, perhaps those who occupy privileged positions typically ought to focus more on cultivating epistemic humility while those who occupy oppressed positions might be more warranted in seeking out strategies for cultivating more epistemic confidence or self-respect. Processes of virtue cultivation must be indexed to individuals’ antecedent personality dispositions, social locations, and so forth, which will inevitably complicate our guidelines and taxonomies. Does acknowledging complexity leave room to say anything systematic and general about epistemicvirtue cultivation? Yes, but, as Kristie Dotson emphasizes, only so long as we “move toward open conceptual structures that signify without absolute foreclosure so as to reduce the continued propagation of epistemic oppression” (2012, 25). What follows is a proof of concept that meaningful steps toward epistemic virtue can be taken. These are some of the things that some individuals can (should) do to cultivate epistemic virtue.

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EVIDENCE First, consider a way to retrain our automatic, interactional dispositions, via what Fricker might call an “unreflective psychological work-out” (2010b, 165–66). The ultimate attribution error refers to the tendency for individuals to interpret undesirable behaviors performed by outgroup members in terms of dispositional traits stereotypical of the outgroup, but to interpret their positive behaviors in terms of situational factors. This social-explanatory bias has clear implications for epistemic injustice. Take Herbert dismissing Marge’s testimony on the grounds that “there’s female intuition, and then there are the facts” (Fricker 2007, 9). Part of what paves the way for this credibility deficit is Herbert wrongly attributing Marge’s anger and frustration, which are actually justified, to the stereotypical-dispositional trait of the “hysterical” woman (2007, 88), easily overrun by feelings. Evidence suggests that both men and women are more likely to interpret women’s anger in terms of dispositional traits (e.g., “She must be an emotional person”) rather than situations (e.g., “She is justifiably angry given the circumstances”), and, as a result, to perceive angry women as less knowledgeable and lower in social status than angry men (Brescoll and Uhlmann 2008). Such attribution errors clearly contribute to epistemic injustice. However, targeted practice can reduce this automatic bias (Stewart, Latu, Kawakami, and Myers 2010; see also Levontin, Halperin, and Dweck 2013). 3 During Situational Attribution Training, participants are shown many examples of behaviors, for which they must select potential explanations. For example, a photo of a black man’s face might be paired with the behavioral description, “Arrived at work an hour late,” and participants must then choose between two potential explanations, “The power went out and reset his alarm,” or “He is a particularly irresponsible person” (Stewart, Latu, Kawakami, and Myers 2010, 223). This training reshaped some of participants’ epistemic dispositions, by increasing the automatic cognitive accessibility of situational explanations and decreasing the accessibility of dispositional ones. What’s more, the training reduced the overall cognitive accessibility of racial stereotypes. This latter evidence, of a close psychological connection between individuals’ epistemic-explanatory dispositions and their implicit stereotypes, supports Fricker’s contention that social bias is deeply tied to credibility deficits and other epistemic injustices. Studies like this also exemplify how part of what it is to be epistemically virtuous is to be attuned to the powerful role of situations in explaining behavior. Becoming more epistemically virtuous, even in micro-interactional contexts, involves an es3. One would like to see these studies replicated with larger samples. I cite more recent and high-powered evidence for epistemic-debiasing techniques in what follows. See Madva (2017) for a qualitative survey and philosophical defense of similar debiasing procedures. See also Ayala-López and Vasilyeva (this volume).

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sentially situation-facing dimension, that is, better understanding testifiers’ contexts and social locations. (Such findings also illustrate how situationist objections against epistemic virtue risk being self-defeating, by demonstrating one way in which awareness of situational influence must be built in to what individual virtue requires.) Situational Attribution Training admittedly sounds simplistic and heavyhanded, but one can easily imagine more sophisticated, “gamified” analogues involving riddles or puzzles, perhaps modeled on games like Clue, 4 as well as straightforward ways for us to practice these strategies in daily life (e.g., “Whenever I get frustrated with a student, I will try to think of three situational explanations!”). Although critics of epistemic virtue (largely under the influence of Daniel Kahneman) have emphasized the stubbornness of our epistemic dispositions, a growing literature demonstrates that targeted, gamified training significantly reduces such notorious cognitive tendencies as the confirmation bias, the “bias blind spot,” and the “anchoring” and “representativeness” heuristics in durable and domain-general ways (Dunbar et al. 2014, Morewedge et al. 2015). Pervasive pessimism about individual change has been premature. At present we have basically no idea just how flexible these dispositions are. Nevertheless, there will presumably be some limits to how far unreflective psychological workouts can take us, and there will accordingly remain an ineliminable role for more self-corrective epistemic virtues. Margot Monteith’s (1993) “Self-Regulation of Prejudice” model, cited by Fricker (2010b, 165; see also Saul 2017), offers a helpful framework for sketching the general structure of metacognitive virtues. On this model, individuals with the virtuous commitment to be unprejudiced can form the habit of attending to their own spontaneous prejudiced thoughts and impulses, feeling guilty in response, and then doubling down on their motivation to do better. For example, calling these individuals’ attention to the discrepancies between their antiprejudiced commitments and their actual dispositions makes them less likely to draw stereotypical inferences or find racist jokes funny (Burns, Monteith, and Parker 2017). Importantly, these and other findings highlight that the automatic activation of stereotypes does not guarantee that the stereotypes will be applied in our considered judgments. To the contrary, metacognitive virtue (partly) involves reliably interpreting one’s impulsively biased thoughts and feelings as signals that this is an opportunity to be just (Madva, forthcoming). Skepticism about the prospects of introspective selfcorrection has been overblown. It is simply not true that our present judgments will always strike us as correct. To the contrary, many individuals regularly experience palpable cognitive dissonance between their reflective

4. Compare the games available on tiltfactor.org.

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commitments and their unreflectively biased judgments and feelings (Davidson and Kelly 2015; Gawronski et al. 2008). Another empirically well-supported example of metacognitive epistemic virtue is perspective-taking. Fricker, Medina, and others rightly emphasize that the imaginative occupation of others’ points of view can reduce testimonial and hermeneutic injustice. Fricker cites, for example, Simone Weil’s claim that “Unless one has placed oneself on the side of the oppressed, to feel with them, one cannot understand” (Fricker 2012, 287, Weil 1978, 139). Consider in this vein a preregistered study that tested the effects of a twentyminute, online “choose-your-own-adventure” game, in which Hungarians in their mid-twenties occupied the perspective of an individual in the Hungarian Roma minority (Simonovits, Kézdi, and Kardos 2018). Both immediately after the game and at least one month later, participants reported much less anti-Roma prejudice, as well as less prejudice toward another social group (refugees) who were not mentioned in the game. Participants were even 10 percent less likely to intend to vote for Hungary’s far-right white-supremacist party. While this particular study did not directly test, say, participants’ interpretations of or belief in Roma testimony, the epistemic implications of perspective-taking are clear. The whole point is to better know and understand others’ views. Thus mock jurors encouraged to adopt the perspective of defendants become less likely to find them guilty (Skorinko et al. 2014). And although perspective-taking is intuitively more at home in interactional contexts (when one person imagines the perspective of another), it also has clear structure-facing implications. For example, adolescents with perspective-taking personalities are less punitive and more supportive of restorative justice, agreeing with such statements (about the testimonial structure of the criminal justice system) as, “I believe that victims’ voices should be heard as part of the justice process” (Rasmussen et al. 2018, 73). Moreover, although being disposed to take others’ perspectives (at the right times in the right way) is an individual-level virtue, there is much that institutions should do to promote it, principally by bringing members of different groups together under terms of cooperation and social equality (Anderson 2012; Galinsky et al. 2015). It should come as no surprise that racially diverse juries are both more likely than homogeneous juries to consider an array of perspectives and to more accurately recall case facts and testimony (Sommers 2006). What about the structure-facing virtues and vices? One of the most pernicious psychological dispositions propping up unjust structures is a kind of default tendency to assume that the status quo is just (Jost 2015). This suggests that debiasing procedures should be oriented toward shifting our defaults, such that our operating assumption is that the status quo is not fair, and that things can and must be done to change it. A key set of structurefacing dispositions therefore revolves around seeing structural change as desirable and believing that agents and groups have the power to bring the

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requisite changes about (Corcoran, Pettinicchio, and Young 2011; Johnson and Kentaro 2012; Stewart, Latu, Branscombe, and Denney 2010; van Zomeren 2013). Which psychological and structural factors make individuals more likely to adopt these structure-facing virtues? Many of the answers are relatively unsurprising. Individuals are more likely to participate in collective action against unjust systems when, for example, they strongly identify with an oppressed group, swiftly and reliably get angry in response to injustices done to that group, and hold a firm conviction in the difference-making power of their participation in collective action. I want to conclude, however, with some perhaps less predictable dispositions that conduce to structure-facing virtue—and that wear their epistemic relevance on their sleeves. Evidence suggests that individuals are more apt to see injustice for what it is, and collectively protest against it, precisely when they are more willing and able to question their epistemic and political intuitions (cf., open-mindedness and humility), to practice and take pleasure in engaging difficulty cognitive activity (cf., curiosity and diligence), and to be relatively untroubled when they see the world differently from those around them (cf., a critical openness to interpersonal epistemic friction). In short, structure-facing epistemic virtue requires resistance to “certainty, security, and conformity” (Jost 2015, 623). By contrast, individuals will more likely rush to judging that the status quo is fair, and even protest to preserve inegalitarian institutions, if they feel a strong need to reduce uncertainty and ambiguity, prefer not to think long and hard about difficult questions, and strongly desire to share an epistemic reality with their proximate peers. This conformist need for shared belief is particularly salient for situationist and structuralist criticisms of epistemic virtue and individual agency. Situationists have, since the earliest high-profile social-psychological experiments on conformity, obedience, and intergroup conflict, portrayed shared reality as a virtually inevitable byproduct of plunking human cognitive systems into certain social contexts (i.e., contexts marked by hierarchical power relations and group-competitive dynamics). Shared reality bias also features in Elizabeth Anderson’s (2012) structuralist criticism of individual virtue cultivation. She treats the impulse toward shared reality as one of a handful of universal and powerful biases, such that everyone’s views tend to converge simply by virtue of sharing social space. But while it is certainly true that structures can be designed to either promote or counteract in-group consensus and conformity, matters are much more complex. One dimension of this complexity is that the need for shared reality varies between individuals, making it a fruitful site for individual-level intervention. Other things equal (making allowances for variations in social position), seeking out a soundproof echo chamber is an epistemic vice, whereas openness to epistemic friction is a virtue.

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I feel compelled to note that, while the empirical evidence for the value of interventions like perspective-taking is robust, many of these interventions are continuous with thoroughly commonsensical pieces of folk wisdom, and with claims that social-justice theorists of many stripes have long defended. Although we should continue seeking out new methods and remain open to new discoveries about how best to become better, we should not falsely portray these strategies as radically novel, inaccessible to laypeople, or fundamentally unknowable sans academic research. REFERENCES Alcoff, Linda Martín. 2006. Visible Identities: Race, Gender, and the Self. New York: Oxford University Press. ———. 2010. “Epistemic Identities.” Episteme 7 (2): 128–37. Alfano, Mark. 2013. Character as Moral Fiction. Cambridge: Cambridge University Press. ———. 2015. “Becoming Less Unreasonable: A Reply to Sherman.” Social Epistemology Review and Reply Collective 4 (7): 59–62. Anderson, Elizabeth. 2012. “Epistemic Justice as a Virtue of Social Institutions.” Social Epistemology 26 (2): 163–73. Ayala-López, Saray. 2018. “A Structural Explanation of Injustice in Conversations: It’s about Norms.” Pacific Philosophical Quarterly. https://onlinelibrary.wiley.com/doi/abs/10.1111/ papq.12244. Ayala-López, Saray, and Nadya Vasilyeva. 2019. “Structural Thinking and Epistemic Justice.” In Overcoming Epistemic Injustice: Social and Psychological Perspectives, edited by Benjamin R. Sherman and Stacey Goguen. Lanham, MD: Rowman & Littlefield. Brescoll, Victoria L., and Eric Luis Uhlmann. 2008. “Can an Angry Woman Get Ahead? Status Conferral, Gender, and Expression of Emotion in the Workplace.” Psychological Science 19 (3): 268–75. Broockman, David, and Joshua Kalla. 2016. “Durably Reducing Transphobia: A Field Experiment on Door-to-Door Canvassing.” Science 352 (6282): 220–24. Brownstein, Michael, Alex Madva, and Bertram Gawronski. Under review. Understanding Implicit Bias: Putting the Criticism into Perspective. Burns, Mason D., Margo Monteith, and Laura Parker. 2017. “Training Away Bias: The Differential Effects of Counterstereotype Training and Self-Regulation on Stereotype Activation and Application.” Journal of Experimental Social Psychology 73: 97–110. Code, Lorraine. 2017. “Epistemic Responsibility.” In The Routledge Handbook of Epistemic Injustice, edited by Ian James Kidd, José Medina, and Gaile Pohlhaus Jr., 89–99. New York: Routledge. Corcoran, Katie E., David Pettinicchio, and Jacob T. N. Young. 2011. “The Context of Control: A Cross-National Investigation of the Link between Political Institutions, Efficacy, and Collective Action.” British Journal of Social Psychology 50 (4): 575–605. Danziger, Shai, Jonathan Levav, and Liora Avnaim-Pesso. 2011. “Extraneous Factors in Judicial Decisions.” Proceedings of the National Academy of Sciences 108 (17): 6889–92. Davidson, Lacey J., and Daniel R. Kelly. 2015. “Intuition, Judgment, and the Space Between: A Reply to Sherman.” Social Epistemology Review and Reply Collective 4 (11): 15–20. Dotson, Kristie. 2012. “A Cautionary Tale: On Limiting Epistemic Oppression.” Frontiers: A Journal of Women Studies 33 (1): 24–47. Dunbar, Norah E., Claude H. Miller, Bradley J. Adame, Javier Elizondo, Scott N. Wilson, Brianna L. Lane, Abigail Allums Kauffman, Elena Besarabova, Matthew L. Jensen, Sara K. Straub, Yu-Hao Lee, Judee K. Burgoon, Joseph J. Valacich, Jeffrey Jenkins, and Jun Zhang. 2014. “Implicit and Explicit Training in the Mitigation of Cognitive Bias through the Use of a Serious Game.” Computers in Human Behavior 37: 307–18.

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Fairweather, Abrol, and Mark Alfano, eds. 2017. Epistemic Situationism. New York: Oxford University Press. Fricker, Miranda. 2007. Epistemic Injustice: Power and the Ethics of Knowing. Oxford: Oxford University Press. ———. 2010a. “Can There Be Institutional Virtues?” In Oxford Studies in Epistemology volume 3, edited by Tamar Szabó Gendler and John Hawthorne, 235–52. Oxford: Oxford University Press. ———. 2010b. “Replies to Alcoff, Goldberg, and Hookway on Epistemic Injustice.” Episteme 7 (2): 164–78. ———. 2012. “Silence and Institutional Prejudice.” In Out from the Shadows: Analytical Feminist Contributions to Traditional Philosophy, edited by Sharon L. Crasnow and Anita M. Superson, 287–306. Oxford: Oxford University Press. ———. 2013. “Epistemic Justice as a Condition of Political Freedom?” Synthese 190 (7): 1317–32. Galinsky, Adam D., Andrew R. Todd, Astrid C. Homan, Katherine W. Phillips, Evan P. Apfelbaum, Stacey J. Sasaki, Jennifer A. Richeson, Jennifer B. Olayon, William W. Maddux. 2015. “Maximizing the Gains and Minimizing the Pains of Diversity: A Policy Perspective.” Perspectives on Psychological Science 10 (6): 742–48. Gawronski, Bertram, Kurt R. Peters, Paula M. Brochu, and Fritz Strack. 2008. “Understanding the Relations between Different Forms of Racial Prejudice: A Cognitive Consistency Perspective.” Personality and Social Psychology Bulletin 34 (5): 648–65. Grasswick, Heidi. 2017. “Feminist Responsibilism, Situationism, and the Complexities of the Virtue of Trustworthiness.” In Epistemic Situationism, edited by Abrol Fairweather and Mark Alfano, 216–34. New York: Oxford University Press. Johnson, India R., and Fujita Kentaro. 2012. “Change We Can Believe In: Using Perceptions of Changeability to Promote System-Change Motives over System-Justification Motives in Information Search.” Psychological Science 23 (2): 133–40. Jost, John T. 2015. “Resistance to Change: A Social Psychological Perspective.” Social Research 82: 607–36. Kahneman, Daniel. 2011. Thinking, Fast and Slow. New York: Farrar, Straus and Giroux. Kawall, Jason. 2002. “Other-Regarding Epistemic Virtues.” Ratio 15 (3): 257–75. Kidd, Ian James, José Medina, and Gaile Pohlhaus Jr., eds. 2017. The Routledge Handbook of Epistemic Injustice. London: Routledge. Langton, Rae. 2010. “Epistemic Injustice: Power and the Ethics of Knowing. By Miranda Fricker.” Hypatia 25 (2): 459–64. Levontin, Liat, Eran Halperin, and Carol S. Dweck. 2013. “Implicit Theories Block Negative Attributions about a Long-Standing Adversary: The Case of Israelis and Arabs.” Journal of Experimental Social Psychology 49 (4): 670–75. Madva, Alex. 2016a. “A Plea for Anti-Anti-Individualism: How Oversimple Psychology Misleads Social Policy.” Ergo 3 (27): 701–28. ———. 2016b. “Virtue, Social Knowledge, and Implicit Bias.” In Implicit Bias and Philosophy: Metaphysics and Epistemology volume 1, edited by Michael Brownstein and Jennifer Saul, 191–215. Oxford: Oxford University Press. ———. 2017. “Biased against Debiasing: On the Role of (Institutionally Sponsored) SelfTransformation in the Struggle against Prejudice.” Ergo 4 (6): 145–79. ———. Forthcoming. “Social Psychology, Phenomenology, and the Indeterminate Content of Unreflective Racial Bias.” In Race as Phenomena, edited by Emily S. Lee. Lanham, MD: Rowman & Littlefield. Madva, Alex, and Michael Brownstein. 2018. “Stereotypes, Prejudice, and the Taxonomy of the Implicit Social Mind.” Noûs 52 (3): 611–44. https://doi.org/10.1111/nous.12182. Medina, José. 2013. The Epistemology of Resistance: Gender and Racial Oppression, Epistemic Injustice, and Resistant Imaginations. Oxford: Oxford University Press. Monteith, Margo J. 1993. “Self-Regulation of Prejudiced Responses: Implications for Progress in Prejudice-Reduction Efforts.” Journal of Personality and Social Psychology 65 (3): 469–85.

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Morewedge, Carey K., Haewon Yoon, Irene Scopelliti, Carl W. Symborski, James H. Korris, and Karim S. Kassam. 2015. “Debiasing Decisions: Improved Decision Making with a Single Training Intervention.” Policy Insights from the Behavioral and Brain Sciences 2 (1): 129–40. Pronin, Emily, Daniel Y. Lin, and Lee Ross. 2002. “The Bias Blind Spot: Perceptions of Bias in Self versus Others.” Personality and Social Psychology Bulletin 28 (3): 369–81. Rasmussen, Hannah F., Michelle C. Ramos, Sohyun Han, Corey Pettit, and Gayla Margolin. 2018. “How Discrimination and Perspective-Taking Influence Adolescents’ Attitudes about Justice.” Journal of Adolescence 62: 70–81. Resnick, Brian. 2016. “These Scientists Can Prove It’s Possible to Reduce Prejudice.” Vox, April 8. https://www.vox.com/2016/4/7/11380974/reduce-prejudice-science-transgender. Saul, Jennifer. 2017. “Implicit Bias, Stereotype Threat, and Epistemic Injustice.” In The Routledge Handbook of Epistemic Injustice, edited by Ian James Kidd, José Medina, and Gaile Pohlhaus Jr., 235–42. New York: Routledge. Sherman, Benjamin. 2015. “There’s No (Testimonial) Justice: Why Pursuit of a Virtue Is Not the Solution to Epistemic Injustice.” Social Epistemology 30 (3): 229–50. Simonovits, Gábor, Gábor Kézdi, Péter Kardos. 2018. “Seeing the World through the Other’s Eye: An Online Intervention Reducing Ethnic Prejudice.” American Political Science Review 112 (1): 186–93. Skorinko, Jeanine L., Sean Laurent, Kaitlin Bountress, Kyi Phuy Nyein, and Daniel Kuckuck. 2014. “Effects of Perspective Taking on Courtroom Decisions.” Journal of Applied Social Psychology 44 (4): 303–18. Sommers, Samuel R. 2006. “On Racial Diversity and Group Decision Making: Identifying Multiple Effects of Racial Composition on Jury Deliberations.” Journal of Personality and Social Psychology 90 (4): 597–612. Stewart, Tracie L., Ioana M. Latu, Nyla R. Branscombe, and H. Ted Denney. 2010. “Yes We Can! Prejudice Reduction through Seeing (Inequality) and Believing (in Social Change).” Psychological Science 21 (11): 1557–62. Stewart, Tracie L., Ioana M. Latu, Kerry Kawakami, and Ashley C. Myers. 2010. “Consider the Situation: Reducing Automatic Stereotyping through Situational Attribution Training.” Journal of Experimental Social Psychology 46 (1): 221–25. van Zomeren, Martijn. 2013. “Four Core Social-Psychological Motivations to Undertake Collective Action.” Social and Personality Psychology Compass 7 (6): 378–88. Washington, Natalia. 2016. “I Don’t Want to Change Your Mind: A Reply to Sherman.” Social Epistemology Review and Reply Collective 5 (3): 10–14. Weil, Simone. 1978. Lectures on Philosophy, translated by Hugh Price. Cambridge: Cambridge University Press.

Chapter Six

Can Epistemic Virtues Help Combat Epistemologies of Ignorance? Emily McWilliams

The study of epistemologies of ignorance (EoI) investigates ignorances that are nonincidental vis-à-vis relations of social power and oppression—as opposed to benign gaps in knowledge that are accidental byproducts of our limited time and resources for inquiring about the world. Many scholars also maintain that EoI are “actively produced for purposes of domination and exploitation” (Sullivan and Tuana 2007, 1). For our purposes, the more general definition will suffice. Some of the factors that produce and sustain epistemologies of ignorance are structural, while others occur at the level of individual psychology. I will be concerned with individual factors. Empirical psychology documents widespread evidence of bias in the ways that people select, interpret, and selectively interpret evidence in forming and revising their beliefs. These biases sometimes function to create and perpetuate EoI. For instance, an agent who does not want to believe that racism and colonialism help explain the federal response to Hurricane Maria in Puerto Rico might give disproportionate weight or credibility to Donald Trump’s claims about the difficulty of getting supplies to the island and might neglect or actively avoid information that challenges the veracity of those claims. What, if anything, can epistemology do or say about these biases in the ways that we select, interpret, and selectively interpret evidence? We might hope for our normative epistemic theories to be able to (1) Explain what goes epistemically wrong (with the beliefs, the inquiry, or the epistemic agent) when people exhibit biases that produce and maintain EoI; and, (2) Offer positive advice, such that our understanding of what goes wrong orients us

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towards potential ways to right it. I will call these Desideratum 1, and Desideratum 2, respectively. I argue that virtue epistemology provides a better theoretical framework for fulfilling these desiderata than some other leading theories do. I focus in particular on evidentialism and reliabilism. I first make the negative case that neither theory is able to fulfill both of these desiderata. Then, I argue that a virtue approach has better prospects. In particular, I defend the virtue approach from a prominent objection on behalf of the epistemic situationist. EVIDENTIALISM, RELIABILISM, AND VIRTUE EPISTEMOLOGY ON DESIDERATA 1 AND 2 Evidentialism Evidentialism about justification says that whether a subject’s belief that p is justified is (only) a matter of whether p is sufficiently well supported by the subject’s evidence. 1 Given this, evidentialism might seem well positioned to fulfill Desideratum 1: A natural thought is that when one’s belief formation or revision process manifests bias, one fails to proportion their belief to their evidence, so the belief is epistemically unjustified. Contra this natural thought, many false beliefs that result from bias count as being well supported by the subject’s evidence, and thus as evidentialistjustified. There are two reasons for this. First, for evidentialism, whether a subject’s belief is justified is only a matter of whether it is well supported by the evidence she currently has. Second (and relatedly), evidentialist justification does not require that one is responsive to evidence available for uptake in her environment, but only to her evidence—that which is already within her ken, and has been filtered through her biases. Given the first point, it does not matter for evidentialist justification whether the subject’s evidence is a result of what Jason Baehr calls defective inquiry (2011, 70), in which a subject’s belief is supported by the evidence she currently has, but only because of defects in the process of inquiry by which she acquired that evidence. For instance, in gathering evidence, the subject may have been intellectually lazy, oblivious, careless, or gullible. Sometimes, the result will simply be that the subject has little evidence. But in other cases, such subjects may gather substantial evidence by simply taking things at face value, or otherwise failing to be scrupulous in evidence-gathering. Had such a subject’s inquiry not been defective, proposition p might not be well supported by her current evidence, but because she was, it is. Given the second point, evidentialist justification does not rule out cases of defective doxastic handling of evidence, in which the subject fails to be 1. See Kelly (2003) and Conee and Feldman (2004).

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responsive to evidence readily available for uptake in her environment at the time of belief (Baehr 2011, 75). The subject might unknowingly ignore, distort, or otherwise misrepresent potential defeaters of her belief that p. As a result, those defeaters will not count as part of the evidence currently within her ken, so will not count against justification. 2 Consider a case in which the origin of these defects in the subject’s inquiry or in her responsiveness to evidence is not benign, but a result of bias or motivated reasoning that serves to construct and maintain EoI. To borrow an example from James Baldwin via Elizabeth Spelman, take the rhetorically conceived white American, W, who does not want to believe the proposition g: “Black America’s grievances are real” (Spelman 2007, 119). As a result, W may (1) avoid situations in which he risks being confronted with evidence for g; and (2) fail to be properly responsive to evidence for g that is readily available for uptake in his environment at the time of belief. For instance, he may decline opportunities to learn about pertinent history and the ways its ramifications are felt in the present; avoid engaging with relevant media sources; choose social circles where participants are unlikely to offer up evidence for g; and he may distort, otherwise misrepresent, or simply suppress testimony from black Americans that would evince g. Supposing the agent is not aware he is doing this, it may turn out that the evidence within his ken at the time of belief supports ~g, but only because of these defects in his inquiry and responsiveness to evidence. Evidentialism about justification does not have the resources to fulfill Desideratum 1. It may criticize W on account of his character, but cannot criticize him epistemically, since epistemic problems must be cashed out in terms of the evidential support relation between one’s evidence and her belief. Thus, it cannot fulfill Desideratum 2 by offering positive advice about how to fix the problem, either. Reliabilism In what follows, I argue that it is unclear whether reliabilism about justification has the resources to fulfill Desideratum 1, and that in any case it cannot fulfill Desideratum 2. Standard process reliabilism says that a subject’s belief is justified just in case it was formed by a reliable (that is, truth condu2. Whether or not such defeaters count as part of the subject’s evidence ultimately depends on how the evidentialist conceives of evidence. Evidentialism about justification is often paired with an accessibilist conception of evidence, on which something counts as part of a one’s evidence only if it is accessible to her by introspection or reflection. This is why I stipulate that the subject unknowingly suppresses, distorts, or misrepresents potential defeaters. Were she to do so knowingly, the defeaters would count as part of her evidence. Questions about exactly when we ought to count potential evidence as accessible by introspection or reflection are beyond my scope, but I take it that it is possible for a subject to distort, suppress, or misrepresent evidence in a way that makes it inaccessible when she forms or revises her belief.

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cive) process. At first pass, this seems to bode well for fulfilling Desideratum 1, since unlike evidentialism, this requires the agent to use belief-forming processes that are responsive to the world, rather than merely to the evidence within her ken. So it might seem that reliabilism can fulfill Desideratum 1 by pointing out that where the subject’s inquiry or doxastic handling of the evidence is defective, she is not using reliable belief-forming processes. But there are two ways that biases can result in EoI. First, the subject might end up with unjustified beliefs about some subject matter. Second, they might end up with no beliefs at all about it: one’s bias might screen him off from processing relevant information and prevent him from forming beliefs. Spelman explains that this is one way things can go in the case of W, who does not want to believe g. W does not believe that g is false. W wants to believe that g is false, but also harbors some fear that g might be true. His response is to screen himself off from inquiry about whether g. He systematically avoids situations where he might acquire evidence that bears on g. When he detects the threat of relevant evidence in his environment, he metaphorically “looks away” to avoid processing it deeply. In Spelman’s words: If he really did believe g was false, he wouldn’t have to be so vigilant about immunizing himself, about trying to ensure that he won’t have to countenance evidence that might point to g’s being true. . . . W ignores g, avoids as much as he can thinking about g. He wants g to be false, but if he treats g as something that could be false, then he would also have to regard it as something that could be true . . . Ignoring g, not thinking about it, allows W to stand by g’s being false, to be committed to g’s being false, without believing g is false. (2007, 121, my emphasis)

In cases like this—call them cases of avoidance ignorance—it is not clear whether reliabilism can explain what goes epistemically wrong. Like evidentialism, reliabilism is a framework theory that is mainly in the business of theorizing the epistemic status of belief tokens. In cases of avoidance ignorance, there are no belief tokens to evaluate. There are a few things the reliabilist might say in response. First, they might offer a theory of reliability that takes no judgment to be significantly less reliable than correct judgment whenever correct judgments could have been produced. 3 But for such a theory to generate the right result here, we would presumably need to take W to be engaged in epistemic inquiry about 3. Thanks to the editors, Stacey Goguen and Ben Sherman, for pointing this out to me. I classify cases of avoidance ignorance as cases of no judgment, rather than as cases of suspended judgment. This follows from a definition of suspension of judgment on which one positively withholds judgment because they have assessed the available evidence and judged it to be inadequate or inconclusive. In cases of avoidance ignorance, one simply avoids inquiry, in order to avoid assessment of evidence altogether. This follows from the motivational profile elaborated earlier, on which W harbors some fear that g might be true, so screens himself off from inquiry.

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whether g in the first place. Otherwise, there is no epistemic state or process to evaluate. 4 The reliabilist might reply that there need not be an occurrent state or process to evaluate; the relevant thing is that W is propositionally justified in believing g, because he has available to him a reliable process or method which, from his current cognitive state, would result in his believing g. 5 But it is unclear whether they could tell a further story on which W thereby incurs an epistemic obligation to inquire, even though he is not antecedently motivated to (and in cases of avoidance ignorance, is motivated not to). Perhaps they could claim that W ought to use certain processes, given a naturalistic account of the proper function of those processes, but this would require further argument. 6 For the most part, reliabilism (like evidentialism) does not seem to be in the business of answering deontological questions about how and when the agent ought to inquire. In the absence of further argument, then, it seems to present epistemic rationality as a kind of desire-based, or instrumental rationality. So, it is not clear that reliabilism can fulfill Desideratum 1 in cases of avoidance ignorance. Reliabilism is not well suited to fulfill Desideratum 2. While it tells us that to do better epistemically, we should use more reliable belief-forming processes, it does not itself offer corollary advice about how to operationalize the advice to “be more reliable.” Virtue Epistemology I argue that virtue epistemology is better suited to fulfill the desiderata than evidentialism or reliabilism. More precisely, I argue for a virtue responsibilist approach—as opposed to a virtue reliabilist one. Virtue reliabilism is a descendant of process reliabilism, which concerns itself with faculty virtues, or knowledge-generating capacities, like excellent perception and memory. Virtue responsibilism understands virtues as cultivated intellectual character traits like open-mindedness and conscientiousness, which are motivational, 4. And there are presumably a larger number of correct judgments that a subject could produce at a given time, but that are simply not relevant or important enough to inquire about. But perhaps the reliabilist would argue that W is engaged in inquiry about whether g, simply by virtue of exerting positive cognitive effort with respect to g (in this case to avoid evidence that bears on g). If that is right, we might still make a case that there are other injustices where we do not need to put in particular effort to avoid drawing the right conclusions; we simply have to not make a particular effort to see the truth. Thanks to the editors, Stacey Goguen and Ben Sherman, for this point. 5. Thanks to Jack Lyons for pointing this out, and for discussion surrounding this point. 6. They might also appeal to Alvin Goldman’s notion of the power of a process or method, arguing that when W has a powerful process available to him, there is something epistemically wrong with making efforts to avoid using it. Goldman does say that power is the antidote to ignorance (1986, 26–27). Still, he defines it as a function of the proportion of questions the cognitive system wants to answer that it can answer correctly (123), which suggests that its value is a kind of instrumental or desire-based one.

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reasons-responsive, explanatorily powerful dispositions to act and react in characteristic ways. One reason it is not surprising that virtue epistemology does better than evidentialism or reliabilism is that its loci of evaluation are the agent and her epistemic interaction with the world. These interactive processes are where the biases that form and maintain EoI are manifest. 7 EPISTEMIC SITUATIONISM’S OBJECTION TO VIRTUE RESPONSIBILISM Epistemic situationism poses a threat to virtue responsibilism’s ability to fulfill my desiderata (and indeed, to virtue responsibilism itself). This section reviews two versions of the epistemic situationist argument. Both conclude that we have good reason to believe there are no such things as responsibilist virtues, because whether we act in accordance with virtue simply has too much to do with epistemically irrelevant features of the situation, like whether we are in a good mood. Challenging Responsibilist Prospects for Fulfilling Desideratum 1 via Alfano This section focuses on Mark Alfano’s (2012) challenge to responsibilism. 8 He argues against the existence of responsibilist epistemic virtues by arguing for epistemic situationism: “Most people’s conative intellectual traits are not virtues because they are highly sensitive to seemingly trivial and epistemically irrelevant situational influences” (2012, 234). In other words, purported virtues are empirically inadequate because they neither explain nor predict a sufficient portion of epistemic conduct. Alfano’s evidence comes from empirical studies designed to test for virtues like curiosity, flexibility, and creativity in problem solving. While subjects in the control conditions of these studies do poorly, those whose mood has been elevated fare much better. For instance, on a test of cognitive flexibility and creativity called the Remote Associates Test, participants whose mood was elevated prior to testing solved 66 percent more puzzles than control subjects. Alfano thus concludes that control subjects were not creative and flexible as such, but acted in accordance with creativity and flexibility because of the epistemically irrelevant mood elevators. He makes a similar argument about intellectual courage. Then, he extrapolates to suggest that “if similar arguments apply to the other global virtues, then much of our epistemic conduct can be explained 7. There is a sense in which evidentialists and reliabilists evaluate these processes too. But they are only interested in whether they have particular features of being reliable, or of being a process in which one successfully proportions her belief to the evidence. 8. Olin and Doris (2014) make a similar argument.

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without reference to such dispositions” (241). If so, then there is no good evidence for responsibilist virtues as global, motivational, reasons-responsive dispositions to act and react in characteristic ways. In response, responsibilists might consider replacing coarse-grained virtues like creativity and flexibility with local, situational traits like creativity while in a good mood. The trouble with this, Alfano says, is that responsibilist virtues are meant to be not only truth-conducive but also praiseworthy (we can thus add praiseworthiness to the list of features that defines responsibilist virtue). He doubts that a situational principle of individuation makes the virtues thus individuated commendable ways to be. Alfano’s argument threatens responsibilist prospects for fulfilling Desideratum 1 since if there is no such thing as virtue, then a lack of virtue cannot explain what goes wrong when biased reasoning results in EoI. In section 4, I argue that responsibilists can adjust their picture of what virtue consists in such that it fulfills the desideratum and is empirically adequate. Challenging Prospects for Fulfilling Desideratum 2 via Sherman One influential argument for a virtue responsibilist approach to fulfilling Desideratum 2 comes from Miranda Fricker’s (2007) suggestion that we overcome the bias that inheres in testimonial injustice by developing a corrective epistemic virtue. Benjamin Sherman (2015) draws on epistemic situationist arguments to challenge this suggestion’s plausibility. Here, I summarize Fricker’s suggestion and Sherman’s challenge, and consider how they might extend to other corrective virtues. In section 4, I respond to the challenge. Fricker’s Virtue Solution to Testimonial Injustice As Fricker defines it, testimonial injustice occurs when a speaker’s testimony is afforded less credibility than it deserves, owing to a prejudice in the hearer’s judgment that attaches to some aspect of the speaker’s social identity. Fricker recommends that we combat testimonial injustice by developing the virtue of corrective testimonial justice. This virtue’s guiding ideal is to neutralize the impact of prejudice in one’s credibility judgments by compensating upward to reach the degree of credibility that one would have given the speaker absent one’s prejudice. Sherman’s Challenge Sherman (2015) agrees with Alfano that empirically, it is not at all clear that there are epistemic virtues, so it is not clear that the corrective virtue Fricker envisions could exist. Sherman’s argument goes beyond the points that Alfano and others have made, though. He argues that even if there were a virtue

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of testimonial justice, it would not provide good guidance for avoiding testimonial injustice. While it might provide a description of the good agent, it would be either unhelpful or (more likely) positively counterproductive for guiding our thinking in practice. So, it would not fulfill Desideratum 2. Sherman first argues that testimonial justice would be unhelpful for guiding our thinking in practice. He points out that achieving corrective testimonial justice in a given case involves first, identifying that one has made an unjust credibility judgment; and second, reinflating it by the right amount. A difficulty with the first step is that our prejudices are—almost by definition—invisible to us. In standard cases, 9 it always seems to us that we are giving people the right amount of credit; that is why we gave them such credit in the first place. We cannot achieve corrective virtue if we cannot reliably identify when correction is called for. So, striving for corrective virtue is unhelpful. Sherman argues that such striving may be positively counterproductive by arguing that it is likely to produce misleading evidence, which leads us away from testimonial justice, while seeming to support the conclusion that we have achieved it. For instance, it will seem to a person who is striving to detect and correct their prejudices that they have achieved their goal when and because they stop noticing errors in their judgment. But there is no empirical evidence that people stop noticing errors only when or because they stop making them. Indeed, because our prejudices are invisible to us, “one’s conception of testimonial justice is virtually guaranteed to match one’s own present state” (Sherman 2015, 11). So, a person’s evidence will likely lead her to falsely believe she has cultivated testimonial justice. This may further cause her to reaffirm her own credibility judgments, and reentrench false confidence. Finally, Sherman points out that there is empirical evidence that striving for objectivity “is likely to be a self-defeating strategy in many contexts. Several studies suggest we are prone to becoming more biased when we consider whether or not we are biased” (15). Despite all this, Sherman suggests that it may be worthwhile to think of testimonial injustice as a vice, and strive to avoid it. The difference between striving for virtue and striving to avoid vice is that, “Whereas my model for correct judgment more or less has to be closely connected with my own considered views, the very process of trying to find and guard against mistakes involves seeking gaps between my own opinions and correct judgment” (13). That is, striving to avoid mistakes invites us to think about what we normally do not notice. Still, Sherman cautions that prejudices are not easy to spot, and reiterates that when we do identify a testimonial injustice, it is not 9. This will of course be different for cases of explicit bias, where the prejudiced individual has some introspective access to their bias against members of a particular group. Even in these cases, it is a further question whether the individual’s introspective access to their bias would allow them to reinflate credibility appropriately.

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clear that we are equipped to reflate the victim’s credibility appropriately. Finally, he points out that Fricker does not provide evidence that there exists a disposition to avoid prejudices in general, since “the ways that prejudices infiltrate our thinking, and the ways we can root them out might not be similar enough for there to be any unified disposition to avoid them” (16). Sherman’s arguments pose a challenge to responsibilist prospects for fulfilling Desideratum 2. If he is right, then even if the virtue framework helps us understand what goes epistemically wrong in cases of testimonial injustice, that understanding would not orient us toward potential ways to right it, since striving for the virtue (and perhaps even striving to avoid vice) is likely to be unhelpful or counterproductive. Sherman’s argument may also be extendable to other virtues since like our prejudices, other biases are normally invisible to us. And when we do identify them, it is not clear that our reflective faculties are equipped to correct them. If Sherman’s arguments are extendable to other virtues, then they might threaten virtue responsibilism’s prospects for fulfilling Desideratum 2 generally. TOWARD AN EMPIRICALLY INFORMED VIRTUE APPROACH I am deeply sympathetic with the general worry that the literature on overcoming biases that result in EoI is empirically underinformed. But I do not think the arguments of the previous section show that we must dispense with a virtue responsibilist approach to overcoming these problems. I argue instead that we can use the relevant empirical literature to develop our understanding of (1) what responsibilist virtues consist in and (2) how to go about developing them. Grounding Virtue in the Dual Process Model Peter Samuelson and Ian Church (2015) and Robert Roberts and Ryan West (2015) both respond to the situationist challenge by developing accounts of epistemic virtues and vices grounded in the dual process theory of cognition. I follow them in appealing to dual process theory, and draw on their accounts in developing my own. Dual process theory distinguishes fast, automatic, and intuitive cognitive processes known as System 1 (Type 1) processes from slow, deliberative, analytic processes known as System 2 (Type 2) processes. Type 1 processes react to stimuli with minimal cognitive load. They are automatic, and not governed by what Jonathan Evans and Keith Stanovich (2013) call “controlled attention,” so they do not make much demand on working memory. Type 2 processing is characterized by hypothetical thinking that is “decoupled” from an individual’s current representation of reality, so the current

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representation is held in mind and compared to others. This requires effort and a load on working memory, so System 2 is only used when there is a perceived need for it. The relationship between System 1 and System 2 processes is described as “default/interventionist.” System 1 processing is the default, while System 2 monitors thought processes, determining when deeper processing is needed, and then intervening to decouple the individual’s thinking from the default, System 1 representation of reality. Samuelson and Church explain that many biases in our reasoning result from the failure of Type 2 processing to decouple from Type 1 representations when necessary. Developing Situational Virtue I agree with Alfano and others that the particular global, stable responsibilist virtues that epistemologists have conceived from the armchair either do not exist or are not very common. 10 But I argue that it does not follow that responsibilist epistemic virtues as such do not exist. And I agree with Sherman that it may be counterproductive to strive for virtue directly. In what follows, I advance my view of how we might develop responsibilist virtues that are (1) situational rather than global, (2) come in degrees, and (3) fulfill my desiderata. We have seen that the ways that we select, interpret, and selectively interpret evidence are sensitive to complex and subtle aspects of situations. Given this, we should begin developing virtue not by trying directly to emulate the ideal agent, but rather by starting with a series of guidelines or heuristics that are based on our best empirical understanding of how cognitive and affective mechanisms and habits work to filter, interpret, and skew evidence in particular kinds of situations. Based on our understanding of the situational features that predict biases, we can use situational cues to trigger the use of heuristics and guidelines that combat them. This turns situationism to our benefit in the process of developing virtue. Dual process theory provides empirical backing for this strategy. Daniel Kahneman says that System 1 “can be programmed by System 2 to mobilize attention when a particular pattern is detected,” and “executes skilled responses and generates skilled intuitions, after adequate training” (2011,105). So, our task in training ourselves toward virtue is to train System 1 to recognize such situational cues, and recruit help from System 2, or (eventually) execute its own skilled responses. With practice, the neural circuits that instantiate associations between cue and response strengthen and become more durable. So, we become reliable in

10. The low success rates in control conditions of the studies Alfano cites do not show that these virtues do not exist, but only that they are not common. This need not be surprising, since virtues are excellences, not averages.

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detecting cues for bias and acting intelligently to circumvent error. 11 For Roberts and West (2015), this indicates that we have acquired the epistemic virtue of self-vigilance. The self-vigilant individual “would be so attuned to the environmental and internal cues to the working of these possible errormakers that his or her System 2 would automatically (intuitively) be triggered into action by warning signs. The individual would see the danger of framing effects . . . just as we quickly learn to see the fins on the lines of the Muller-Lyer figure as a cue to distrust the apparent length of the lines” (2566). For this suggestion to work, there must be situational cues that reliably predict biased reasoning. They may be either internal or external. Roberts and West provide evidence of reliable internal cues. They argue that many common biases and illusions result from a small handful of more basic patterns of thinking, so aspects of these thought patterns can act as internal cues. For instance, they suggest that an experience of optimistic excitement may alert one to guard against hubris in certain contexts. To find external cues, we can mine the situationist literature for its best understanding of the external aspects of situations our reasoning is sensitive to (2566). Although the situationist results themselves are evidence that external factors sometimes predict and explain bias, one might worry that they are too complex and subtle to be used as cues. The worry can be resolved by using conservative cues, which are present in a broader range of situations than those in which they reliably predict bias. For instance, if we are prone to intellectual cowardice when faced with the unanimous dissent of more than three people, we might guard against it whenever we find ourselves in a situation of group deliberation where almost everyone seems to be agreeing. Ultimately, how to individuate situational cues such that we can reliably recognize them is an empirical question. 12 The acquired situational virtues may either work to correct biased judgments or they may circumvent or replace biased processes altogether. The latter is what Fricker envisions in her picture of testimonial justice. She suggests that eventually, one’s judgment will be suitably reconditioned by corrective experience so that it issues in ready-corrected judgments. It may 11. Empirical literature supports the point that such associations strengthen and become more durable. Chen and Chaiken (1999) point out that a heuristic’s accessibility, or activation potential, varies as a function of factors internal and external to the subject. The degree to which a heuristic is accessible when the subject is faced with a particular judgmental task increases with its repeated activation and use for that task. This implies an increase in the likelihood and speed with which the heuristic is brought to bear on the same task in the future. This is referred to as the specific practice effect and reflects a mental link between the heuristic and the particular task. 12. Chen and Chaiken (1999) supports the idea that particular types of judgmental tasks can be reliably recognized as external cues, though further work may be needed to circumscribe exactly which types are reliably recognizable in the wild.

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be that System 1 becomes expert enough to recognize relevant patterns and give the proper responses, as in the case of the chess expert who intuitively and automatically “sees” what the right move is. Or, it may be that System 1 reliably recruits System 2 whenever more deliberate processing is needed. Expertise in correcting and circumventing bias in familiar types of situations may not extend to unfamiliar ones. Still, situational virtue may be broadly applicable: the thought patterns that serve as internal cues may occur across numerous kinds of external situations. Indeed, this is likely if Roberts and West are right that most biases result from a small handful of basic thought patterns. 13 Examples Consider a classic, Kahneman-and-Tversky-style reasoning error known as the availability heuristic. It operates on the principle that if something can be recalled, then it must be important or significant. When asked to make a judgment about the frequency of some phenomenon, people rely on how many examples come immediately to mind, without considering the circumstances that might cause those examples to be easy to recall (Tversky and Kahneman 1973). The availability cascade is a related phenomenon that explains the development of certain kinds of common beliefs. It occurs when an idea or explanation gains traction in popular discourse, so that it becomes readily available to many individuals. A well-known example concerns vaccination scares. In 1998, the Lancet published a paper presenting apparent evidence linking autism spectrum disorders to the MMR vaccine (Wakefield et al. 1998). In 2004, it was revealed that the author had manipulated evidence. The article was eventually retracted, but not before the idea gained significant uptake in popular discourse. So, for individuals considering whether the link is plausible, it is easy to recall having seen a lot of media discussion on the topic, which makes it seem more probable. As a result, many people now give some credence to the proposition that there is a link between vaccines and autism spectrum disorders. Whether the vaccine case constitutes an EoI depends on how and why the idea gained uptake in popular discourse. But there are many paradigmatic cases of EoI that also plausibly result from availability cascades. Consider the belief that President Obama was not born in the United States, or any of the prejudiced beliefs about people of color that find support in biased media portrayals. Here is a suggestion for an internal cue paired with a heuristic that aims at correcting this type of thinking. Whenever an agent is trying to decide how common some phenomenon is, and the examples that come to mind are 13. Ultimately, of course, this is an empirical question.

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based on having seen a lot of relevant media discussion, this should cue them to reflectively consider whether an availability cascade might be at work. The literature on overcoming prejudice contains numerous potential external cues for combatting bias. For instance, Mason Burns, Laura Parker, and Margo Monteith (2017) report evidence that people can self-regulate certain prejudiced responses by learning to recognize cues leading to those responses (cues for control), and forming specific implementation intentions in the form of if-then plans, describing what they will do when the cue is encountered: “When such implementation intentions are formed, the cues activating these statements become more salient and the intended then response occurs more quickly, reflexively, and with less effort” (509). For instance, “Stewart and Payne (2008) instructed participants to form the implementation intention to think ‘good’ when they saw a Black person during a race-IAT,” and “Forming this simple implementation intention significantly reduced automatic stereotype bias” (510). Here, participants used an external cue to intervene on their automatic negative associations with black faces, and replace them with positive associations. Nonetheless, there are significant empirical questions about how the effects of this strategy would transfer beyond the lab, and significant moral questions about what it would mean for (primarily white) people to treat encounters with black people as cues for control. 14 WHY SITUATIONAL VIRTUES COUNT AS RESPONSIBILIST VIRTUES, AND HOW THEY FULFILL THE DESIDERATA Desideratum 1 Alfano’s situationist argument poses a threat to virtue responsibilism’s prospects for fulfilling Desideratum 1 since if there is no such thing as responsibilist virtue, then a lack of virtue cannot explain what goes wrong in these cases. The conclusion of his argument against inquiry responsibilism was that virtues—as global, motivational, reasons responsive, explanatorily powerful, (and ultimately) praiseworthy dispositions to act and react in characteristic ways—do not exist. While I concede there is evidence that global virtues either do not exist or are not common, I argue that (1) responsibilist virtues need not be global; and, (2) virtues that possess these other features can exist and are sufficient to fulfill Desideratum 1. I will address each feature in turn.

14. The empirical literature on overcoming implicit biases is in its infancy, but it provides ample prima facie evidence that pairing cues with heuristics can help us overcome biases. The moral questions deserve careful consideration by philosophers.

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I begin with explanatory power, since Alfano’s worry about global stability is ultimately a worry about explanatory power. He is worried that because we are sensitive to situational variables, having a virtue is not what explains a subject’s epistemic success or failure; the situation is. My situational virtues circumvent this, since there is an important difference between using features of the situation to cue oneself to reason well and being unknowingly influenced or controlled by such features. One who has acquired situational virtue is able to reliably succeed in situations where those lacking such virtue do not, and their virtue explains this. As Christopher Lepock (2017) puts it: “What limits the range of possible virtues is that they must be robust enough to make distinctive contributions to their possessor’s intellectual life” (131). Situational virtues fit the bill. Relatedly, situational virtues are reasons responsive. When subjects succeed in acting and reacting in characteristic ways, they do so in response to reasons, and do so reliably in the relevant kinds of situations. The accessibility of reasons is domain-specific, but a situationally virtuous subject is reliably responsive within those domains. Situational virtues are motivational. Linda Zagzebski says that an act of intellectual virtue requires motivation for epistemic goods and defines such motivation as a disposition to be moved by an emotion or feeling that initiates and directs action towards an epistemic end (1996, 126–34; 2003, 135–54). To the degree that one possesses situational virtue, she is disposed to be moved by a feeling that directs action toward the epistemic end of reasoning well and the ethical end of avoiding or correcting EoI. That is, one’s virtuous intervention on a default, biased reasoning process is either initiated or partly constituted by an affective experience that stems from her desire for the relevant epistemic and ethical goods. Moreover, one may be motivated toward some end but not achieve it. The fact that many subjects in the studies Alfano cites solved puzzles that required creative and flexible reasoning only when their moods were elevated does not entail that they were not motivated. Indeed, subjects tried to solve the puzzles, which is evidence of motivation. It may simply be that for control subjects, there was not enough dopaminergic or other relevant fuel in the tank, so the enabling conditions for success were not met. Situational virtues explain what goes epistemically wrong when an agent fails to reason in accordance with them, because they constitute epistemically good-making features of the relationship between the agent and the world, which are lacking in cases of biased reasoning. They are also (ethically and epistemically) good ways for an agent to be. They have intrinsic value as human excellences (which has both ethical and epistemic aspects) and instrumental ethical and epistemic value, since they help us do better epistemically, and overcome ethically and epistemically problematic ignorances.

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Relatedly, situational virtues are praiseworthy. They may not constitute the pinnacles of human intellectual achievement, but as Lepock (2017) puts it: “non-global virtues can still be exemplars or ideals for us to work toward. Really, they should provide better exemplars for us limited agents than an idealized phronimos can” (131). So, they are praiseworthy as human excellences, in spite of being situational. Moreover, they are praiseworthy in a further sense because they are acquired dispositions. The subject deserves credit and praise for having the disposition (as opposed to being naturally gifted with an intellectual talent). 15 Desideratum 2 I am convinced by Sherman’s arguments that even if a responsibilist virtue like testimonial justice does exist, it may be unhelpful or counterproductive to strive for it directly by taking the injunction to “be epistemically just!” as our guiding principle in testimonial interactions. Much like taking the injunction to “be the phronimos!” as a practical guide, it is impossible to operationalize for one who is not already most of the way there. But I suggested a means of striving for virtue indirectly, by inculcating situational virtues. More specifically, Sherman pointed out that achieving testimonial justice in a given case involves: first identifying an unjust credibility judgment, and second, reinflating it by the right amount. With regard to the first step, I argued that with training, situational cues can make our prejudices easier to spot. More empirical research is needed to understand how the particular prejudices that underlie testimonial injustice operate, and how we might intervene. Another worry was that when we stop noticing our own prejudices, we might be misled into thinking that we have eliminated them. This can be managed by taking that very thought—“I have stopped noticing prejudicial errors”—as an internal cue to consider the likelihood that one remains subject to prejudice in ways that are harder to identify from one’s current standpoint, but no less real. The problem with the second step was that, “determining how much we should reflate someone’s credibility will not be a simple matter, with a clearly identifiable standard of correctness” (Sherman 2015, 15). Sherman points out that conscious, reflective thought is likely unable to process the complex judgments involved in evaluating credibility. This seems right, so far as it goes. Ultimately, it is an empirical question, but phenomenologically, it 15. There is a distinction that underlies this point between virtues as excellent ways for humans to be and virtues as excellences that we have reason to acquire. An important part of the problem with the a priori literature on intellectual virtue is that it assumes that the best possible ways for humans to be (globally, nonsituationally) virtuous are necessarily the same as the dispositions we have most reason to aim to acquire. But the normative facts about what virtues we have most reason to aim for are circumscribed by pragmatic, psychological facts about what our psychological machinery enables.

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seems that what underlies credibility judgments is not a conscious calculation that codifies credences or quantities of credit. Rather, it seems that what is needed to correct biased credibility judgments is a particular kind of open, reflective, affective, and cognitive engagement, not only with what is being said but with the speaker. If so, then cues for bias should be taken as directives to slow down and engage openly, affording the speaker the kind of affective/cognitive recognition and respect that we ordinarily and automatically give to trusted others in testimonial exchanges. 16 This puts us in a better position to understand the speaker’s perspective, and thus the testimony itself. At the very least, it opens a path toward giving them the deserved credit. 17 In the end, parts of my conclusion are quite similar to Sherman’s. I agree that “our best chance of succeeding in avoiding or correcting prejudices is to remain vigilant about the kinds of prejudices we might be subject to, how to identify them, and how to correct for them. We might not be able to succeed without information from the social sciences. . . . Now perhaps someone who did remain vigilant, and made good use of social scientific information, could develop a habitual disposition to successfully respond justly to others” (Sherman 2015, 16). This is the very sort of thing I recommend as a model for developing situational virtue. And I am convinced by Sherman that if there is or could be a virtue of testimonial justice (a question that cannot be decided without empirical information), then striving for it directly is not a promising strategy for achieving it. Nonetheless, I disagree with Sherman that in light of all this, our best option is to abandon virtue theory. I argued that situational virtues count as genuine responsibilist virtues. Conceiving them this way is useful because it both helps us understand what goes wrong when biased reasoning leads to EoI and gives us tools for inculcating the virtues needed to correct it. We should use all the tools at our disposal for overcoming EoI. REFERENCES Alfano, Mark. 2012. “Expanding the Situationist Challenge to Responsibilist Virtue Epistemology.” The Philosophical Quarterly 62 (247): 223–49. Baehr, Jason. 2011. The Inquiring Mind: On Intellectual Virtues and Virtue Epistemology. Oxford: Oxford University Press.

16. This thought draws inspiration from Richard Moran’s idea that there is a relation of believing where the direct object is not a proposition but a person. 17. We might charitably interpret Fricker to have something like this in mind. She says that when one suspects prejudice in her judgment, she should switch into “active critical reflection in order to identify how far the suspected prejudice has influenced her judgment” (Fricker 2007, 91).

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Burns, Mason D., Laura Parker, and Margo Monteith. 2017. “Self-Regulation Strategies for Combating Prejudice.” In Cambridge Handbook of the Psychology of Prejudice, edited by Chris G. Sibley and Fiona Kate Barlow, 500–18. Cambridge: Cambridge University Press. Chen, Serena, and Shelly Chaiken. 1999. “The Heuristic-Systematic Model in Its Broader Context.” In Dual Process Theories in Social Psychology, edited by Shelly Chaiken, 73–96. New York: Guilford Press. Conee, Earl, and Richard Feldman. 2004. Evidentialism: Essays in Epistemology. Oxford: Oxford University Press. Evans, Jonathan St. B. T., and Keith E. Stanovich. 2013. “Dual-Process Theories of Higher Cognition: Advancing the Debate.” Perspectives in Psychological Science 8 (3): 223–41. Foot, Philippa. 2002. “Virtues and Vices.” In Virtues and Vices: And Other Essays in Moral Philosophy, 1–18. Oxford: Oxford University Press. Fricker, Miranda. 2007. Epistemic Injustice: Power and the Ethics of Knowing. Oxford: Oxford University Press. Goldman, Alvin I. 1986. Epistemology and Cognition. Cambridge: Harvard University Press. Kahneman, Daniel. 2011. Thinking, Fast and Slow. New York: Farrar, Straus and Giroux. Kelly, Thomas. 2003. “Epistemic Rationality as Instrumental Rationality: A Critique.” Philosophy and Phenomenological Research 66 (3): 612–40. King, Nathan L. 2014. “Responsibilist Virtue Epistemology: A Reply to the Situationist Challenge.” The Philosophical Quarterly 64 (255): 243–53. Lepock, Christopher. 2017. “Intellectual Virtue Now and Again.” In Epistemic Situationism, edited by Abrol Fairweather and Mark Alfano, 116–32. Oxford: Oxford University Press. Liu, Cheng-Hong. 2016. “Evaluating Arguments during Instigations of Defense Motivation and Accuracy Motivation.” British Journal of Psychology 108 (2): 296–317. Medina, José. 2013. The Epistemology of Resistance: Gender and Racial Oppression, Epistemic Injustice, and Resistant Imaginations. Oxford: Oxford University Press. Olin, Lauren, and John Doris. 2014. “Vicious Minds: Virtue Epistemology, Cognition, and Skepticism.” Philosophical Studies 168 (3): 665–92. Pronin, Emily, Daniel Y. Lin, and Lee Ross. 2002. “The Bias Blind Spot: Perceptions of Bias in Self versus Others.” Personality and Social Psychology Bulletin 28 (3): 369–81. Roberts, Robert C., and Ryan West. 2015. “Natural Epistemic Defects and Corrective Virtues.” Synthese 192 (8): 2557–76. Samuelson, Peter L., and Ian M. Church. 2015. “When Cognition Turns Vicious: Heuristics and Biases in Light of Virtue Epistemology.” Philosophical Psychology 28 (8): 1095–113. Sherman, Benjamin. 2015. “There’s No (Testimonial) Justice: Why Pursuit of a Virtue Is Not the Solution to Epistemic Injustice.” Social Epistemology 30 (3): 229–50. Spelman, Elizabeth. 2007. “Managing Ignorance.” In Race and Epistemologies of Ignorance, edited by Shannon Sullivan and Nancy Tuana, 119–31. Albany: State University of New York Press. Stewart, Brandon D., and B. Keith Payne. 2008. “Bringing Automatic Stereotyping under Control: Implementation Intentions as Efficient Means of Thought Control.” Personality and Social Psychology Bulletin 35 (10): 1332–45. Sullivan, Shannon, and Nancy Tuana, eds. 2007. Race and Epistemologies of Ignorance. Albany: State University of New York Press. Tversky, Amos, and Daniel Kahneman. 1973. “Availability: A Heuristic for Judging Frequency and Probability.” Cognitive Psychology 5: 207–32. Uhlmann, Eric Luis, and Geoffrey L. Cohen. 2007. “I Think It, Therefore It’s True: Effects of Self-Perceived Objectivity on Hiring Discrimination.” Organizational Behavior and Human Decision Processes 104 (2): 207–23. Wakefield, A. J., S. H. Murch, A. Anthony, J. Linnell, D. M. Casson, M. Malik, M. Berelowitz, A. P. Dhillon, M. A. Thomson, P. Harvey, A. Valentine, S. E. Davies, and J. A. WalkerSmith. 1998. “Illeal-Lymphoid-Nodular Hyperplasia, Non-Specific Colitis, and Pervasive Developmental Disorder in Children.” Lancet [RETRACTED] 351 (9103): 637–41. Zagzebski, Linda. 1996. Virtues of the Mind. Cambridge: Cambridge University Press.

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———. 2003. “Intellectual Motivation and the Good of Truth.” In Intellectual Virtue: Perspectives from Ethics and Epistemology, edited by Michael DePaul and Linda Zagzebski, 135–54. Oxford: Oxford University Press.

II

Curing Epistemic Injustice in Healthcare

Chapter Seven

Epistemic Microaggressions and Epistemic Injustices in Clinical Medicine Lauren Freeman and Heather Stewart

This chapter considers a particular kind of epistemic injustice that often occurs to patients in the context of clinical medicine: namely, those that result from what we are calling “epistemic microaggressions.” In what follows we (1) problematize how microaggressions are currently conceptualized; (2) draw on our alternative account of microaggressions to discuss the concept of “epistemic microaggressions,” (3) consider several examples of this phenomenon within clinical medicine 1 and demonstrate how they lead to a variety of harms for patients, and (4) discuss the serious short- and longterm consequences of such microaggressions. On the basis of our analysis, we argue that epistemic microaggressions in medicine can cause serious harm and therefore ought to be avoided by healthcare providers. MICROAGGRESSIONS “Microaggression,” a term originally coined by Chester Pierce (Pierce and Rowe 1970) which gained traction in the last decade, refers to brief and commonplace verbal, behavioral, and environmental indignities—either intentional or unintentional—that are rooted in (implicit or explicit) prejudice and/or racial, ethnic, gender, sexuality, religious, disability, or other stereo1. We focus on clinical medicine because a good deal of the existing literature on microaggressions focuses almost exclusively on clinical therapeutic relationships (between therapist and patient). Virtually no work has considered microaggressions committed by healthcare providers toward patients.

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types which are directed at and subsequently harm members of marginalized groups (see, for example, Sue et al. 2007; Sue 2010; Torres Driscoll, and Burrow 2010; McWhorter 2014). A common taxonomy for understanding microaggressions—one that’s taken for granted in most of the literature on the topic—was initially introduced by Derald Sue (2010). This account divides microaggressions into three different kinds: microinsults, microassaults, and microinvalidations. This taxonomy is act-based: microaggressions are understood and delineated according to the kind of act perpetuated by the microaggressor. While much discussion of microaggressions focuses on the intent of the perpetrator, we believe that this approach is problematic since it fails to adequately foreground the perspectives of victims and the kinds of harms they experience. 2 Instead, we propose understanding microaggressions according to the harms suffered by victims. Such a victim-centered approach both reflects and is guided by the experiences of the oppressed. 3 EPISTEMIC MICROAGGRESSION AND EPISTEMIC HARMS What we have coined “epistemic microaggressions” (Freeman and Stewart 2018) are a specific kind of microaggression that result in characteristically epistemic harm to victims, that is, harm to them in their capacity as knowers. In medical encounters, epistemic microaggressions can be defined as intentional or unintentional slights made by healthcare providers that dismiss, ignore, ridicule, or otherwise fail to give uptake to knowledge claims made by patients. While microaggressions are typically understood to target and affect members of structurally marginalized groups (see for example, Sue 2010, 23 and 39)—namely, groups that have been historically and systematically oppressed—we understand “marginalization” to have a slightly broader scope in medical contexts. Following Ian James Kidd and Havi Carel (2017a, 2017b; Carel and Kidd 2014), we contend that within medical contexts, patients occupy a marginalized position qua patients, relative to physicians, 2. For a longer discussion of our reasons for shifting the terms of discussion surrounding microaggression, see Freeman and Stewart (2018). To briefly summarize our view, we believe that our victim-centered approach does three things that Sue’s action-centered approach does not: (1) takes seriously, validates, and puts at the forefront the experiences of victims, rather than perpetrators; (2) ensures that the harms experienced by victims aren’t undermined; and (3) makes sure that the various different types of harm aren’t missed, erased, or collapsed into a single category. 3. This chapter is part of a larger project in which we develop this victim-centered, harmbased approach to microaggressions by dividing microaggressions into three kinds: epistemic, emotional, and self-identity, corresponding to harms that are epistemic, emotional, and existential respectively (Freeman and Stewart 2018). Though for the purposes of analysis we separate the harms into three different kinds, for the one experiencing them, such tidy analytic distinctions are rarely possible. In what follows, we focus only on epistemic microaggressions in clinical medicine.

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as a result of (temporary or permanent) vulnerabilities with respect to their illnesses; their general subservience to physicians’ demands; their overall lack of (institutional) power and (epistemic) authority; their (assumed or actual) lack of education and medical expertise relative to physicians within the space of the clinic, and their transient or enduring social identity as an ill person. 4 It is in this respect that even people who are socially dominant in other contexts can still occupy a diminished position of power, authority, or status within medical contexts and therefore, in our view, experience microaggressions in that setting. For example, on our account, within a medical context, even an uppermiddle-class, white, cis-gender, heterosexual man could be subjected to microaggressions based on his diminished status as a patient. It must be underscored, however, that the microaggressions he might so experience would have less serious, overall, enduring consequences than those experienced by members of marginalized groups. This is because part of the harm of microaggressions rests on their repeat nature in a variety of different contexts that accumulate over time. Moreover, those in more privileged positions often have greater material, psychological, and/or emotional resources for coping with the negative effects of microaggressions. 5 In medical contexts, epistemic microaggressions occur when physicians and other healthcare providers view themselves as experts over patients’ bodies in problematic ways. Healthcare providers are, in some sense, experts over patients’ bodies; they are trained professionals and as such, possess relevant medical knowledge and technical skill. That is why patients visit them in the first place, namely, to benefit from their specific knowledge, expertise, and technical skill sets. We are not problematizing this point. What we are calling attention to, however, is twofold. First, modern healthcare only recognizes certain forms of knowledge and understanding as medically relevant and therefore has an overly narrow conception of the epistemic scope of medical expertise. Second, and more specifically, physicians tend to prioritize their own technical expertise, professional habits, and the deeper epistemological structures of healthcare systems (see Kidd and Carel in this volume). This, in turn, can prevent them from recognizing, taking seriously, or giving uptake to claims made by their patients and can lead them to ignore or discredit the first personal perspectives that their patients have over their bodies and mental states. These first personal perspectives are not directly

4. Where our account differs, importantly, from Carel and Kidd’s is that ours takes an intersectional approach to distinguish different degrees of marginalization within the more general category of “patient,” whereas theirs considers “patients” to be a homogenous group. Their approach is problematic when considering issues of oppression and injustice in medical contexts since patients of different identities experience different kinds of injustices. 5. We are grateful to Ian Kidd for this point.

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available to healthcare providers, yet they can be crucial in aiding and guiding their medical expertise and in ultimately arriving at a correct diagnosis. Our claim is that it can be problematic and often harmful for healthcare providers to privilege their third-personal, “objective” knowledge of what a patient is experiencing and feeling over and to the exclusion of the patients’ first-personal, subjective, embodied knowledge and resulting testimony. Specifically, the problem is when the assumed epistemic privilege of healthcare providers over their patients’ bodies, experiences, and testimonies results in microaggressive acts and behaviors directed at patients, such as implicit or explicit deflation of their patient’s credibility or failure to give uptake to their claims. These failures of uptake can be either overt and explicit, or subtle or implied. For example, healthcare providers might ignore what a patient says outright, or they might roll their eyes when a patient reports being in pain, interrupt patients mid-sentence if/when they think they know the patients’ needs better than the patient does, or if they’re in a rush, and so on. Some microaggressions might be committed with so-called good intentions (i.e., to save time) or without healthcare providers being consciously aware that they’re committing them or that their behavior is experienced by patients as harmful (as opposed, say, to being efficient). While healthcare providers might not intend to cause harm to their patients when engaging in actions that epistemically microaggress them, there are nonetheless a variety of harms which can result. One kind of harm that results from epistemic microaggressions is epistemic harm, manifesting as a type of epistemic injustice, specifically testimonial injustice (Fricker 2007). 6 Testimonial injustices (one type of epistemic injustice) occur when the claims of a speaker aren’t given proper uptake by the listener due to prejudicial stereotypes held (either consciously or unconsciously) by the listener about some aspect of the speaker’s identity. As Fricker (2007) notes, one of the most serious consequences of testimonial injustices are the moral harms committed against speakers, which for our purposes are patients. The primary (i.e., more underlying, though not necessarily more severe) moral harm is that speakers are harmed in their capacity as knowers. To be regarded as a knower is a central component of human 6. Since the publication of Miranda Fricker’s 2007 book, there’s been a growing philosophical literature on the topic of epistemic injustice. See, for example, Dotson (2011, 2012) and Medina (2013) for challenges to and expansions of Fricker’s account. For accounts of epistemic injustices within medicine, see Carel and Kidd (2014). See Carel and Györffy (2014) and Burroughs and Tollefson (2016) for accounts of epistemic injustices in children. A bibliography of work on epistemic injustice, illness, and healthcare is maintained at https://ianjameskidd.weebly.com/epistemic-injustice-and-illness.html. See Freeman (2014) for an account of epistemic injustice within the context of pregnancy, and Sanati and Kyratsous (2015) for an account of epistemic injustices within psychiatry. Also see Kidd, Medina, and Pohlhaus (eds.) 2017 handbook on epistemic injustice for a comprehensive overview of the expanding literature on epistemic injustice.

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dignity and value; thus, to be harmed in this capacity results in a violation of the speaker’s very humanity (Fricker 2007, 43–44). According to Fricker, this primary moral harm can lead to a variety of secondary harms, which are either practical or epistemic in nature—though of course these can be entangled in practice. Practical secondary harms that can result from patients being harmed in their capacity as knowers include misdiagnoses (which are not at all “micro”), which often could have been avoided had the patients’ testimonies been taken seriously in the first place. Epistemic secondary harms occur when listeners’ doubting of the speaker’s testimony is internalized by the speaker, which can result in the speaker questioning their own capacity for knowledge and self-understanding. In the case of patients who are victims of repeated epistemic microaggressions by healthcare providers and others, they might begin to doubt their own testimonies and experiences, which can exacerbate emotional and existential harm, which we discuss elsewhere (Freeman and Stewart 2018). Additionally, repeated experiences of microaggressions in clinical contexts can lead to fractured trust in medical practitioners in particular and the medical system more generally, which can contribute to foregoing care, and subsequently to poorer health outcomes (a consequence we discuss below). Let’s now consider several cases in order to see how epistemic microaggressions work and the primary and secondary harms that result from them. First, the case of Alan Pean, a twenty-seven-year-old black male who struggles with mental illness. 7 While experiencing a delusional episode, he drove himself to a local Houston hospital to seek psychiatric care. Upon arriving at the hospital in his psychotic state, he crashed his car into the side of the building. When he was taken into the emergency room, Pean repeatedly exclaimed, “I’m manic! I’m manic!” Despite expressing multiple times to the healthcare team that he was having a manic episode, and that that was the reason he was there, he was treated exclusively for his physical injuries from the car accident. He was never given a psychiatric evaluation, seen by a psychiatrist, and importantly for how this story unfolds, he was not moved to the psychiatric floor of the hospital. The central epistemic microaggression in this case is that Pean’s claims about his condition weren’t taken seriously, which resulted in potentially lethal consequences. But in addition to Pean’s own testimony about his mental state not being given proper uptake by the healthcare team, there are further epistemic microaggressions occurring. When Pean was first admitted to the hospital, his father, a medical doctor (who, importantly for our analysis, has a thick West Indies accent) and his brother, who was a medical 7. This case was featured in the New York Times (Rosenthal 2016a and 2016b), the Guardian (Dart 2016), and on This American Life (Glass 2016).

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student, both called the hospital to alert them of Pean’s mental state and requested that he receive a psychiatric evaluation. Their words were similarly dismissed (be it on the basis of race and/or accent) and Pean continued to be treated only for his physical injuries. His psychological symptoms were ignored. To this end, Pean was given a muscle relaxant for his back pain, a drug which is known to exacerbate psychotic symptoms. Consequently, his manic episode escalated. He ended up having an altercation with two armed police officers who were serving as hospital security in the emergency ward (!). When his manic symptoms (which included delusions and failure to follow instructions) were taken by these authorities to be threats, Pean was tasered. But when that didn’t subdue him, he was shot in the chest. The bullets missed his heart by only a few centimeters. After having spent four days in the intensive care unit, he survived. Before discussing the various harms that Alan Pean suffered, we must be clear that the fact that he was shot is not a microaggression. Rather, it’s a clear assault: nothing “micro” about it. There are many alarming issues with regard to having armed officers in emergency wards; but that’s not our present concern. Rather, we’re more interested in the microaggressions that lead to Pean being shot in the first place. These microaggressions occurred when Pean, who is young, black, and male, had his testimony repeatedly dismissed by the emergency room healthcare providers. Similarly, the requests of Pean’s father and brother were also dismissed. They too were victims of radicalized epistemic microaggressions. Pean, along with his father and brother, are black. Consciously or not, the healthcare team likely failed to give uptake to their claims due to racial stereotypes and prejudices. All three were snubbed as epistemic equals and were treated with a general attitude of epistemic superiority. Additionally, we want to suggest that one of the reasons why Pean’s father’s request for his son to receive a psychiatric evaluation was ignored was because of his thick accent, which might have signaled to the healthcare team (consciously or not) that this person cannot possibly be intelligent, credible, or well-trained enough to be taken seriously. One might object that Pean was not necessarily ignored because he was black, and instead, this case was more likely an unfortunate instance of miscommunication between him and the medical team. We have at least two reasons to presume that given the available facts, Pean experienced radicalized epistemic microaggressions. First, it’s well known that some people’s testimonies are taken more seriously than others, where the testimonies of people of color in general and of women of color in particular tend to be taken less seriously than those of white people (see, for example, Hill Collins 2017; Lockhart 2018; Rickford and King 2016). Moreover, it’s well documented that this is a systemic problem in medicine with serious and enduring consequences on individuals and communities (see Williams, Neighbors, and

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Jackson 2003; CDC 2013). If Pean were a white male, there’s a good chance that his claims would not have been ignored. Second, it’s well documented that most healthcare providers hold implicit and explicit racial bias (Staats et al. 2017) and that most medical schools still do little, if anything, to dispel such prejudices (Chuck 2018; Sukhera and Watling 2017). An example of one prejudice that many laypeople, medical students, and healthcare providers hold is that black people have higher thresholds for pain than white people (Hoffman et al. 2016). As a result, it’s well documented that in emergency rooms, black patients (including pediatric patients) don’t receive pain medication as quickly or as frequently as white patients for the same injuries and conditions, and when they do, the pain medication is less potent (i.e., nonopioid pain relief) (Bakalar 2015; Johnson 2012; Tamayo-Sarver et al. 2003). In light of the empirical evidence and what we know about testimonial injustices more generally, in addition to the various studies we’ve cited, we can plausibly conclude that race was a relevant factor in Pean’s testimony having been so easily and readily dismissed. The series of epistemic microaggressions experienced by Pean brought about a range of harmful secondary consequences. Following Fricker’s framework of harms outlined above, Pean, his father, and his brother all suffered the primary harm of being devalued as knowers, and thus were undermined in an important human capacity that’s essential for human dignity and respect. Furthermore, Pean faced practical secondary harms of not being treated appropriately in response to his testimony. He wasn’t given the psychiatric evaluation he requested (and needed); he wasn’t relocated to the psychiatric floor where guards don’t carry guns; and the combination of these two practical consequences brought about physical harm for Pean, as they resulted in his being tasered and then shot. Moreover, despite having been assaulted himself, Pean was later charged with two counts of aggravated assault on a public servant and retroactively charged with reckless driving for the accident that led to his physical injuries. Though the charges were ultimately dropped, Pean’s family spent over $100,000 on his defense (Rosenthal 2016b). These incredibly damaging primary and secondary harms of epistemic microaggressions could have all been avoided had his testimony been given proper uptake in the first place—that is, if the healthcare providers hadn’t committed multiple epistemic microaggressions against him (and his father and brother), had listened to them, and had given their claims proper uptake. Doing so would have resulted in Pean having been placed in the proper medical ward and treated for the medical issue at stake (namely, his manic episode). Even in Pean’s manic state, he still knew what was best for himself. He had insight into his mental condition and knew, at least in a preliminary way, what he needed from the healthcare team (namely, a psychiatric evaluation

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and to be moved out of the general emergency room). Meeting these particular needs could have prevented the escalation of events. Instead of using Pean’s first-personal knowledge, however, the healthcare providers took their own (biased) assumptions to be more credible than the Peans’ respective testimonies. In order to develop our point about the enduring consequences of epistemic microaggressions, we consider another case where gendered epistemic microaggressions are central. Bronte Doyne was a nineteen-year-old woman recovering from a rare form of liver cancer. After expressing concerns to her medical team that her cancer had returned, her physicians told her to “stop Googling” her symptoms. Believing that she was overreacting, they ignored her genuine concerns that her cancer had returned. As a result, they failed to diagnose the recurrence of her cancer in a timely enough manner for her to have received adequate pain management and cancer care (Cara 2015; Srivastava 2015). 8 Doyne ultimately died as a result of her undiagnosed cancer recurrence, sixteen months after having her concerns dismissed and being told that she would survive. In this case, healthcare providers committed an epistemic microaggression by failing to give uptake to Doyne’s claims about her body and symptoms, specifically her concern that her cancer had returned. Doyne is marginalized here both in her status as a patient in general and in her status as a woman. In medical contexts, women’s claims—in particular, their claims of being in pain—aren’t taken seriously, are often considered to be overreactions, and are systematically ignored and/or dismissed. Within medical (and other) contexts, due to pernicious gender-based stereotypes, women have diminished status as credible givers of knowledge regarding their bodies (see, for example, Kukla 2005; Foreman 2014a; Foreman 2014b; Code 1991, Dusenbery 2018). The ways that Doyne was treated constitute microaggressions given the nature of the interactions: the seemingly small offhand remarks and slights, such as questioning whether she’d been “Googling her symptoms again,” where the assumption, based on her gender, is that she’s overreacting and overly sensitive to what they believe is nothing serious, or nothing at all. However, Doyne had been experiencing physical changes and pain and was trying to make sense of them both to herself, and in a way that would receive uptake by her medical team. These sorts of seemingly small comments are examples of microaggressions that, we’re suggesting, are directly tied to Doyne’s marginalized status qua female and female patient. Importantly, our position doesn’t commit us to the claim that Doyne was in a position to self-diagnose her cancer or to determine the course of treat8. For more on the death of Bronte Doyne, see BBC Radio (2015), Goddard (2015), Masters (2015), and Vize (2015).

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ment. The particular sort of expertise possessed by healthcare providers is crucial to accurately diagnosing and treating patients, and we don’t wish to undermine that. Rather, we’re suggesting that the ideal scenario would have been for Doyne’s healthcare team to have treated her as an epistemic peer (see Freeman 2014) 9 with reference to her privileged status as uniquely authoritative to report on changes in her bodily phenomenology, 10 and to have drawn upon her first-personal, embodied knowledge in tandem with and to inform their more generalized medical expertise. With Doyne’s knowledge, combined with their medical/technical expertise, the epistemic, emotional, and physical/embodied harms she experienced and possibly even her death could have been avoided. The epistemic microaggressions experienced by Doyne contributed both to serious physical harm (and ultimately, to her death), as well as to significant epistemic harm (and related emotional trauma) for Doyne and her family. The latter is a result of their not being listened to and to their claims pertaining to her medical condition not having received uptake. These negative consequences could have been avoided had Doyne’s physicians taken her and her family’s claims seriously at the outset. Gail Pohlhaus Jr. argues that epistemic injustice can be epistemic by (1) wronging a knower as a knower, (2) causing epistemic dysfunction, or (3) wronging someone via an epistemic practice or institution (2017, 13). Moreover, according to Pohlhaus, the “primary harm” of epistemic injustice is truncated subjectivity, insofar as one’s epistemic capacities—that is, to know, to testify, to make sense of one’s experiences—are constitutive of personal identity, agency, and dignity. In Doyne’s case, all three dimensions of epistemic injustice are present and the harms outlined by Pohlhaus occurred. First, Doyne’s claims about her diminishing medical condition were ignored, thereby undermining her credibility, truncating her subjectivity, and thus wronging her as a knower and an agent. The physicians’ assumptions that they knew better and that she was merely overreacting were wrong, which had fatal consequences. Second, failing to give uptake to her claims caused epistemic dysfunction: her family ceased trusting medical practitioners (as we discuss below). Trust is a central component in physician–patient relationships and necessary to ensure high quality of care. Third, Doyne was harmed via the institution of medicine that failed her: physicians failed to properly diagnose her condition on account of failing to listen to her as a knower; as a result, it failed to save her life. This failure is institutional in nature insofar as it’s part of a pattern of dismissals leading to serious and detrimental outcomes for women (see, for 9. Epistemic agents are epistemic peers if “they can both make legitimate claims to knowledge about S, and if their respective claims are taken seriously by each of them” (Freeman 2014, 5). Such a relationship is “based on mutual respect, open responsiveness, and strong communication between women and physicians” (ibid.). 10. Thanks to Ian James Kidd for pushing us on this point.

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example, Dusenbery 2018, ch. 2; Lichtman et al. 2015). In sum, Doyne suffered the primary moral harm of being devalued as a giver of knowledge about her body and this devaluation and the subsequent epistemic and institutional dysfunction contributed (in part) to further physical harm and ultimately to her untimely death. One might object to our analysis by claiming that the healthcare team’s suspicion of Doyne’s claims was at least in part rational in light of their experiences with other patients. It’s common for people to Google their symptoms and to respond in ways that could be seen as overreactions or, having been influenced by symptom clusters found online, they could simply say things to healthcare providers that aren’t in keeping with what they’re actually experiencing. Furthermore, her liver cancer was rare, so statistically, one might argue that the doctors were rational to not act in response to her claims. We argue that this objection fails for three reasons, and thus it’s more reasonable than not to presume that Doyne experienced a microaggression. First, the testimonies of women (in medial contexts and beyond) are less likely than those of men to be taken as credible on account of prejudicial stereotypes pertaining to gender (Fricker 2007; Dusenbery 2018). Within medical contexts in particular, there’s a long history of women’s physical symptoms being ascribed to mental pathology, based in stereotypes of women as “dramatic,” “irrational,” or “crazy” (Culp-Ressler 2015). These stereotypes can lead to women being labeled as “catastrophizers” (Frances 2013) and being gaslit—that is, told that their physical symptoms are “all in their head.” These stereotypes and biases can (and often do) lead physicians to miss potentially life-threatening physical conditions, in addition to compounding the emotional distress that female patients are already experiencing (see, for example, Walters 2016; Watt 2006). Given the evidence, it’s likely that Doyne’s claims were dismissed and ignored at least in part due to these gendered microaggressions. Another way to put this claim is that we hold it’s unlikely that Doyne (and others in cases similar to hers) would have been so dismissed if she’d been a white cis-male. Second, and more specifically, there’s a well-documented tendency for healthcare providers and others to misjudge the seriousness of women’s claims about their physical symptoms, especially their pain (see Dusenbery 2018; Foreman 2014a; Foreman 2014b; Hoffman and Tarzian 2001; Kukla 2005; National Pain Report 2014; Walters 2016; Watt 2006). When Doyne attempted to inform physicians of pain that she was experiencing, she was taken to be complaining, exaggerating, or lying. 11

11. See Kukla 2014 for an account of discursive injustice, which gets at what Doyne was experiencing.

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Finally, even if one still suspects that healthcare providers acted rationally in light of the available evidence, there’s no justification for the tone they took toward Doyne (i.e., scoffing at her having potentially used Google as a resource to better understand what she was experiencing) and the disrespectful remarks they made toward her. If the doctors genuinely believed that she was wrong about her symptoms, there are more responsible, professional, compassionate, and epistemically charitable ways to convey that without sending a message of disrespect and dismissal. On these grounds, we argue that the healthcare team committed gendered epistemic microaggressions, which contributed serious harm to Doyne. LONG-TERM CONSEQUENCES OF EPISTEMIC MICROAGGRESSIONS In this section, we discuss some of the long-term consequences that epistemic microaggressions can have when they occur in medical contexts. 12 Specifically, we argue that repeated experiences of epistemic microaggressions can undermine physician–patient relationships, preclude relationships of trust, and therefore compromise the kind and quality of care that is received. In Bronte Doyne’s case, where physicians failed to take her testimony seriously, a result was that her family lost trust in healthcare providers. 13 In reference to their repeated attempts to be believed, to be heard, and to secure adequate cancer care for Bronte, Doyne’s mother stated: “I can’t begin to tell you how it feels to have to tell an oncologist they are wrong, [but] it’s a young person’s cancer. I had to. I’m fed up trusting them” (Cara 2015). When (epistemic) microaggressions are repeated, the long-term distrust or testimonial betrayal that can result can have serious and dangerous physical and psychological consequences. Another case where this is present is that of Xeph Kalma. Kalma is a trans woman who was the target of microaggressions in the emergency room when she was repeatedly deadnamed, 14 misgendered, interrupted, cut off, and eventually silenced 15: 12. This section is slightly modified and shortened from a similar discussion that appears in Freeman and Stewart (2018). 13. For a fuller account of the ways in which continued dismissal or denial of the lived experiences of members of marginalized groups fractures their trust in institutions, see Pohlhaus (2017). 14. “Deadnaming” refers to the practice of uttering or publishing the name that a trans person used prior to their transition. Though cisgender people often refer to this as a trans person’s “real” name, which undermines the name a trans person either uses or has legally changed as being less real than the one that was given to them at birth, deadnaming is considered to be a verbally violent offense that attempts to invalidate a person’s authentic gender identity (Ennis 2016). 15. Kalma was a victim of epistemic, as well as self-identity microaggressions, as we discuss in Freeman and Stewart (2018).

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Lauren Freeman and Heather Stewart In this moment, in my already suicidal state, the doctor has made it a million times worse. I put my coat on and walk out. . . . Instead of having those whom I trust take care of me, those whose job it is to take care of me, I am now at a brand new low—hopeless, hungry, and cold. . . . The way I was treated in the ER—the misgendering, deadnaming, ignorance, and the lack of discretion I experienced—is incredibly dangerous. When I say it was “my last visit,” I mean it. I will not voluntarily return to an ER the next time I’m feeling suicidal. Anything would be a better option than experiencing that level of embarrassment and shame again. Embarrassment and shame, from those who were meant to take care of me. (Kalma 2017, 206; our emphasis)

Kalma refuses to speak to or engage with medical professionals in the future, even if she feels suicidal again, because “those who were meant to take care of me” instead made her feel “embarrassment and shame” (Kalma 2017, 206). This is a textbook example of what Kristie Dotson (2011) has called testimonial smothering, when a speaker perceives that their audience is or will likely be unwilling or unable to give appropriate uptake to their testimony, and in response, elects to truncate their own testimony as a result (2011, 244). Testimonial smothering is an example of epistemic violence (237–38). Epistemic violence in general and testimonial smothering in particular are common among members of marginalized groups, including within the context of medicine, and can have serious, even fatal consequences. Such self-silencing, we contend, is one potential consequence of repeated epistemic microaggressions in medicine, especially when patients lose trust in their healthcare providers. This can result in long-term avoidance of care, and thus ultimately, poorer health outcomes. It’s important to underscore that though these types of microaggressive comments and actions may be micro from the perspective of healthcare providers committing them, the harms suffered by recipients are not micro at all. In fact, they can lead to such avoidance of healthcare settings to the detriment of one’s health. In one of the only two studies of which we are aware that specifically focuses on microaggressions toward patients within clinical medical contexts (Walls et al. 2015), the investigators conducted interviews with 218 adult American Indians diagnosed with type 2 diabetes. 16 They found that greater than one-third of the sample population self-reported having experienced microaggressions in interactions with healthcare providers. Moreover, reports of microaggressions correlated with self-reported history of heart attack, worse depressive symptoms, and prior-year hospitalization. The researchers conclude that microaggressive experiences undermine the ideals of patient-centered care and, like us, argue that providers ought to be

16. Though the study discusses microaggressions in general, we believe that their conclusions apply to our analysis of epistemic microaggressions in particular.

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cognizant of these subtle and often unintentional and unconscious forms of discrimination. Walls et al. write: The potential impact of microaggressions in clinical encounters is notable given the provider-patient relationship and inherent power differential wherein authority and prestige favors the clinician. When a healthcare provider commits a microaggression, the exchange may undermine attempted provision of care, trust may be broken and the visit becomes a source of patient stress. (2015, 232)

Moreover, the researchers claim that microaggressions, in addition to other kinds of discrimination faced by members of marginalized groups within medical contexts, can ultimately contribute to worse behavior, poorer physical and mental health, decreased service utilization, and reduced treatment compliance (2015, 233, 237). Decreased service use and treatment compliance can in turn, result in further disease complications and comorbidities. Our point is this: when one’s health, well-being, and in many cases, one’s very life is at stake, it’s imperative to trust and to have a positive relationship with those who are in charge of your treatment and care. Being a victim of epistemic microaggressions, however, can undermine trust in healthcare professionals, which can lead to a variety of roadblocks for successful treatment, as well as to serious psychological and existential pain for victims, as evidenced by the testimonies detailed above. We must bring attention to the kinds of microaggressions that arise within medical contexts in order to try to eliminate, or, perhaps more realistically, to diminish them as much as possible. Working to decrease clinical microaggressions is especially important in light of the resurgent popularity of the concept of patient-centered care. If we truly believe that medicine should be centered around and guided by quality care of patients, then this is all the more reason to promote understanding of health and illness “through the eyes of patients” (Saha, Beach, and Cooper 2008). Doing so would involve a commitment to understanding what microaggressions are; to recognize that they occur; to understand the severity of the harms that result from them; and finally, to take steps to be mindful so as not to commit them. Nonphysical harms within the context of illness and care—that is, being dismissed as a knower, internalizing such dismissals, and the subsequent psychological fallout accompanied by internalization—can be just as serious as (and sometimes even more enduring than) physical harms. Moreover, it’s not always the case that there’s a sharp line between physical and nonphysical harms. For example, stress lies in limbo between the physiological and psychological in that it might manifest as anxiety (psychological) but also in a variety of physical symptoms such as low energy; headaches; upset stomach; aches, pains, and tense muscles; chest

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pain and rapid heartbeat; insomnia; frequent colds and infections; loss of sexual desire or ability (DeLongis, Folkman, and Lazarus 1988). Medical practitioners who commit microaggressions (intentionally or unintentionally) are failing to fulfill the ethical cornerstone of medicine, namely, to do no harm. Their actions are resulting in serious and potentially longterm consequences, both physical and psychological. As such, they need to take heed and work to reduce clinical microaggressions for moral, practical, and medical reasons. CONCLUSION In this chapter, we’ve provided an account of epistemic microaggressions and their related harms within the context of clinical medicine. In so doing, we’ve added a novel and nuanced element to the growing theorization of the concept of epistemic injustice, and specifically testimonial injustice, insofar as we see epistemic microaggressions as constituting a subset of the broader category of testimonial injustice. Insofar as epistemic microaggressions in medicine result in a variety of serious and enduring harms to patients, it’s imperative that the phenomenon undergoes further empirical study and becomes better understood, so that awareness of them and their resulting harms is brought to the fore among healthcare providers and so that normative guidelines for reducing them can be implemented in clinical settings. At this point, there’s been very little empirical research on microaggressions in clinical medical setting, 17 so drawing attention to the moral significance of these microaggressions is a crucial step in encouraging further empirical study and eventually the implementation of empirically based normative guidelines. REFERENCES Allen, Frances. 2013. “The New Somatic Symptom Disorder in DSM-5 Risks Mislabeling Many People as Mentally Ill.” B MJ 346 (March). Bakalar, Nicolas. 2015. “Minorities Get Less Pain Treatment in E.R.” New York Times, November 30. BBC Radio. 2015. “Bronte Doyne Left in a ‘Big Black Hole.’” BBC Radio, June 18. http:// www.bbc.co.uk/programmes/p02v044s. Burroughs, Michael, and Deborah Tollefson. 2016. “Learning to Listen: Epistemic Injustice and the Child.” Episteme: Journal of Individual and Social Epistemology 13 (3): 359–77. Cara, Ed. 2015. “Hospital Apologizes for Ignoring Cancer Patient Who ‘Googled’ Her Symptoms.” Medical Daily, June 18. Carel, Havi, and Gita Györffy. 2014. “Seen but Not Heard: Children and Epistemic Injustice.” Lancet 384 (9950): 1256–57. Carel, Havi, and Ian James Kidd. 2014. “Epistemic Injustice in Healthcare: A Philosophical Analysis.” Medicine, Health Care and Philosophy 17 (4): 529–40.

17. Williams (forthcoming) is an exception.

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Centers for Disease Control. 2013. CDC Health Disparities and Inequalities Report—United States, 2011. http://www.cdc.gov/mmwr/pdf/other/su6203.pdf. Chuck, Elizabeth. 2018. “How Training in Implicit Bias Could Save the Lives of Black Mothers.” NBC News, May 11. https://www.nbcnews.com/news/us-news/how-training-doctorsimplicit-bias-could-save-lives-black-mothers-n873036. Code, Lorraine. 1991. What Can She Know? Feminist Theory and the Construction of Knowledge. Ithaca, NY: Cornell University Press. Culp-Ressler, Tara. 2015. “When Gender Stereotypes Become a Serious Hazard to Women’s Health.” Think Progress, May 11. https://thinkprogress.org/when-gender-stereotypes-be come-a-serious-hazard-to-womens-health-f1f130a5e79/. Dart, Tom. 2016. “Houston Man Shot by Police While Having Mental Crisis Files Lawsuit.” Guardian, June 29. https://www.theguardian.com/usnews/2016/jun/29/houston-police-law suit-mental-health-crisis. DeLongis, Anita, Susan Folkman, and Richard S. Lazarus. 1988. Journal of Personality and Social Psychology 54 (3): 486–95. Dotson, Kristie. 2011. “Tracking Epistemic Violence, Tracking Practices of Silencing.” Hypatia 26 (2): 236–57. ———. 2012. “A Cautionary Tale: On Limiting Epistemic Oppression.” Frontiers: A Journal of Women Studies 33 (1): 24–47. Dusenbery, Maya. 2018. Doing Harm: The Truth about How Bad Medicine and Lazy Science Leave Women Dismissed, Misdiagnosed, and Sick. New York: HarperCollins. Edwards, Laurie. 2013. “The Gender Gap in Pain.” New York Times, March 16. Ennis, Dawn. 2016. “10 Words Transgender People Want You to Know (But Not Say).” The Advocate, February 4. https://www.advocate.com/transgender/2016/1/19/10-words-trans gender-people-want-you-know-not-say. Foreman, Judy. 2014a. A Nation in Pain: Healing Our Biggest Health Problem. Oxford: Oxford University Press. ———. 2014b. “Why Women Are Living in the Discomfort Zone.” Wall Street Journal, January 31. Frances, Allen. 2013. “The New Somatic Symptom Disorder in DSM-5 Risks Mislabeling Many People as Mentally Ill.” BMJ 364: f1580. Freeman, Lauren. 2014. “Confronting Diminished Epistemic Privilege and Epistemic Injustice in Pregnancy by Challenging a ‘Panoptics of the Womb.’” Journal of Medicine and Philosophy 40 (1): 1–25. Freeman, Lauren, and Heather Stewart. 2018. “Microaggressions in Clinical Medicine.” Kennedy Institute of Ethics Journal 28 (4): 411–49. Fricker, Miranda. 2007. Epistemic Injustice: Power and the Ethics of Knowing. Oxford: Oxford University Press. ———. 2017.“Evolving Concepts of Epistemic Injustice.” In The Routledge Handbook of Epistemic Injustice, edited by Ian James Kidd, José Medina, and Gaile Pohlhaus Jr., 53–60. New York: Routledge. Glass, Ira. 2016. “My Damn Mind.” This American Life, February 12. Goddard, Sophie. 2015. “Teenager Dies from Cancer after Being Told to ‘Stop Googling Her Symptoms.’” Cosmopolitan, June 18. https://www.cosmopolitan.com/uk/reports/news/ a36559/teenager-dies-from-cancer-after-being-told-to-stop-googling-symptoms/. Hill Collins, Patricia. 2017 “Intersectionality and Epistemic Injustice.” In The Routledge Handbook of Epistemic Injustice, edited by Ian James Kidd, José Medina, and Gaile Pohlhaus Jr., 115–24. New York: Routledge. Hoffman, Diane, and Anita Tarzian. 2001. “The Girl Who Cried Pain: A Bias against Women in the Treatment of Pain.” Journal of Law, Medicine, & Ethics 29: 13–27. Hoffman, Kelly, Sophie Trawalter, Jordan Axt, and M. Norman Oliver. 2016. “Racial Bias in Pain Assessment and Treatment Recommendations, and False Beliefs about Biological Differences between Blacks and Whites.” Proceedings of the National Academy of Sciences of the United States of America 113 (16): 4296–301. Johnson, Tiffany. 2012. “Racial and Ethnic Disparities in the Management of Pediatric Abdominal Pain.” Paper presented at Pediatric Academic Society. Boston, April 28.

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Kalma, Xeph. 2017. “Mind Your Words.” In The Remedy: Queer and Trans Voices on Health and Health Care, edited by Zena Sharman, 203–06.Vancouver, BC: Arsenal Pulp Press. Kidd, Ian James. n.d. Epistemic Injustice and Illness Bibliography. https://ianjameskidd.weebly.com/epistemic-injustice-and-illness.html. Kidd, Ian James, and Havi Carel. 2017a. “Epistemic Injustice in Medicine and Health Care.” In The Routledge Handbook of Epistemic Injustice, edited by Ian James Kidd, José Medina, and Gaile Pohlhaus Jr., 336–46. New York: Routledge. ———. 2017b. “Epistemic Injustice and Illness.” Journal of Applied Philosophy 34 (2): 172–90. Kidd, Ian James, José Medina, and Gaile Pohlhaus Jr., eds. 2017. The Routledge Handbook of Epistemic Injustice. New York: Routledge. Kukla, Rebecca. 2005. Mass Hysteria: Medicine, Culture, and Women’s Bodies. Lanham, MD: Rowman & Littlefield. ———. 2014. “Performative Force, Convention, and Discursive Injustice.” Hypatia 29 (2): 440–57. Lichtman, Judith, Erica Leifheit-Limson, Emi Eatanabe, Norrina Allen, Brian Garavalia, Linda Garavalia, John Spertus, Harlan Krumholz, and Leslie Curry. 2015. “Symptom Recognition and Healthcare Experiences of Young Women with Acute Myocardial Infarction.” Circulation: Cardiovascular Quality and Outcomes. doi: 10.1161/CIRCOUTCOMES.114.001612. Lockhart, P. R. 2018. “What Serena Williams’ Scary Childbirth Story Says about Medical Treatment of Black Women.” Vox, January 11. https://www.vox.com/identities/2018/1/11/ 16879984/serena-williams-childbirth-scare-black-women. Masters, Ken. 2015 “The E-Patient and Medical Students.” Medical Teacher 38 (3): 1–3. McWhorter, John. 2014. “‘Microaggression’ Is the New Racism on Campus.” Time, March 21. http://time.com/32618/microaggression-is-the-new-racism-on-campus/. Medina, José. 2013. The Epistemology of Resistance: Gender and Racial Oppression, Epistemic Injustice, and Resistant Imaginations. Oxford: Oxford University Press. Nadal, Kevin L. 2013. That’s So Gay! Microaggressions and the Lesbian, Gay, Bisexual, and Transgender Community. Washington, DC: American Psychological Association. National Pain Report. 2014. “Women in Pain Report Significant Gender Bias.” National Pain Report, September 12. Pierce, C., and M. Rowe. 1970. “Offensive Mechanisms.” In The Black Seventies, edited by F. Barbour, 265–82. Boston: Porter Sargent. Pohlhaus, Gaile, Jr. 2017. “Varieties of Epistemic Injustice.” In The Routledge Handbook of Epistemic Injustice, edited by Ian James Kidd, José Medina, and Gaile Pohlahus Jr., 13–26. New York: Routledge. Rickford, John R., and Sharese King. 2016. “Language and Linguistics on Trial: Hearing Rachel Jeantel (and Other Vernacular Speakers) in the Courtroom and Beyond.” Language 92 (4): 948–88. Rosenthal, Elisabeth. 2016a. “When the Hospital Fires the Bullet.” New York Times, February 13. ———. 2016b. “Assault Charges against Man Shot in Texas Hospital Are Dropped.” New York Times, March 18. https://www.nytimes.com/2016/03/19/us/alan-pean-hospital-gunsmental-health.html. Saha, Somnath, Mary Catherine Beach, and Lisa A. Cooper. 2008. “Patient Centeredness, Cultural Competence and Healthcare Quality.” Journal of National Medical Association 100: 1275–85. Sanati, Abdi, and Michalis Kyratsous. 2015. “Epistemic Injustice in Assessment of Delusions.” Journal of Evaluation in Clinical Practice 21 (3): 479–85. Srivastava, Ranjana. 2015. “Doctor Google Is Here to Stay—And Here to Help.” Guardian, June 22. https://www.theguardian.com/commentisfree/2015/jun/22/bronte-doyne-cancergoogle. Staats, Cheryl, Kelly Capatosto, Lena Tenney, and Sarah Mamo. 2017. State of the Science: Implicit Bias Review. Kirwin Institute. Sue, Derald Wing. 2010. Microaggressions in Everyday Life: Race, Gender, and Sexual Orientation. New York: Wiley.

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Chapter Eight

Returning to the “There Is” PTSD, Phenomenology, and Systems of Knowing MaryCatherine McDonald

Though there has been discussion about the intersections between epistemic injustice and mental illness (Carel and Kidd 2014, 2017; Scrutton 2017), posttraumatic stress disorder (PTSD) related to trauma in particular has not yet been examined. In the United States, the suicide rate of combat veterans has reached near-epidemic proportions. 1 To be sure, this is in part because of the ever-shifting nature of combat, and the ever-shifting nature of the trauma that follows. It is my contention that we simultaneously give combat veterans too little epistemic credibility given their status as traumatized, and we give too much epistemic credibility to scientific data. In failing to see the combat veteran as a trustworthy knower, we overprivilege the scientific understanding of combat trauma to the detriment of the traumatized. I will further suggest that we can resist epistemic injustice by focusing on the phenomenological method of Maurice Merleau-Ponty. 2

1. Current reports on veteran suicide data estimate that twenty-two veterans commit suicide every day, a statistic that is cited often. What many people do not know is that these current reports do not include veterans who have been dishonorably discharged, nor those who are active service members, nor those who die by overdose, nor the deaths that occur in Texas and California, as these states have not provided data. There is significant reason, then, to think that the actual number of suicides due to military-related PTSD is much higher than twenty-two people a day (Kemp 2014; Kemp and Bossarte 2012). 2. The bringing together of phenomenology and epistemic injustice is a common impulse, as the phenomenological aims to return us to the lived experience of the subject. See, for example, Guenther (2017). My analysis here differs in that it focuses on the phenomenology of MerleauPonty distinct from Husserl, and I focus on both the phenomenological analysis of lived experience and the way that Merleau-Ponty intends phenomenology to work dynamically with science.

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One of the things that Merleau-Ponty contributes to the field of phenomenology is his critique of reductive accounts of human behavior typical of the field of psychology. Rather than viewing life in all of its richness—as it is lived—psychology attempts to dissect behavior from above, in order to understand it in general rather than in the context in which the behavior arose. In a certain way, Miranda Fricker (2007) is also battling against a kind of reductionism in her work. Fricker brings epistemology and ethics together to argue that prejudice and stereotyping result in epistemic injustice, of which there are two types. The first, testimonial injustice, occurs when prejudice causes a hearer to give less credibility than is due to a speaker. The second, hermeneutical injustice, occurs when deficits in collective understanding create a situation in which someone has a difficult time making sense of their social experience (1). What these injustices have in common with MerleauPonty is that they result from the reduction of a person (or a significant feature of a person) into a prejudicial belief and result in harm. Fricker’s examples focus on groups that are widely considered to be marginalized (e.g., women, members of racial minorities). I will suggest that combat veterans who suffer from posttraumatic stress disorder are also victims of both testimonial and hermeneutic injustice, and accordingly suffer harm. Though they are often members of privileged groups (largely white, largely male, largely straight, and largely cis-gendered), this does not mean that they are exempt from the dangers of epistemic injustice. I would like to further offer that the phenomenological lens developed by Merleau-Ponty can help us unravel and resist this injustice. To this end, I first explore the ways in which those who are diagnosed with combat trauma can suffer from epistemic injustices as a result of stereotypes about their ability to be reliable speakers. I then explore how this group meets the necessary criteria for both testimonial and hermeneutical injustice. I conclude by returning briefly to Merleau-Ponty and highlighting how his phenomenological method may help us avoid this kind of epistemic injustice. Throughout the chapter, I draw from qualitative interviews with veterans that I have completed in my research. 3 EPISTEMIC INJUSTICE AND COMBAT TRAUMA Before delving into the specific experiences of veterans with PTSD, it is helpful to consider epistemic injustice alongside trauma. In what ways are those who have been diagnosed with trauma-related mental illness vulnerable

3. Qualitative data cited here were obtained in compliance with all IRB protocol and were approved by Institutional Review Boards at Old Dominion University.

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to epistemic injustice? In this section, I will argue that victims of trauma are vulnerable both to testimonial injustice and hermeneutical injustice. Testimonial Injustice and Trauma In the case of testimonial injustice, where prejudice causes a hearer to give less credibility to the speaker, it is relatively easy to see both how those with mental illness in general and veterans in particular might be at risk. There is a long history of societal stigma against those who are mentally ill that relates to their status as knowers. One need not look any further than the storied history of mental institutions to see this. From the late 1700s onward, those who were committed were often members of minority groups, and almost never seen as reliable reporters of their own reality (Foucault [1972] 2009). These early beliefs reverberate through current society. Stereotypes like these contribute to the social power dynamics that fuel epistemic injustice and create barriers to care (Wahl 2012; Link 2001). When it comes to the traumatized veteran in particular, the stereotypes are especially narrow and specific. As I have written about elsewhere, male veterans with PTSD struggle against stereotypes related to masculinity and femininity (McDonald 2018). Current stereotypes of veterans with PTSD imagine them to be out of control, angry, violent, and impulsive, even when the veteran shows no such symptoms. For example, I interviewed Stewart, 4 a veteran who began work at a large factory. He had sustained substantial injuries on deployment and had disclosed to his boss in confidence that he had been diagnosed with PTSD. He describes the way that he was introduced to the other employees: There’s a lot of people, like maybe a hundred. And it’s the first time I’m meeting everyone. And I already feel under the spotlight because of my scars and things, so I’m sort of looking down and just waiting for it to be over, and then my boss goes, “So yeah, make sure you watch out for Stewart. Be sure to tiptoe around him. He’s got PTSD. You never know when he’s going to blow!” I was totally stunned. I think maybe it was supposed to be a joke, but how am I supposed to face those people?

When he disclosed to his boss that he had PTSD, Stewart explained that his main symptom was a heightened sense of anxiety and that his PTSD was being treated and was under control. Despite his disclosure, he was not given the benefit of epistemic authority because counter to his own narrative, he is imagined to be out of control, potentially dangerous, worthy of keeping an eye on. The underlying assumption is that Stewart cannot be trusted to give an account of his own PTSD and its potential implications. 4. Name and minor details changed to protect anonymity.

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Hermeneutical Injustice and Trauma As far as hermeneutical injustice, the burden of proof is heavier, as Fricker specifies that there must be deficits in the collective understanding of trauma that are not incidental, and that this results in someone failing to understand their own social experience in a way that leads to harm (Fricker 2007, 158). I would like to suggest that giving an excess of credibility to the scientific view and a deficiency of credibility to the patient because of a prejudice about those who suffer from mental illness creates and perpetuates a deficit in the collective understanding of mental illness to the detriment of healing. Working backward through her definition of hermeneutical injustice, it seems relatively uncontroversial to say that processing and understanding their own social experience is something that is acutely relevant for those suffering from combat trauma. Conversely, failing to work through and understand their own social experience of trauma can lead to the perpetuation and potentially intensification of symptoms. For this population to be harmed by hermeneutical injustice under Fricker’s account, the source of prejudice needs to be a gap in collective understanding that is not incidental (Fricker 2007, 151). We cannot argue that there is no terminology or symptomatology to classify and diagnose PTSD. Unlike something like sexual harassment, combat trauma as a concept has been around in some iteration since the late 1800s. It is not the case, then, that the concepts necessary for understanding that PTSD exists are missing. However, the creation of a diagnostic category certainly does not imply the full understanding of the disorder that the category aims to grasp. There is a gap in the collective understanding of mental illness that takes the form of a misunderstanding that is systematic and not incidental, and that is rooted in testimonial injustice: we prima facie believe that science gives us access to the objective truth about psychological disorder whereas the personal account of what it is like to live through it leads us away from truth. This underprivileging of first-person accounts, when combined with the overprivileging of scientific data, creates barriers to understanding and treating trauma. To give an example, there is an argument gaining traction in the philosophy of psychology that memoirs of those who suffer from certain mental illnesses (trauma and depression specifically) should be dismissed because individuals who suffer from these disorders have been shown to have structural and functional differences in the brain (and we should read “difference”

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as disordered; in other words, these individuals have disordered brain structures and functioning). 5 Though there is data that suggests changes in the brains of those who have suffered from depression, none of this data reveals the individual to be unreliable as a knower of their own mental illness. There’s a conflation operative here between “personal account” and “accurate account of objective reality.” When someone sets out to give an account of their own experience, what they are trying to do is explain what it is like to live through that experience—not what is always and objectively true about it. The first-person account is useful precisely because it is a firsthand experience that can then be measured against the scientific account to make sure that the scientific account is accurate. This preference for scientific data over and against the first-person account begins to reveal that there are deficits in the collective understanding that are not incidental but created and reinforced by a structure of power. The structure of power is the field of empirical science, and the gap consists of everything that the scientific account does not capture, including (but not limited to) a critical understanding of the limitations of the scientific studies. Fricker specifies that for this to be unjust, it must lead to a situation in which one’s sense of self is ill-understood because the relevant concept is illunderstood by the collective. Since this “ill-understanding” can happen in a number of different ways and for a number of different reasons, it is important to identify when this is a result of prejudice and when it is not. Fricker carefully brackets situations in which someone is hermeneutically disadvantaged from those in which someone suffers a hermeneutic injustice: We can imagine, after all . . . serious hermeneutic disadvantages that do not inflict any epistemic injustice. If, for instance, someone has a medical condition affecting their social behavior at a historical moment at which that condition is still misunderstood and largely undiagnosed, then they may suffer a hermeneutical disadvantage that is, while collective, especially damaging to them in particular. . . . But they are not subject to hermeneutical injustice; rather, theirs is a poignant case of circumstantial epistemic bad luck. (Fricker 2007, 152)

5. In the 1980s, researchers found that subjects suffering from trauma and depression had overgeneral memory—the tendency to refer to a category of events rather than retrieving a single episode. For example, a 1986 study showed that suicidal patients—when asked to give a specific memory after being given a word cue—often responded with a general memory, rather than a specific one (Williams and Broadbent 1986). Again, this occurs despite being asked to give a specific memory. This suggested to researchers that the autobiographical memory of suicidal patients might differ in form and content from the autobiographical memory of nonsuicidal patients. These findings were replicated easily and often—in 1988, 1992, 1996, 2001, and so on. (See Williams and Scott 1988; Evans et al. 1992; Williams et al. 1996; Watkins and Teasdale 2001.)

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This statement might make it seem like veterans with PTSD belong solidly in the category of “circumstantial epistemic bad luck.” If it is the case that these individuals are misunderstood only because we are assessing it at a historical moment at which this condition is still misunderstood and largely undiagnosed, it would then follow that they are suffering circumstantially. However, it is not the case that we lack a name or general understanding of the disorder. Rather, the privileging of empirical data over and against the personal account results in a systematic misunderstanding of PTSD. Like many other marginalized groups, they suffer a double injustice—both hermeneutic and testimonial. The system of power that they struggle with is the persistent myth of scientism in psychology alongside stereotypes. If we grant that there is a misunderstanding within our collective understanding of the role of scientific data, it is still necessary to show that the misunderstanding within the collective understanding leads to harm. There are (at least) two reasons to believe that harm is incurred when we dismiss the first-person account of trauma. First, we strip the sufferer of epistemic authority because of their status as someone who suffers from mental illness/disorder. Since none of the data supports the idea that those who suffer from trauma and depression are less capable of reporting what it is like to experience this, it must be the case that we are giving them less credibility simply because of prejudice. It is important to note that we are not simply doubting their capacity to know, we are doubting their capacity to know their own experience—an especially intimate form of epistemic injustice. When we strip away their epistemic authority, this is not limited to their credibility as speakers in this particular subject, but to their credibility as speakers in general. We are not just saying that there is a better way to get the data that we need, we are saying people who have these mental disorders are incapable of telling us what it is like because their stories are always fundamentally unreliable in general. This kind of silencing stands in the way of collective and subjective understanding. To summarize, the idea that those who suffer from depression or trauma are less epistemically trustworthy is not just an idea that exists within the social structure, it is one that is currently being advocated for and actively promoted. 6 The argument is that accounts of those who are mentally ill 6. Gaile Pohlhaus Jr. has made a similar argument in her work (2012). Willful hermeneutical injustice refers to situations where dominant groups refuse to acknowledge the epistemic tools that marginalized groups have developed (out of necessity) to understand their own experience. I hesitate to use her framework because I’m not sure that veterans with PTSD form an intact group of marginalized people. They do not tend to build community around their marginalization because they do not see it as marginalization (as far as I am aware, I am the only person so far who has suggested that they are marginalized), and they do not share much knowledge about PTSD with each other because there is a stigma within the military about having it in the first place.

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should be jettisoned because those who suffer from depression or trauma are incapable of reliably reporting their own experience. In this argument we see an instance of testimonial injustice (those who are writing these memoirs are not credible) as it occurs within the larger web of hermeneutical injustice (we dismiss these memoirs because of a collective misunderstanding about the role and capacity of science). The harm members of this group suffer is the inability to understand and correctly categorize their own experience. CASE STUDIES IN EPISTEMIC INJUSTICE AND COMBAT TRAUMA We can now move on to two case studies which show the existence and impact of epistemic injustice on combat veterans in particular. Case Study A James is a former combat marine who has been diagnosed with PTSD. In many ways, his career embodied the ideal for a young marine. Prior to his retirement, he received multiple honors. What was starkly obvious when interviewing James was the way in which his treatment for PTSD failed him. Right away, James had misgivings about his treatment. He felt that the therapeutic environment that he was in was not equipped to understand his experience with violence, or the real etiology of his symptoms: When they try to treat the root problem, they focus on entirely the wrong thing, presuming that exposure to violence is what is causing the symptoms. . . . I have absolutely no issue with those experiences in any way, shape, or form. I was accomplishing a mission; I was protecting me and my own . . . I really have no issues or qualms (with violence). The things that bother me the most are the shots that I did not take; not the ones I did.

According to James’s experience and contrary to a classical theoretical understanding of exposure to combat violence, he and the majority of soldiers he fought with were not necessarily averse to the combat, enemy engagement, or the violence of war. Each time he explained this to a therapist, she dismissed his account and told him that he was incapable of understanding the source of his symptoms. It is tempting to read this and think, “James doesn’t think that he has an issue with violence, but can we trust his account?” Herein reveals the testimonial injustice. James’s account of his experience is discredited because he is suffering from PTSD and therefore judged to be unreliable, while his therapist is given an excess of credibility.

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There remains a question of how much epistemic authority one should be given. This situation is structured in such a way that we must choose between the clinician or the patient. If the patient is right, then the clinician must be wrong, and if the clinician is right, the patient must be wrong. This is not a zero-sum game. It need not be the case that the clinician receives all of the epistemic credibility and the patient receives none. It could indeed be the case that James is unable to articulate or identify some of his own experience. Simultaneously, it seems possible that the clinician is unprepared to categorize some of his account because of the narrowness of the diagnostic criteria. The salient point is that we dismiss James’s account because it does not match with the current clinical map and because he is deemed unreliable given that he has been diagnosed with a mental disorder. James was continually met with narrowness within the clinical setting and was frustrated by his therapist’s inability to accept his reality—the fact that he was not averse to the violence of war. I did three months of therapy (at a VA-sponsored center). The head therapist started doing prolonged exposure stuff with me and I was talking about the most violent, horrific things that I had gone through. The doctor kept saying, “Why aren’t you showing any emotion? You’re not crying. You’re not getting choked up.” I said (to the doctor), “because this is not what is screwing me up.” That was the light bulb. I realized that this (therapy) is focused on the wrong thing. This entire treatment process is focused on the wrong thing. So if it isn’t violence, what is it? Then I started thinking about what really causes me the most internal strife, anxiety, and problems. What causes me to drink? What causes me to seek out crazy behavior or anything else? It wasn’t the memories of violence or anything like that. It was a need to prove myself and to accomplish a mission that I never fully could.

In an indirect way, the therapy did enable James to heal. Not because it enabled him to process traumatic and violent episodes from deployment that he had yet to process, but because in its failure—in the clinicians’ continuous refusal to think that it might be the therapeutic method that was wrong, that there must be something wrong with James—James was able to realize what was causing him pain. Namely, the military had instilled in him an impossible mission of becoming a war hero and finishing a never-ending war. Luckily, James is an introspective individual and he persisted down the path of his own understanding rather than cave to the clinical model that did not resonate with his experience. It is worth noting, however, that while he did this, he remained constantly in pain—suffering deeply both psychologically and physically—until he was able to sort things out on his own. Could he have potentially healed faster if his account was given more credibility?

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Case Study B David Morris is a veteran and war journalist who wrote a bestseller about his experience with PTSD. Though it is about his experience in whole, a part of the book centered on his negative experience with Prolonged Exposure (PE) therapy. PE is a type of cognitive behavioral therapy in which the patient repeatedly visualizes the traumatic event in great detail until the event loses its emotional “charge.” Originally designed for victims of a single sexual assault (rather than, say, a series of assaults over childhood), it is a method that has garnered much attention and received a great deal of funding. It is currently considered the “gold standard” for PTSD treatment by the military. Morris describes his experience: I began to think of the treatment not as therapy so much as punishment. Penance. I would show up with some things I wanted to talk about, thoughts I’d had, questions that had arisen when I looked over the journals I’d kept during the war, and after hearing me out, Scott would invariably direct me back to the imaginals. At one point, I went in and out of the cul-de-sac in Saydia eleven times in one afternoon. I say “I” went . . . because I always felt like I was alone in this activity. This . . . was a controlled form of treatment. Scripted even. Stage-managed. I had a role to play. The role was that of the patient diligently repeating his story, ad infinitum. . . . It was, I would later learn, a “manualized” therapy. A therapy, in other words, whose results were designed by researchers for researchers, a therapy designed to be touted by medical administrators as being “efficacious” and scientifically tested. (Morris 2016, 181)

Similar to James, Morris describes going into therapy with certain things he wanted to express and process and being dismissed and told that he was doing his therapy incorrectly. In response to Morris’s critique of PE, Richard J. McNally, a well-known Harvard psychologist, gave an online interview to the Association for Psychological Science in which he states: David Morris is a former Marine officer who experienced multiple traumatic events as a civilian war correspondent embedded within American combat units in Iraq. He is a thoughtful and excellent writer. Troubled by PTSD symptoms, he sought help at the San Diego VA and received Prolonged Exposure (PE) therapy, the treatment with the strongest evidence of efficacy. Sadly, however, his distress did not diminish during imaginal exposure sessions, and he terminated treatment early. His case is atypical; most patients do benefit, and many recover from PTSD. Although his symptoms apparently worsened temporarily, persistent worsening is very rare for patients receiving PE. (McNally 2015)

To begin with, McNally has much more epistemic credibility because he is speaking out against a single patient on behalf of science. The subjective,

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first-person account does not stand a chance against the objective stance of psychology. Morris’s status as patient is acutely relevant because it relegates him to a much lower epistemic status than McNally. Further, McNally’s assertion that Morris’s case is atypical and that most patients do benefit is at best inaccurate and at worst incorrect. In fact, a critical look at this particular protocol reveals that what seems to be most predictable about veterans who enroll in PE therapy protocols is that they will drop out (Najavits 2015). What is most relevant here is how easy it is to dismiss Morris when one is on the side of clinical psychology. The problem is not just about hearing Morris’s particular story; it is about whom we are trained to give epistemic authority to, and how we react when that authority is challenged. MOVING FORWARD: EPISTEMIC JUSTICE AND PHENOMENOLOGY In the beginning of her book, Fricker laments that epistemology is not brought together with ethics often enough. This is true both when it comes to identifying epistemic injustice and for solving it, as she develops a response to these injustices by cultivating the virtues of testimonial and hermeneutic justice. The viability of her solution has been debated (Sherman 2015). Rather than trying to solve these issues here, I would like to suggest that we might imagine a phenomenological epistemology as a way to hedge against the prevalence of these injustices. If it is the case that epistemology and ethics are brought together too infrequently, one might make the same argument about phenomenology and epistemology. The phenomenological project, from Husserl onward, is to make sense of what it is to know conscious, lived experience. The epistemological is written into the phenomenological. There are two values to Merleau-Ponty’s system that I will focus on here. The first is in his conception of returning to the lived experience, or the “there is.” The second is that of the dynamic interplay between the scientific and the personal. These values work against epistemic injustice and move toward a solution that allows for both the personal account and the scientific account. In his essay “Eye and Mind,” Merleau-Ponty highlights the importance of balancing the scientific with the phenomenological. He says: Scientific thinking, a thinking which looks on from above, and thinks of the object-in-general, must return to the there is which precedes it; to the site, the soil of the sensible and humanly modified world such as it is in our lives and for our bodies—not that possible body which we many legitimately think of as an information machine but this actual body I call mine, this sentinel standing quietly at the command of my words and acts. (Merleau-Ponty 1964, 160–61)

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A critical part of what Merleau-Ponty aims to do is to remain aware that the human being is a living, embodied, and worldly center of experience, and, as such, is not reducible to the mere object of scientific inquiry. Science— which gazes from above, aims to generalize and to pull apart experience for examination—must periodically return to the experience as it occurs in a lived context. One might ask why it is helpful to look at the science behind a human phenomenon like trauma if the phenomenological perspective is going to point out the limitations of scientific objectification. It is critical here to realize that, again, this is not a zero-sum game. It is not science or phenomenology, it is science and phenomenology. Though Merleau-Ponty is certainly criticizing a particular type of scientism, by no means does he intend to jettison science in favor of phenomenology. Though scientific exploration is certainly important, what Merleau-Ponty is particularly concerned about is the regard for science as the ultimate and sole source of knowledge about human behavior. As we have seen above, this is the very misunderstanding that bears out in epistemic injustice in the case of veterans with PTSD. It is not scientific investigation itself that is problematic, but the reduction of human life to causal explanations. Attempting to understand a human being as merely a biological or psychological object for scientific inquiry disregards something foundational about human existence. To place this framework squarely back into the discussion of epistemic injustice, returning to the “there is” as Merleau-Ponty suggests, accomplishes two things. First, it reminds the clinical gaze to remain open-minded to the personal account of the patient. This opens up space for the possibility that the patient account may differ from clinical understanding and still be relevant and accurate. Second, this account allows for us to appreciate the limitations of both. Rather than having to figure out whether and when the patient account trumps the clinical account, this perspective allows us to see that the patient account should be brought together with the clinical account. I will conclude with one final example. CONCLUSION A veteran with PTSD was plagued with traumatic nightmares for years after returning home. He describes the impact of this on his life as follows: I haven’t spent a complete night in bed with my wife for at least ten years. I always end up on the sofa. It’s safer for her. . . . I’d do this crazy [stuff] at night. I once threw her out of bed so hard it broke her shoulder. I thought there was an NVA potato-masher come in on us. Another night I thought she was

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It is tempting to say that this patient is not able to tell the difference between memory and reality and therefore fundamentally unreliable. This temptation results from a mistake. When we are psychologically assessing a patient, the question is not just whether their account is accurate (accuracy meaning the degree to which it maps on to reality), but what is true about it? While it is not objectively true that the veteran is actually under fire, it is not accurate to say that the account is false, either. The perception of gunfire and the chain of behavior that follows that perception are very real. Indeed, the classification of this symptom as a part of PTSD requires that both patient and clinician are given epistemic trust in the right way. As Merleau-Ponty explains: The situation of the patient whom I question appears to me within my own situation and, in this phenomenon with two centers, I learn to know myself as much as I learn to know the other person. We must put ourselves back into the actual situation in which the hallucinations and the “real” are presented to us, and we must grasp their concrete differentiation at the moment it operates in the communication with the patient. I am seated before my subject and I speak with him; he attempts to describe what he “sees” and what he “hears”; there is no question of taking him at his word, nor of reducing his experiences to mind, nor of coinciding with him, nor of holding myself to my point of view; rather, it is a question of making explicit my experience and his experience, such as it is indicated in my own, or of making explicit hallucinatory belief and my real belief, and of understanding them through each other. ([1945] 2009, 354–55)

Understanding the account of the veteran requires granting the veteran epistemic credibility as a knower. Giving epistemic authority in the right way in this situation requires the simultaneous recognition that the disorder is present, and that the first personal account of its manifestation is also real and credible. What this shows is that the survivor must be upheld as a knower of her own experience. When Merleau-Ponty says, “When the victim of hallucination declares that he sees and hears, we must not believe him, since he also declares the opposite; what we must do is understand him” ([1945] 2009, 352), he means that the “victim” is a unique knower in two ways. First, she knows that the hallucination is a hallucination—she declares that she sees something that she knows is not there. Second, she knows her experience better than the person on the outside, which is why we need to move to understand the victim. The question is not, then, when the patient’s account should override the clinician, rather, how can these accounts come together toward a full understanding of the experience? Returning to Merleau-Ponty’s idea of the “there is,” then, allows us to balance epistemic trust in a way that resists epistemic injustice.

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REFERENCES Carel, Havi, and Ian James Kidd. 2014. “Epistemic Injustice in Healthcare: A Philosophical Analysis.” Medicine, Health Care and Philosophy 17: 529–40. Evans, Jonathan, Mark Williams, Simon O’Loughlin, and Kevin Howells. 1992. “Autobiographical Memory and Problem-Solving Strategies of Parasuicide Patients.” Psychological Medicine 22 (2): 399–405. Foucault, Michel. (1972) 2009. History of Madness. Translated by Jonathan Murphy and Jean Khalfa. New York: Routledge. Citations refer to the Routledge edition. Fricker, Miranda. 2007. Epistemic Injustice: Power and the Ethics of Knowing. Oxford: Oxford University Press. Guenther, Lisa. 2017. “Epistemic Injustice and Phenomenology.” In The Routledge Handbook of Epistemic Injustice, edited by Ian James Kidd, José Medina, and Gaile Pohlhaus Jr. New York: Routledge. Kemp, Janet. 2014. “Suicide Rates in VHA Patients Through 2011 with Comparisons with Other Americans and Other Veterans Through 2010.” US Veterans Health Administration. https://www.mentalhealth.va.gov/docs/Suicide_Data_Report_ Update_January_2014.pdf. Kemp, Janet, and Robert Bossarte. 2012. “Suicide Data Report 2012.” Department of Veterans Affairs Mental Health Services Suicide Prevention Program. https://www.va.gov/opa/docs/ Suicide-Data Report-2012-final.pdf. Kidd, Ian James, and Havi Carel. 2017. “Epistemic Injustice in Medicine and Health Care.” In The Routledge Handbook of Epistemic Injustice, edited by Ian James Kidd, José Medina, and Gaile Pohlhaus Jr., 336–46. New York: Routledge. Link, Bruce. 2001. “Stigma as a Barrier to Recovery: The Consequences of Stigma for the SelfEsteem of People with Mental Illness.” Psychiatric Services 52 (12): 1621–26. McDonald, MaryCatherine. 2018. “Hysterical Girls: Combat Issue as a Feminist Issue.” International Journal of Feminist Approaches to Bioethics 11 (1): 3–23. McNally, Richard. 2015. “The Facts about Prolonged Exposure Therapy.” Association for Psychological Science, January 25. https://www.psychologicalscience.org/publications/ob server/obsonline/the-facts-about-prolonged-exposure-therapy-for-ptsd.html. Merleau-Ponty, Maurice. (1945) 2009. Phenomenology of Perception. Translated by Donald Landes. New York: Taylor & Francis. ———. 1964. “Eye and Mind.” The Primacy of Perception: and Other Essays on Phenomenological Psychology, the Philosophy of Art, History and Politics. Translated by Carleton Dallery, edited by James M. Edie. Evanston, IL: Northwestern University Press. Morris, David. 2016. The Evil Hours: A Biography of Post-Traumatic Stress Disorder. New York: Eamon Dolan. Najavits, Lisa M. 2015. “The Problem of Dropout from ‘Gold Standard’ PTSD Therapies.” F1000 prime Reports (7.43): 43. http://www.readcube.com/articles/10.12703/P7-43. Pohlhaus, Gaile, Jr. 2012. “Relational Knowing and Epistemic Injustice: Toward a Theory of Willful Hermeneutical Ignorance.” Hypatia 27 (4): 715–35. Scrutton, Anastasia. 2017. “Epistemic Injustice and Mental Illness.” In The Routledge Handbook of Epistemic Injustice, edited by Ian James Kidd, José Medina, and Gaile Pohlhaus Jr. New York: Routledge. Shay, Jonathan. 1994. Achilles in Vietnam: Combat Trauma and the Undoing of Character. New York: Scribner. Sherman, Benjamin. 2015. “There’s No (Testimonial) Justice: Why Pursuit of a Virtue Is Not the Solution to Epistemic Injustice.” Social Epistemology 30 (3): 229–50. Wahl, Otto. 2012. “Stigma as a Barrier to Recovery from Mental Illness.” Trends in Cognitive Science 16 (1): 9–10. Watkins, Ed, and John Teasdale. 2001. “Rumination and Overgeneral Memory in Depression: Effects of Self-Focus and Analytic Thinking.” Journal of Abnormal Psychology 110 (2): 353–57. Williams, Mark, and Keith Broadbent. 1986. “Autobiographical Memory in Suicide Attempters.” Journal of Abnormal Psychology 95 (2): 144–49.

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Williams, Mark, Nick Ellis, Claire Tyers, Colm Healy, Gary Rose, and Andrew MacLeod. 1996. “The Specificity of Autobiographical Memory and Imageability of the Future.” Memory & Cognition 24 (1): 116–25. Williams, Mark, and John Scott. 1988. “Autobiographical Memory in Depression.” Psychological Medicine 18 (3): 689–95.

Chapter Nine

Pathocentric Epistemic Injustice and Conceptions of Health Ian James Kidd and Havi Carel

Over the last few years, a flourishing literature has emerged that uses the concept of epistemic injustice to articulate and understand the negative social experiences of ill persons within healthcare environments and in the broader social world (Blease, Carel, and Geraghty 2016; Crichton, Carel, and Kidd 2016; Kidd and Carel 2016; Carel and Kidd 2014; Carel and Györffy 2014). 1 We label these pathocentric epistemic injustices, ones that arise from the epistemic prejudices and hermeneutical difficulties associated with experiences of illness (Kidd and Carel 2018). The experiences are consistently of unfair and injurious epistemic exclusion and marginalization: of ill persons being ignored, silenced, or dismissed; of not being listened to or taken seriously, and of being treated as mere sources of information, only able to answer within the defined terms of clinical-epistemic practice, and locked into what one critic has dubbed a “stance of silence” (Hinshaw 2008, 8–9). Such reports are common within a large literature produced by healthcare researchers, patient activists, and pathographers who document and describe the lived experience of illness, most obviously in the range of writings that fit under the capacious category of “illness narratives” (Carel 2016 and 2018; Cutter 2018; Sontag 1978; Toombs 1988, 1993). Many of these narratives document patient needs, requests, dignity, and testimony being ignored and sometimes silenced. For example, psychiatric patients’ views and utterances can be dismissed by psychiatric staff to the extent that there is, since 2009, a 1. We thank Benjamin Sherman and Stacey Goguen for inviting us to write this chapter and for their comments, which greatly improved this chapter. Havi Carel thanks the University of Bristol for granting her a period of research leave, during which this chapter was written. Ian James Kidd is grateful to the University of Nottingham for a semester of research leave.

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legal duty to provide Independent Mental Health Advocacy (IMHA) to patients who qualify under the Mental Health Act 1983 (seAp 2019). There is compelling evidence that psychiatric patients can be treated harshly and inconsiderately, with their views ignored, leading to unnecessary suffering (Crichton et al. 2016). Those suffering from somatic illness find their requests for basic care and assistance routinely ignored, as seen in the case of the Mid-Staffordshire Inquiry, published in 2013, detailing the horrific neglect, leading to increased mortality rates, of elderly patients that was systematic, continuous, and pervasive (The Mid Staffordshire 2013). Individual patients provide countless, and ongoing, examples of being ignored. Paul Kalanithi, a neurosurgeon diagnosed with lung cancer at the age of thirty-five, for example, recalls how Brad, a resident physician, refuses to reorder a medication for him, without which he would be in excruciating pain within hours. After repeated requests from Kalanithi to receive the drug, and explanations of why he needs it, Brad dismisses Kalanithi’s claims and finishes his shift without reordering the medication. Kalanithi understands this as Brad’s way of getting out of an unpalatable situation. In order to order the drug, he needs to ring up a more senior clinician, disturbing them at home. He doesn’t want to do that so simply does nothing, passing the problem on to the next physician on shift. Kalanithi says: “I could see that in Brad’s eyes I was not a patient, I was a problem: a box to be checked off. “‘Look,’ [Brad] continued, ‘if you weren’t you [i.e., a medic] we wouldn’t be having this conversation. I’d just stop the drug and make you prove it causes all this pain’” (Kalanithi 2016, 187). The epistemic injustice affecting ill persons within and beyond healthcare environments is a central concern of patient activists, health professionals, and healthcare policy makers. This can be evidenced by the “patient-centered care” movement, on the web pages of organizations such as the Patients Association, and by stable and high levels of dissatisfaction reported by patients (see Kmietowicz 2018; Patient Association 2019). Building on our previous work on epistemic injustice in illness (Carel and Kidd 2014; Kidd and Carel 2016, 2018), in this chapter we broaden our understanding of what can cause epistemic injustice to ill persons. Until now we examined individuals (e.g., healthcare professionals) and institutional structures and processes as causing epistemic injustice (Carel and Kidd 2014; Kidd and Carel 2016, 2018). Here we argue that certain theoretical conceptions of health, particularly those described as “biomedical” or “naturalistic,” contingently but powerfully support epistemically unjust conduct and attitudes of health professionals. However, our claim that abstract, nonagential objects can be bearers of virtues and vices sounds counterintuitive, at best, and a category mistake, at worse. We therefore draw on recent work in vice epistemology to identity three ways that abstract objects—such as theoretical conceptions—can be legiti-

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mately described as epistemically vicious. Although only two of these apply to theoretical conceptions of health, this is enough for our claim that amelioration of pathocentric epistemic injustice must go “all the way down” to the conceptions of health that shape how people talk and think about illness and ill persons. If this is right, then robust reform of individuals, social systems, and institutions would not be enough to secure epistemic justice. Also needed are substantive changes in the underlying conceptions of the nature of health that undergird medical education and training, including health professionals’ education, training, attitudes, and ethos. Before we move on to the main claim of the chapter, we would like to highlight three features of pathocentric epistemic injustice. First, the social experiences of ill persons are diverse and dynamic, since there are so many different forms of illness, which are experienced according to the values, needs, social situations, and intersectional identities of particular ill persons (Carel 2016). This diversity should not be collapsed by an epistemic analysis. Second, there are many different practices and experiences of disregarding, ignoring, and dismissing patient utterances, wishes, and needs. These admit of local variations, shaped by particular and changing power relations, social and practical arrangements, and different social contexts (Dotson 2011; Medina 2013). We must remain aware of this diversity too. In particular, we note the stereotypes and stigma surrounding mental illness, which makes those suffering from it particularly vulnerable to epistemic (and other kinds of) injustice (Crichton et al. 2016; Kurs and Grinshpoon 2018; Kyratsous and Sanati 2015; LeBlanc and Kinsella 2016). Finally, there are different vocabularies and conceptual resources available for making sense of epistemically toned concerns, as reported by ill persons and those who care for them. Epistemic injustice is only one of these, albeit a powerful one, that can play roles within and beyond philosophy. 2 We would like to leave the door open to other forms of concern—for example, inclusion and exclusion practices—to be studied in the future. We do not suggest that epistemic injustice captures all such concerns, only that it is a powerful tool for such an analysis. PATHOCENTRIC HERMENEUTICAL INJUSTICE In previous work we analyze pathocentric epistemic injustices, ones that target and track ill persons, generally. In this section, we turn our attention specifically to pathocentric hermeneutical injustice experienced by chronically ill persons, preparing the ground for the claims in the following sections 2. A bibliography of work on epistemic injustice, illness, and healthcare is maintained at https://ianjameskidd.weebly.com/epistemic-injustice-and-illness.html. See also Kidd, Medina, and Pohlhaus (2017).

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about concepts of illness and their role in such injustice. Hermeneutical injustice is only one dimension of a subject’s complex vulnerability to a variety of forms of epistemic injustice, but insofar as chronic illness can be, and usually is, a dominant component of a subject’s social identity, it will be one of the main loci for those injustices. Indeed, one of the most common laments in illness pathography is “I became my illness.” At their most general, the varieties of hermeneutical injustice all involve interactive and/or institutional constraints that limit the capacity of a person or group to create or share the meanings of some of their social experiences in appropriately intelligible ways. Following José Medina, in this section we discuss the source, dynamics, breadth, and depth of pathocentric hermeneutical injustice (Medina 2017, 45–48). Starting with sources, hermeneutical injustices can be produced semantically or performatively. The former is more familiar, arising from an absence of appropriate labels, categories, terms, or concepts for recognizing, understanding, and appreciating forms of social meaning. But hermeneutical injustice can also be generated when a subject fails to perform, epistemically and socially, in legitimated ways. Perhaps the styles of expression or forms of communicative performance are unfairly regarded as unintelligible, or, at the least, as less intelligible than others, as when chronically ill persons use highly subjective, narrative, autobiographical, or anecdotal styles in their efforts to describe their lived experiences. Pathographic testimonies are often derogated as imprecise, vague, irrelevant, lacking relevant detail, or communicatively and epistemically deficient in other ways (Burley 2011; Kidd 2017). Such derogations ignore the fact that chronically ill persons determine that content or those styles to best suit their expressive capacities and hermeneutical needs: to speak in those ways with those words about those experiences is an exercise of hermeneutical agency. Impugning or thwarting that agency prevents the person from performing hermeneutically—obstructing their efforts to make or share a sense of one’s bodily, social, and existential experiences as a chronically ill person—making them especially vulnerable to hermeneutical injustice. The dynamics of hermeneutical injustice are the ways that access to and use of different resources and styles can be impaired or constrained by structural (or institutional) conditions and interpersonal interactions. Certain institutional designs, for instance, favor certain hermeneutical resources or make it difficult to use certain expressive styles, while certain ways of interacting with other subjects can be more or less receptive to mutually productive hermeneutical agency. Structurally, an obvious feature of multiple areas of the social world is pervasive constraints on the task of creating and sharing understanding of the lived experience of chronic illness, of many sorts. Chronic illness might not be talked about at all; or only spoken of in banal ways insensitive to the subjective and situational particularities of a particu-

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lar ill person; or only discussed within specific contexts, such as healthcare practice or end-of-life care, whose norms and practices may not allow for appropriately sensitive discussion of the various dimensions of the lived experience of illness, or only allow discussion of certain “acceptable” aspects of those experiences. When patients are asked “how they are,” for instance, they’re typically expected to limit their answer to providing factual information about somatic sensations, functionality, response to medication, or the appearance and severity of symptoms. Such a piecemeal approach yields a partial view of the full phenomenon: it recognizes and privileges the physiological dysfunction (disease), while hiding the experience of this dysfunction (illness). In effect, this approach glosses over and marginalizes the holistic, existential nature of the illness experience, reducing the patient’s ability to see the wide-ranging impact of illness on their life. Since this sense-making is largely absent from medical discourse, ill persons are often left to their own devices to make sense of the dramatic, holistic, overwhelming experience of falling ill and being ill. Those ill persons can then be trapped between the Scylla of medical jargon rooted in natural science and the Charybdis of confining social scripts and stereotypes—of “combating” cancer, being brave and stoical, “not making a nuisance of oneself.” Interpersonally, chronic illness is typically difficult for people to discuss, and many pathographies attest to the various forms of interpersonal obstacles they encounter in their efforts to initiate and sustain meaningful conversations about the lived experience of illness. Initially, ill persons may encounter aversive behavior that has the effect, whether intended or not, of discouraging social interaction: think of the awkwardness or discomfort that healthy persons often display when they encounter ill persons, especially those with visible or stigmatized conditions. In such encounters interactions might be resolutely banal, reliant on ritualized exchange of trite assurances, superficial counsels, and prosaic commentary of the sort that proliferate on social media, posters, and postcards—the worst being “What doesn’t kill me makes me stronger” (a statement Nietzsche intended to critique, not condone, in Twilight of the Idols). There are important social roles for banalities, of course, most obviously as a means of escape for ill persons who may wish, at times, to avoid the task of recounting their experiences. But when such banalities are the norm, prospects for appropriately complex, sustained hermeneutical agency will become increasingly remote. After all, people often resort to banality as a means of signaling to an interlocutor their lack of desire to engage seriously with others’ experiences. Banality therefore functions symbolically and communicatively as the rejection of the invitation to engage in shared hermeneutical activity.

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An example is Barbara Ehrenreich’s experience of breast cancer, especially when she sought support and wisdom from fellow sufferers of the disease. Struck by the culture of zealous optimism, she posted a negative post on an online breast cancer forum, entitled “Angry.” It immediately met a hostile reception: anything other than “gratefulness” for the “gift” or “journey” she has been “invited” to go on, was considered blasphemy and policed accordingly (Ehrenreich 2009, 55). Other cultures frown on testimonies that are too self-centered (e.g., ill persons describing in detail their symptoms or treatment), divulging information deemed personal or upsetting (e.g., describing the details of chemotherapy, talking about an “embarrassing” illness), or “attention seeking” behavior that includes displays of pain, discomfort, or anguish. As Ehrenreich concludes: [B]reast cancer did not make me prettier or stronger, more feminine or spiritual. What it gave me, if you want to call this a “gift,” was a very personal, agonizing encounter with an ideological force in American culture I have not been aware of before—one that encourages us to deny reality, submit cheerfully to misfortune, and blame only ourselves for our fate. (Ehrenreich 2009, 44)

The breadth of pathocentric hermeneutical injustices concerns their reach across the social world, whether they are, in Fricker’s terms, incidental or systematic cases. Certain injustices may be confined to hermeneutical hotspots, generated by contextually specific conditions, meaning that the subject still enjoys relatively unconstrained hermeneutical agency elsewhere in their social world. But injustice can also be systematic, tracking the subject across different domains of their social world. In later writings, Fricker refers to a “continuum of possibilities,” ranging from maximal to minimal cases of hermeneutical injustice, focusing mainly on what she calls “midway cases” where there exist “sophisticated interpretive practices [. . .] not shared with at least one out-group with whom communication is needed,” in which the injustice “does not involve any confused experiences whatever, but only frustratingly failed attempts to communicate them to members of an outgroup” (Fricker 2016, 167). In pathocentric cases, many ill persons may initially lack the sorts of practices and resources needed to make sense of altered experience of their body, their self, and the world. 3 Considering the intensity and negativity of the process of falling ill, from symptom appearance to diagnosis, prognosis, and adjustment, it’s not surprising that ill persons lack the resources required for sense making. 4 Sometimes, these can be partially acquired from the social world—from patient support groups, online communities, blogs, pathographic literature, healthcare professionals. Unfortunately, the intellectual 3. For an ameliorative tool kit, see Carel (2012). 4. For an account of that process, see Carel (2015) and (2018).

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and emotional labor needed to create and share understanding of overwhelming and upsetting experiences cannot always be done solely by chatting to strangers online or reading blog posts. The hermeneutical labor intrinsic to chronic illness is all too often unrecognized, misunderstood, and underestimated. In other cases, the resources are largely confined to members of specific communities, most obviously groups and communities of those with particular illnesses—a local breast cancer support group or the online community for a certain rare disease. These often function as hermeneutical communities, by virtue of the distinctive hermeneutical needs and interests of their members, even if accounts of the role of support groups tend to be articulated in terms of moral, emotional, and practical support. Finally, the depth of hermeneutical injustice concerns Medina’s question, “how deep the hermeneutical harm goes in undermining or destroying the meaning-making and meaning-sharing capacities of the victims of such harm.” If they become sufficiently pervasive, such experiences can come to destroy one’s very capacity to make sense of one’s experiences, a state that Medina calls hermeneutical death (Medina 2017, 47). 5 Although such cases are comparatively rare, they are more likely to occur within the lives of agents who are already hermeneutically vulnerable. This includes those suffering from acute destabilization of their structures of meaning, amplified by the imposition of a disturbing new set of hermeneutical demands, as their bodily and social experiences are transformed, in ways that bring emotional and cognitive stress. Chronic illness offers precisely these sorts of cases, since its lived experience typically incorporates radical changes to the content and structure of experience (Carel 2013). Many pathocentric forms of hermeneutical injustice arise from the structural features of contemporary social and healthcare environments, consistent with Fricker’s original characterization of hermeneutical injustice as an exclusively structural phenomenon. Subsequent research, however, cogently demonstrates the existence of an important agential dimension, too. Medina, for one, notes that societies and cultures are typically heterogeneous, with different groups and publics bearing different degrees of responsibility for the adequacy and authority of available hermeneutical practices and resources. Some groups attempt to identify and repair gaps in those resources, or to reform those practices. Although some members of a society may be content with hermeneutical failure, other groups and publics will not be similarly content. Think, for instance, of social activist movements, which may be assisted, resisted, or simply observed. If so, argues Medina, there is an essential, irreducible agential dimension to hermeneutical injustice, rooted 5. For a cinematic exploration of this theme, see Murder in the First (1995, director Marc Rocco, US).

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in the “degrees of complicity in how individuals [and groups] respond to the lacunas and limitations in the hermeneutical resources they have inherited and in how they participate (or fail to participate) in expressive and interpretative dynamics” (Medina 2017, 42–43). With this account in place, we now want to suggest one possible source of such injustice. We locate this in the deeper epistemological structures that underlie the hermeneutical dynamics of communities. What’s epistemically unjust may, fundamentally, be certain conceptions of disease that overlook the experience of illness. EPISTEMICALLY UNJUST CONCEPTIONS OF DISEASE We have pointed out that there can be epistemically unjust individual and collective agents, structures, and institutions perpetrating pathocentric forms of testimonial and hermeneutical injustice by unfairly subjecting ill persons to credibility deflations and constraints on their capacity to create or share intelligible accounts of their experiences. In the final section, we argue that hermeneutical injustice can be a vice manifested not only by individual and collective agents and institutions, but also by abstract nonagential objects, specifically certain theoretical conceptions of health. Our claim is that theoretical conceptions can be epistemically unjust, as well as persons and groups, such that the pursuit of epistemic justice for ill persons is going to need to go beyond reform of agents and institutions. The typical claim within virtue ethics and epistemology is that the bearers of virtues and vices must be agents, with the individual moral or epistemic agent being the locus par excellence. Within virtue epistemology, there is a growing interest in the idea of collective epistemic virtues, where a virtue is possessed by the group, but not all (or any) of its members: imagine a group whose members individually lack the virtue of epistemic courage, but who, when acting together as a group, reliably act in epistemically courageous ways (Kidd 2019; Lahroodi 2019). The best defense of a collective or structural virtue of epistemic justice is developed by Elizabeth Anderson. While retaining a role for individual virtue, there is an essential role for “reform of our social practices of enquiry,” so that agential virtue is accompanied by more systematic efforts to “scale up the virtue of epistemic justice to systemic size” (Anderson 2012). Such epistemically virtuous social systems and practices can help to amplify and reinforce acts of epistemic justice of individual agents, while—in a stronger claim—there are acts and forms of epistemic justice that are only attainable at the social or structural level. Anderson explains: in the face of massive structural injustice, individual epistemic virtue plays a comparable role to the practice of individual charity in the context of massive

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structural poverty. Just as it would be better and more effective to redesign economic institutions so as to prevent mass poverty in the first place, it would be better to reconfigure epistemic institutions so as to prevent epistemic injustice from arising. (Anderson 2012, 171)

In the case of pathocentric epistemic injustice, we claim that the bearers of the virtue of epistemic justice can be individual agents (health professionals, carers, managers), collective agents (a multidisciplinary team, a hospital executive committee), and institutions (a hospital, a national health service). We suggest that these three possibilities hold true in the pathocentric cases and so should be taken seriously by those committed to epistemic justice for ill persons. But there is a further possibility that we want to consider: that stances, policies, doctrines, or theoretical conceptions can also be epistemically vicious, such that the vice is not located in an individual, collective, or institution (see Battaly 2013, Kidd 2018). If this is right and applicable to epistemic injustice, then ameliorative efforts to achieve epistemic justice must target such abstracta, as well as agents, collectives, and institutions. In this section, we make a case for the existence of vicious abstracta; then, in the following, we argue that some theoretical conceptions of disease are epistemically unjust. The idea of vicious theoretical conceptions finds support in recent work in vice epistemology by Heather Battaly, who proposes we shift “our focus from the vices of people to the vices of policies,” as a specific type of abstracta (2013, 264). In brief, she describes a vice of epistemic insensibility, a deficiency of epistemic appetite, marked by failures to desire, consume, or appreciate appropriate epistemic goods. Epistemically insensible people may, for instance, only value knowledge with obvious instrumental value, not what has intrinsic value—they lack the sense that some things are just “good to know” for their own sake. Battaly then goes on to argue that we can reasonably extend talk of epistemic insensibility to higher educational policies, such as the Research Excellence Framework (REF) in the United Kingdom: [A]n epistemically insensible policy promotes a failure to desire, consume, and enjoy some true beliefs that it is appropriate to desire, consume, and enjoy; and does so because it employs a false conception of the epistemic good—it wrongly assumes that such true beliefs are not, or are not sufficiently, epistemically good. (Battaly 2013, 272)

In these cases, the policy itself is vicious—epistemically insensible—independently of the viciousness of the educators and others whose activities it shapes or dictates. One may object that this is a category mistake, since policies, as abstract objects, cannot be bearers of virtues and vices. In response, Battaly (2013, 276) notes, first, that we do talk naturally of policies,

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stances, practices, and institutions as vicious, whether cruel, unjust, or dogmatic, like the cruelty of slavery (cf. Kidd 2016). Second, a vicious policy need not possess all of the features of a vicious person, such as perceptual habits or affective dispositions, only those definitive of the vice. The REF, for instance, (1) promotes a failure to desire, consume, and enjoy some appropriate epistemic goods and (2) does so because it has a false or deficient conception of the epistemic good. A vicious policy, then, promotes vicious actions, attitudes, or states of affairs. We accept the “promotion” account developed by Battaly and add two others: “exercise” and “attraction.” First, a policy is vicious if its enactment or implementation requires the exercise of one or more vices: the institution of slavery, for instance, requires slaveowners to exercise the vices of cruelty and injustice, which are necessary to deprive human beings of their freedom and objectify them. Second, a policy will be vicious if one must be vicious, at least latently, in order to find it attractive. A person who regarded acts or institutions of enslavement as attractive—as exciting, or worth “having on the table” as a tenable option—must be already disposed, to some degree, to cruelty, injustice, and other vices. Anyone who regards slavery as anything other than atrocious must be, to some degree, guilty of such failings as willful ignorance, insensitivity, or conformism. Gathering these points together, we propose that a theoretical conception will be epistemically vicious if it does one or more of the following: a. promotes epistemically vicious attitudes or actions; b. requires the exercise of one or more epistemic vices for its enactment in agential conduct, structures, or institutions; c. could only be regarded as attractive by agents with at least some disposition to one or more epistemic vices. A few caveats are needed before we go on to consider epistemically unjust conceptions of health: first, a single vice can be borne by individual and collective agents as well as by the policies, theoretical conceptions, or other abstracta that make up a community. Second, careful work will be needed to identify the viciousness of a conception, since this will be expressed in and through the practices, social structures, and institutional arrangements that concretize and give form and force to the conception. In the final section of this chapter we argue that theoretical conceptions of health can also be epistemically unjust, if and when they become exclusively privileged within a social system.

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NATURALISM ABOUT HEALTH Modern healthcare practice and science are largely governed by a naturalistic or biomedical conception of health that privileges the concepts, theories, and terminology of natural science. The most influential account within philosophy of medicine is that of Christopher Boorse, who conceptualizes health and disease in terms of biological functionality and dysfunctionality, respectively, defined relative to statistical norms within a reference class (see, for instance, Boorse 1977 and Rachel Cooper 2002). Ideally, health is defined from a value-free, third-person perspective, independently of subjective and contextual values and other “extra-biological” factors, such as “intentional actions,” “goals,” and other aspects of human subjectivity (Nordenfelt 2014, 25). As a consequence, both the conceptualization and treatment of health and illness become the primary, if not exclusive, responsibility of biomedical science. It is this epistemic and practical privileging of naturalistic resources that can, we argue, act as a source of pathocentric hermeneutical injustice. By “naturalistic conception of health” we mean one that privileges or presents as exclusively or primarily authoritative the concepts, categories, and vocabularies of biomedical science. Such conceptions involve certain attitudes toward biochemistry, physiology, and other sciences, rather than use of those sciences themselves. The use of scientific resources does not require adoption of a naturalistic conception of health. A person can view their cancer in the terms of oncology, without thinking those terms offer a complete, exhaustive account of the lived experience of cancer. Many ill persons, carers, and health professionals accept the existence of dimensions of health and illness that are only articulable and intelligible using methods and resources taken from outside biomedical science, such as those offered by embodied existential phenomenology of illness (see Carel 2016; Toombs 1993; and Svenaeus 2000). The epistemic privileging of naturalistic conceptions of health can take many different forms, instantiated in interpersonal interactions, institutional structures, or background cultural convictions. At its most basic, privileging can consist of blunt rejection of alternative accounts of health and illness as alterations to one’s embodiment or structures of experience, as false, inchoate, or unintelligible. When cancer patients talk of feeling “betrayed” by their body and its “traitorous” tumors, or when ill persons report that the world feels “weird,” “unstable,” or “hostile,” their testimonies can be rejected as clinically irrelevant at best, confused or meaningless at worst. Closely related is acceptance of nonnaturalistic accounts of health and illness, coupled to the judgment that they are epistemically inferior to those of the biomedical sciences. An altered sense of embodiment, time, and space may be accepted as genuine, but nonetheless of only marginal relevance to medico-epistemic practices.

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A further privileging practice is the insistence that only natural scientific methods and resources can disclose the fundamental features of health and illness, beyond superficial or subjective appearances. Phenomenological description of one’s altering experiences of self, body, and world is relegated to an epistemically second-order role, unable to tell us the truth about the nature of health and illness. 6 Such criticisms of the privileging of naturalistic conceptions is a theme of Martin Heidegger’s defence of the primacy of engaged experience, and his complaint, in his later writings, that what is distorting modern thought is “the dominance and primacy of the theoretical” (Heidegger [1919] 1987, 56/57: 87). Heidegger was not impugning naturalistic science or theory tout court, since these have important roles in human life; the “danger” only arises when their limits become forgotten and other, alternative ways of experiencing and engaging with the world are “driven out” (Heidegger 1977, 26ff). Indeed, if taken to the extreme, the very idea that there are or could be any alternatives to natural scientific descriptions of phenomena comes to be excluded from individual or collective imagination—an obliviousness to possibilities that is a breeding ground for such vices as closed-mindedness and dogmatism, construed as an unwillingness or inability to engage seriously with relevant epistemic options (Battaly 2017). These are some general privileging practices that can help to sustain the naturalistic conceptions that prevail within contemporary Westernized societies, which are already predisposed to privilege the sciences. We now need to demonstrate that the privileging of naturalistic conceptions of health within healthcare systems tends to generate the pathocentric hermeneutical injustices described in section 2. We suggest they can do this in three mutually reinforcing ways: 1. Privileging of naturalistic conceptions can manifest as failure to acknowledge the existence of alternative accounts of health and illness, meaning the only available options are those from biomedical methods and resources. 2. Privileging can encourage epistemic derogation of those alternatives, perhaps as “subjective,” “unscientific,” or worse. 3. Privileging of naturalistic conceptions could allow limited roles for alternatives, albeit tempered by the conviction that only biomedical science can disclose the fundamental features of health and illness. We suggest that the contemporary entrenchment of naturalistic conceptions of health in healthcare practice has epistemically privileged natural scientific ways of conceiving and responding to health and illness. As a 6. This account of theoretical conceptions and of privileging practices is informed by David E. Cooper (2002, 341ff).

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consequence, alternative ways of conceptualizing and understanding illness that fall outside the strictures of natural science tend to be excluded, marginalized, or derogated. An important consequence, with reference to epistemic injustice, is the generation of gaps in the range and type of hermeneutical resources and practices privileged within healthcare environments. Such hermeneutical gaps arise because naturalistic medicine recognizes only certain types of meaning and significance and certain kinds of experience, namely, those relevant to the biomedical sciences and their associated forms of clinical practice. This is entirely legitimate, since much can be achieved, medically, using biomedical theoretical and therapeutic modalities. Moreover, any conception of health can only serve certain types of hermeneutical needs, just as any tool can only serve a certain range of functions: partiality is the price one pays for specificity. But this is a problem if one lacks a sufficiently diverse set of tools, depriving one of the right tools for the job. Our worry is that the privileging of naturalistic conceptions of health tends to deprive medical science and healthcare practice of a sufficiently diverse range of hermeneutical resources. It has also concealed this poverty by reducing sensitivity to the range of experiences and meanings that make clear the need for enrichment. As a consequence, the privileging of those naturalistic conceptions both promotes and requires the exercise of pathocentric hermeneutical injustice. If so, those conceptions are hermeneutically unjust. Recalling our account of vicious abstracta in the last section, we proposed that a naturalistic conception of health is hermeneutically unjust if it: a. promotes hermeneutically unjust attitudes or actions; b. requires the exercise of hermeneutical injustice for its enactment and in agential conduct, structures, or institutions. c. could only be regarded as attractive by agents with at least some disposition to cause or accept hermeneutical injustice. All of these features obtain in the case of naturalistic conceptions of healthcare as enacted within many, if not most, contemporary healthcare systems. But, crucially, the injustice only occurs with the privileging of those conceptions in ways that reject, derogate, or marginalize alternative hermeneutical resources and practices pertinent to experiences of illness. We can therefore pinpoint these privileging practices as an important, if not primary, cause of pathocentric hermeneutical injustices. If so, we can now ask about the etiology of those injustices: What form do these privileging practices take? Where do they take place? Who performs them? How do they become legitimated and authoritative? How can they be resisted?

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We offer these questions to guide future investigations of pathocentric epistemic injustice, hopefully in the direction of epistemic justice. Whatever the results, a role still exists for a virtue-theoretic framing of those injustices, including at the level of theoretical conceptions. It is not only individual and collective agents and institutions that can be viciously epistemically unjust, but also naturalistic conceptions of health, if privileged epistemically within a healthcare system and social culture. If privileged, a conception can start to promote and to require exercise of the vice of hermeneutical injustice. Ben Sherman remarks that “harms can be caused through social structures,” and so could be “improved through structural change without anyone becoming more virtuous” (Sherman 2015, 233). We have argued that insofar as theoretical structures cause the harms constitutive of hermeneutical injustice, those structures are hermeneutically unjust, just as the very concept and institution of slavery are cruel and unjust, over and above the cruelty and injustice of individual slave-owners, practices, and so on. Successfully improving vicious structures, in itself, can make for a more virtuous society, independently of any contemporaneous increase in incidences of agential virtue, even if that is something to strive for, too. REFERENCES Anderson, Elizabeth. 2012. “Epistemic Justice as a Virtue of Social Institutions.” Social Epistemology 26 (2): 163–73. Battaly, Heather. 2013. “Detecting Epistemic Vice in Higher Education Policy: Epistemic Insensibility in the Seven Solutions and the REF.” Journal of Philosophy of Education 47 (2): 263–80. ———. 2017. “Closed-Mindedness and Dogmatism.” Episteme 15 (3): 261–82. Blease, Charlotte, Havi Carel, and Keith Geraghty. 2016. “Epistemic Injustice in Healthcare Encounters: Evidence from Chronic Fatigue Syndrome.” Journal of Medical Ethics 43: 549–57. Boorse, Christopher. 1977. “Health as a Theoretical Concept.” Philosophy of Science 44 (4): 542–73. Burley, Mikel. 2011. “Emotion and Anecdote in Philosophical Argument: The Case of Havi Carel’s Illness.” Metaphilosophy 42: 33–48. Carel, Havi. 2012. “Phenomenology as a Resource for Patients.” Journal of Medicine and Philosophy 37 (2): 96–113. ———. 2013. “Bodily Doubt.” Journal of Consciousness Studies 20 (7–8): 178–97. ———. 2015. “With Bated Breath: Diagnosis of Respiratory Illness.” Perspectives in Biology and Medicine 58 (1): 53–65. ———. 2016. Phenomenology of Illness. Oxford: Oxford University Press. ———. 2018. Illness. London: Routledge. Carel, Havi, and Gita Györffy. 2014. “Seen but Not Heard: Children and Epistemic Injustice.” Lancet 384 (9950): 1256–57. Carel, Havi, and Ian James Kidd. 2014. “Epistemic Injustice in Healthcare: A Philosophical Analysis.” Medicine, Health Care and Philosophy 17: 529–40. Cooper, David E. 2002. The Measure of Things: Humanism, Humility, and Mystery. Oxford: Clarendon Press. Cooper, Rachel. 2002. “Disease.” Studies in History and Philosophy of Biological and Biomedical Sciences 33 (2): 263–82.

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Crichton, Paul, Havi Carel, and Ian James Kidd. 2016. “Epistemic Injustice in Psychiatry.” BJPsych Bulletin 41 (2): 65–70. Cutter, Mary Ann G. 2018. Thinking through Breast Cancer. Oxford: Oxford University Press. Dotson, Kristie. 2011. “Tracking Epistemic Violence, Tracking Practices of Silencing.” Hypatia 26 (2): 236–57. Ehrenreich, Barbara. 2009. Smile or Die: How Positive Thinking Fooled America and the World. London: Granta Books. Fricker, Miranda. 2016. “Epistemic Injustice and the Preservation of Ignorance.” In The Epistemic Dimensions of Ignorance, edited by Rik Peels and Martijn Blaauw, 160–77. Cambridge: Cambridge University Press. Heidegger, Martin. 1977. The Question Concerning Technology and Other Essays, translated by William Lovitt. New York: Harper & Row. Heidegger, Martin. (1919) 1987. Gesamtausgabe, vols. 56/57: Zur Bestimmung der Philosophie [Toward the Definition of Philosophy], edited by Vittorio Klostermann. Frankfurt am Main. https://www.beyng.com/hb/gesamt.html. Hinshaw, Stephen P. 2008. Breaking the Silence: Mental Health Professionals Disclose Their Personal and Family Experiences of Mental Illness. Oxford: Oxford University Press. Kalanithi, Paul. 2016. When Breath Becomes Air. London: Vintage. Kidd, Ian James. 2016. “Charging Others with Epistemic Vice.” The Monist 99 (3): 181–97. ———. 2017. “Exemplars, Ethics, and Illness Narratives.” Theoretical Medicine and Bioethics 38 (4): 323–34. ———. 2018. “Is Scientism Epistemically Vicious?” In Scientism: Prospects and Problems, edited by Jeroen de Ridder, Rik Peels, and René van Woudenberg, 222–49. Oxford: Oxford University Press. ———. 2019. “Epistemic Courage and the Harms of Enquiry.” In The Routledge Handbook to Virtue Epistemology, edited by Heather Battaly, 244–55. New York: Routledge. Kidd, Ian James, and Havi Carel. 2016. “Epistemic Injustice and Illness.” Journal of Applied Philosophy 34 (2): 172–90. ———. 2018. “Healthcare Practice, Epistemic Injustice, and Naturalism.” In Harms and Wrongs in Epistemic Practice, edited by Simon Barker, Charlie Crerar, and Trystan Goetz, 1–23. Cambridge: Cambridge University Press. Kidd, Ian James, José Medina, and Gaile Pohlhaus Jr., eds. 2017. The Routledge Handbook of Epistemic Injustice. New York: Routledge. Kmietowicz, Zosia. 2018. “Satisfaction with NHS Hits New Low.” BMJ 360: k943. https:// doi.org/10.1136/bmj.k943. Kurs, Rena, and Alexander Grinshpoon. 2018. “Vulnerability of Individuals with Mental Disorders to Epistemic Injustice in Both Clinical and Social Domains.” Ethics & Behavior 4: 336–46. Kyratsous, Michaelis, and Abdi Sanati. 2015. “Epistemic Injustice in Assessment of Delusions.” Journal of Evaluation in Clinical Practice 21 (3): 479–85. Lahroodi, Reza. 2019. “Virtue Epistemology and Collective Epistemology.” In The Routledge Handbook to Virtue Epistemology, edited by Heather Battaly, 407–19. New York: Routledge. LeBlanc, Stephanie, and Elizabeth Anne Kinsella. 2016. “Toward Epistemic Justice: A Critically Reflexive Examination of ‘Sanism’ and Implications for Knowledge Generation.” Studies in Social Justice 10 (1): 59–78. Medina, José. 2013. The Epistemology of Resistance: Gender and Racial Oppression, Epistemic Injustice, and Resistant Imaginations. Oxford: Oxford University Press. ———. 2017. “Varieties of Hermeneutical Injustice.” In The Routledge Handbook of Epistemic Injustice, edited by Ian James Kidd, José Medina, and Gaile Pohlhaus Jr., 41–52. New York: Routledge. Nordenfelt, Lennart. 2014. “The Opposition between Naturalistic and Holistic Theories of Health and Disease.” In Health, Illness, and Disease: Philosophical Essays, edited by Havi Carel and Rachel Cooper, 23–36. New York: Routledge.

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Patient Association. 2019. untitled document. https://www.patients-association.org.uk/Han dlers/Download.ashx?IDMF=f4f5bfb8-e61a-49fa-8635-07a7af98d076 (accessed January 23, 2019). seAp Advocacy [seAp]. 2019. “What Is Independent Mental Health Advocacy?” https:// www.seap.org.uk/services/independent-mental-health-advocacy/about-independent-mentalhealth-advocacy.html. Sherman, Benjamin. 2015. “There’s No (Testimonial) Justice: Why Pursuit of a Virtue Is Not the Solution to Epistemic Injustice.” Social Epistemology 30 (3): 229–50. Sontag, Susan. 1978. Illness as Metaphor. New York: Farrar, Straus & Giroux. Svenaeus, Fredrik. 2000. The Hermeneutics of Medicine and the Phenomenology of Health: Steps towards a Philosophy of Medical Practice. Dordrecht: Kluwer. The Mid Staffordshire NHS Foundation Trust [The Mid Staffordshire]. 2013. “Executive Summary.” Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, chaired by Robert Francis QC. February. https://assets.publishing.service.gov.uk/government/uploads/ system/uploads/attachment_data/file/279124/0947.pdf. Toombs, S. K. 1988. “Illness and the Paradigm of Lived Body.” Theoretical Medicine 9: 201–26. ———. 1993. The Meaning of Illness: A Phenomenological Account of the Different Perspectives of Physician and Patient. Amsterdam: Kluwer.

Chapter Ten

Uncovering Prejudice and Where It Lives Stereotype Mapping in Professional Domains Elianna Fetterolf

Our everyday testimonial exchanges typically have an immediate, spontaneous character as we move between being speakers and hearers. When in the position of hearer, we characteristically must make some attribution of credibility with respect to the speaker. This is the sort of practice where one can make errors through attributing an undue excess or deficit of credibility to the speaker, owing to collective epistemic bad luck, or to myriad epistemic vices and/or prejudices. As Fricker’s account makes plain, a central mechanism through which we make our spontaneous attributions of credibility are social stereotypes (Fricker 2007, 18). A prevalent strand of thought in social psychology and philosophy understands stereotypes as a distinct class of empirically and ethically bad sorts of social generalizations. Under this view, very roughly, a stereotype is a social generalization that is prejudiced in favor or disfavor of one social group or another, and empirically inaccurate or unreliable at the group level. Fricker, however, upholds a broader, more neutral way of thinking about stereotypes as “widely held associations between a given social group and one or more attributes” which “entails a cognitive commitment to some empirical generalization about a particular social group” (where a generalization can vary in strength with qualifiers, e.g., “all,” “many,” “some”) (Fricker 2007, 31). On this view, stereotypes (1) may or may not be infused with negative or positive prejudice, (2) may or may not be empirically reliable, (3) have context sensitivity (e.g., a positively valenced stereotype in one setting may be viewed negatively in another), and (4) can be beliefs as well as other less transparent dimensions of cognitive 169

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commitment (Fricker 2007, 30–31). Casting a central mechanism of our variably fallible credibility attributions in this way allows Fricker to preserve testimonial spontaneity while distinguishing an influential ethically poisonous strain of stereotypes—negative prejudicial identity stereotypes—which are far more likely to produce ethically and epistemically unjust credibility attributions. At the level of the theory, if the widely held association between an attribute and the relevant social group is not reliably supported by empirical evidence, then the association between the attribute and the social group is irrational. On Fricker’s account, the association being false is not sufficient, however, to reveal the stereotype to be prejudicial. If the current evidence supporting the association is distorted but this is as yet widely unknown such that the stereotype is deployed as if it is accurate, then Fricker allows for the controversial possibility of collective epistemic bad luck (i.e., nonculpable ethical-epistemic error). Stereotypes are then prejudicial when the association is false such that the use of the stereotype reflects “the most basic idea of prejudice as a pre-judgement, that is, as a judgement made or maintained without proper regard to the evidence” (Fricker 2007, 32–33). Namely, stereotypes are prejudicial when there is sufficient available evidence showing the association to be false but that this evidence is variously ignored, dismissed, unattended to, or given insufficient weight across social levels (from individual agents to the collective) such that the false stereotype goes unchallenged and continues to circulate possibly as reliable and accurate. In granting that stereotypes are standardly part of our spontaneous attributions of credibility while accepting they are highly susceptible to the ethical poison of negative prejudice, it follows that attempts to overcome epistemic injustice in practice would benefit from first uncovering and articulating influential stereotypes. A way to create greater awareness concerning stereotypes that are liable to trigger and perpetuate epistemic injustices is what I will call “stereotype mapping.” Roughly, the idea is not merely to catalogue relevant stereotypes but to add further awareness of their operations and interconnections by mapping links between the stereotypes, positive and negative alike. This additional information can matter for gaining insight into the subtler dynamics of stereotypes as they relate to prejudice. For example, in contexts where the participating women are stereotyped as “emotional” and the men are stereotyped as “stoic,” we might see that the stereotypes are mutually reinforcing, creating conditions for the increased likelihood of the women suffering from testimonial injustices and making the practice of the virtues of epistemic justice harder. We might conclude, for example, that both stereotypes must be unseated to improve the epistemic conditions and/or that it would be best to create a distinct testimonial space or environment for women.

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Given the scale and ubiquity of stereotypes, I propose the process of stereotype mapping can be usefully constrained by first limiting our attention to a species of stereotypes, what I will call “credibility stereotypes”; and, second, to domain-specific credibility stereotypes, and less so to influential general sociocultural credibility stereotypes. Why credibility stereotypes and not negative identity-prejudicial stereotypes? Although the latter will likely be evidenced in any stereotype map, as I will argue, focusing on the credibility dimensions of domain-specific stereotypes has several benefits including the potential to uncover whether, where, and to what extent negative prejudice may or may not be influential within a domain’s credibility economy. As such, mapping domain-specific credibility stereotypes and their inflationary and deflationary pressures provides grounds for practitioners, stakeholders, and researchers to differentiate and evaluate where errors are owing to prejudices, epistemic vices, and/or bad luck. WHAT ARE CREDIBILITY STEREOTYPES? Credibility stereotypes address competence and/or sincerity attributes signaling the epistemic trustworthiness/untrustworthiness of a group, and thereby constitute a determining factor in the credibility assessment of speakers. Fricker makes the idea plain when she considers the position of a hearer gauging what a speaker has said to be true: “Barring a wealth of personal knowledge of the speaker as an individual, such a judgement of credibility must reflect some kind of social generalization about the epistemic trustworthiness—the competence and sincerity—of people of the speaker’s social type” (Fricker 2007, 32). In cases where there is a relative absence of individuating information concerning the epistemic trustworthiness of the speaker, credibility stereotypes are likely more central in our attempts to assess the speaker’s credibility. Given these ideas, I think heavier reliance on credibility stereotypes is arguably more likely to be prevalent and active in areas and contexts where, structurally, interlocutors are typically strangers or acquaintances such as in the hospital, lawyer’s office, lecture theater, bank, police station, mechanic garage, or shopping mall. Although general sociocultural credibility stereotypes permeate and penetrate many levels and areas of human life and social interaction, it is worth distinguishing domain-specific credibility stereotypes perpetrated in highstakes domains. Within domains like medicine, law, finance, education, and politics where the parties are typically strangers or acquaintances, stereotypes relating to familiar social groupings formed according to gender, race, ethnicity, class, religion, abilities, weight, and age will be active as well as with respect to roles such as “student,” “victim,” “patient,” “voter” or “teacher,” “psychiatrist,” “judge,” “senator.” Usefully, roles can pick out stereo-

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type-ready social groupings within a particular domain and its credibility economy (i.e., stereotypes qua patient or student or mechanic). High-school teachers might, for example, have negative credibility stereotypes about students that they are intellectually lazy, arrogant, or lacking in objectivity. Teachers might also split students along gender, race, age, and class such that a domain-specific role-based grouping likely intersects with other dimensions of social identity that are more familiarly associated with negative prejudice. It is nonetheless analytically valuable to isolate role-based credibility stereotyping within particular credibility economies where testimonial injustices and hermeneutical marginalization can lead to very high material and psychological costs for individuals and groups. This is because, in the first instance of an analysis of a credibility economy’s dynamics, domain-specific indicators of epistemic (in)competence and (in)sincerity, and their corresponding relations to inflations and deflations will likely be tied to the interlocutors’ structuring roles. Within a hospital, for example, doctors may be routinely stereotyped as being “all-knowing” not simply with respect to biomedical expertise but about life in general, or criminal defense lawyers may be stereotyped as concerned with truthfulness only insofar as it can be manipulated, and so are perceived as insincere in their legal dealings. If our analytic focus is on the dynamics of a particular credibility economy, such role-based credibility stereotypes are useful to distinguish as they are likely to have distinctive credibility characteristics, even if their deployment may intersect with race, gender, or class-based stereotypes. I take this to be a potential benefit for revealing some of the complexity of the dynamics of credibility within a relevant economy, and whether, where, or to what extent ethically poisonous prejudice is at work. It may turn out that, on average, doctors who are women and/or people of color, for example, are not generally stereotyped in the “all-knowing” excessively inflationary manner to the same extent as their male and/or white peers. Such a possibility suggests that the distribution of the excessively inflated role-based credibility stereotype within the domain’s credibility economy can then be said to be prejudicial (independently of the evident inaccuracy of the stereotype). Another possibility for revealing where prejudice may be covertly at work is if a role-based credibility stereotype within a domain is empirically accurate or reliable but is nonetheless more negatively self-fulfilling and/or consequential for some social groups and perhaps not others. In such cases, we may uncover grounds for doubting the stereotype’s use on the basis of ethically poisonous prejudice concealed below the role-based dimensions. For example, a role-based credibility stereotype in medicine is that patients exaggerate their pain levels. Given the largely subjective nature of pain, the desire for relief, the widespread dependence on pain as an indicator for signs of disease, and the few nonsubjective tests for measuring it, doctors are

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especially epistemically reliant on patient testimony where patients seem most likely to exaggerate. As such, doctors might consider this stereotype reliable and practically effective (Hoffman and Tarzian 2001, 20). Even if this were the case, research suggests this stereotype is distributed across social groups differently. Women as patients are often perceived to be especially high in exaggerating their pain and are thereby more likely to suffer a lower credibility deflation than the stereotype might otherwise inflect (Hoffman and Tarzian 2001; Dusenbery 2018). People of color as patients suffer similar additional downgrading of their pain testimony by practitioners. The suggested explanation is the persistence of false beliefs once developed to justify slavery concerning differences in the physiology of black people (Hoffman et al. 2016). These examples suggest that within a domain it may be agreed that a role-based credibility stereotype is sufficiently reliable to be useful but its role-based dimensions may conceal ways negative prejudice seeps into and takes shape in its credibility economy. Mapping for domain-specific role-based credibility stereotypes can also reveal potentially problematic nonprejudicial elements. If we alter the “allknowing doctor” example making it inclusive of all doctors and constrained to biomedical expertise, it may be that although it is accurate to claim doctors know more about biomedicine than nondoctors, the credibility inflation may be judged to be too distorting to meet an accepted threshold of ethical and epistemic justification for practice. Alternatively, it may not because, for example, at initial points of contact it might, on average, serve patients better for establishing longer-term care relationships with their doctors (where the influence of the stereotype can recede with increased familiarity). It might be that where the stereotype is best unseated is not so much with respect to patients’ perceptions of doctors but of doctors’ expectations of themselves and their colleagues. In an analysis of the credibility economy’s dynamics, the degree and scale of the inflation or deflation embodied in a credibility stereotype and its associated effects on the different parties may be judged by practitioners, stakeholders, and researchers to be acceptable or unacceptable given that stereotyping is necessary and a determining factor in credibility assessments. In other words, inflations and deflations associated with credibility stereotypes may be more or less ethically and epistemically problematic from a practical standpoint in the relevant domain. To make these judgments of hybrid justification requires the input of those who practice and participate in these domains as well as those who, from outside the domain, can contribute valuable ethical and epistemic insights into what might not otherwise appear in more closed discussions of justification. One of the central benefits of mapping domain-specific role-based credibility stereotypes and their operations within high-stakes areas is that it can bring awareness to, and a basis for evaluations of these complex credibility dynamics— prejudicial and otherwise—within a credibility economy.

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IN THE CASE OF MEDICINE Havi Carel and Ian James Kidd apply the conceptual tools of epistemic injustice to medicine and healthcare (Carel and Kidd 2014, 2016, 2017). They show how viewing persistent complaints from patients about doctors and doctors about patients through an epistemic lens yields a significant degree of explanatory power. This is especially clear with respect to reframing well-worn sites and sources of tension, which are broadly and one-dimensionally termed “failures of communication.” Although patient and doctor complaints may in fact be failures of communication, viewing such failures through an epistemic lens—specifically credibility stereotypes—has the potential to bring fresh understanding to subtle interpersonal and institutional dynamics that variously block, mute, or obscure the necessary informational flow between the parties. Given that (1) the stakes can be extremely high, (2) that reliable informational flow between patients and doctors is essential to correct diagnosis, treatment, and outcome, and (3) that patients and doctors are typically strangers or acquaintances such that stereotypes are necessary and likely prevalent, uncovering the operations of positive and negative credibility stereotypes within medicine’s credibility economy may ultimately serve to improve communication and outcomes. Focusing on negative stereotyping of ill persons in medicine, Carel and Kidd write, [I]ll persons are often subjected to one or more of a range of negative stereotypes, which, though diverse, often include attributions which tend to undermine their epistemic competence and capacities. These include the stereotypical description of ill persons as cognitively impaired or emotionally compromised, owing either to their somatic condition or their psychological reactions to it (mutatis mutandis for psychiatric illness). . . . Such negative stereotypes will therefore tend to prejudicially deprive ill persons of the prerequisites of reliable epistemic conduct, such as cognitive capacity and psychological stability, and also attribute to them characteristics—like intensified emotionality—that are usually (and contentiously) supposed to be opposed to rationality and reliability. (Carel and Kidd 2016, 178)

The negative attributes that can be associated with ill persons are ones relating to cognitive impairment (i.e., irrational, illogical) or emotional instability (i.e., hysterical, overly anxious) which are characteristic indicators of epistemic incompetence or insincerity (i.e., epistemic untrustworthiness). What Carel and Kidd are describing, for my purposes, can be called “negative credibility stereotypes” relating to the role-based group “ill persons.” They claim that at the level of interpersonal exchange, practitioners may fall back on such negative credibility stereotypes “uncritically and unconsciously” as they are likely to operate “without focused awareness” and are “(typically)

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culpably resistant to evidence” (Carel and Kidd 2016, 5). Institutionally, they take such stereotypes to be generated and supported by structural features such as the nature of medical training and the authoritative dominance of third-personal biomedical knowledge, which can obscure the operations of the stereotypes. At the very least, the lack of awareness at individual and institutional levels motivates the value of stereotype mapping in medicine as a means of bringing their presence and operations into view for practitioners. At the level of interpersonal exchange, negative credibility stereotypes are likely to be active at initial points of contact between practitioners and persons seeking treatment and/or after diagnosis through a process of treatment. Although negative credibility stereotypes may be at work in the initial contact between psychiatrists and persons seeking or legally required to pursue treatment, the literature on epistemic injustice in psychiatry mainly addresses postdiagnosis examples. Psychiatrists Kyratsous and Sanati (2015, 2017), and Crichton, Carel, and Kidd (2017) have argued that there can be a powerful tendency among practitioners to overgeneralize any dysfunction identified in diagnosis to all aspects of a person’s cognitive and emotional competences and capacities. Kyratsous and Sanati (2015) analyze cases of delusions where diagnostic criteria include standard markers of irrationality such as “resistance to counter-evidence” and “lack of evidential support.” Where a patient has been diagnosed with suffering from delusions she becomes at risk of being subject to a self-fulfilling negative credibility stereotype whereby psychiatrists may interpret most or all of her testimony as deluded reinforcing a belief of global incapacity (for themselves, their colleagues and potentially the patient). Similarly, a self-fulfilling deflating credibility loop can arise from personality disorder cluster cases where deception and manipulation of self and others (i.e., lack of sincerity) are diagnostic criteria (Kyratsous and Sanati 2017). If the person has been diagnosed with Borderline Personality Disorder, for example, then the psychiatrist may overgeneralize and assume she lies and manipulates about everything, discounting much if not all of her testimony in circumstances where finding evidence for assessing veracity is often very difficult and too time consuming. In both examples, there is a prejudicial undercutting of a person’s capacity as a knower postdiagnosis. Part of what they imply is that the risk of overgeneralization of dysfunction can be an expert’s expression of the generic sociocultural prejudice that equates mental illness with a loss of rationality tout court and may be expressed in practice via unconscious dependence on domain-specific stereotypes. This level of analysis may be correct, but in order to analyze how the authority of psychiatric knowledge can generate and legitimate a deep prejudicial association between mental illness and a loss of epistemic status that is potentially so powerful as to reach all the way down to the loss of one’s basic status as a knower, we need to understand how the prejudice operates within the credibility dynamics of the domain. Being ex-

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perts, psychiatrists may not overtly express such blunt prejudice toward patients, but if it finds expression via credibility stereotypes associated with the epistemic features of diagnostic clusters, then psychiatrists may be covertly, and with specialist authority, exercising that prejudice in distinctively harmful ways. Given that central to what it means to be diagnosed with a mental illness is that specific cognitive and emotional capacities supporting what it is to be knower are “officially” considered impaired or offline (i.e., legitimate grounds for credibility deflation) and that many different attributes of incompetence and insincerity appear in official DSM V (APA 2013) and ICD-10 (WHO 2016) diagnostic criteria, I suspect that deflating credibility stereotypes operating within the confines of psychiatry’s credibility economy may be generated and supported by the content and authority of the classificatory system itself. If this is correct, a map can reveal how prejudice against mental illness finds expression in credibility stereotypes deployed by psychiatrists and potentially internalized by patients as well as provide a catalogue for analytic comparison with diagnostic criteria and their potentially deflating associations with insincerity and/or incompetence. Another pattern of credibility deflation emerges from women who report going to emergency rooms, not being believed about their symptoms and/or severity, and being sent home, sometimes to return repeatedly until practitioners recognize the need to investigate an underlying somatic cause (Hoffman and Tarzian 2001; Dusenbery 2018). This phenomenon has been partially explained in terms of present-day manifestations of historical stereotypes in medicine that associated women who were ill with being “hysterical” or that their illnesses were “all in their heads” (Herman 1997; Dusenbery 2018). In her recent book Doing Harm, Maya Dusenbery (2018) has written a careful analysis of the empirical research on this tendency to deflate the credibility of women in reporting their pain and symptoms across ages and illnesses including heart attacks, autoimmune diseases, and COPD. Built into this negative credibility stereotype blocking the flow of information is the idea that women as a social group suffer from a basic inability or difficulty in rightly knowing their own minds and bodies. In a context where the capacities to know one’s mind and body and be able to testify credibly to that awareness are fundamental, this negative credibility stereotype of women across age, race, class, and disease is clearly very damaging, inaccurate, and prejudiced. Not unsurprisingly, many women report avoiding, delaying, or fearing going to the doctor when ill because of concerns of not being believed (Hoffman and Tarzian 2001; Dusenbery 2018). Echoing the idea in the psychiatric cases of a potentially pernicious relation between its credibility stereotypes and the context’s governing system of knowledge, Dusenbery’s work illuminates how across medical conditions, compounding and reinforcement of the stereotype of women as hysterical can be traced to an historical and ongoing bias running through biomedical

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knowledge and research: it has largely been based on the physiology and experiences of the average white male (Dunsenbery 2018, 109–71). The institutional neglect of developing a better independent understanding of female physiology not only ignores the ways physiologies and experiences of disease may be different according to sex, it also, thereby, weakens claims for how they are in fact similar. If a doctor does not know, for example, that contemporary research shows women typically have different symptoms for heart attacks than men do, they may be more likely to misdiagnose suffering women who do not show the “conventional signs” (Dusenbery 2018, 109–35). Where this happens, it can be characterized as a case of epistemic vice on the part of the doctor because the knowledge is available, although it can also involve claims to prejudice in so far as the doctor may or may not have relied on this particular negative credibility stereotype. To what extent an individual doctor can be said to be prejudiced against women in this way, and to what extent biomedical knowledge and the institutional structures of medicine support and passively encourage the prejudice embedded in the negative credibility stereotype is a challenging question. Although it can only be properly addressed by those qualified to evaluate it, it suggests that gaining awareness of the presence and operations of this dominant stereotype across diseases could serve to improve interpersonal exchanges for practitioners and the women who seek medical help. It also opens the possibility of revealing where bias in existing biomedical knowledge and research may be passively supporting the stereotype. That is, there may be a self-fulling element: where biomedical knowledge has been founded and pursued on the basis of male physiology at the exclusion of female physiology so the empirical evidence that may serve to support the accuracy of the negative credibility stereotype can itself be biased in such a way as to reinscribe the stereotype. Even if women are educated in the signs of heart attack and can match their symptoms accordingly, the credibility stereotype may be activated against them should the doctor not be up to date. These women can then be seen as subject to a hermeneutical drift whereby the knowledge of differences in symptomology in heart attacks reaches the highest levels of empirical certainty without yet being sufficiently widespread to challenge dependence on outdated evidence, which can indirectly support the idea that the negative credibility stereotype is accurate. On the side of positive credibility, the previously discussed “all-knowing doctor” stereotype could be useful to track. Negatively, the stereotype may, for example, serve to prevent acknowledgment on the part of patients and doctors of the uncertainty and fallibility of professional judgment, and the epistemic limits of biomedicine encouraging unrealistic expectations and distorted communications for treatment and outcome. However, it might also temporarily aid in initial communicative exchanges because it helps patients feel more at ease believing someone has the answers they need. Understand-

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ing the influences of the stereotype and mitigating its negative impacts might be best directed to practitioners who can use language that acknowledges uncertainty and fallibility. From this example and the negative ones, we glimpse a complex situation where credibility stereotypes between parties are necessary, where patients being perceived by practitioners as credible testifiers is essential to diagnosis, treatment, and outcome; and yet, when ill persons present with indicators of epistemic untrustworthiness as part of their condition and/or where their symptoms do not match existing biomedical knowledge, practitioners might read them as flagging signs for doubt or mistrust. Unless a negative credibility stereotype is baldly prejudicial, for example, it will be challenging to distinguish where credibility deflations associated with negative stereotypes are predominantly owing to individual and/or institutional prejudices and where they may be arising in zones of greater legitimacy because (a) signs of disease may be associated with familiar attributes of untrustworthiness and/or (b) current biomedical knowledge and research is shaped by biases and limited. Between the individual and institutional levels, moreover, there may be self-fulfilling elements whereby psychiatric and biomedical knowledge systems can support the supposed accuracy of a credibility stereotype that is negatively prejudiced passively encouraging its usefulness in practice. A way to mitigate some of this complexity would be to create distinct maps, with one for “ill persons” subdivided into categories of somatic illness for further precision (heart disease and stroke, autoimmune diseases, cancer, etc.), another for mental illness and its distinct categories (personality disorders, delusions, cognitive impairments, etc.), and one focused on practitioners. In each case, deeper analysis on how the dominant credibility stereotypes—positive and negative—can operate intersectionally with respect to race, sex, gender, class, weight, and age can then be illuminated. Finally, if such maps were created in medicine and other high-stakes domains, a helpful epistemological frame for making evaluations of credibility stereotypes is that these domains are structured by wide and stable epistemic asymmetries between professionals/experts and laypersons. Characteristic of these sorts of epistemic asymmetries is a justified domain-specific epistemic authority to the professional/expert that has significant influence on domain-specific norms governing inflations and deflations. In the case of medicine, asymmetries in biomedical or psychiatric knowledge structure communication. Doctors are expert in biomedical models for understanding illness and disease so though they may not know what the phenomenological experience of living with a particular illness is like, they will know important aspects of a person’s illness and treatment patients are unlikely to know. In their position as hearers, doctors are attributing and assessing patient credibility in relation to their biomedical expertise, which is related to but distinct from first-personal understanding of illness and disease.

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In medicine much depends on layperson testimony in a context where the authority of biomedical knowledge is dominant. Given that the practice depends on the information offered by patients, and determinations of testimonial credibility are filtered through practitioners’ expertise in biomedical knowledge, it seems likely there will be routine and more or less justified credibility deflations of patient testimony with respect to biomedical understanding of illness and disease as well as inflations of practitioner testimony with respect to the authority of biomedical knowledge. Making such dynamics more complex, patients are often understandably in heightened states of physical and/or psychological vulnerability and uncertainty, which can be an additional source of credibility deflation (e.g., “merely anxious,” “overly emotional”). Although the contextual dominance of biomedical knowledge may function with patient vulnerability to encourage a standing susceptibility to perceive patients on a sliding-scale as mere laypersons, the ethical-epistemic baseline is that patients’ basic status as knowers is not undermined tout court (Carel and Kidd 2016, 175). Therefore, when evaluating a particular negative credibility stereotype, a key aspect of whether it can be ethically and epistemically justified will turn on whether or to what extent it encourages deflation to a level that functions to remove one’s basic status as a knower, as in the examples of women being stereotyped as hysterical about their suffering and patients diagnosed with delusions stereotyped as globally irrational. If we take together the fact that patients and practitioners are often strangers, that patients are often in states of heightened vulnerability, and that the credibility economy is dominated by biomedical knowledge structuring a wide and stable epistemic asymmetry, then the contextual dependence on credibility stereotypes for all parties becomes salient. Mapping the dominant credibility stereotypes can then be useful, first in bringing awareness to the presence and influences of such stereotypes in communication and, second, in providing a basis for clarifying whether, where, and to what extent its credibility stereotypes can be understood as straightforwardly or more subtly partaking in forms of prejudice. Which ones are purely pieces of negative prejudice and so ought to be actively erased via institutional and procedural mechanisms? Are there others that are generally useful and justified in practice but may sometimes lead to negative prejudice? Are there some that are so entrenched institutionally they are more resistant to individuating information or counterevidence? Which ones are most influenced by biases and gaps in biomedical knowledge and so may be supported by and indicative of hermeneutical gaps or collective epistemic bad luck? What sorts of epistemic vices may be related to the credibility stereotypes? Given the scale and authority of the asymmetry, what epistemic vices are practitioners likely to fall into? Increased clarity about these questions is important if we aim to mitigate instances of epistemic injustice by instituting structural mechanisms to shape and encourage behavioral changes. In light of the necessity and

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fallibility of credibility attributions and the influential mechanism of stereotypes, some ways of improving conditions for epistemic justice could be: changing wording in questionnaires; architecting medical education and professional training to reflect the influences of stereotypes on communication; translating stereotype map findings into visual tools for easy reference in medical education, in professional training, and for patient awareness; instituting postvisit reporting mechanisms for tracking practitioner judgments over time to get clearer on frequency and types of errors; increasing practitioner and patient awareness about biases, gaps, and the limits of biomedical research and knowledge; creating separate diagnostic streams for illnesses that are not well understood (e.g., autoimmune diseases) or establishing clinic hours that focus on treating particular social groups. CONCLUSION Openly and honestly addressing negative prejudice where it actually lives and the many subtle forms it takes is an important step toward ameliorating its operations. However, even the acknowledgment of the manifestations of prejudice can be extremely difficult to do. The challenges aren’t simply owing to how prejudice can obscure and conceal its presence, making it slippery and hard to pin down. They are also connected to our sometimes deep investments in maintaining robust images of ourselves, others, and our institutions as above reproach, which can resist clear-eyed moral perception of prejudice and subsequent calls to action with respect to its injustices, epistemic and otherwise. If we cannot see the manifestations and operations of prejudice with acuity, then the pressures to take reparative or ameliorative action can remain vague and underground. These sorts of considerations lead me to think an indirect strategic approach, such as mapping credibility stereotypes as a means to uncover where prejudice is more or less active, may be especially useful in first bringing about acknowledgment of the realities of such dynamics in domains where epistemic injustices can have enduring damaging effects. Of course, acknowledgment is only the beginning and any efforts to improve conditions of epistemic justice in these important domains will depend on the hard work of those individuals and groups who are best placed to know what can be done and to realize it on the ground. REFERENCES American Psychiatric Association [APA]. 2013. Diagnostic and Statistical Manual Of Mental Disorders, fifth edition. Arlington, VA: American Psychiatric Publishing. Carel, Havi, and Ian James Kidd. 2017. “Epistemic Injustice in Healthcare: A Philosophical Analysis.” Medicine, Health Care and Philosophy 17: 529–40.

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Carel, Havi, and Ian James Kidd. 2016. “Epistemic Injustice and Illness.” Journal of Applied Philosophy 34 (2): 172–90. Crichton, Paul, Havi Carel, and Ian James Kidd. 2017. “Epistemic Injustice in Psychiatry.” BJPsych Bulletin 41 (2): 65–70. Dusenbery, Maya. 2018. Doing Harm: The Truth about How Bad Medicine and Lazy Science Leave Women Dismissed, Misdiagnosed, and Sick. New York: HarperCollins. Fricker, Miranda. 2007. Epistemic Injustice: Power and the Ethics of Knowing. Oxford: Oxford University Press. Herman, Judith Lewis. 1997. Trauma and Recovery. New York: Basic Books. Hoffman, Diane, and Anita Tarzian. 2001. “The Girl Who Cried Pain: A Bias against Women in the Treatment of Pain.” Journal of Law, Medicine, & Ethics 29: 13–27. Hoffman, Kelly, Sophie Trawalter, Jordan Axt, and M. Norman Oliver. 2016. “Racial Bias in Pain Assessment and Treatment Recommendations, and False Beliefs about Biological Differences between Blacks and Whites.” Proceedings of the National Academy of Sciences of the United States of America 113 (16): 4296–301. ———. 2017. “Epistemic Injustice in Medicine and Health Care.” In The Routledge Handbook of Epistemic Injustice, edited by Ian James Kidd, José Medina, and Gaile Pohlhaus Jr., 336–46. New York: Routledge. Kyratsous, Michalis, and Abdi Sanati. 2015. “Epistemic Injustice in Assessment of Delusions.” Journal of Evaluation of Clinical Practice 21 (3): 479–85. ———. 2017. “Epistemic Injustice and Responsibility in Borderline Personality Disorder.” Journal of Evaluation of Clinical Practice 23 (5): 974–80. World Health Organization [WHO]. 2016. International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10).

Chapter Eleven

Epistemic Injustice in Careers Insights from a Study with Women Surgeons Katrina Hutchison

This chapter draws on findings of a qualitative interview-based study with women surgeons. I present analyzed data from the study, which illustrates epistemic dysfunction and credibility deficits experienced by women surgeons in their interactions with patients. 1 A key question of the chapter is whether these experiences are appropriately classified as epistemic injustices. I will argue that while only some of the findings fit Miranda Fricker’s theory of epistemic injustice, recent work by Gaile Pohlhaus Jr. on different varieties of epistemic injustice and by Katherine Hawley and Alexis Shotwell on epistemic injustices associated with knowledge-how better characterize the epistemic harms women surgeons experience. Theories of epistemic injustice have potential to illuminate a variety of real-world situations in which significant consequences can result from, for example, misjudging the credibility of a knower. One such context is the workplace. Bias in the workplace has received considerable attention from those keen to analyze its causes and potential solutions. Pressure is mounting to explain and address material differences in remuneration (the “gender pay gap”) and to address the underrepresentation of marginalized groups in careers, especially careers that are well paid or involve the exercise of political power. Even within our own discipline of philosophy there has been considerable concern about the underrepresentation and low status of women and racial minorities (for example, see Haslanger 2008; Calhoun 2009; Dotson 1. My focus is on epistemic injustices experienced by surgeons. Patients also experience significant epistemic injustices in clinical contexts, a point that has been argued convincingly elsewhere (e.g., Carel and Kidd 2014; Kidd and Carel 2017; and Buchman et al. 2017).

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2013; Botts et al. 2014; Baron, Dougherty, and Miller 2015; Schouten 2015; Hutchison and Jenkins 2013). Surgery provides an interesting case for exploring gender bias in the workplace. Patterns of gender bias are evident in surgical training and practice, particularly in the underrepresentation of women within the profession (Royal Australasian College of Surgeons 2016; Royal College of Surgeons 2018). This is worse in leadership and academic roles (Cochran et al. 2013; Zhuge et al. 2011). Women surgeons also receive less pay on average than their male peers (Savona 2018). Most research on the underrepresentation of women in surgery has focused on macroscopic factors. These include lifestyle factors such as life balancing, workload, and parental leave entitlements; the availability of role models and mentors; and the impact of sexual discrimination and harassment (e.g., Park et al. 2005; Hoover 2006; Saunders, Nichevich, and Ellis 2008; Turner, Lumpkins, and Gabre 2012; Fitzgerald et al. 2013). These are serious issues for women surgeons, but it is likely that subtle factors also contribute to women’s underrepresentation and low status. Epistemic injustice may be one such factor. Knowledge, power, and identity stereotypes are key ingredients in epistemic injustice as characterized by Miranda Fricker (2007). They are also features of surgery, making it a good case study of the applicability of epistemic injustice to workplace inequity. Specialized knowledge is central to the role of the surgeon. Becoming a surgeon requires significant education. Fully qualified surgeons have usually undertaken at least twelve years of formal study. Not only does surgery require expert knowledge, but the practice of surgical care centers on patients seeking this knowledge from surgeons. It seems appropriate to characterize the practice of surgical care as a knowledge practice because it is due to the specialist expertise that surgeons have, and that patients seek, that the surgeon-patient relationship exists. And it is the communication and application of this knowledge (consulting with the patient, making diagnoses, and performing successful surgery) that most fundamentally characterizes the surgeon’s role. In addition to the central role that knowledge plays in surgery, it is also a career that involves significant power. Surgeons are at the top of the clinical hierarchy (Rosoff and Leone 1991). While some question the appropriate extent and nature of surgeon power, it is appropriate that surgeons hold some power due to their expert knowledge and skill. The surgeon is the leader of the operating team, with ultimate responsibility for clinical decisions. Not only is surgery a nexus of knowledge and power, it is also associated with stereotypes, particularly gender stereotypes. For example, a recent study with medical students found that surgery was strongly associated with masculinity, self-confidence, and competitiveness (Hill et al. 2014). All these

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features make surgery an interesting case study for exploring the effect of epistemic injustices on women’s careers. A QUALITATIVE STUDY WITH WOMEN SURGEONS For the empirical study I conducted in-depth, semistructured interviews with forty-six women surgeons from across the nine recognized surgical specialties in Australia: general; cardiothoracic; neurosurgery; orthopedics; otolaryngology head and neck; pediatric; plastic and reconstructive; urology; and vascular surgery. All career stages were represented, including trainees, recently graduated fellows of the college, and consultant surgeons. Recruitment was supported by advertisements in the Royal Australasian College of Surgeons’ newsletters. Snowball methods were also used, with some participants circulating an invitation to others in their networks. The participants were diverse across many aspects of identity, including cultural background, social class, and sexuality. Written information was provided to prospective participants, and consent was obtained in accordance with Australia’s National Statement on Ethical Conduct in Human Research (National Health and Medical Research Council 2007). Interviews took place in person, by telephone, or by video link. They were guided by a set of open-ended questions about career motivations, barriers, and supports, interpersonal dynamics with colleagues and patients, and training experiences. 2 The prompt guide was intended to elicit deep reflections on various aspects of surgical training and careers, without preempting the types of experiences participants might discuss. For example, participants were asked about the interpersonal dynamics involved in being a surgeon and encouraged to discuss these in relation to different groups they interacted with (such as patients, nurses, and surgical colleagues). Although this question was intended to elicit examples of gender bias, including epistemic injustices, participants were not prompted to respond in terms of gender, and I did not introduce concepts such as epistemic injustice or implicit bias. All interviews were digitally recorded. Interview length varied from thirty minutes to over two hours. Interviews were professionally transcribed, and identifying information (such as names and places) removed. Transcription and analysis occurred concurrently with data collection to ensure that the findings from early interviews could inform subsequent interviews, and to make it possible to identify when saturation of data occurred. The initial analysis revealed significant material in the interviews relating to the epistemic roles and interactions of participants. A research assistant provided support in identifying this material, and we worked together on an iterative analysis of this data. This chapter 2. Prompts can be provided on request (email: [email protected]).

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is informed by a subset of this data—that relating to interactions between patients and surgeons. The study was approved by the Macquarie University Human Research Ethics Committee (Approval #5201700117) and was designed and conducted in accordance with Australia’s National Statement on Ethical Conduct in Human Research (National Health and Medical Research Council 2007). RESULTS I found two broad types of challenge arising for women surgeons in their encounters with patients. The first involved patients making assumptions or treating the surgeon in ways that disrupt the knowledge encounter. The second type involved patients misjudging the credibility of the surgeon, including both credibility deficits and credibility excesses associated with their gender. Disruptions to the Knowledge Encounter Two sorts of disruption to the knowledge encounter are reported: patients mistaking the roles of women surgeons by assuming they were not the surgeon; and patients sexualizing the encounter so that it did not unfold like a normal clinical encounter. Being Misidentified An experience frequently described by surgeons in the study was the failure of patients to recognize them as the surgeon. For example: you do the consultation, you tell someone what they need and you sign the consent and book them for the operation and they’d say, “But who’s actually going to do the surgery?” (Laughs) So I think they thought maybe you were just the surgeon’s helper. [P16]

Different patients react differently to learning that the woman is their surgeon. Some patients are delighted when they find out that their surgeon is a woman. Describing an interaction with an elderly patient, one participant said: And we had this chat, and at the end she did the usual thing of, “So, wonderful, girls. So, when are we going to meet the surgeon?” That’s at the end of it. And her husband and daughter, to their credit, turned around and said, “That is the surgeon.” And you could see, she had this “What the fuck?” like, in a good way, and then she goes, “My goodness! A lady doctor! Would you believe it?” [. . .] She was really happy and proud of us, but she was, “Three lady doctors, and one of them’s a lady surgeon! My goodness.” [P15]

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Most participants described patient reactions as neutral. A typical response was described by participant 18: They’ll say, “Who will be doing the operating?” and usually when I say, “It’s me!” they’re quite relaxed about that, because you’ve had so much invested in them, and vice-versa. [P18]

However, in some cases patient’s mistakes lead to the professionalism of the surgeon being questioned: During my country rotation [the consultant] came to me one day and he said “[. . .] I have to ask you: have you been seeing the patients each day?” I’m like, “Yes, I have been seeing the patients each day.” He said “Yeah, I thought so. Mrs So-and-So, she said she hadn’t seen a [surgeon] for a week.” [P44]

The patient’s mistake in this case led to the serious accusation that the trainee surgeon had not been completing her rounds. Many surgeons modified the way they introduced themselves to patients to minimize such mistakes: “since I was an intern, I’ve always introduced myself as the doctor” [P41] although this was not always successful, as one surgeon recounted: I’m like, “No! I’m your doctor! I’m the senior person!” (Laughs) I said it to her. It didn’t make any difference. [P9]

Sexualization of the Surgeon/Patient Relationship Another type of disruption described by some participants involved the clinical encounter being sexualized by the patient. One described an interaction with an older patient who had had a circumcision. She hadn’t met the patient before because she was filling in for a colleague: I said, “Yes, so are you comfortable? Any issues? I think the guys have already told me they’ve had a look at your wounds,” and everything. I was as professional as I normally am. And this guy turned around and looked me up and down and goes, “You’re lucky it’s sore down there, because if it wasn’t, I’d have a real good go!” [P15]

These comments cut short the encounter between the surgeon and the patient. She told me: “I was like, ‘On that note, I think you’re OK to go home today. I’m just going to go now!’ And I left” [P15]. The patient lost the opportunity to benefit from the surgeon’s knowledge in this final consultation before being discharged from the hospital. Others described dealing with instances of sexual harassment from patients. For example: “I’ve been kissed inappropriately by a patient” [P4]; “I

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had one or two patients try and get a bit familiar” [P34]; and “I have one patient who insists on patting me on the backside every time he left my consulting room” [P30]. Another surgeon was stalked by a patient: I had a stalker! That’s one interpersonal relationship that I wasn’t very happy with. He’d been a patient [. . .] I kept saying no and in the end I had to go to the police. [P28]

In some cases sexualization of the encounter can have other consequences: I did have this one man, you know, he had anal pain so I asked to examine him and he said—he started making all these weird jokes, like, “Oh, you have to buy me dinner first!” You know: “Give me your phone number.” I was like, “Oh, look, this is just part of the examination” or whatever. So I examined him. And then he made a complaint about me that I was being inappropriate. [P35]

As described, this surgeon was the subject of a complaint about “inappropriate” care after a patient sexualized a consultation that she was trying to keep clinically focused. 3 Even in relatively minor cases surgeons made connections between sexualization and credibility. For example, one trainee surgeon relayed the following patient comment about her appearance: “You don’t look like any surgeon I’ve ever seen! In my day, surgeons were old, white men, but I like the look of you a lot better!” [P38]

Reflecting on this comment, she said: I don’t expect a patient to respect me when they meet me, but I expect they will respect me by the end of my consultation with them, because I know what I’m talking about, and it’s clear, talking to me, that I know what I’m talking about. [P38]

Although the patient’s comment is not about expertise, the surgeon hears it as implicating her knowledge, something she then consciously attempts to address.

3. Intimate examinations raise challenging ethical questions, and involve risks for both patient and doctor. See note 5 of this chapter.

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Credibility Deficits and Excesses Many surgeons in the study described reactions from patients that indicated a prejudgment of the surgeon’s knowledge or skill based on her gender. These prejudgments took the form of both under- and overestimations of expertise. Credibility Deficits Some reactions from patients directly impugned the surgeon’s knowledge. Often these took the form of patients querying the surgeon’s qualifications, age, or experience: “So, it’s still not uncommon to have people [ask] have you qualified?” [P2]; and “They will often ask me how many times I’ve done the procedure” [P3]. At times, patients failed to take clinical advice seriously when it was given by a woman surgeon: “they potentially don’t take me as seriously as they would take a male consultant” [P30]; and “there were some where they didn’t believe me because I was a woman” [P4]. One participant described a patient who would not follow postoperative instructions until they were given by a male surgeon: he said, “You can’t do this!” And she goes, “Oh, OK! Thank you, Doctor.” We’d been telling her for a week! So frustrating! [P9]

Many surgeons described strategies for minimizing patients’ uncertainty in them: That’s the initial consultation, and getting them to trust you [. . .] when you’re a young female and you don’t physically embody the general perception of a surgeon, which is a middle-aged man in a suit [. . .] You just have to ignore the obvious hesitation and just win them over slowly with competence and, hopefully, excellence. [P3]

This surgeon accepts that as a “young female” the onus will be on her to “win over” hesitant patients who question her expertise. Other surgeons echoed this theme of overcoming uncertainty and cultivating patient trust. One said: some of them, maybe older male patients, will sometimes be suspicious and think that you’re probably not going to give them the right diagnosis, and maybe the male doctor will be better. [P29]

But she continued, I think usually once you’ve spent enough time with them, you can build trust with those patients as well. [P29]

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Surgeons also drew connections between patient judgments of credibility and the private practice fees they charged: patients go, “Oh, she’s cheap. Maybe she’s not that good.” [P33] I hate coming back to money, but to me that seems like it’s possibly the most objective way of saying how I think the patients see me. Are they willing to pay me? [P39]

Gender was perceived to affect pay in multiple ways. Several participants felt they were more sympathetic about patients’ financial struggles than male colleagues, while others felt that some patients expect women surgeons to be cheaper: “She’s just a female doctor. Why is that really expensive?” [P13] Sometimes it wasn’t clear if it was age, race, gender, or a combination that the patient was reacting to when expressing uncertainty. Reflecting on apparently biased reactions from patients, one surgeon said: I’m in my early forties, which, if you’re a man in your early forties, it wouldn’t be an issue, and I suppose it’s worse because I’m Asian and we tend to look younger than we are, anyway, but one gentleman said to me, as we were doing the consent, he said, “Have you been doing this for long?” and I said, “Oh, yes. About ten years now, as a consultant.” And he looked at me astounded and said, “Girl, I’ve got beer in my fridge older than you!” [P5]

Many of the surgeons elided age and gender when describing patient uncertainty: So sometimes people will be like, “I don’t want to see you because you’re too young, or you’re a female,” or whatever. [P35]

The tendency to think gender and age go together was also apparent when participants referred to themselves and other women surgeons as “girls.” For example, “I know a girl now who’s doing orthopedics” [P41]; and “I’m just not a very girlie girl” [P42]. More than half the participants referred to women surgeons as girls during the interview, and this cut across all ages and career stages. Credibility Excesses In addition to the patterns in the data indicating credibility deficits, patients also expected women to be better at some aspects of surgical care. The commonest involved communication, including communication of diagnoses, treatment choices, and explaining technical aspects of the procedure. This was apparent in the number of surgeons who described being frequently sought for second and third opinions:

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I, at one stage, had to refuse to see second and third opinions. At one stage the staff said, “About ten percent of your patients are second or third opinions [. . .]” [P20] I went through a period of time seeing quite a lot of men who wanted to just get another opinion. And I think that that was also that thing of, “Look, he hasn’t really told me anything and I’m terrified. Can you just explain it to me?” [P46]

Often, once patients had been reassured, “they’d go back to the original surgeon!” [P46] These positive expectations about communication were not, however, limited to clinical aspects. There was also an expectation that women would better understand emotional issues: “they know I’m probably likely to understand—in their mind, as part of the stereotype” [P2]. And that they could be trusted with embarrassing details of illness: “it has the advantage of them feeling like they can mention an awkward symptom” [P21]. Some women surgeons cultivated their communication skills to meet these expectations: I know that I can’t be as offhand as some of my male colleagues and just respond to something in a very male way, because patients [. . .] potentially have selected you because they think you’re going to be something different. [P44]

When women met these expectations and provided good communication it was valued by some patients but was not equally valued by surgical colleagues, who sometimes reacted with “frustration and mocking” [P39]. It could also impact the perceived professionalism of women surgeons who “run late more” [P22]. Women were also presumed to have special knowledge relating to the female reproductive organs: I do think the young women with slow-growing brain tumors, there probably is a little bit of a bias to wanting a woman to look after them, and as much as I don’t have children, so I don’t know quite how that works, it is that sort of . . . whether or not to have a baby, and the mechanics of that, is a big deal for them, and I’m comfortable navigating that for them. [P11]

Although this surgeon felt confident supporting these patients, she did not have the firsthand knowledge implicit in the stereotype. Participants did not generally describe credibility excesses relating to the performance of surgical operations, such as dexterity or surgical skill, although one surgeon said patients sometimes say: “Oh, look at your beautiful stitching. How nice the wound is!” [P5].

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DISCUSSION The results reveal multiple ways in which the knowledge encounter between women surgeons and their patients is distorted by the gender of the surgeon—by gender stereotypes and biases. This interferes with the knowledge exchange between women surgeons and their patients and can create challenges for women surgeons in establishing credibility. In the remainder of the chapter I explore whether these biases are appropriately characterized as epistemic injustices. Is the Misidentification of Women (as Not) Surgeons a Type of Epistemic Injustice? The results of the research suggest that women surgeons are sometimes assumed not to be the surgeon by patients. One way of understanding these judgments about who is a surgeon is as proxy judgments about expertise. Patients seek out clinicians due to their expert knowledge. When they ask, “But who’s actually going to do the surgery?” [P16] they reveal an expectation that the woman is not the expert whose knowledge and skill the patient seeks and will be relying on for the treatment of their condition. Insofar as the surgeon’s role is characterized by her specialist knowledge, the failure to correctly attribute the role to the individual surgeon is also a failure to attribute this knowledge or expertise to the woman. It involves a stereotyped assumption about what sort of knowledge and skills the woman is likely to have. In this sense it is plausible that these misidentifications are what Miranda Fricker has called “distinctively epistemic” injustices, involving “a wrong done to someone specifically in their capacity as a knower” (Fricker 2007, 1). Recently, Gaile Pohlhaus Jr. has argued that epistemic injustices can be distinctively epistemic in another way: by causing “epistemic dysfunction, for example by distorting understanding or stymieing inquiry” (Pohlhaus 2017, 13). Cases of misidentification may be better characterized in terms of dysfunction than in terms of credibility deficit, as they can cause significant downstream epistemic harm. Patients who do not believe they have met the surgeon yet may not have fully described relevant symptoms or concerns, and may not have asked important questions. The surgeon, too, can be affected. Her knowledge of relevant clinical information may be incomplete, with implications for treatment, follow-up, and patient outcomes. She may also experience the misidentification as impugning her credibility and modify aspects of the consultation, as described in the results (“I’ve always introduced myself as the doctor” [P41]; “No! I’m your doctor! I’m the senior person!”[P9]).

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Sexualization, Epistemic Injustice, and Care Sexualization can affect the surgeon/patient encounter like an extreme form of misidentification: rather than relating to the woman as a surgeon and clinical expert, the patient relates to the woman as though the encounter is a prospective sexual encounter. Nevertheless (unlike in misidentification cases) the patient may know that the woman is the surgeon and be disposed to regard her advice and technical skills highly. According to Fricker, epistemic injustice can sometimes occur despite the speaker being treated as credible. Individuals such as Tom Robinson in To Kill a Mockingbird continue suffering epistemic injustice even in contexts where his word is believed, such as “on many an issue relating to the harvest” (Fricker 2007, 135). Fricker argues that such cases involve epistemic injustice because the speaker is treated as an object rather than a subject in the knowledge exchange, a source of information but not a true participant. 4 Fricker calls this “epistemic objectification” (2007, 133), an idea informed by feminist work on sexual objectification. She suggests that sexual objectification can cause epistemic objectification. For example this can occur when men are exposed to women as sexual objects (e.g., by watching hard-core pornography) and come to view all women through this lens. In such cases the man “never really hears the woman at all—her utterance simply fails to register with his testimonial sensibility” (Fricker 2007, 140). Some of the examples of sexualization presented in the results, such as the patient who had just had the circumcision and the patient who complained following the intimate examination, might admit this analysis. In these cases the patients do seem unable to see past the woman surgeon’s physical body. This physical objectification disrupts their ability to interact with and “hear” her as a surgeon. 5 It can also cause epistemic dysfunction, as when the surgeon cut short the consultation with the circumcision patient. Other cases described in the results are less open to this analysis, because the patient’s ability to “hear” the surgeon remains intact. Even when the patient in fact regards the surgeon as credible, sexualization can be experienced by women surgeons as conveying a negative cred4. For this purpose, Fricker adopts a distinction by Edward Craig between seeing someone as an informant versus seeing them as a source of knowledge (Craig 1990). 5. The circumcision case and the anal examination case are, however, difficult to analyze for another reason: they involve intimate examinations. Intimate examinations give rise to significant ethical challenges. They can be confronting for both patients and doctors. For the doctor, the risk of embarrassment and discomfort associated with performing an examination must be weighed against the risk of making a significant diagnostic error due to avoiding it (Hine and Smith 2014). There is also some evidence that negative experiences with intimate examinations occur more frequently for surgeons than for doctors in other medical specialties (Rees, Monrouxe, and McDonald 2013). A clear assessment of the nature of epistemic injustices toward surgeons in these cases may be impossible due to the patient’s vulnerability in the context of intimate examinations.

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ibility judgment. This is illustrated by the case of the woman trainee who responded by showing the patient that “I know what I’m talking about” [P38]. Surgeons may experience epistemic harm from sexualization irrespective of patients’ underlying views of their credibility. As in the misidentification cases, sexualization of the clinical encounter places a burden on women surgeons to establish their role and competence. Credibility Deficits and Excesses for Women Surgeons: What about Knowledge-How? In contrast with misidentification and sexualization, the credibility deficits and excesses reported in the results (3.2.1 and 3.2.2) involve direct under- or overascriptions of credibility to women surgeons. Some of these credibility deficits fit Fricker’s notion of testimonial injustice, as with patients who “didn’t believe me because I was a woman” [P4]; “don’t take me as seriously as they would take a male” [P30]; or “think that you’re probably not going to give them the right diagnosis” [P29]. However, other expressions of uncertainty seemed to focus on the performance of the surgical procedure (“One gentleman said to me, as we were doing the consent, he said ‘Have you been doing this for long?’” [P5]; or “They will often ask me how many times I’ve done the procedure” [P3]). The sort of knowledge involved in the performance of surgery is sometimes referred to by philosophers as “knowledge-how” in contrast with propositional knowledge, or “knowledge-that.” Miranda Fricker’s account of epistemic injustice focuses on propositional knowledge. Subsequently, a small number of philosophers have expanded the conception of epistemic injustice in ways that encompass knowing how. Katherine Hawley has explored whether judgments about knowledge-how can involve epistemic injustice. Her analysis focuses on two perspectives that are central in the quest for someone who possesses knowledge-how. The apprentice seeks someone who knows how to do something because they want to learn. The client seeks someone who knows how to do something because they want something done. Of these two perspectives, the perspective of the client is closest to that of a patient who seeks a surgeon. Hawley argues that clients can underestimate knowledge-how due to prejudice, and when they do so this is a distinctively epistemic injustice that harms the person as a knower (Hawley 2011, 294). In at least this sense, Hawley argues that Fricker’s theory of epistemic injustice should be extended to recognize epistemic injustices in knowledge-how. Hawley’s contribution is made against the backdrop of an ongoing debate about the relationship between knowledge-how and propositional knowledge. Some philosophers, usually termed “intellectualists,” argue that there is only one type of knowledge—propositional knowledge—and that the knowl-

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edge (as opposed to ability) involved in knowing how to do something can be reduced to this (e.g., Stanley and Williamson 2001), while their opponents disagree. Recently Alexis Shotwell has proposed a new argument against intellectualism. She argues that intellectualist approaches offer an impoverished—and indeed biased—perspective on knowledge, because “focusing on propositional knowledge as though it is the only form of knowing” (2017, 79) is not only incorrect, but also constitutes an epistemic injustice. One of her arguments against reducing knowledge-how to propositional knowledge is that intellectualist accounts of knowing how are unable to capture what is lost in cases of profound bodily change. Drawing inspiration from one of Stanley and Williamson’s own thought experiments, she explores the epistemic consequences for a master pianist of losing her arms. She then draws upon real cases—Julie Andrews’s loss of her singing range, and former US Marine Claudia Mitchell’s loss of an arm—to further ground her arguments. Shotwell argues that these agents—imagined and real—suffer significant losses in their knowledge when they lose these embodied abilities. As just one example, a master pianist who loses her arms does not simply lose the ability to play the piano in contrast with the knowledge pertaining to doing so. Her skill is maintained partly through a strict regime of practice, something she cannot now do. She may also gradually lose the brain-basis of the knowledge due to cortical reorganization. Furthermore, she loses the identity of being a master pianist, meaning that her identity as someone with a particular sort of know-how is affected. This impacts the way she is seen by others (with implications for attributions of credibility and expertise). Shotwell argues that not only does reducing knowledge-how to propositional knowledge mischaracterize what is lost or changed in this sort of situation. It is also unjust. It describes away the experiences of specifically those who have experienced profound bodily change, including acquired disability. It also obscures inequities in access to attainment of knowledge-how that may be due to disability or to material or political disadvantage. My study does not provide new empirical insight into the arguments about profound bodily change. However, Shotwell’s argument in support of the irreducibility of knowledge-how is consistent with descriptions of surgical skill, which is experienced by surgeons as complex and enmeshed with (but not reducible to) propositional knowledge. Performing surgery has been described as a form of embodied knowledge incorporating the application of a deep understanding of anatomy and physiology; rich professional memory; problem-solving ability; and automated processes including technical skills. All these aspects working together underpin the ability to make appropriate decisions and thus operate successfully under pressure (Hall et al. 2003). Surgery, then, provides a good illustration of some of the strengths of Shotwell’s account of knowledge-how.

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Women surgeons in the study described being sought for their (perceived) ability to communicate propositional knowledge to patients (including being sought for “second and third opinions” [P20]). In contrast, there were few examples of credibility excesses relating to surgical skill, except the surgeon whose was praised for her “beautiful stitching.” This tendency of patients to positively associate women surgeons with communication of the theoretical aspects of surgery, rather than with skillful performance of surgical procedures, means that epistemic injustices associated with knowledge-how may be particularly common for women surgeons. Insofar as this is true it is consistent with Shotwell’s contention that members of socially marginalized groups may be disproportionately affected by injustices associated with knowledge-how. It is also worth noting that many careers involve knowledge-how. Hawley and Shotwell’s expansion of the concept of epistemic injustice to this type of knowledge thus makes the theory more applicable to workplace contexts. Credibility Excesses, Care, and Epistemic Labor Exploitation The credibility excesses identified in the study suggest that patients expect women surgeons to be good at the care aspects of surgery—communication, empathy, and appropriate handling of awkward symptoms. However, despite being sought by some patients, these aspects of care are not materially valued. Women surgeons connected their lower pay to patient perceptions about the material value of the services they offer (“Are they willing to pay me?” [P39]), and thought patients expected them to charge less (“She’s just a female doctor. Why is that really expensive?” [P13]). Much has been written on the topic of gender and care, and one recurring theme is the undervaluing of care work. This includes the unpaid status of care work in the private sphere and the relatively low wages paid for care work such as nursing and childcare in the commercial sphere (e.g., Meyer 2002; England, Budig, and Folbre 2002; England 2005; Abel and Nelson 1990). Pohlhaus describes the invalidation and exploitation of epistemic labor as forms of epistemic injustice (Pohlhaus 2017, 21–22). These occur, respectively, when epistemic labor is not acknowledged or when it is exploited or undervalued. Arguably both these types of epistemic labor injustice are found in women surgeons’ interactions with patients. The epistemic aspects of good communication and empathy may be unacknowledged, constituting a form of what Pohlhaus calls epistemic labor invalidation. The fact that the aspects of surgical practice that women are expected to excel at seem less materially valued constitutes epistemic labor exploitation.

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Is Gender the Relevant Social Identity? Given that I spoke only to women, and the study provides no contrasting evidence from male surgeons, it might be asked how robust the link is between gender and the experiences described. This question warrants exploration in follow-up research with male participants. A related concern is whether gender or some other factor underlies different treatment. Racism sometimes emerged as an additional or confounding factor in the interviews (“I suppose it’s worse because I’m Asian” [P5]). However, the findings presented in this chapter cut across different cultural backgrounds, including those for whom English was a second language. Nevertheless, it will be important in future research to investigate how cultural identities affect these experiences. This is particularly true given that racism has been well documented in surgical contexts (e.g., Royal Australasian College of Surgeons 2015). Surgeons sometimes expressed uncertainty about whether credibility deficits were due to (young) age or gender (“I don’t want to see you because you’re too young, or you’re a female” [P35]). Another possibility is that the two are connected. Feminists have long discussed the widespread use of “girl” to describe women in contrast with the rarer “boy” to describe men (e.g., Messner, Duncan, and Jensen 1993). “Girl” was frequently used by the women surgeons in the study to refer to themselves and other women surgeons, and it crossed all levels of seniority, with older consultant surgeons just as likely to refer to themselves and others as “girls” as the younger trainees. This suggests that there is what Messner, Duncan, and Jensen call a “hierarchy of naming” (1993, 127) in the profession: that is, that more junior, less-powerful generic nouns and titles tend to be used more often for women than for men. If this is correct, then disparagement of women surgeon’s knowledge on the basis of age and gender may not be separable, because the gender of the surgeon may influence patients’ perceptions of age or seniority. CONCLUSION These findings indicate that women surgeons are often misidentified by patients as not surgeons; that their consultations are sometimes sexualized by patients; and that they experience both credibility deficits and excesses that seem to relate to their gender. It is significant that these patterns of epistemic injustice emerged from the research, given that the notion of epistemic injustice was not explained to participants and there was no explicit prompt to discuss it. In fact, arguably participants’ lack of a concept of epistemic injustice is a hermeneutic deficit that limits their ability to articulate a significant aspect of their professional experience. Women surgeons experience a burden of proof in their interactions with patients—to establish their professional identity as surgeons; to

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establish their credibility; and to ensure that the surgical encounter remains knowledge-orientated. Being able to articulate and conceptualize the nature of this burden—as an epistemic injustice—could be a breakthrough for women surgeons, and potentially facilitate new strategies to support their careers, just as the conceptualization of sexual harassment during the women’s liberation movement empowered women to address it (Fricker 2007, 149–52). It is likely that some of the types of epistemic injustice that occur in surgery also occur in other careers, especially careers that center around a knowledge exchange, as surgery does. I argued that the findings provide support for some recent work on epistemic injustice. In particular, Pohlhaus’s notions of epistemic dysfunction and epistemic labor injustice (2017), are highly relevant to career contexts. Epistemic dysfunction provides a useful lens for describing how bias affects knowledge relationships such as the relationship between women surgeons and their patients. Epistemic labor injustice—a concept that is likely to be widely applicable to workplace contexts—captures various ways in which professional knowledge can be systematically denied or exploited due to bias. Hawley (2011) and Shotwell (2017) have both explored the nature of epistemic injustices involving knowledge-how. In addition to conceptualizing an important dimension of epistemic injustice experienced by women surgeons, their insights are also likely to apply to other careers. There is a need for further empirical and conceptual work to develop these ideas and bring them to bear other careers that involve expert skill. REFERENCES Abel, Emily K., and Margaret K. Nelson, eds. 1990. Circles of Care: Work and Identity in Women’s Lives. Albany: SUNY Press. Baron, Sam, Tom Dougherty, and Kristie Miller. 2015. “Why Is There Female Under-Representation among Philosophy Majors?” Ergo 2 (14). http://dx.doi.org/10.3998/ ergo.12405314.0002.014. Botts, Tina. F., Liam Bright, Myisha Cherry, Guntur Mallarangeng, and Quayshawn Spencer. 2014. “What Is the State of Blacks in Philosophy?” Critical Philosophy of Race 2 (2): 224–42. Buchman, Daniel Z., Anita Ho, and Daniel S. Goldberg. 2017. “Investigating Trust, Expertise, and Epistemic Injustice in Chronic Pain.” Journal of Bioethical Inquiry 14 (1): 31–42. Calhoun, Cheshire. 2009. “The Undergraduate Pipeline Problem.” Hypatia 24 (2): 216–23. Carel, Havi, and Ian James Kidd. 2014. “Epistemic Injustice in Healthcare: A Philosophical Analysis.” Medicine, Health Care and Philosophy 17: 529–40. Cochran, Amalia, Tricia Hauschild, William Elder, Leigh Neumayer, Karen Brasel, and Marie Crandall. 2013. “Perceived Gender-Based Barriers to Careers in Academic Surgery.” American Journal of Surgery 206 (2): 263–68. Craig, Edward. 1990. Knowledge and the State of Nature: An Essay in Conceptual Synthesis. Oxford: Clarendon Press. Dotson, Kristie. 2013. “How Is This Paper Philosophy?” Comparative Philosophy 3 (1): 3–29. ———. 2014. “‘Thinking Familiar with the Interstitial’: An Introduction.” Hypatia 29 (1): 1–17.

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England, Paula. 2005. “Emerging Theories of Care Work.” Annual Review of Sociology 31: 381–99. England, Paula, Michelle Budig, and Nancy Folbre. 2002. “Wages of Virtue: The Relative Pay of Care Work.” Social Problems 49 (4): 455–73. Fitzgerald, J., F. Edward, Siau-Wei Tang, Pravisha Ravindra, and Charles A. Maxwell-Armstrong. 2013. “Gender-Related Perceptions of Careers in Surgery among New Medical Graduates: Results of a Cross-Sectional Study.” American Journal of Surgery 206 (1): 112–19. Fricker, Miranda. 2007. Epistemic Injustice: Power and the Ethics of Knowing. Oxford: Oxford University Press. Hall, J., C. Ellis, and J. Hamdorf. 2003. “Surgeons and Cognitive Processes.” British Journal of Surgery 90 (1): 10–16. Haslanger, Sally. 2008. “Changing the Ideology and Culture of Philosophy: Not by Reason (Alone).” Hypatia 23 (2): 210–23. Hawley, Katherine. 2011. “Knowing How and Epistemic Injustice.” In Knowing How: Essays on Knowledge, Mind, and Action, edited by John Bengson and Marc Moffett, 283–99. Oxford: Oxford University Press. Hill, Elspeth J., Katherine A. Bowman, Renee E. Stalmeijer, Yvette Solomon, and Tim Dornan. 2014. “Can I Cut It? Medical Students’ Perceptions of Surgeons and Surgical Careers.” American Journal of Surgery 208 (5): 860–67. Hine, Paul, and Helen Smith. 2014. “Attitudes of UK Doctors to Intimate Examinations.” Culture, Health & Sexuality 16 (8): 944–59. Hoover, Eddie L. 2006. “Mentoring Women in Academic Surgery: Overcoming Institutional Barriers to Success.” Journal of the National Medical Association 98 (9): 1542. Hutchison, Katrina, and Fiona Jenkins, eds. 2013. Women in Philosophy: What Needs to Change. Oxford: Oxford University Press. Kidd, Ian James, and Havi Carel. 2017. “Epistemic Injustice and Illness.” Journal of Applied Philosophy 34 (2): 172–90. Messner, Michael A., Margaret Duncan, and Kerry Jensen. 1993. “Separating the Men from the Girls: The Gendered Language of Televised Sports.” Gender & Society 7 (1): 121–37. Meyer, M. H., 2002. Care Work: Gender, Labor, and The Welfare State. New York: Routledge. National Health and Medical Research Council. 2007. “National Statement on Ethical Conduct in Human Research.” https://www.nhmrc.gov.au/guidelines-publications/e72. Park, Jason, Sam Minor, Rebecca Anne Taylor, Elena Vikis, and Dan Poenaru. 2005. “Why Are Women Deterred from General Surgery Training?” American Journal of Surgery 190 (1): 141–46. Pohlhaus, Gaile, Jr. 2017. “Varieties of Epistemic Injustice.” In The Routledge Handbook of Epistemic Injustice, edited by Ian James Kidd, José Medina, and Gaile Pohlahus Jr., 13–26. New York: Routledge. Rees, Charlotte E., Lynn V. Monrouxe, and Laura A. McDonald. 2013. “Narrative, Emotion and Action: Analysing ‘Most Memorable’ Professionalism Dilemmas.” Medical Education 47 (1): 80–96. Rosoff, Stephen M., and Matthew C. Leone. 1991. “The Public Prestige of Medical Specialties: Overviews and Undercurrents.” Social Science & Medicine 32 (3): 321–26. Royal Australasian College of Surgeons. 2015. “Expert Advisory Group on Discrimination, Bullying and Sexual Harassment. Report to the Royal Australasian College of Surgeons.” September 28. https://www.surgeons.org/media/22086656/EAG-Report-to-RACS-FINAL28-September-2015-.pdf. ———. 2016. “Activities Report.” https://www.surgeons.org/media/25115804/racs-activitiesreport-2016.pdf (accessed January 23, 2018). Royal College of Surgeons. 2018. “Statistics: Women in Surgery.” https://www.rcseng.ac.uk/ careers-in-surgery/women-in-surgery/statistics/ (accessed January 23, 2018). Saunders, Christobel M., Aimee Nichevich, and Carleen Ellis. 2008. “Frontiers in Academic Surgery: The Five M’S.” ANZ Journal of Surgery 78 (5): 350–55.

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Savona, Benjamin. 2018. “Gender Pay Gaps Revealed: The Jobs Where There’s a Huge Difference between Male and Female Incomes.” Smart Company, April 30. https:// www.smartcompany.com.au/people-human-resources/gender-pay-gap-jobs-differencemale-female-incomes/. Schouten, Gina. 2015. “The Stereotype Threat Hypothesis: An Assessment from the Philosopher’s Armchair, for the Philosopher’s Classroom.” Hypatia 30 (2): 450–66. Shotwell, Alexis. 2017. “Forms of Knowing and Epistemic Resources.” In The Routledge Handbook of Epistemic Injustice, edited by Ian James Kidd, José Medina, and Gaile Pohlhaus Jr., 79–88. New York: Routledge. Stanley, Jason, and Timothy Willlamson. 2001. “Knowing How.” Journal of Philosophy 98 (8): 411–44. Turner, Patricia L., Kimberly Lumpkins, and Joel Gabre. 2012. “Pregnancy among Women Surgeons: Trends over Time.” Archives of Surgery 147 (5): 474–79. Zhuge, Ying, Joyce Kaufman, Diane Simeone, Herbert Chen, and Omaida Velazquez. 2011. “Is There Still a Glass Ceiling for Women in Academic Surgery?” Annals of Surgery 253 (4): 637–43.

III

Arresting Epistemic Injustice in the Legal and Correctional Systems

Chapter Twelve

The Episteme, Epistemic Injustice, and the Limits of White Sensibility Lissa Skitolsky

In her book Epistemic Injustice, Miranda Fricker (2007) coined a term for a specific type of epistemic harm—testimonial injustice—with which scholars can now name the habit of perceiving and thinking about certain individuals associated with certain racialized and/or gendered groups in a way that undermines their status as knowers or epistemic agents. This harm becomes habit due to our frequent inability to imagine or perceive certain individuals as trustworthy, as capable of honoring the truth. In particular, we can see the routine operation of epistemic injustice against African Americans as essential to the epidemic of police murders against black citizens who are vulnerable to state-sanctioned violence precisely because they are so often perceived as untrustworthy, as suspect, dangerous, and “criminal.” Fricker’s emphasis on the regularity of testimonial injustice and its connection to implicit bias shifts the philosophical focus to the role that sensibility—rather than logic—plays in the formation of moral judgments. In his text The Epistemology of Resistance: Gender and Racial Oppression, Epistemic Injustice, and Resistant Imaginations, José Medina (2013) follows Fricker’s lead and draws greater attention to the role of the imagination in structuring the racist and sexist sensibility prone to regard certain racialized and gendered “others” as “suspect,” “untrustworthy,” or less than fully “rational.” Their renewed focus on the promise and perils of our moral imagination for the possibility of reasoned judgment about (and respect for) the racialized other resonates with the concerns raised by existentialist and postmodern philosophers such as W. E. B. Du Bois, Frantz Fanon, Michel Foucault, and Judith Butler about the socially conditioned structure of sensibility that allows the status quo to “make sense” through the perception of 203

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those who are victims to state violence as somehow compromised in their devotion to Truth, as untrustworthy as epistemic agents who honor truth and justice, and so as deserving of said violence which is then reimagined as an essential part of Justice. These Continental philosophers view the habit of testimonial injustice as central to the performance of whiteness, or acting in accord with the sensibility that perceives black citizens as a threat to the social order, as “criminal,” whose testimony is always already suspect. In his influential text The Souls of Black Folk, Du Bois ([1903] 1994) coined the notion of the “Veil” to refer to the irreducible difference between the sensibilities of those on either side of “the color line.” In the field of critical philosophy of race, his notion of the Veil is necessary to expose the limits of white sensibility that is conditioned to imagine and thus see black people as criminal, or as deficient in epistemic and moral integrity. 1 In his text Black Skin, White Masks, Fanon ([1952] 2008) makes use of the term “overdetermined” to describe the experience of the white gaze that perceives him as black, and so can only perceive him through the racist associations and assumptions that inform the category of “black,” and which—on the level of sensibility—inform the white perception of black skin. As Fanon explains: “But in my case everything takes on a new guise. I am given no chance. I am overdetermined from without. I am the slave not of the ‘idea’ that others have of me but of my own appearance” (Fanon 2008, 116). Fanon describes the problem of the overdetermination of black men as a problem of sensibility that exposes the relation between the epistemic and the aesthetic, insofar as he is trapped by the way he necessarily appears to citizens racialized as “white,” who see him as someone who is not-white, and thus trap him within the confines of “blackness” from which he cannot escape as he cannot appeal to a false idea they have of him, or appeal to their reason to recognize their error. Fanon draws attention to how the white sensibility of black men as “black” is also, at the same time, to regard them at 1. The term “white sensibility” refers to a way of seeing, feeling, and judging experiences in accord with the social, economic, and political privileges of white citizens, or citizens who have been racialized as “white” in contrast to “black.” In a society that is structured around the material and ideological needs of white supremacy, it is not the case that every white citizen is consciously “racist,” but rather that all white citizens are conditioned to see and think about black people in a way that allows them to defer the reality of systemic state violence against black communities, and all white citizens benefit from our racial democracy at the cost of black citizens. This claim does not preclude the possibility of white citizens from thinking critically about their sensibility and caring about the suffering of black citizens, nor does it preclude the possibility of white citizens protesting their privilege. However, theorists and social scientists have identified patterns of white sensibility marked by (1) moral indifference to the suffering of black citizens and (2) willful ignorance about race and racism in the United States. This notion of white sensibility was recently explained by George Yancy in his editorial for the New York Times, “Dear White America” (Yancy 2015); as a result of this editorial, he still receives death threats on a regular basis. For a description of his experience in the aftermath of this editorial, see his recent book: Backlash (Yancy 2018).

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a distance, through a veil that also produces suspicion and so inhibits epistemic respect. In her essay about the Rodney King verdict, “Endangered/Endangering: Schematic Racism and White Paranoia,” Butler (1993) illustrates that, in order to make sense of the jury’s verdict that the police officers who assaulted and tortured Mr. King were not guilty, we must consider the racist saturation of the visual field and the problems this raises for any appeal to our perception as evidence for our judgments: “If racism pervades white perception, structuring what can and cannot appear within the horizon of white perception, then to what extent does it interpret in advance ‘visual evidence?’ And how, then, does such ‘evidence’ have to be read, and read publicly, against the racist disposition of the visible, which will prepare and achieve its own inverted perceptions under the rubric of ‘what is seen?’” Butler insists that the white perception of black citizens as criminal permeates the visual field itself; there is no “seeing” without a simultaneous “reading” in a racially saturated field of vision. Butler’s view that the evidence read in a court of law occurs within and against “the racist disposition of the visible,” which “will prepare and achieve its own inverted perceptions under the rubric of ‘what is seen,’” also resonates with the meaning of an iconic phrase in underground hip-hop lyrics, “Claimin’ I’m a Criminal.” In countless tracks, this verse is rapped in order to draw attention to the way in which the collective sensibility of white citizens actually creates the conditions that seemingly “prove” the “grounds” for its predisposition toward viewing black life as criminal, through normalizing the racist conditions that force black citizens into compromised, sometimes “criminal” choices. In other words, white Americans see and affirm a just Justice system through criminalizing black Americans for the compromised choices they face as victims of a white supremacist state organized around their subordination and destruction. In a recording that was released only after his death, Tupac Shakur raps: “Crazy, I gotta work with what’chu gave me/You claimin’ I’m a criminal and you the one that made me” (Shakur 2004). Here Shakur skillfully illustrates that since black men are criminalized from birth, they are in fact made criminal as a result of what they are forced to do to stay alive in a system in which they are largely excluded from the labor market and targeted for police brutality, incarceration, and state-sanctioned murder. In the introduction to her book, Fricker offers her concept of epistemic injustice as an important corrective to the postmodern analysis of our epistemic practices which, she claims, reduces the problem to the nature of social power and rests on a disillusionment with the “untenable ideals of reason” given its entanglements with social power (Fricker 2007, 3). Instead, I argue that greater attention to postmodern insights about the production of sensibility in accord with what Foucault termed the episteme can both draw out the

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limits of Fricker’s analysis and expand our understanding of her notion of “testimonial injustice” such that we can reimagine strategies of epistemic resistance. Specifically, attention to these texts throws doubt on Fricker’s recourse to sensibility as a source for virtuous knowers to clarify their moral perceptions and correct for testimonial injustice. Instead they suggest that greater awareness of the limits of white sensibility is more helpful to correct for the habit of testimonial injustice—even and especially when this awareness occurs through the disruption of common sense. I argue that the effort to correct for the racist saturation of the visual domain interferes with the effort to grasp the limits of one’s sensibility, which is a difficult, necessarily ongoing effort that can allow us to better listen to and honor the epistemic authority of marginalized discourses and perspectives. First, I draw on texts by Du Bois and Fanon to illustrate their concern with testimonial injustice as central to the performance of whiteness and the systemic exclusion of black citizens from the protection of the law and moral consideration. Then I draw on texts by Foucault and Butler to illustrate the epistemic complicity of the dominant discourse in the production of white sensibility that sees the “other” in accord with the racialized categories that allow for and preemptively rationalize the subordination of black citizens and their default exclusion from our democratic community of possible knowers and responsible citizens. Drawing on all of these texts, I will recommend a greater effort to accept the limits of white sensibility rather than aiming to perfect our own power of moral perception. Lastly, in order to better oppose and feel the racist limits of white sensibility, I recommend that we should pay greater attention to the philosophical value of what Foucault termed “subjugated knowledges,” or discursive practices created by marginalized communities in order to oppose the dominant discourse that both displaces and normalizes their suffering. As an example, I will briefly suggest that the genre of underground hip-hop serves as one of these “subjugated knowledges” in the United States that is capable of disrupting our ability to “make sense” of the world within the confines of dominant discursive practices. 2 TESTIMONIAL INJUSTICE AND WHITE SENSIBILITY Du Bois introduces the notion of the Veil to provide an image for the dysfunctional nature of white sensibility that only ever “sees” black people through the filter of associations that rationalize the “color line” itself. In his text The Souls of Black Folk, Du Bois refers to the “two worlds within and

2. The full argument to defend this view will appear in my forthcoming book, Hip-Hop as Philosophical Text and Testimony: Can I Get a Witness? as part of Lexington Books’ series in Philosophy of Race, edited by George Yancy.

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without the Veil” as “the central problem of training men for life” (v). He expounds on this problem early in the text: the Negro is a sort of seventh son, born with a veil, and gifted with secondsight in this American world.—a world which yields him no true self-consciousness, this sense of always looking at one’s self through the eyes of others, of measuring one’s soul by the tape of a world that looks on in amused contempt and pity. One ever feels his two-ness,—an American, a Negro; two souls, two thoughts, two unreconciled strivings; two warring ideals in one dark body, whose dogged strength alone keeps it from being torn asunder. (Du Bois 1994, 2)

Here Du Bois describes what it feels like to be seen as black by the white gaze, or through a Veil that confirms he is black, first, and then American, only “as a problem,” evident in the posture of amused contempt and/or pity with which he is approached, spoken to, or seen by white citizens. To be seen as black is already to be seen as at odds with America, or always already suspicious as a citizen and as an epistemic agent. The problem of white sensibility is not a problem of whether certain white individuals are knowingly racist, but rather a problem of how those people racialized as “white” are conditioned to see and imagine those who are not-white in a system that is organized around the subordination and destruction of black communities. Du Bois does not provide any indication that the Veil of racialized sensibility can be “lifted,” but his text suggests the importance of acknowledging its existence and the limits of white sensibility to adequately see or understand those trapped behind the Veil. After the previously cited passage in Black Skin, White Masks in which Fanon explains that he is “overdetermined” from without by the appearance of his skin, he continues to explain how this feels: I progress by crawling. And already I am being dissected under white eyes, the only real eyes. I am fixed. Having adjusted their microtomes, they objectively cut away slices of my reality. I am laid bare. I feel, I see in those white faces that it is not a new man who has come in, but a new kind of man, a new genus. Why, it’s a Negro! (Fanon 2008, 116)

Fanon draws attention to how the category of race informs the perception of the “other” in such a way as to implicitly undermine the epistemic integrity of those who are seen as “black,” or always seen and recognized first as a “black” person in accord with all of the racist associations that allow for this perception of a “black man” to “make sense.” These associations that inform the perception of someone who is “black” permanently defer the possibility of full epistemic or moral respect for someone seen as black, or as “other” to the “genus” of human beings who form a natural community of epistemic

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agents who share the same respect for and understanding of logic and truth. Here the dominant sensibility demands a set of epistemic microtomes that “cut away” at the reality of the fact of blackness to preserve its sense of epistemic order, or confirm the validity of those categories that correspond to and allow for the perception of “black bodies.” For our sensibility is informed by discourse which is not morally neutral, and so our recognition of a “black man” is also filtered through the discursive stereotypes that have historically produced the “meaning” of being-black. Fanon explains that, “Wherever he goes, the Negro remains a Negro” (2008, 173). He associates the trap of blackness with the trap of the dominant discourse that locks him into a category that undercuts all other traits and capacities such as reason and epistemic integrity, eliciting his shame and self-loathing: Shame. Shame and self-contempt. Nausea. When they like me, they tell me my color has nothing to do with it. When they hate me, they add that it’s not because of my color. Either way, I am a prisoner of the vicious circle. (Fanon 2008, 96)

Wherever Fanon goes, he is never identified as a professor or a physician but instead as “the Negro teacher, the Negro physician” (Fanon 2008, 97). Fanon’s use of the term “overdetermination” draws attention to the ideological rather than economic logic of racist oppression that informs sensibility and cannot be entirely explained with reference to instrumental ends. As Sandro Luce explains in her article “From Fanon to the Postcolonials: For a Strategic and Political Use of Identities,” Thanks to an eclectic and unorthodox use of psychoanalytical, philosophical, and experiential references Fanon’s analyses are centered on the symbolic construction of the subordination of the colonized, structured through the subjection to the discourse of the Other that hegemonizes its meaning, stabilizing it. (Luce 2016)

Before Fricker sought to name a specific form of harm that emerges from the relation between the epistemic and the aesthetic, or from the perception of someone who appears untrustworthy, black existentialists were describing their oppression in terms of the white sensibility that emerges from the dominant discourse in a society in which antiblack violence is systemic and yet normalized and disavowed by the dominant narratives, categories, and images that allow for this violence to “make sense” as occasional, tragic exceptions to the norm. With their notions of the Veil and racial overdetermination, Du Bois and Fanon suggest that the source of the problem can never become the solution. Furthermore, they suggest that those who are racialized as white should be aware of the racialization of their sensibility, even and especially in their efforts to depart from historically inherited, racist views in

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a white supremacist society in which their own material and social privilege is a direct product of and reinforces that society. FOUCAULT’S NOTION OF THE “EPISTEME” AND THE LIMITS OF SENSIBILITY Although Ludwig Wittgenstein introduced the notion of “language-games” in order to reconceive of language from a medium for truth to a tool (or a series of tools) to communicate in accord with rules connected to actions and an entire worldview, he did not explicitly connect the language games of specific cultures to specific sociopolitical and economic arrangements of power relations that achieve specific forms of oppression and domination. This is one way to approach Foucault’s notion of the episteme, or those rules that inform the production of the dominant discourse that is viewed as the only logical, rational, professional way in which to communicate and “make sense” of one’s ideas to others. For example, though many of us would feel comfortable cursing in professional environments, this will always be perceived as a “vulgar” and “unprofessional” form of communication. There is no objective reason why this must be the case; instead this rule is silently accepted and more rigorously enforced with regard to groups already marginalized by the dominant discourse and more vulnerable to discipline and sanctions in educational and professional environments. Foucault’s notion of the episteme reinforces Wittgenstein’s insight that language games are not value-neutral, but also situates them within the social field that is organized around relations of power in order to illustrate their political function in relation to preserving systems of oppression. In interviews and texts Foucault describes the episteme as the system of assumptions that together allow us to separate those statements that we regard as “making sense” or as epistemically valuable, from those that we regard as “senseless” or without epistemic value. Foucault limits his analysis of the episteme as referring to that web of assumptions that informs thought and the production of the dominant—or authoritative—discursive practices in every field and sector of society. This interconnected web of assumptions and rules that is “the” episteme predetermines what does and does not make “sense” in public discourse in order to exclude those discourses that oppose the episteme and expose the arbitrary and oppressive organization of power relations in any given institution or social structure. For example, the dominant discourse and standard assignments in academia that are considered “professional” and as indicative of knowledgeable subjects, exclude alternative discourses from marginalized communities as “real” or “important” sources of knowledge, and this serves to reinforce the sexist and racist structure of the academy.

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Through this lens we can see that the notion of “epistemic injustice” also conveys the idea that real disparities in power and privilege are sustained and justified through ideal systems of “knowledge” as they are circulated in educational, medical, and penal institutions, corporations, Congress, and the home. For example, the administration of the criminal justice system presupposes our ability to separate “criminals” from the general populace and punish them in a way to restore justice; the dominant discourse about the prison system (including calls for reform) will always reinforce this presupposition that obfuscates both the racist and extra-legal conditions of confinement that systemically traumatize entire black communities. The epistemic overdetermination of racialized prisoners as one-dimensional, evil “criminals” both rationalizes the infliction of excessive violence in the prison system as well as silently authorizes and normalizes the repetition of specific practices of extra-legal violence that cease to appear violent or disturb our moral sensibility. Butler expands Foucault’s notion as she argues that the racist, classist, and heterosexist structure of the episteme also informs our visual and imaginative fields. In the American judicial system, the harm of testimonial injustice is not just inflicted through the default denial of epistemic value to the testimony of black defendants, but instead through the default perception of black defendants as criminals who must be held accountable for their wrongdoing. The epidemic of police murders of unarmed black men and women depends upon the criminalization of black citizens as a group, who are always already “seen” as a threat to the social order. For example, in his statement to a grand jury about why he murdered Michael Brown—a black, unarmed teenager— officer Darren Wilson testified about his perception of this young man right before he started shooting: “The only way I can describe it, it looks like a demon, that’s how angry he looked” (Gore Perry 2014, 225). On the basis of his testimony—including his racist overdetermination of Brown in the act of perceiving him, Wilson was not charged with any crimes. Fricker’s solution to this epistemic habit that emerges from our (mis)perception is based on the ideal of the virtuous agent who has a capacity for “moral perceptual judgement” that is “non-inferential” (Fricker 2007, 72). As she explains: Now this kind of perceptual judgement is spontaneous and unreflective; it involves no argumentation or inference on the agent’s part. The virtuous agent’s perceptual capacity is accounted for in terms of a sensitivity to morally salient features of the situation confronting him. In the testimonial case, the parallel suggestion is that the virtuous hearer’s perceptual capacity be understood in terms of a sensitivity to epistemically salient features of the situation and the speaker’s performance. These epistemically salient features are the various social cues that relate to trustworthiness—cues relating to the sincerity and competence of the speaker on the matter at hand. (Fricker 2007, 72)

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If we are meant to follow the tradition of virtue-ethics and regard the virtuous agent as our regulative ideal for action, then Fricker’s recommendation for correcting for testimonial injustice is to hone our “virtuous perceptual capacity” (Fricker 2007, 73) through enhancing our sensitivity to “morally salient features of the situation” confronting us so that, like the virtuous agent, we can exercise “perceptual judgment” that is both spontaneous and unreflective. However, as illustrated in the works of Du Bois, Fanon, and Butler, the root of testimonial injustice regards our refusal to acknowledge the limits of our sensibility rather than our penchant for sluggish “perceptual judgment.” Fricker’s recourse to sensibility as one practical solution to the problem of testimonial injustice is based on her assumption that we can make a “perceptual judgment” about the visual field that is “non-inferential,” “spontaneous,” and “unreflective.” There are no grounds for this assumption, and instead appears to conflict with the work of black existentialists who recommend a greater effort to recognize the limits of white sensibility, rather than aspire to overcome these limits to attain more accurate perceptions and epistemic judgments of racialized others in the act of seeing and hearing them. In other words, aspiring to the ideal of more perfect perceptions runs counter to the effort to grasp their conditioned limits and the role they play in perpetuating the real conditions of antiblack violence; this is felt in the experience of disorientation or the inability to “make sense” of what one perceives in accord with these limits. Indeed, in the field of social psychology, there are empirical grounds for understanding the interdependence of perception and oppressive relations of power. For example, Jennifer L. Eberhardt, a social psychologist at Stanford University, has conducted a series of experiments to show how “mostly unconscious racial stereotypes can criminalize African Americans,” and has proved that police officers are more likely to judge as criminals those whose faces are the most stereotypically “black.” As she explains, “It’s almost as if people are thinking of blackness as a crime” (Lee 2014). If this form of testimonial injustice has its source in a consistent habit of perception and imagination conditioned by the system of white supremacy that generates its own sensibility to furnish its own visual “evidence,” then we cannot hope to “correct” for this particular type of epistemic injustice by an appeal to our own prereflective and “spontaneous” powers of moral perception to better “recognize” the epistemic authority of individuals who we cannot see or imagine as reliable knowers. Nor can we assume that there are “virtuous” agents capable of this sort of moral perception, akin to the hope that the most virtuous among us can “lift the Veil” of sensibility produced and reinforced by “the color line.” This hope is not always (if ever) conducive to the humility required to accept that one feels and sees the world in accord with conditioned patterns of “making sense” of our experiences that serve to obfuscate the systemic,

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brutal infliction of antiblack violence through its disarticulation as so many individual, tragic exceptions to the norm of a Just Justice system. The focus on one’s own progress toward greater testimonial justice also reflects the neoliberal misconception that the problem with systemic antiblack violence regards racist individuals and the solution can be found in our own efforts to be “woke” and advocate for piecemeal legal reforms. This is another form of “making sense” of the present that allows for a certain moral apathy regarding the everyday infliction of antiblack violence as a problem disconnected from oneself, rather than greater sensitivity to the limitations of our power of moral perception. The perception of a black man as a threat is, in itself, an act of testimonial injustice insofar as someone who is seen as a threat is someone who cannot be trusted to honor the moral and legal codes. This is a critical point that throws into doubt Fricker’s view that the harm of testimonial injustice can be traced to a problem of poor judgment, or a lack of adequate knowledge, that can be rectified—in part—with greater attention to perceptual awareness. In his important text The Epistemology of Resistance: Gender and Racial Oppression, Epistemic Injustice, and Resistant Imaginations, José Medina draws greater attention to the role of our imagination in structuring our racist and sexist sensibility, and yet he still tends to view the problem of epistemic injustice as a problem of epistemic ignorance: We develop particular sensibilities as situated agents in social networks who are exposed to specific cognitive-affective structures; and these sensibilities simultaneously constrain and enable our capacities to know ourselves and to know others, and hence our capacities to make distinctive contributions to the melioration of social knowledge and to the fight against ignorance. I will argue that our epistemic sensibilities govern simultaneously our capacities for acquiring self-knowledge and our capacities for acquiring knowledge of others. (Medina 2013, 17)

However, if we take seriously Foucault’s notion of the episteme and Butler’s view that our sensibility is saturated with the racist and heterosexist assumptions that also inform the dominant discursive practices that rationalize and normalize the suffering of “others,” it is clear that the problem of epistemic injustice is not essentially related to a lack of knowledge but rather to an affective disposition that is reinforced by our perception of what is “real.” In other words, the problem is not that we are ignorant of the various ways in which institutions and social practices marginalize racialized and gendered groups, but rather that we don’t care about the fact that they suffer; we are conditioned to imagine certain groups as always already deserving of punishment. For we perceive and imagine these groups as threatening and untrustworthy, and so imagine that it is necessary for the state to inflict violence in order to contain and preempt the harm they present to the social body. How-

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ever, once violence is justified as necessary for the common good then it is not seen or thought of as “violence” at all, but instead as a necessary means of Justice. For this reason, the everyday infliction of antiblack violence in social practices and state institutions ceases to appear violent and does not provoke the collective moral horror that could otherwise act as a register of this violence. Actions that are “violent” provoke moral horror, while the “justified” use of force by the state is neither seen nor felt as violent. For example, at the women’s state prison where I volunteer to teach philosophy, the department of corrections staff are informed that 99 percent of the women incarcerated there are victims of sexual assault and battery, and that the crimes for which they have been judged guilty occurred in the context of coping with this assault with drugs or acting as an accomplice to an abusive partner. However this information does not affect their view that all of these women need to suffer from daily torments because they are a “threat to public safety” who must be “kept in line” through verbal and physical abuse. There are no “facts” about these women’s lives that could change the way they are “seen” by those who have the social power to harm them in an institution organized around their subordination. This is one example that indicates the larger premise that the problem of epistemic injustice is largely a problem of our sensibility and a fundamental lack of empathy for racialized “others” who are unnaturally vulnerable to everyday varieties of torture and death. As explained by the late artist Tupac Shakur, the problem is that “they don’t give a fuck about us” (Shakur 2002), rather than a deficit of knowledge. For this reason, I do not think that Medina’s call for “imaginative resistance” can proceed through an attempt to fully “know” others, but rather can only proceed through an awareness of the limits of our ability to completely “understand” the other and the limits of our sensibility to adequately “perceive” the other. In this way, we may become better able to feel moral horror for the suffering of racialized “others” who we do not presume to know and understand; the will to knowledge often interferes with the ability to feel the magnitude of something that is beyond one’s frame of reference or experience of the world. Although I agree with Fricker and Medina that our sensibility is the source of testimonial injustice, I disagree with them that we can “rectify” our emotional indifference to the suffering of others or “perfect” our moral sensibility through the effort to enhance our knowledge or understanding of different perspectives. Though Medina speaks of the need for “friction” between competing perspectives, I would go further and claim that we require aesthetic disruptions of our sense-making ability. In my view, academic philosophers still overestimate the capacity of reason to identify and correct for epistemic injustices when our discursive practices generate beliefs that are immune to their refutation by empirical evidence. Furthermore, these consistent patterns

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of discursive bias also inform the visual field itself, which then appears to “confirm” the validity of these biases and the epistemic injustices that follow. As Alfred Frankowski (2015) argues in his book The Post-Racial Limits of Memorialization: Toward a Political Sense of Mourning, the entrenched nature of postracial discourse that obfuscates the continuity of systemic antiblack violence indicates the need for a political shift incited by aesthetic means. Aesthetic disruptions of our sensibility can interrupt the ability to “make sense” of the present through dominant discursive practices that also produce patterns of seeing and imagining racialized others that serve to minimize and disarticulate the systemic, brutal infliction of state-sanctioned antiblack violence. AESTHETIC INTERRUPTIONS OF THE SENSIBLE In his 1975–1976 Lectures at the College de France titled “Society Must Be Defended,” Foucault (2003) refers to the existence of “subjugated knowledges” in every society that serve to contest the episteme and are generally regarded as naïve or crude forms of knowledge: When I say “subjugated knowledges” I mean two things. On the one hand, I am referring to historical contents that have been buried or masked in functional coherences or formal systemizations. . . . Second, when I say “subjugated knowledges” I am also referring to a whole series of knowledges that have been disqualified as . . . insufficiently elaborated knowledges: naive knowledges, hierarchically inferior knowledges, knowledges that are below the required level of erudition or scientificity. (Foucault, 2003, 7)

Insofar as underground hip-hop culture in the United States has always served to contest neoliberal and postracial narratives about American antiblack racism through its form and content, or through the disruption and cooption of melodies, beats, and lyrics as well as through phenomenological accounts of the lived experience of black Americans in the past and the present, it has always served as one of these “subjugated knowledges” that critique and disrupt the totalizing hold of the episteme on our sensibility and thought. 3 This is one reason why hip-hop artists—including DJs, rappers, and breakdancers—have been demonized in the media as “gangsters” and “thugs” since the 1980s, and the sophisticated construction and multilayered meaning of hip-hop discourse—referred to as “Hip-Hop Nation Language” by the sociolinguist H. Samy Alim—has been ignored by philosophers and political scientists as outside the parameters of professional and scientific 3. It is important to note that rap music is only one aesthetic expression of hip-hop culture, which also incorporates distinct forms of visual art (graffiti and fashion), as well as dance (breakdancing), a language, an ethics, and a political theory.

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interest, for it is viewed as a naïve and philosophically inferior form of discourse (Alim 2011). Hip-hop was born in the South Bronx and burst onto the music scene in the 1980s, just as our politicians lay the groundwork for the prison-industrial complex through the guise of a new “War on Drugs” that targeted black men. This “war” received greater funding and public support after the White House and media incited panic about the use of crack cocaine in low-income, inner-city neighborhoods. At the same time, Ronald Reagan identified “welfare queens” and “criminals” as largely responsible for the ills of black communities. In this context, hip-hop was born as a form of countertestimony about the nature and source of the suffering of African Americans, and drew on African traditions of music as well as earlier genres of African American music in creating the novel genre of hip-hop that is based on the skills of the DJ (sampling and scratching) and the MC (who spits prewritten bars or freestyles his poetry-in-motion). At its inception, hip-hop music did not include rapping or the presence of the MC, but instead was created through the skills of a DJ to create a new song through the novel method of playing two records on two turntables at the same time in order to “sample” and mix beats and lyrics, as well as practice the art of “scratching,” or moving a vinyl record with one’s hand back and forth in order to perpetually interrupt the ability to decipher the song on the record; in this sense the scratch produces the sound of the indecipherable. Over time the MC created the art of rapping over the beats produced by the DJ, a skill that is judged by the quality of the verse as well as by the distinct “flow” and rhyming scheme through which the verse is rapped. And from its inception the verse of rap songs took the form of testimony in which rappers testified both to the everyday forms of racist violence from which they suffered and to the superiority of their own skills to “spit bars” that spoke to their capacity to resist and survive this violence. The history of underground—as opposed to commercial—hip-hop is also identified by a certain attitude toward the United States (embodied in Ice Cube’s oft-repeated term AmeriKKKa) that is at once a protest and a politics of anxiety, and this sensibility produces specific commitments in thought (critical analyses of American race and racism) and action (revolution as opposed to reform, prisoner advocacy). Underground rappers testify to the traumas of antiblack genocide that elude our discursive practices that are informed by and reinforce a postracial sensibility that whitewashes both the harm, continuity, and severity of carceral torture, police brutality, and our racist economy. The form of rap music (based on interruption, cooption, and distortion) and the subject of hip-hop culture (everyday forms of antiblack violence rendered invisible by the media and the dominant discourse) aim to disrupt our complacency and our comfort as citizens in a racial democracy that depends on the systemic, useless, gratuitous suffering of black citizens

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that our politicians would rather not confront or address. Those who identify with the political mission of hip-hop culture (also referred to as Hip-Hop Nation) often proudly declare, “I am hip-hop,” to signify its importance for how one feels, sees, and acts in the world. Furthermore, an essential part of hip-hop culture is a constant examination of how and in what way hip-hop can serve to resist oppressive practices that are normalized by discourse and white sensibility, and to what extent hip-hop also serves to reinforce certain forms of oppression in its “commercial” or popular variety that is played on the radio. Indeed, this is the subject of most of the famous “beefs” between rappers, as they routinely call each other out for disrespecting the values and disregarding the political commitments of Hip-Hop Nation. There is evidence that hip-hop culture can affect the sensibility in one of two ways: (1) it can provide “life-force” to black citizens as the only genre of culture that testifies to the reality of black life against dominant narratives and illustrates the capacity of black artists to expose and resist antiblack violence through creative genius; (2) it can disrupt our sense of what “makes sense” as a form of “common sense” to better grasp the limits of being white in knowing, understanding, representing, or imagining the experience of those citizens who are perceived as black. There is a common refrain in hip-hop culture that “hip-hop saved my life,” and when underground, unsigned rappers tell me this they always add “No, literally. Hip-hop literally saved my life.” The literalness of this sentence is actually meant in two senses, which are both expressed in the song “Hip-Hop Saved My Life” by Lupe Fiasco. First, hip-hop testifies to the structural conditions that aim to subordinate and destroy black communities and simultaneously illustrates the ability to resist these conditions; this allows for a sense of pride and hope to counter the sense of shame and despair felt in relation to the inevitable and senseless infliction of antiblack violence. Second, hip-hop has always provided material opportunities for black artists otherwise locked out of the labor market, and thus a means of survival in a racist economy. For this reason, hip-hop culture offers an essential “lifeforce” for black Americans, and underground rappers frequently express their devotion and appreciation for hip-hop culture in songs about hip-hop— there are thousands of songs simply titled “Hip-Hop” that express love for the culture and a concern for the future of hip-hop, and also aim to reinforce the ethical and political commitments required to “keep it real” and respect Hip-Hop Nation. The ethical injunction to “keep it real” in hip-hop culture also provides a standard by which white rappers are judged as either respecting the culture— and the limits of their own participation—or coopting and “leeching off” the culture for the sake of their own material success, in ways that are decidedly opposed to hip-hop. Examples of the former include the Beastie Boys and Eminem, who immersed themselves in hip-hop culture and wrote songs from

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their own experiences that contributed something new to both the form and content of rap music, while they shared the political and moral commitments of hip-hop to oppose antiblack violence and racist ideology. When Toure Neblett interviewed Eminem in 2004 for Rolling Stone and asked him why he wouldn’t use the term “nigga” in his lyrics when it is often used by both black and white kids as a term of love, Eminem replied: “Yeah, it’s just a word I don’t feel comfortable with. It wouldn’t sound right coming out of my mouth. . . . Some white kids feel comfortable throwing the word around all day. I don’t. . . . It doesn’t feel right to come out of my mouth.” When he was then asked: “Does it bother you when a black man says, ‘Eminem is my nigga?’ he replied, “No. If a white kid came up to me and said it, I probably would look at him funny. And if given the time to sit down with him I’d say, ‘Look, just don’t say the word. It’s not meant to be used by us. ’Specially if you want something to do with hip-hop’” (Neblett 2004). Eminem explains his refusal to follow other successful rappers and use the n-word in his music in terms of his discomfort as a white man, concerned with crossing or denying the limits of his sensibility to feel or “be” black; this concern leads to his discomfort about coopting a racial epithet whose harm he cannot feel or understand. Furthermore, he associates the ability to be aware of and respect these limits with his love of hip-hop culture and, indeed, insists that one cannot hear or be associated with hip-hop unless one already accepts these limits to white sensibility. In contrast, when Iggy Azalea—a white woman from Australia—released her chart-topping rap song “Fancy,” she was criticized for cultural appropriation for imitating the accent and cadence of black rappers (derided as “verbal blackface” by her critics), as well as including insensitive lyrics in her songs, 4 and appearing largely indifferent to antiblack violence in the United States; as a result, she was “called out” by numerous underground rappers on Twitter and then largely rejected by the hip-hop community—despite having been mentored by T.I., a successful black rapper, who also ended his collaboration with her after she insulted some of the rappers who had criticized her (Guo 2016). And indeed, at the height of the controversy Azalea was quick to shed the persona of a hip-hop artist, as she stated to Vanity Fair, “People have said I’m not real rap or real hip-hop. But I don’t care if people think I’m pop or rap. Everyone interprets music differently” (Robinson 2015). Azalea was rejected from Hip-Hop Nation because she lacked any sensibility of her limits as a white woman that could have allowed her to “keep it real,” or rap from her own experiences, rather than imitate and mock the sensibility of black artists, which is decidedly opposed to hip-hop culture. The injunction to “keep it real” also serves to assess the extent to which someone who has listened to 4. In her song D.R.U.G.S. she raps, “When the relay starts I’m a runaway slave-master” (Azalea 2011).

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hip-hop has actually heard it, or been affected to the extent that one is able to adopt a critical stance toward discursive practices and perceptions that serve to evade, defer, or disarticulate the extremity and regularity of state-sanctioned, antiblack violence in the United States. This is not to claim that it is possible to “lift” the Veil that separates those on either side of the color line, but it is possible for hip-hop to disrupt its totalizing hold on our thought and imagination. One of the most iconic statements in the lyrics of underground hip-hop— “Can I Get a Witness?”—indicates the extent to which rap serves as a plea for recognition for those traumas inflicted and disavowed by the state, then rendered invisible by the criminalization of black life. However, the repetitiveness of the question in hip-hop culture for over thirty years also speaks to the difficulty of an affirmative answer, or the difficulty of seeing and imagining and thinking that which is obscured and disarticulated through our dominant discursive practices. It is not possible for anyone “outside” the color line to bear witness until we reckon with our inability to bear witness, or the conditioned limits of white sensibility and the dominant discourse and their role in the normalization of state violence and the production of moral indifference toward black suffering. As we strategize about new forms of epistemic resistance to patterns of testimonial injustice, we must consider the value of subjugated knowledges and cultural movements that do not reinforce but instead disrupt our sensibility of the present so that we can better feel the horror that escapes the limits of perception and thought. REFERENCES Alim, Samy H. 2011. “‘Bring It to the Cypher’: Hip Hop Nation Language.” In That’s the Joint! The Hip-Hop Studies Reader, edited by Murray Forman and Mark Anthony Neal. New York: Routledge. Azalea, Iggy. 2011. “D.R.U.G.S.” D.R.U.G.S. Butler, Judith. 1993. “Endangered/Endangering: Schematic Racism and White Paranoia.” In Reading Rodney King, Reading Urban Uprising, edited by Robert Goodings Williams. New York: Routledge. Du Bois, W. E. B. (1903) 1994. The Souls of Black Folk. New York: Dover. Fanon, Frantz. (1952) 2008. Black Skin, White Masks. Translated by Richard Philcox. New York: Grove Press. Citations are from the Grove Press Edition. Foucault, Michel. 2003. “Society Must Be Defended.” In Lectures at the College de France (1975–1976). Translated by David Macey. New York: Picador. Frankowski, Alfred. 2015. The Post-Racial Limits of Memorialization: Toward a Political Sense of Mourning. New York: Lexington Press. Fricker, Miranda. 2007. Epistemic Injustice: Power and the Ethics of Knowing. Oxford: Oxford University Press. Gore Perry Reporting and Video [Gore Perry]. 2014.“Transcript of Grand Jury Volume V.” State of Missouri v. Darren Wilson. Sept. 16. Uploaded to scribd.com. https:// www.scribd.com/doc/248128351/Darren-Wilson-Testimony (accessed October 12, 2018). Guo, Jeff. 2016. “How Iggy Azalea Mastered Her ‘Blaccent.’” Washington Post, January 4. https://www.washingtonpost.com/news/wonk/wp/2016/01/04/how-a-white-australian-rap per-mastered-her-blaccent/?utm_term=.53a1949d66ee.

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Lee, Felicia R. 2014. “MacArthur Awards Go to 21 Diverse Fellows.” New York Times, September 17. https://www.nytimes.com/2014/09/17/arts/macarthur-awards-go-to-21-di verse-fellows.html. Luce, Sandro. 2016. “From Fanon to the Postcolonials: For a Strategic and Political Use of Identities.” Politica comú n, 9. http://dx.doi.org/10.3998/pc.12322227.0009.010. Medina, José. 2013. The Epistemology of Resistance: Gender and Racial Oppression, Epistemic Injustice, and Resistant Imaginations. Oxford: Oxford University Press. Neblett, Toure. 2004. “Eminem: The Rolling Stone Interview.” Rolling Stone, November 25. https://www.rollingstone.com/music/music-news/eminem-the-rolling-stone-interview-3103720/. Robinson, Lisa. 2015. “Hot Tracks: Iggy Azalea.” VanityFair.com, January 7. https:// www.vanityfair.com/hollywood/2015/01/iggy-azalea-fancy-fame. Shakur, Tupac. 2002. “They Don’t Give a Fuck about Us.” Amaru Entertainment, Death Row Records and Interscope Records. ———. 2004. “Po’ Nigga Blues: Scott Storch Remix.” Interscope Records. Remix of “Cuz I Had 2 (Po Nigga Blues OG)” by 2Pac (Ft. Govenor). Skitolsky, Lissa. Forthcoming. Hip-Hop as Philosophical Text and Testimony: Can I Get a Witness? New York: Lexington Press. Yancy, George. 2015. “Dear White America.” New York Times, The Stone, December 24. https://opinionator.blogs.nytimes.com/2015/12/24/dear-white-america/. ———. 2018. Backlash: What Happens When We Talk Honestly about Racism in America. Lanham, MD: Rowman & Littlefield.

Chapter Thirteen

Carceral Medicine and Prison Abolition Trust and Truth-Telling in Correctional Healthcare Andrea J. Pitts

The US Supreme Court ruled in 1976 that the privation of healthcare for incarcerated people constitutes a violation of the Eighth Amendment (Estelle v. Gamble 1976). While that ruling mandated a standard of medical care for incarcerated populations, the institutional means through which healthcare is provided in federal, state, and private carceral facilities have been neither uniform nor without their share of problems. A number of human rights organizations and prisoner advocacy groups have documented patterns of neglect and malpractice within the nation’s prisons, jails, and detention facilities, including unsanitary conditions, undertreatment for severe illnesses and injuries, and the structural incapacity of many correctional healthcare systems to meet the needs of their patients. 1 Alongside the literature outlining concerns in correctional healthcare, a distinct and theoretically dense body of evidence on the patterns of oppression operating through carceral systems in the United States has also demanded scholarly and political attention. 2 Much of this work marks the continuities that mass incarceration in the United States has with historical patterns of disenfranchisement, exploitation, and state-sanctioned violence inflicted on communities of color (especially black Americans and indigenous peoples), disabled people, and queer and trans people.

1. See, for example, Cloud (2014); Pew Charitable Trusts (2017). 2. See, for example, Chapman et al. (2014); James (2005); Ross (1998); Stanley and Smith (2015).

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In dialogue with contemporary research on correctional healthcare and literature within biomedical ethics and social epistemology, this chapter analyzes trust and truth-telling among patients and providers in correctional settings to develop an argument for prison abolition. My argument in this chapter frames some basic principles from moral philosophy and biomedical ethics within contemporary discussions of social epistemology in an effort to address the structural terms of trust/distrust in correctional healthcare settings. I conclude by offering an abolitionist reframing of correctional healthcare. PRELIMINARY QUESTIONS AND CAVEATS To frame this research on trust and truth-telling in correctional healthcare, I would like to foreground the collaborative work of R.E.A.C.H. Coalition, an anti-death-penalty organization in Nashville, Tennessee. R.E.A.C.H. Coalition describes itself as “a diverse, unified group of people emerging from different perspectives. We are educators, students, artists, writers, social reformers, people of faith, and death row prisoners.” 3 In 2012, I began working with R.E.A.C.H. Coalition and participated in several projects as part of the group’s subcommittee on “Prison Mental Health and Healthcare Reform.” During that time, a number of incarcerated members of the subcommittee used the language of “intentional misdiagnosis” to describe their concerns about the medical care they received at Riverbend Maximum Security Institution (hereafter referred to as “Riverbend”). The phrase, “intentional misdiagnosis,” referred, according to these members, to the willful medical negligence conducted by prison medical staff at Riverbend. Their concerns, however, spoke beyond the institutional failures of Riverbend alone, and, instead, offered a framework to interpret the systemic patterns of neglect and abuse that incarcerated people suffer more generally. Alongside a demand for better care and an end to the patterned violence they were experiencing, members of R.E.A.C.H. Coalition were raising a series of important political and epistemological concerns regarding the relationships between patients and medical providers within carceral settings. Members of R.E.A.C.H. Coalition were pointing to the willful neglect and/or refusal by individual providers to address the healthcare needs of incarcerated patients. In this sense, their concerns addressed more than “diagnostic” concerns in healthcare, and, as such, shifted our terms of analysis toward the complex interpersonal dynamics between patients and providers in carceral settings. Moreover, they were also naming a shared set of unjust prejudicial beliefs that undergird the interpersonal dynamics between prisoners and pris3. “R.E.A.C.H.” is an acronym for “Reciprocal Education and Community Healing” (R.E.A.C.H. Coalition 2018).

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on staff (including medical staff) within carceral settings. Their critical stance toward correctional healthcare thus conveyed a specific form of skepticism or lack of trust that incarcerated members of R.E.A.C.H. held regarding the therapeutic aims of their providers. Regarding these dynamics of trust/distrust, consider Charles Mills’s account of white ignorance. White ignorance, he argues, is an epistemological pillar of white supremacy that maintains “misunderstanding, misrepresentation, evasion, and self-deception on matters related to race” (Mills 1997, 19). On this reading, we could likewise interpret prisons as operating under what Mills calls an “inverted epistemology” that distorts a given domain of knowledge for the benefit of one group to the systemic disadvantage of another (Mills 1997, 18). As I argue below, the carceral system too creates an “inverted epistemology” regarding the credibility, knowledge, and worth of incarcerated peoples. Following Mills, we can extend his analysis of white supremacy to analyze how prisoners are treated as “subpersons” in relation to nonincarcerated peoples (Mills 1997, 11). People convicted of crimes, many of whom are poor and people of color, are often treated as morally and epistemologically deficient. As such, the denial of credibility and neglect of the epistemic resources of incarcerated peoples functions to maintain the authority of prison staff, administration, and the wider sociopolitical terms through which the modern penal industry remains justified. Based on systemic denials of credibility and worth, we might ask, echoing members of R.E.A.C.H. Coalition, whether incarcerated patients should trust their providers, whether it is in their interest to do so, and, relatedly, whether conditions of confinement are capable of fostering a context that supports mutual trust between patients and their healthcare providers. As I argue in this chapter, prison staff and administration, including healthcare providers, participate in a broader epistemic landscape that unjustly denies the credibility of incarcerated people. Relatedly, incarcerated patients’ mistrust of correctional staff—a justified mistrust—may be read as a subtle manner in which detainees are attempting to address an “inverted epistemology” that shapes beliefs about prisoners within the modern carceral system today. This framing of the epistemic dimensions of trust and trustworthiness in the context of correctional healthcare demonstrates that there are important structural dimensions to the forms of patterned neglect and harm that incarcerated people experience. The concerns raised by members of R.E.A.C.H. Coalition, again, should not be read solely as describing an individualistic set of prejudices. Rather, if we understand their concerns to refer to the broader institutional aims of carceral systems, then we can begin to understand the extent to which carceral systems perpetuate patterns of ignorance that subjugate some groups while allowing others to exist with relative privilege. That is, as I outline below, the harms arising in medical contexts should be traced

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through structural critiques of the carceral system offered by abolitionists. For example, as Jason Lydon states: Abolitionists assert that the U.S. prison system has been built up with the purpose of, among other things, maintaining systems of “anti-Blackness,” regulating and disciplining non-normative gender/sexuality, controlling im/migration, suppressing resistance, and establishing a capitalist response to surplus labor. (Lydon 2016, 62)

Correctional healthcare industries, I propose, similarly participate in these ends. Likewise, my work with R.E.A.C.H. Coalition has led me to more firmly endorse the claim that an explicit focus on correctional healthcare and the medical conditions of incarcerated populations reveals a great deal about systemic forms of oppression impacting the predominantly poor and racialized populations who often end up in US prisons, jails, and detention facilities. Correctional healthcare thus shines a light both on the harms occurring within the confines of carceral facilities and those occurring outside their walls and fences. I return to themes of abolitionism at the close of the chapter. However, it is important to foreground these commitments and caveats so that the following argument frames my concerns about correctional healthcare in an adequate light. TRUST AND TRUTH-TELLING IN CLINICAL MEDICINE Regarding trust between patients and providers, it is important to briefly analyze the ethical and political value of trust. Trust is an important facet of many healthy relationships, and persistent patterns of distrust suggest that forms of injustice may be at work. Tracing these concerns, Sissela Bok frames questions about truthfulness and lying in the context of one’s social and political world. She writes “Whatever matters to human beings, trust is the atmosphere in which it thrives” (Bok 1978, 33). For our purposes here, we can note that Bok’s work points to the value of a broader public context and set of conditions that must be conducive for trust. Annette Baier builds on this idea, and argues that not all conditions of trust result in morally beneficial outcomes. For example, trust can be a precondition for exploitation or conspiracy under unjust conditions (Baier 1986, 231–32). Baier’s work also frames the moral permissibility or impermissibility of lying as dependent upon whether we are in a situation in which we are obligated to tell the truth. Accordingly, if a given situation is unjust, then a moral agent may not be under any obligation to tell the truth. In the context of biomedical ethics, truth-telling—or veracity—has been posed as a core principle within clinical practice. Tom Beauchamp and James Childress’s Principles of Biomedical Ethics describes veracity as an obliga-

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tion and a virtue. They write: “the relationships between healthcare professionals and their patients and between researchers and their subjects ultimately depend on trust, and adherence to rules of veracity is essential to foster trust” (Beauchamp and Childress 2001, 284). This obligation, they state, is not absolute. Competing duties may override the clinician’s obligation to tell the truth (e.g., protecting patient confidentiality or nondisclosure of specific alternative treatments). Additionally, Jennifer Jackson’s (2001) book-length treatment of trust and truth-telling in medicine builds from these literatures in moral philosophy and biomedical ethics as well. Jackson argues, however, that many accounts of trust and truth-telling have relied too heavily on ideal conditions for sharing information. Developing a nonideal framework for understanding the conditions for trust and truth-telling in biomedical contexts, Jackson argues that when assessing whether a lie is justifiable or morally permissible, we must broaden our scope to observe the underlying background conditions in which the moral act is under consideration. In this vein, Jackson’s work on lying and deception in clinical medicine brings to the fore the need for structural conditions of justice and mutual protection to ensure that adequate care is possible. This brief framing of the literature on trust offers some core components of my analysis. Notably, the conditions of trust and truth-telling between patients and providers within carceral contexts should begin to appear somewhat fraught with respect to upholding a climate conducive to a just and mutually affirming healthcare practice. First, we can begin by highlighting a moral claim embedded within the 1976 Supreme Court ruling in Estelle v. Gamble. While admittedly there are important debates regarding the relationship between morality and law, a basic humanist precept coextensive with Estelle v. Gamble is that state confinement should not entail medical deprivation. We might assume that many of the international guidelines that seek to regulate the healthcare of prisoners, such as those of the United Nations and the World Health Organization, rely on such a basic liberal humanist tenet as well. In the following section regarding the emergence of legal oversight for healthcare in prisons and jails, I demonstrate that social and legal views about the rights of prisoners have shifted over the second half of the twentieth century. For now, and for the sake of argument, I draw from the basic claim that the deprivation of healthcare is not justified as a facet of modern imprisonment. 4 Following Bok, another basic premise in this argument is that trust is important for maintaining healthy relationships. However, as Baier and Jack4. Given my own position regarding the unjustifiability of state confinement and punishment, I do not share the terms implied within this liberal humanist position (i.e., that carceral systems are justifiable if they provide adequate healthcare). However, for the sake of developing an argument that builds from these moral humanist principles, I provisionally accept this premise.

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son each discuss, many relationships are often fraught by unjust, nonideal conditions, and accordingly, trust and veracity may actually lead to further disadvantages under such conditions. As such, it may be important to distrust those who seek to cause you harm. Returning to Mills’s notion of the “inverted epistemology,” carceral systems tend to perpetuate the belief that everyone who has received a criminal sentence and/or has faced incarceration has sought, or perhaps continue to seek, to cause others harm. In carceral settings, such forms of distrust function in several ways. Healthcare providers and prison staff may believe that prisoners lack credibility and do not warrant trust because they seek to cause others harm. However, given their knowledge of their own moral and epistemic worth, and given the histories of harm that they or others may have experienced at the hands of police officers, court systems, and prison staff, prisoners too may justifiably distrust prison staff and administration. In this vein, we are drawn closer to addressing how structural oppressions function in carceral healthcare settings. While we may consider the clinical encounter between healthcare providers and patients an important site to analyze with respect to its interpersonal significance, an epistemological emphasis in this context need not reduce to individual biases or simply “bad doctors.” My concern is that encounters between patients and providers in carceral settings are fundamentally shaped by forms of oppression, including patterns of epistemic violence, biases, and stigmatization, and systemic barriers to healthcare that operate within and beyond prison walls. As such, there are a number of obstacles to receiving care within carceral facilities, such as prisoner copayment programs (Fisher and Hatton 2010), shortages of clinical staff (Brown v. Plata 2011), poor medical record keeping among prison staff (Coleman v. Wilson 1995; Montgomery v. Pinchak 2002), and unsanitary conditions leading to increased spread of infections among prison populations (Newman v. Alabama 1974; Benjamin v. Fraser 2001), and such barriers to care bear important epistemological dimensions. As I show in the following section, these epistemological layers are important to help us understand the dynamics of trust/distrust in carceral settings. To begin to expand this point regarding structural epistemic harms in carceral medicine, we can draw from Frantz Fanon’s writings on structural conditions of violence and clinical medicine. Fanon writes that, with respect to an Algerian colonized patient’s trust in French colonial doctors during the Algerian anticolonial struggles of the 1950s and early 1960s, “the technician’s words are always understood in a pejorative way” (Fanon 1965, 128). Even if there is some truth in the clinician’s recommendations, Fanon states, “[t]he truth objectively expressed is constantly vitiated by the lie of the colonial situation” (Fanon 1965, 128). French colonialism, in this case, the structural form of violence enacted on Algerian patients, distorts the capacity for trust between providers and patients. We might, then, draw from Fanon’s insight here, and suggest that the “lie” of correctional healthcare in the Unit-

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ed States is that carceral medicine can retain a therapeutic role in the context of the deathly racialized institutions that comprise US prisons, jails, and detention facilities. Thus, in the following section, I turn directly to the therapeutic and punitive functions operating within correctional healthcare. HEALING AND PUNISHMENT US carceral practices have long functioned via conceptions of redemption and spiritual well-being. The earliest US penitentiary models in the late eighteenth and early nineteenth centuries used isolation and enforced labor as a means to improve the spiritual well-being of prisoners (Davis 2003, 48). Today, while faith-based programs remain prominent throughout US penal institutions, correctional healthcare has taken on a therapeutic role that did not exist in earlier models of penitentiary confinement. In fact, the institutionalization of correctional healthcare within US carceral facilities is relatively recent. Prior to the 1960s, the US legal system established a “hands off” approach to medical provisions in prisons and jails (Anno 2001, 15). There were several reasons for this. First, many courts considered prison healthcare conditions beyond their jurisdictional reach. Moreover, prisoners were not thought to have “rights” in any well-defined sense, and little comprehensive data existed regarding medical care in prisons and jails. It was the “prisoner’s rights movement” beginning in the 1960s, as well as the investigative and standardization efforts of professional organizations such as the American Medical Association and the American Public Health Association, that eventually gave rise to a concerted disciplinary field of correctional healthcare (Anno 2001; Chase 2015). By 1991, B. Jaye Anno raised some critical concerns in a report for the US Department of Justice regarding severe difficulties with the delivery of healthcare in prison and jail settings. Anno writes: To act within the ethic of their profession, healthcare providers must act counter to the prevailing ethic of the location. Between provider and patient, mutual trust and respect must exist in order for the relationship to work, i.e., to provide the support for diagnosis, care and treatment. The inmate must trust that the physician will act only in the inmate’s best interest, will be his/her advocate and will place his/her health needs above all other considerations. Most providers enter correctional healthcare with these values, but they are challenged immediately and constantly by the overriding assumptions and norms of corrections. (Anno 1991, 55)

Anno’s caution here is that the punitive ends of carceral facilities may effectively undermine the therapeutic relationship between providers and patients. Pont, Stöver, and Wolff (2012) expand this insight and describe healthcare

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providers as essentially dealing with dual loyalties in carceral settings. 5 They write, “The dual loyalty practitioners most commonly face in prison is between their patients and the prison administration or the state authority” (Pont et al. 2012, 475). In carceral settings, they write, healthcare providers are often asked to engage in clinical practices that violate their therapeutic ends as healthcare practitioners. For example, healthcare providers may be asked to participate in body cavity searches; to disclose results of blood, urine, or other screenings that lead to punitive measures; to engage in forcefeedings or forced administration of medication; or to provide health screenings to determine whether a patient is able to be physically restrained. In this sense, material consequences that may worsen a patient’s life are often in the hands of same providers who are meant to serve as providers for their care. Under such conditions, we could add, incarcerated patients ought not be expected to trust the same providers who determine whether they will receive harsh punishments based on the information that they share, including information about drug use, sexual activity, or other forms of information that may have both medical and punitive implications in carceral settings. Given such conflicting aims, we might propose a solution to this concern by attempting to separate the therapeutic role of healthcare providers from the forensic, administrative, or punitive roles of prison staff. In fact, Anno and Pont et al. pose such a solution. Anno proposes that “constant vigilance, self-awareness and periodic reexamination [is necessary] to avoid being coopted by and developing an identification with correctional authorities, their goals, modes of thinking conception of and relationship to inmates” (Anno 1991, 53). Yet, the epistemic impact of such dual loyalties appears to be broader than simply administrative distinctions made between forensic or therapeutic roles in correctional healthcare. Such a division of clinical responsibilities does not address the structural conditions undergirding distrust that preserve the “lie” of correctional healthcare (to paraphrase Fanon). We can turn here to some epistemic dimensions of trust/distrust in carceral medicine to frame the structural forms of oppression operating therein. The proposed solution above by Anno and Pont et al. appears to frame the problems of distrust and concerns regarding the conflicting therapeutic and punitive aims of correctional healthcare as resolvable by individual and institutional vigilance regarding implicit biases and dual loyalties. A number of social epistemologists have offered similar solutions to epistemic injustices, posing individual reflection, vigilance, and the cultivation of epistemic virtues to rectify unjust prejudicial beliefs impacting credibility assessments or patterns of ignorance. 6 My claim here is that such a response is insufficient 5. It is important to note here that single-payer and publicly funded healthcare systems are not free from the dual loyalties and structural problems outlined here. 6. Fricker (2007) is one such example.

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to address the structural harms impacting incarcerated peoples within carceral healthcare settings. In a recent piece, José Medina and Matt S. Whitt argue that testimonial injustices—epistemic injustices wherein speakers are wronged by virtue of being unjustly denied credibility as knowers—encompass more than interpersonal dimensions of individual agents (Medina and Whitt forthcoming). 7 In carceral contexts, they argue: [T]estimonial injustice also involves wider contests for knowledge. These contests are shaped by not only the positions, power, and agency of their participants, but also the wider social context in which the contests are fought, and the patterns of social action that impact the effectiveness of any particular epistemic “move” within these contests. Turning to our central example, jail detainees face testimonial injustices that cannot be adequately diagnosed as the general public’s refusal or failure to be good listeners when detainees speak on particular matters. Rather, the institutional context of the jail, the limited means of communicating from inside to outside, and the wider patterns of social interaction that routinely position detainees as “criminal” all shape how different audiences receive detainee testimony. . . . In other words, with regard to detainee testimony at least, credibility assessments involve contests over social, political, and epistemic power. (Medina and Whitt forthcoming)

Thus, in the correctional healthcare context, rather than viewing unjust credibility assessments made by medical practitioners as a matter of a few “bad” nurses or doctors or as merely requiring a correct assignment of clinical roles in carceral facilities, we must also examine the structural contestations over power inside and outside carceral facilities. These would include (but are not limited to) contestations regarding healthcare resources and the relative desert of incarcerated patients, contestations regarding epistemic and political authority inside prisons, and the wider patterns of social interaction that deem incarcerated persons untrustworthy and/or socially deviant. With respect to some of the social and political contestations for power that impact correctional medicine, consider Angela Davis’s claims regarding the presumed social functions of prisons. She argues that prisons are viewed as places to house people who have committed wrongs, and as an inevitable response to social problems. She writes: We thus think about imprisonment as a fate reserved for others, a fate reserved for the “evildoers,” to use a term recently popularized by George W. Bush. Because of the persistent power of racism, “criminals” and “evildoers” are, in the collective imagination, fantasized as people of color. The prison therefore functions ideologically as an abstract site into which undesirables are deposited, relieving us of the responsibility of thinking about the real issues afflicting 7. “Testimonial Injustice” is a term coined by Fricker (2007). For a brief analysis of Fricker’s conception of testimonial injustices within the context of correctional healthcare, see Pitts (2014).

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Andrea J. Pitts those communities from which prisoners are drawn in such disproportionate numbers. This is the ideological work that the prison performs—it relieves us of the responsibility of seriously engaging with the problems of our society, especially those produced by racism and, increasingly, global capitalism. (Davis 2003, 16)

Correctional healthcare providers, I propose, are not immune from this shared social belief. As such, the view that prisons protect the social body as a whole, and effectively solve social problems is part of the “inverted epistemology” that abolitionists seek to overturn. Abolitionists, like Nils Christie, for example, have long argued that many institutions rely on the mistaken belief that punishment actually addresses social harms (Christie 1977). However, against this view, he and many other abolitionists defend the view that carceral systems effectively diminish the capacities of communities from addressing the roots of social conflict. The maintenance of this inverted epistemology can be found in the educational materials of correctional healthcare professionals. For example, consider this claim from Lorry Schoenly—a licensed registered nurse, with a PhD in nursing, who has over thirty years of experience in corrections, and is the author of several major educational resources for correctional nursing and the host of the podcast Correctional Nursing Today. Schoenly writes regarding the patients she encounters in her practice: By the time our patients arrive in the facility, they have lived a life based on distrust, manipulation and deception. It is how they view the world and how they have used their skills to obtain what they want. (Schoenly 2014)

Schoenly’s discussion of this attitude that she considers shared among many providers (including herself) is placed in the context of fighting providers’ cynicism regarding their patients’ needs. She warns that many clinicians develop patterned forms of skepticism about the health concerns expressed by their patients, and that this requires a set of strategies for remaining “objectively caring” (Schoenly 2014, 25). Yet, despite her optimism in providers’ abilities to take a neutral stance with respect to the myriad racial, class, gender, and disability stigmas that impact their perceptions of patients’ needs, Schoenly’s underlying belief regarding the “lives lived” by her incarcerated patients (especially when endorsed within an educational context for healthcare providers) may perpetuate further ignorance regarding the structural reasons that explain why so many people are detained in US carceral facilities. Consider one such explanation from abolitionist Ruth Wilson Gilmore. Gilmore (2007) argues that the typical narrative from the 1970s until today— that the massive increase in the nation’s incarcerated population can be explained by the simple framing that “crime went up; we cracked down; crime

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came down”—does not adequately explain the political history of the United States (Gilmore 2007, 17). Instead, she writes, a more accurate framing would be: “crime went up; crime came down; we cracked down” (Gilmore 2007, 20). Crime rates, including illicit drug usage, were actually on the decline when prisons began to expand in the 1980s and 1990s (Gilmore 2007, 18–20). Thus, Gilmore’s conclusion, as well as those of many other penal abolitionists, is that rates of crime and “criminal behavior” cannot explain who ends up in prisons and jails in the country. Rather, abolitionists seek to explain how racial profiling, changing drug laws and bureaucracy, and shifting economic conditions explain the mass increases in patterns of incarceration since the 1970s. Moreover, following José Medina’s (2013) framing of the social imagination, we can also consider the further affective and aesthetic dimensions of these shared beliefs regarding what prisons do and who is held within their walls. Medina states: The social imagination that goes into the formation of our shared identities and coordinated actions underlies our doxastic and affective lives, but is not directly tied to any specific doxastic and affective commitment that we may have. Once internalized, the social imagination permeates the cognitive and affective dimensions of our experience, without being reducible to a mere list of specific cognitive commitments and affective reactions. . . . A social imagination is inscribed in our habitual ways of thinking, acting, and feeling. (Medina 2013, 269)

From this, we can begin to unpack how correctional healthcare providers may share in a collective belief that incarcerated people are unworthy of care, untrustworthy, and chronic malingerers. For example, consider Shields and de Moya’s findings that a large number of correctional nurses feel little concern for the health of their patients. They write: “Most relevant to our study of nurses’ attitudes toward inmates was their finding that 65 percent of the subjects felt a moderate to high degree of lack of caring toward those for whom they were responsible for providing care” (Shields and de Moya 1997). As such, the shared social imagination that undergirds the patterns of distrust found in correctional healthcare settings cannot be alleviated by merely addressing the interpersonal dynamics between patients and providers, nor by attempting to remove the few “bad actors” who are believed to perpetuate beliefs about the lack of credibility of prisoners. Rather, I propose that we turn to abolitionist models for critiques of the carceral system as forms of what Medina and Whitt might consider “transgressive forms of epistemic interaction that call attention to, and potentially disrupt, contexts, intercontextual relations, and patterns of interaction that contribute to epistemic injustice” (Medina and Whitt, forthcoming). In this vein, as I propose in the last section, abolitionism becomes the means by which we can begin to

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address both the interpersonal forms of harm operating within the patient–provider relationship in carceral facilities, and the broader sociopolitical contexts that shape our “habitual ways of thinking, acting, and feeling” about prisons and the people who are held in them (Medina 2013, 269). CARCERAL MEDICINE AND PRISON ABOLITION First, consider this statement from Laura Whitehorn: “That relationship of being ‘cared for’ by someone who sees you as their enemy is completely deleterious to your health” (Whitehorn 2001). Whitehorn’s work with the Black Liberation movement and the Weather Underground made her a target of police surveillance, and she was imprisoned for charges relating to the bombing of several government buildings in the mid-1980s. Whitehorn’s political activism while incarcerated included a number of efforts to address HIV/AIDS-related medical care for incarcerated women. More generally with respect to HIV/AIDS, rates of the immunodeficiency disease are five times higher among incarcerated populations than nonincarcerated populations (Centers for Disease Control and Prevention 2015). Additionally, black people are three times more likely to die of AIDS-related complications than whites while incarcerated (Martinez 2016). In this vein, Whitehorn’s HIV/ AIDS activism continues her radical efforts to stop the deathly forms of state violence impacting people of color across the United States. Returning to her quotation above, her critique names the antagonisms and systemic patterns of neglect and ignorance within correctional medicine that, to paraphrase Fanon, simply become “part of the oppressive system” (Fanon 1965, 121, 123). We can conclude, then, by considering again the project of penal abolitionism. As Davis’s work brings to light: “punishment” does not follow from “crime” in the neat and logical sequence offered by discourses that insist on the justice of imprisonment, but rather punishment—primarily through imprisonment (and sometimes death)—is linked to the agendas of politicians, the profit drives of corporations, and media representations of crime . . . our focus [then] must not rest only on the prison system as an isolated institution but must also be directed at all the social relations that support the permanence of the prison. (Davis 2003, 112)

In this sense, Davis’s work implicates the vast institutional networks embedded within the prison industrial complex, including those medical networks that seek to operate within the nation’s prisons, jails, and detention facilities. Drawing from W. E. B. Du Bois’s Black Reconstruction in America (1935), Davis points to a comprehensive conception of abolition, an approach that DuBois understood as necessary to address the violence and histories of trauma and degradation of black Americans experienced as the result of the

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formal institution of racialized chattel slavery. DuBois proposed that new institutions needed to be built to replace those that prevented black Americans’ participation in civic, social, and cultural life in the United States. Davis’s account of prison abolition thus draws from this notion of comprehensive abolitionism and proposes that abolishing prisons does not merely mean tearing them down. Rather, abolitionism must be a project by which we construct those institutions that address the problems that prisons are intended to solve. By building models for healthcare that eliminate structural oppressions, cycles of medicalized violence, and forms of criminalization, we can aim to effectively render prisons and correctional healthcare obsolete. Thus, by addressing carceral medicine through a framing of the capacity for trust in the patient–provider relationship, I hope to have urged us to broaden our interpretive horizons with respect to healthcare and the prison industrial complex. Among the institutional efforts that may begin to take on this comprehensive notion of abolition, we might include in the legislative realm: overturning the “deliberate indifference” standards that have evolved since Estelle v. Gamble, which render “cruel and unusual punishment” a feature of individual acts of malice rather than structural harms (Genty 1996); decriminalizing drug use and sex work; and working toward a singlepayer healthcare system. In nonlegislative arenas, efforts such as developing community accountability models rather than relying on those of the criminal justice system (INCITE! 2006; Chapman, Carey, and Ben-Moshe 2014), divestments from prisons and their corporate partners, and restructuring medical education models to demonstrate the inconsistencies between health and confinement would be additional possibilities. One last point is important here regarding the relationship between penal reform and penal abolition. As Julia Sudbury notes regarding this relationship: Abolition exists in productive tension with efforts to reform the penal system. While abolitionists point out that reform in isolation of a broader decarcerative strategy serves to legitimate and even expand the prison-industrial complex, we [abolitionists] also work in solidarity with prisoners to challenge inhumane conditions inside. Described by Angela Y. Davis as “non-reformist reforms,” these efforts are assessed first in terms of whether they contribute toward decreasing or increasing prison budgets and the reach of the criminal justice system. For anti-prison activists, however, reform is not the primary objective. (Sudbury 2016)

In this sense, the needs of currently incarcerated prisoners points to the importance of “nonreformist reforms,” which effectively seek to dismantle carceral institutions’ power and control over people’s lives. This means that we must critically interrogate how medical industries—both inside and outside of prisons—operate to support the expansion of carceral industries. Un-

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like reformist efforts that seek to expand medical industries within prisons, jails, and detention facilities (often aiming toward broadly humanist ends), the goal of abolitionism is to build alternative institutions—healthcare institutions; drug treatment programs; models for basic income, food, childcare, and housing security; and so on—that meet the needs of currently incarcerated people while also diminishing the role of punishment industries more generally. As such, following Davis’s call and the questions we echoed above alongside R.E.A.C.H. Coalition, we must, therefore, “strive for a very different social landscape” (Davis 2005). REFERENCES Anno, B. Jaye. 1991. Prison Health Care: Guidelines for the Management of an Adequate Delivery System. Chicago: National Commission on Correctional Health Care. ———. 2001. Correctional Health Care: Guidelines for the Management of an Adequate Delivery System. Chicago: National Commission on Correctional Health Care. Baier, Annette. 1986. “Trust and Antitrust.” Ethics 96 (2): 231–60. Beauchamp, Tom, and James Childress. 2001. Principles of Biomedical Ethics, fifth edition. Oxford: Oxford University Press. Benjamin v. Fraser. 161 F. Su 2d 151, 186 (S.D.N.Y. 2001). Bok, Sissela. 1978. Lying: Moral Choice in Public and Private Life. New York: Vintage Books. Brown v. Plata. 131 S.Ct. 1910, 1933-34 (2011). Centers for Disease Control and Prevention. 2015. “HIV among Incarcerated Populations.” Centers for Disease Control and Prevention. Chapman, Chris, Allison C. Carey, and Liat Ben-Moshe. 2014. Disability Incarcerated: Imprisonment and Disability in the United States and Canada. New York: Palgrave. Chase, Robert T. 2015. “We Are Not Slaves: Rethinking the Rise of Carceral States through the Lens of the Prisoners’ Rights Movement.” Journal of American History 102 (1): 73–86. Christie, Nils. 1977. “Conflict as Property.” British Journal of Criminology 17 (2): 1–15. Cloud, David. 2014. On Life Support: Public Health in the Age of Mass Incarceration. New York: Vera Institute of Justice. Coleman v. Wilson. 912 F. Su 1282, 1314 (E.D. Cal. 1995). Davis, Angela. 2003. Are Prisons Obsolete? New York: Seven Stories. ———. 2005. “The Challenge of Prison Abolition: A Conversation.” Social Justice 27 (3): 212–18. Du Bois, W. E. B. 1935. Black Reconstruction in America. New York: Harcourt Brace & Company. Estelle v. Gamble. 429 U.S. 97 (1976). Fanon, Frantz. 1965. “Medicine and Colonialism.” In A Dying Colonialism, 121–46. New York: Grove Press. Fisher, Anastasia A., and Diane C. Hatton. 2010. “A Study of Women Prisoners’ Use of CoPayments for Health Care: Issues of Access.” Women’s Health Issues 20 (3): 185–92. Fricker, Miranda. 2007. Epistemic Injustice: Power and the Ethics of Knowing. Oxford: Oxford University Press. Genty, Philip M. 1996. “Confusing Punishment with Custodial Care: The Troublesome Legacy of Estelle v. Gamble.” Vermont Law Review 21: 379–407. Gilmore, Ruth Wilson. 2007. Golden Gulag: Prisons, Surplus, Crisis, and Opposition in Globalizing California. Oakland: University of California Press. INCITE! Women of Color against Violence. 2006. Color of Violence: The INCITE! Anthology. Durham, NC: Duke University Press. Jackson, Jennifer. 2001. Truth, Trust, and Medicine. New York: Routledge.

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James, Joy. 2005. The New Abolitionists: (Neo)slave Narratives and Contemporary Prison Writings. Albany: SUNY Press. Lydon, Jason M. 2016. “Once There Was No Prison Rape: Ending Sexual Violence as Strategy for Prison Abolition.” philoSOPHIA 6 (1): 61–71. Martinez, Yolanda. 2016. “How Blacks and Whites Die Differently in Prison: New Federal Data Shows Some Stark Racial Disparities.” The Marshall Project.org. https:// www.themarshallproject.org/2016/12/15/how-blacks-and-whites-die-differently-in-prison (accessed March 31, 2018). Medina, José. 2013. The Epistemology of Resistance: Gender and Racial Oppression, Epistemic Injustice, and Resistant Imaginations. Oxford: Oxford University Press. Medina, José, and Matt S. Whitt. Forthcoming. “Epistemic Activism and the Politics of Credibility: Testimonial Injustice Inside/Outside a North Carolina Jail.” In Making the Case: Feminist and Critical Race Theorists Investigate Case Studies, edited by Heidi Grasswick and Nancy McHugh. Albany: SUNY Press. Mills, Charles W. 1997. The Racial Contract. Ithaca, NY: Cornell University Press. Montgomery v. Pinchak. 294 F.3d 492, 500 (3d Cir. 2002). Newman v. Alabama. 503 F.2d 1320, 1331-33 (5th Cir. 1974). Pew Charitable Trusts. 2017. Prison Health Care: Costs and Quality. Philadelphia: Pew Charitable Trusts. Pitts, Andrea. 2014. “Cruel and Unusual Care and Punishment: Epistemic Injustices in Correctional Health Care.” APA Newsletter on Philosophy and Medicine 14 (1): 6–9. Pont, Jörg, Heino Stöver, and Hans Wolff. 2012. “Dual Loyalty in Prison Health Care.” American Journal of Public Health 102 (3): 475–80. R.E.A.C.H. Coalition. 2018. “About.” R.E.A.C.H. https://reachcoalition.wordpress.com/about/ (accessed March 26, 2018). Ross, Luana. 1998. Inventing the Savage: The Social Construction of Native American Criminality. Austin: University of Texas Press. Schoenly, Lorry. 2014. The Correctional Nurse Manifesto. Genesee, PA: Enchanted Mountain Press. Shields, Kristine E., and Dorothy de Moya. 1997. “Correctional Health Care Nurses’ Attitudes towards Inmates.” Journal of Correctional Health Care 4 (1): 37–59. Stanley, Eric A., and Nat Smith. 2015. Captive Genders: Trans Embodiment and the Prison Industrial Complex, second edition. Oakland: AK Press. Sudbury, Julia. 2016. “Reform or Abolition? Using Popular Mobilisations to Dismantle the ‘Prison Industrial Complex.’” Criminal Justice Matters 102 (1): 17–19. Whitehorn, Laura. 2001. “Cruel but Not Unusual—The Punishment of Women in U.S. Prisons.” Monthly Review 53 (3).

Chapter Fourteen

Epistemic Injustice and Medical Neglect in Ontario Jails The Case of Pregnant Women Harry Critchley

Julie Bilotta’s story 1 is as follows: On September 25, 2012, Julie Bilotta, a twenty-six-year-old white woman from Cornwall, Ontario, was remanded into custody at the Ottawa Carleton Detention Centre (OCDC). 2 Bilotta had been charged with drug trafficking and fraud in 2010 and cycled back and forth between remand and release while awaiting trial. While on remand in 2012, she discovered she was pregnant. Bilotta was later released on bail but was remanded again after a family member who had agreed to supervise her release asked to be relieved of this responsibility. The night before she returned to custody, Bilotta was under observation at the Ottawa Hospital after experiencing stomach pains. Her OBGYN wrote a doctor note’s informing OCDC staff of Bilotta’s high-risk pregnancy. OCDC was aware Bilotta was thirty-six-weeks pregnant, but did not work with her to implement a birth plan. On September 29, Bilotta began experiencing cramps and threw up in her cell. A correctional officer (CO) brought her to the healthcare unit, where a nurse administered antacid. Bilotta’s cramps intensified throughout the afternoon and she reported experiencing a recurring sharp abdominal pain. Bilotta was reassessed by a nurse at 4:10 p.m. At this point, accounts diverge. Bilotta said the nurse checked her vital signs and told her she was not in labor. The nurse denies having said this, 1. See Bilotta (2014), Gyasi v. College of Nurses of Ontario 2014, and Fiander (2016). 2. “Remand” means temporary detention prior to trial or a finding of guilt.

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instead reporting that the COs told her Bilotta had a history of drug addiction and was likely “faking it.” An hour later, Bilotta was moved to a segregation cell. Here, accounts diverge again. According to Bilotta, her transfer was because of her disruptive pain-provoked moans. According to a CO on duty, it was because of “tension” between Bilotta and her two cellmates. Bilotta’s pain continued to worsen and she begged to be taken to the hospital. By 6:25 p.m., she could no longer stand or eat. Around this time, she was seen by the same nurse, who gave her Tylenol. At 8:00 p.m., Bilotta yelled to a CO that she could see a foot sticking out of her. When the nurse and two COs responded, each could see a white object. The nurse suggested it was a mucous plug, but one of the COs asked if Bilotta was actually concealing drugs she had smuggled into the facility. The nurse left and went to speak with another, more senior nurse while the COs resumed their normal duties. At 8:15 p.m., two COs responded once more to Bilotta’s screaming and found her in medical distress, with one of the baby’s feet now clearly visible. A CO placed a medical emergency page within the facility, but it would be another twenty-five minutes before an ambulance was finally called. Paramedics helped Bilotta deliver her son, Gionni Lee, who was in a breach position with the umbilical cord wrapped around his neck. Bilotta and Gionni were rushed to the hospital, where they were separated. Bilotta underwent surgery to remove a residual placenta and experienced severe postpartum hemorrhaging. She was then moved to a private room and shackled to her bed. Gionni arrived at the hospital in critical condition and suffered seizures. He was intubated, placed on a ventilator, and fed through a catheter. Neither Bilotta nor her partner, Dakota Garlow, were permitted to contact him until Bilotta and Gionni underwent drug tests, which they subsequently cleared. Bilotta was discharged from the hospital and brought back to OCDC on October 2, 2012. Gionni was repeatedly readmitted to the hospital over the next year owing to ongoing respiratory problems. Bilotta’s lawyer arranged to have her outstanding charges resolved, to which she pled guilty. With time served, she was sentenced to two months in jail and eighteen months’ probation. After her release, Bilotta and Garlow reunited with Gionni. On October 13, 2013, Gionni was found without vital signs and was pronounced dead later that day. Although the autopsy report has not yet been released, Bilotta alleges that the respiratory problems Gionni suffered at birth contributed to his death.

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INTRODUCTION The events outlined here detail a litany of injustices. At least some of these derived from specific transactions between Bilotta and individuals with whom she came into contact during her incarceration. Legally, the wrongful actions and negligence of OCDC staff breached the duty of care they owed her while in their custody (Iftene, Hansen, and Manson 2014, 668). Epistemically, Bilotta faced persistent testimonial injustices—instances in which OCDC staff wrongfully discounted the credibility of her testimony owing to prejudice against her resulting from her identity as a criminalized pregnant woman (Fricker 2007). This pattern of epistemically unjust transactions contributed to a set of circumstances in which, by the time a medical emergency was declared, Bilotta had been exhibiting signs of distress for over ten hours. However, Bilotta also faced other kinds of injustices that contributed to this set of circumstances that were structural in nature. By “structural,” I refer to the “global properties of a system of rules that govern transactions, and imposes constraints on permissible rules with an eye toward controlling the cumulative effects of individual transactions,” as well as the associated distribution of relevant goods (Anderson 2012, 164), including epistemic goods (Fricker 2013). Some of the injustices Bilotta faced were structural in that their injustice derived from institutional features of the criminal justice system. In particular, the design, governance, and operation of these institutions exposed her to structural epistemic injustice. For example, that Bilotta’s note from her OBGYN identifying her high-risk pregnancy was not given uptake within the facility was not primarily the result of an “identity-prejudicial credibility deficit” to which she was subjected (Fricker 2007, 27–28), but instead because OCDC did not have a procedure in place to implement birth plans for pregnant women in their custody. Although the Ministry of Community Safety and Correctional Services implemented a new policy on prenatal and postnatal care in response to widespread public backlash (IROC 2017b, note 148 at 58), took disciplinary action against a nurse and numerous correctional officers (IROC 2017a, 15), and developed an action plan to address a variety of issues at OCDC (MCSCS 2016), incidents like this keep happening. On January 25, 2017, a woman suffered a miscarriage in her cell after her cries for help were ignored by staff for ten to fifteen minutes (Seymour 2017). The woman’s miscarriage was the culmination of “15 days of jail staff failing to properly treat the 28year-old, who arrived at the jail directly from the hospital on January 11 after an ultrasound that confirmed she was 11 or 12 weeks pregnant,” despite efforts of “a criminal defense lawyer, a Crown prosecutor, a support worker from the Elizabeth Fry Society, and a social worker” to advocate on her behalf (Seymour 2017).

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In this chapter, I demonstrate how the statute, regulations, and policies governing corrections generate an institutional “epistemology of ignorance,” which functions to generate and maintain pernicious ignorance that undermines the recognition and resolution of injustices in jails. I adopt this phrase from Charles Mills (1997), who introduces the concept to identify a feature of “the racial contract”—the moral, political, and epistemological agreement between whites that undergirds the social contract and gives rise to global white supremacy. It refers to a “pattern of localized and global cognitive dysfunctions (which are psychologically and socially functional)” that collectively comprise a “cognitive model that precludes self-transparency and genuine understanding of social realities” and undergird the “cognitive and moral economy psychically required for conquest, colonization, and enslavement” (Mills 1997, 18–19). Mills’s account of the epistemology of ignorance rests on the insight that, as the dominant social group, ignorance acts for white people as a shared social practice that plays roles in defining them as the group that they are and in maintaining their dominance over other groups. White racism therefore functions as “a type of subjectivity that forms patterns of perceptual attentiveness and supplies belief-influencing premises that result in a distorted or faulty account of reality” (Alcoff 2006, 48). Such patterns of behavior can include refusals to ask specific questions or analyze taken-for-granted assumptions and, at a group level, failures to collect certain records, or more active attempts to rewrite commonly held histories (Mills 2007). They also manifest in group-differentiated presumptions regarding epistemic agents’ credibility, such that, even if evidentiary resources exist within minority social groups by which to contest features of white ignorance, the testimony of such agents will not be given uptake (Mills 2007, 33). My central contention is that there is an epistemology of ignorance at work in the administration of Ontario jails that functions institutionally in an analogous manner to how, on Mills’s account of the racial contract, it functions psychologically for individual whites and socially for white people as a group. 3 That is to say, the production, maintenance, and mobilization of pernicious ignorance are central means by which the correctional system

3. To clarify: Like Mills, I maintain that the production and maintenance of ignorance are central to the institutional arrangements and administrative practices of the correctional system and play a key role in maintaining its dominance. Whereas, for Mills, this dominance is over other social groups; I here use “dominance” to refer to the correctional system’s ability to maintain control over its own administration largely unencumbered by meaningful independent oversight.

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conceals individual and systemic injustices ongoing behind its walls, and, so doing, consolidates its power. 4 My argument proceeds in three sections. First, I overview the governance frameworks for Ontario jails in order to explain how the epistemology of ignorance is produced and what its effects are. Second, I examine how this epistemology of ignorance is further compounded when currently or formerly incarcerated persons attempt to seek review of or redress for treatment they experience while in custody. I identify three epistemic barriers that curtail the possible uptake of incarcerated persons’ testimonies, impede the success of litigation efforts, and insulate correctional systems from judicial reform. Third, I contend that by adopting an abolitionist epistemology, currently and formerly incarcerated persons and their advocates can best disrupt practices of ignorance production, maintenance, and mobilization, and push for meaningful change, instead of reinforcing the institutional epistemology of ignorance. THE EPISTEMOLOGY OF IGNORANCE IN ONTARIO JAILS Statute, Regulations, and Policies Ontario jails are governed statutorily by the Ministry of Correctional Services Act (MCSA). 5 However, as the Independent Review of Ontario Corrections (IROC) committee notes, the MCSA is “skeletal” (IROC 2017a, 58). It gives minimal guidance on significant aspects of jail operation, including minimum standards for medical treatment. The MCSA does, however, empower the lieutenant governor to make supplemental regulations concerning the operation of jails (s. 60(1))—namely, the Ministry of Correctional Services Regulations (MCSR). 6 The MCSR delegates to each jail’s Superintendent responsibility “for the care, health, discipline, safety and custody of the inmates under the superintendent’s authority” (s. 2(1)). It requires that there be at least one healthcare professional on-site (s. 4(1)), that incarcerated persons receive a medical examination as soon as possible upon entry (s. 4(2)), and that healthcare professionals examine, treat “as seems advisable,” and prepare reports on injuries (s. 4(4)). Beyond these general provisions, the MCSR does little better in spelling out specific guidelines for healthcare delivery.

4. Following Dotson (2011), I understand “pernicious ignorance” to refer to “reliable ignorance that, in a given context, harms another person (or set of persons),” where “reliable ignorance” in turn refers to “ignorance that is consistent or follows from a predictable epistemic gap in cognitive resources” (Dotson 2011, 238). 5. Ministry of Correctional Services Act [MCSA], RSO 1990, c M-22. 6. Ministry of Correctional Services Regulations, RRO 1990, Reg 778.

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Rather, a significant degree of detail regarding jail operations is contained in internal policy documents (IROC 2017a, 58). These policies are oftentimes drafted and implemented “with little public knowledge and without the democratic process or political attention that might be expected for a coercive governmental regime” (Kerr 2015, 92). Together with deficiencies in the legislation, this creates the conditions under which the administration of policies can defy legislative and constitutional boundaries. Furthermore, these policies “are frequently confusing and overlapping, and lack clarity, definition and guidance” (IROC 2017a, 3) and sometimes afford correctional staff “an enormous amount of discretion regarding even the most basic services” (IROC 2017a, 59). Unclear policies are especially troubling given that key decisions in jails are made “not by elected public figures or legal advisors but by low-level officials who are not well-positioned to interpret and honor constitutional norms” (Kerr 2014, 49). Worse still, these policies are not publicly available and are only provided when requested through a freedom of information request (IROC 2017a, 99). For pregnant women, guidelines for their healthcare are outlined in the Healthcare Services Policy and Procedures Manual: Healthcare Services for Women: Management of Prenatal and Postnatal Care, which, as noted above, was implemented after the public outcry from Bilotta’s story (IROC 2017b, note 148 at 58). What can be gleaned about this policy comes from the Inmate Information Guide for Adult Institutions (MCSCS 2015), which clarifies that pregnant women shall receive appropriately sized clothing (36) and a special diet (16), and that pregnancy is recognized within “sex” as a ground of discrimination under the Ontario Human Rights Code (22). These minimal allowances notwithstanding, this document does little to specify the perinatal care pregnant women can expect to receive while incarcerated. It also provides no clear answers as to whether, as in Bilotta’s case, correctional staff can permissibly segregate or shackle pregnant women, despite the fact that both practices are linked to negative birth outcomes and are barred by the United Nations Rules for the Treatment of Women Prisoners and Noncustodial Measures for Women Offenders, to which Canada is a signatory (CCPHE 2015). It is in the interplay of these two features of the administration of corrections in Ontario (i.e., the minimal legislative foundation for the daily operation of jails and the lack of clarity in and transparency around internal policies) that the epistemology of ignorance is produced. Leaving open significant discretion to correctional staff, these intersecting problems ensure that “neither incarcerated individuals nor the public at large have a straightforward way of determining how Ontario’s correctional system should be operating” (IROC 2017a, 99).

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Healthcare Delivery This epistemology of ignorance is further entrenched in that responsibility for healthcare delivery flows from the Ministry of Correctional Services Act (MCSA) via the Ministry of Correctional Services Regulations (MCSR), which responsibility is, in turn, operationalized by MCSCS administrators in ministry-specific policy directives. In effect, the provincial government operates a two-tiered medical system. The Ministry of Health and Long-Term Care (MOHLTC) provides healthcare to everyone in the province, except adults in jails, whose healthcare is provided by the Ministry of Community Safety and Correctional Services (MCSCS). This bifurcation of healthcare delivery has disastrous consequences. For instance, the MCSCS has tremendous difficulty in recruiting and retaining healthcare professionals. As a result, jails suffer from chronic vacancies and underresourcing, which can lead to a general lack of access to healthcare (JHSO 2016, 11–12). These issues are exacerbated by the fact that incarcerated persons have a higher prevalence of acute and chronic health needs, but also have a greater dependency on correctional medical services to address these needs given that their incarceration limits their ability to self-care (JHSO 2016, 13). The bifurcation of healthcare delivery also creates an epistemic “break” between the MCSCS and the MOHLTC, such that there is a disparity in the distribution of epistemic goods between the two ministries caused by the limited ability of healthcare providers to engage in interministerial communication and information sharing and discrepancies in their respective data collection protocols. Consequently, each ministry holds itself to wildly divergent standards, the most fundamental of which is that, in the IROC committee’s appraisal, the MCSCS views healthcare “as merely one among a number of ‘service programs’ offered to inmates, rather than an essential right [. . .] and a primary and distinct government obligation” (IROC 2017b, 192). Operationally, this break manifests in the fact that incarcerated persons receive healthcare “absent the dedicated resources, experience, expertise, strategic vision and mandate of the MOHLTC” and delivered by a ministry that “has no particular expertise in the design, delivery, management, or oversight of either healthcare or public health services” (IROC 2017b, 196). It is further perpetuated given that “there is no general requirement for MCSCS to align its correctional healthcare services with MOHLTC services and objectives, or to consult with MOHLTC when developing healthcare policies” (IROC 2017b, 196). This epistemic break therefore effects a pernicious form of structural epistemic injustice—an unfair distribution of epistemic goods, including ministry-specific medical knowledge and clinical expertise, which negatively affects the healthcare incarcerated pregnant women receive (Fricker 2013).

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This epistemic break also manifests in other features of healthcare delivery in jails, which further compound the institutional epistemology of ignorance. Whereas the MOHLTC has made significant efforts to support the implementation of electronic health records, the MCSCS has made no such shift (JHSO 2016, 13). Consequently, “communication regarding patient health information between correctional staff and external medical institutions is difficult and inefficient” (JHSO 2016, 13). With no ability to monitor health trends digitally, “the medical services provided in correctional institutions continue to be delivered primarily through a reactive care model” (JHSO 2016, 13–14), which is “geared mainly at addressing the most acute and urgent medical conditions” (IROC 2017b, 192). For incarcerated pregnant women, this reactive model of healthcare delivery is especially inappropriate. A primary focus on servicing acute conditions suggests that it is unlikely that they have access to the supports and services women in the community enjoy and which are associated with positive birth outcomes (CCPHE 2015). The IROC committee notes, for instance, that “while Vanier Centre for Women, the primary institution for sentenced women, does provide access to doulas to assist with pre-natal care, the birth, and the postpartum period, these services are not available to women incarcerated at other institutions” (IROC 2017b, 58). The MCSCS also enjoys significant discretion regarding medical record keeping. The MCSR requires that correctional healthcare professionals report to the superintendent whenever an incarcerated person is seriously ill (s. 4(3)), has injuries treated (s. 4(4)), or is unable to work because of illness or disability (s. 4(5)). Beyond these general provisions, however, any more specific guidelines regarding medical record keeping that might exist are only contained in internal policy documents. One consequence of these deficiencies is that there are no centralized records regarding the number of pregnant women in provincial custody, though one facility keeps localized statistics (IROC 2017b, 58). Although variation in service provision may exist between facilities, the fact remains that, without publicly available data, little can be known about the number, treatment, and consequences of care for incarcerated pregnant women. Without this data—the collection of which is largely at the discretion of correctional administrators—it is nearly impossible to develop an accurate picture of the systemic character of the medical neglect relating to perinatal care ongoing in Ontario jails. Epistemic Barriers to Litigation To summarize, the institutional epistemology of ignorance at work in Ontario jails functions to generate pernicious ignorance that conceal ongoing injustices. Consequently, jails become epistemically demarcated from the rest of the society, to the extent that the epistemic goods and norms of this particular

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domain of knowledge, together with epistemic agents active within the domain, come to be seen as largely irrelevant within or having no bearing on other such domains. Although epistemic demarcation can be innocuous, it becomes pernicious when it contributes to structural epistemic injustice. 7 Regarding healthcare delivery, this phenomenon is evidenced in the epistemic break between the MCSCS and the MOHLTC. To the extent that this epistemology of ignorance conceals the broad discretion correctional administrators are afforded, it impedes the recognition and resolution of systemic injustices relating to medical neglect. This means that the same governance frameworks that create the regulatory conditions under which incarcerated pregnant women may be denied adequate perinatal care also create the epistemic conditions under which this fact oftentimes cannot be demonstrably proven in any reliably generalizable sense. The influence of this epistemology of ignorance is not restricted to jails, however, as is clear when currently and formerly incarcerated persons avail themselves of the courts in order to seek review of or redress for treatment they experience while in custody. In particular, it curtails their epistemic agency and undermines the possible uptake of their testimonies by generating and maintaining group-differentiated credibility presumptions. In this section, I identify three epistemic barriers that undercut litigation efforts and insulate correctional systems from judicial reform. As Lisa Kerr writes, “prisons have a stark advantage at the outset of a complaint,” due to an extreme “power/knowledge imbalance” (Kerr 2014, 48). On the one hand, “the institutional defendant can rely on extensive evidence [. . .] from correctional staff, as to the basis and justification of its actions with respect to the plaintiff prisoner and with respect to its policies more generally” (Kerr 2014, 50). On the other, “plaintiff’s counsel [. . .] will rarely have the benefit of an independent, reliable evidentiary record over the time period most relevant to the case, and the individual plaintiff will not be able to speak personally to the legitimacy of penological techniques as a general matter” (Kerr 2014, 50). This advantage also extends to the different ability of each party to draw upon epistemic resources and deploy information in such a way as to constitute an official narrative, or “Statement of Facts” in a legal setting. Consider the disciplinary hearing proceedings of one of the nurses involved in Bilotta’s case (Gyasi v. College of Nurses of Ontario 2014). Two different reasons were given as to why Bilotta was segregated. According to Bilotta, her trans7. My account of “epistemic demarcation” takes inspiration from Mills’s (2007) discussion of the “epistemic ghettoization” of black intellectuals, which has “whited out” the distinct conceptual insights of black scholarly perspectives (Mills 2007, 33–34). Accordingly, “whites cite other whites in a closed circuit of epistemic authority that reproduces white delusions” (34). I take the perspectives and insights of incarcerated people to be analogous, in that they are denied access to circuits of epistemic authority in both the penal system and society at large.

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fer was the result of her pain-provoked moans (5). According to a correctional officer, however, it was because of “tension” involving Bilotta and her two cellmates (5). However, in her interview with Sarah Fiander (2016), Bilotta clarified that her cellmates’ frustration—the source of the alleged “tension”—“was not directed at [her], but rather towards the guards in response to their lack of intervention and their overall disregard of Bilotta’s cries for help” (83). Although the Discipline Committee of the College of Nurses of Ontario is not a judicial body, the same informational asymmetry exists here as in court. In both contexts, correctional administrators are able to coopt and reframe the testimonies of incarcerated persons, so as to deploy their testimonies against them in constituting official institutional narratives. This informational asymmetry is buttressed by a credibility asymmetry. Incarcerated persons are therefore disadvantaged both in their ability to generate and deploy knowledge and with respect to the uptake their knowledge is given. As Kerr (2014) identifies, courts have historically afforded correctional administrators an unduly broad degree of deference. Although this credibility asymmetry once manifested as a “frank prejudice against offenders,” it persists today in a “language of limited judicial capacity and a lack of expertise” (49). Courts justify underscrutinizing the decisions of correctional administrators by intimating that they occupy a unique position as the possessors of the knowledge necessary for the preservation of internal order and discipline—a position that others are unable to occupy as a result of seemingly insurmountable epistemic barriers. The deference courts afford correctional administrators manifests as a general unwillingness to see jails on a continuum with other social spaces and therefore as governed by similar standards, which exacerbates the epistemic demarcation of the jail. Kerr (2017) identifies two forms this demarcation takes in judicial contexts: “sociological insulation” and “legal compartmentalization.” In the former, the jail is taken to be an “exceptional space,” such that correctional administrators are justified in applying standards to support their decisions, without their needing to be contextualized with reference to standards applied in other similar institutional settings (Kerr 2017, 184–85). In the latter, the jail is “segregated” from the rest of public law in that correctional decision makers are only held responsible for specific tenets of prison law and correctional policies, as opposed to the “full spectrum of law governing state action” (Kerr 2017, 185–86). Even the choice of the legal avenue sought can further entrench this epistemology of ignorance. In Bilotta’s case, this was civil litigation (2014). Suing healthcare professionals, correctional officers, and institutions in cases of inadequate care depicts the incident as stemming from the wrongful actions and negligence of particular individuals—an aberration from otherwise adequate procedures—as opposed to one resulting from deficiencies within the governance frameworks. Accordingly, civil litigation is unable to estab-

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lish the systemic character of the injustices to which Bilotta and others were and are subjected. These issues are further compounded by the fact that many civil suits, including Bilotta’s (The Canadian Press 2018), end in out-of-court settlements, the terms of which are confidential. Consequently, no findings will ever be released to the public and the case will not set precedent (Kerr 2015, note 75 at 110). This point should not be taken to suggest that Bilotta or others like her are at fault for pursuing civil litigation. Rather, it highlights the limited number of legal avenues to which incarcerated persons have access. Hypothetically, Bilotta could have sought a judicial review of the discretionary actions of OCDC staff. This approach would also have faced a number of roadblocks, including that courts can refuse a remedy if the issue is moot (Flood and Sossin 2013, 109). Nonetheless, judicial review is still largely inaccessible owing to the high cost of litigation and the lack of possible financial redress. Despite the fact that a successful judicial review decision might set valuable precedent and limit prison administrators’ discretion, it remains largely out of reach. TOWARD AN ABOLITIONIST EPISTEMOLOGY My discussion thus far might lead one to suspect that, though the issues I have outlined derive from structural features of the administration of Ontario jails, they could be resolved by developing more constitutionally compliant governance frameworks and collecting more and better data. This is the approach the Independent Review of Ontario Corrections committee takes in their recommendations, which focus on the need for clearer directives at the statutory, regulatory, and policy levels, as well as robust oversight mechanisms (IROC 2017b, 221). Regarding healthcare, they recommend that responsibility be transferred to the Ministry of Health and Long-Term Care, so as to allow for integration into the provincial system and the standardization of delivery and record keeping mechanisms (IROC 2017b, 236–38). These recommendations are invaluable but will not be a conclusive “fix” to the injustices I have described because the problem is not solely or even primarily one of informational deficit. This is why I have adopted Mills’s phrase “the epistemology of ignorance.” For Mills, a strength of the epistemology of ignorance is its flexibility. As the racial contract is continually rewritten, it finds new ways to quiet the cognitive dissonance between the social contract’s ideals and the racial contract’s realities. In taking up the concept from Mills, my intention is to convey the resilience of the institutional epistemology of ignorance at work in Ontario jails—and to stress that Ontario’s system is by no means unique in this regard. As correctional systems across Canada are continually reformed, they persist in finding new

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ways to generate pernicious ignorance by which to conceal injustices behind their walls. The history of prisoners’ justice in Canada provides countless examples of this dynamic. In Nova Scotia, Canadian Association of Elizabeth Fry Societies’ advocates encountered a woman in 2016 whose prenatal nutrition needs were being reported as “met” with one additional rice crispy square per day (Garson 2017). In Ontario, a tautological definition of segregation as “confinement within the segregation area” has allowed for the proliferation of a variety of de facto segregation units by which correctional administrators skirt the procedural protections for and rights of persons in segregation (IROC 2017a, 60–62). More generally, both federal and provincial systems have a long history of coopting the testimonies, expertise, and terminology of advocacy groups in order to justify building more and larger prisons (Hannah-Moffat 2000; Monture 2006; Piché, Kleuskens, and Walby 2017). To the extent that the epistemology of ignorance at work in Ontario jails conceals the structural injustices through which it is generated and perpetuated, it is not enough to simply address the informational deficit that is its symptom. Rather, what is needed is a cluster of continually evolving epistemic tools, practices, and communities—what Lorraine Code (2008) calls an “instituting social imaginary,” or a “locus of social critique and change” (Code 2008, 34)—oriented toward recognizing and resisting the strategies of ignorance production and maintenance correctional systems employ to conceal injustices behind their walls. However, as the history of prisoners’ justice in Canada demonstrates, and as I argue further below, if this epistemology is to serve incarcerated persons and their advocates as they work toward dismantling the structures that make these injustices possible, then it must critically interrogate whether prisons can ever be adequately reformed and, indeed, whether and how reformist approaches may in fact more deeply entrench forms of pernicious ignorance already in place. Such lines of questioning align this epistemology with the vision and stated aims of prison abolition movement (Davis 2003; Hewitt-White 2006; Sudbury 2009), and, as such, I refer to it as an abolitionist epistemology. Central to an abolitionist epistemology is a “hermeneutics of suspicion” capable of identifying these strategies in action, and especially when otherwise well-intentioned reforms may be contributing to them (Ricoeur 1970). Indeed, reforms intended to produce better prisons are a central means by which penal systems are expanded and consolidated. For example, considering litigation efforts aimed at reforming the use of segregation, Debra Parkes (2017) argues that, in receiving “the imprimatur of constitutionality,” shortterm improvements may make it “more difficult in the future to argue that the whole practice of prisoner isolation is cruel, inhumane, and therefore, unlawful” (Parkes 2017, 172). More generally, in appraising the potential efficacy of any kind of prison reform, scholars have long recognized the need to

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distinguish “reformist” reforms, which ultimately render the prison system more impermeable to change, from their “nonreformist” counterparts— “changes that, at the end of the day, unravel rather than widen the net of social control through criminalization” (Gilmore 2007, 242). An abolitionist epistemology must also challenge the processes of epistemic demarcation by which jails are enabled to operate largely undisturbed. Paradoxically, this epistemic demarcation is buttressed by an “epistemic occupation” with the practice of incarceration, the result of which is that “many of us encounter profound difficulty imagining and conceptualizing the redress and prevention of violence (including state violence) without recourse to the heteropatriarchal violence of the state” (Heiner and Tyson 2017, 2). The jail may be out of sight and out of mind for many, but the practice of incarceration is still so present that “we do not question whether it should exist” (Davis 2003, 18–19). Consequently, what goes unchallenged is the underlying “carceral logic” of incarceration—“the idea that imprisonment and policing are a solution for social, political, and economic problems” (Critical Resistance 2018). The epistemic demarcation of the jail and the epistemic occupation with incarceration together effect an imaginative rigidity regarding prison reform. They make it difficult to imagine reforms for the jail that are not internal to the jail itself, and which are therefore reliant on the continued existence of the jail for their efficacy. Rather than identify “one single alternative system of punishment that would occupy the same footprint as the prison system,” Angela Davis (2003) challenges abolitionists to overcome this rigidity by imagining “a constellation of alternative strategies and institutions, with the ultimate aim of removing the prison from the social and ideological landscapes of our society” (Davis 2003, 107). As it pertains to reforms aimed at meeting incarcerated women’s health needs, this imaginative rigidity can have disastrous consequences. Historically, attempts to advocate for greater service provision in jails have had the perverse effect of incarcerating more women for longer, owing to a presumption on the part of courts that they will be able to receive the help they need there at a time when such services are increasingly unavailable in the community (Neve and Pate 2005). In Atlantic Canada, for instance, there were only thirteen women serving federal sentences in 2001 (Ayers 2017). As Darlene MacEachern, executive director of the Elizabeth Fry Society of Cape Breton, notes, “within two years, we had a 500 percent increase in the number of women who were being sentenced to prison because judges had heard about all the systems and all the healthcare that could be accessed in there” (Ayers 2017). It is therefore imperative that an abolitionist epistemology’s pursuit of nonreformist reforms come together in a commitment to “reproductive justice” (Ross 2006). This principle calls for the investigation of “how repro-

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ductive oppression may occur in all arenas of life,” so as to work toward securing “the complete physical, mental, spiritual, political, economic, and social well-being of women and girls” (ACRJ 2005, 1–9). Recognizing the inextricable connection between the well-being of women everywhere, abolitionists must resist being put in a position of having to advocate for additional health services in correctional settings at the expense of community-based care (Ayers 2017). Instead, they seek out anticarceral remedies, such as the decarceration of women, in order to meet their health needs (Parkes 2017). Formulating an abolitionist epistemology also requires foregrounding the epistemic agency of incarcerated persons and their individual and collective epistemic resources. With this point in mind, I conclude by noting that Women’s Wellness Within (WWW), a collective based in my home province of Nova Scotia, fully embody an abolitionist epistemology—and the principle of reproductive justice to which it is committed—by bringing together women from medical and legal backgrounds with those who have directly experienced and been impacted by incarceration. Although WWW’s primary role is to coordinate doula services for incarcerated women, one of the organization’s core values is that “pregnant women and nursing mothers should not be in jail” (Rahr 2017). Accordingly, their advocacy efforts increase public awareness of the perspectives and experiences of incarcerated women, and particularly pregnant women held in segregation (WWW 2016). In striking “a balance between reforms that are clearly necessary to safeguard the lives of prisoners and those strategies designed to promote the eventual abolition of prisons as the dominant mode of punishment” (Davis and Rodriguez 2004, 216), groups like WWW therefore accomplish the “great feat of the imagination” required to envision life beyond prisons (Davis 2003, 19). REFERENCES Alcoff, Linda Martín. 2006. “Epistemologies of Ignorance: Three Types.” In Race and Epistemologies of Ignorance, edited by Shannon Sullivan and Nancy Tuana, 39–58. Albany: State University of New York Press. Anderson, Elizabeth. 2012. “Epistemic Justice as a Virtue of Social Institutions.” Social Epistemology 26 (2): 163–73. Asian Communities for Reproductive Justice [ACRJ]. 2005. “A New Vision for Advancing our Movement for Reproductive Health, Reproductive Rights and Reproductive Justice.” http:// forwardtogether.org/assets/docs/ACRJ-A-New-Vision.pdf. Ayers, Tom. 2017. “Prison Sentences Sometimes Used to Beat Mental Health Wait Times: Expert.” The Chronicle Herald, November 25. https://www.trurodaily.com/living/prisonsentences-used-to-beat-wait-times-for-mental-health-services-expert-165305/. Bilotta, Julie. 2014. Statement of Claim. Filed in Ontario Superior Court of Justice, September 23, 2014. Court File No. 14-62057. https://www.documentcloud.org/documents/1305128julie-bilotta-statement-of-claim.html. Code, Lorraine. 2008. “Advocacy, Negotiation, and the Politics of Unknowing.” Southern Journal of Philosophy 46 (S1): 32–51.

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Collaborating Centre for Prison Health and Education [CCPHE]. 2015. Guidelines for the Implementation of Mother-Child Units in Canadian Correctional Facilities. http://med-fomfamilymed-ccphe.sites.olt.ubc.ca/files/2012/05/MCUGuidelines_Nov15_FINAL.pdf. Critical Resistance. 2018. “History.” http://criticalresistance.org/about/history/. Davis, Angela. 2003. Are Prisons Obsolete? New York: Seven Stories. Davis, Angela, and Dylan Rodriguez. 2004. “The Challenge of Prison Abolition: A Conversation.” Social Justice 27 (3): 212–18. Dotson, Kristie. 2011. “Tracking Epistemic Violence, Tracking Practices of Silencing.” Hypatia 26 (2): 236–57. Fiander, Sarah. 2016. “Pregnancy, Birth, and Mothering behind Bars: A Case Study of One Woman’s Journey through the Ontario Criminal Justice and Jail Systems.” MA thesis, Wilfred Laurier University. Flood, Colleen, and Lorne Sossin. 2013. Administrative Law in Context: Second Edition. Toronto: Emond. Fricker, Miranda. 2007. Epistemic Injustice: Power and the Ethics of Knowing. Oxford: Oxford University Press. ———. 2013. “Epistemic Justice as a Condition of Political Freedom?” Synthese 190 (7): 1317–32. Garson, Hanna. 2017. “Prenatal and Natal Care for Pregnant Women in Canadian Jails.” Presentation at Annual Bill Brown Conference: Incarceration Across the Americas—Transnational Perspectives on the Prison Industrial Complex and Globalization. University of North Carolina: Charlotte. Charlotte, NC. February 11, 2017. Gilmore, Ruth Wilson. 2007. Golden Gulag: Prisons, Surplus, Crisis, and Opposition in Globalizing California. Berkeley: University of California Press. Gyasi v College of Nurses of Ontario [Gyasi]. 2014. Discipline Committee of the College of Nurses of Ontario. Registration No. 12491047. http://www.cno.org/en/protect-public/disci pline-decisions/g/4139/. Hannah-Moffat, Kelly, 2000 “Prisons That Empower: Neo-liberal Governance in Canadian Women’s Prisons.” British Journal of Criminology 40 (3): 510–31. Heiner, Brady, and Sarah Tyson. 2017. “Feminism and the Carceral State: Gender-Responsive Justice, Community Accountability, and the Epistemology of Antiviolence.” Feminist Philosophy Quarterly 3 (1): 1–36. Hewitt-White, Caitlin, ed. 2006. “Prison Abolition in Canada.” Upping the Anti 4: 125–46. Iftene, Adelina, Lynne Hansen, and Allan Manson. 2014. “Tort Claims and Canadian Prisoners.” Queen’s Law Journal 39 (2): 1–28. Independent Review of Ontario Correction [IROC]. 2017a. Segregation in Ontario. https:// www.mcscs.jus.gov.on.ca/english/Corrections/IndependentReviewOntarioCorrections/Inde pendentReviewOntarioCorrectionsSegregationOntario.html. ———. 2017b. Corrections in Ontario: Directions for Reform. https://www.mcscs .jus.gov.on.ca/english/Corrections/IndependentReviewOntarioCorrectionsIndependent ReviewOntarioCorrectionsDirectionsReform.html. John Howard Society of Ontario [JHSO]. 2016. Fractured Care: Public Health Opportunities in Ontario’s Correctional Facilities. http://johnhoward.on.ca/wpcontent/uploads/2016/04/ Fractured-Care-Final.pdf. Kerr, Lisa. 2014. “Contesting Expertise in Prison Law.” McGill Law Journal 60 (1): 43–94. ———. 2015. “The Origins of Unlawful Prison Policies.” Canadian Journal of Human Rights 4 (1): 89–119. ———. 2017. “Making Prisoner Rights Real: The Case of Mothers.” In The New Criminal Justice Thinking, edited by Sharon Dolovich and Alexandra Natapoff, 168–95. New York: NYU Press. Mills, Charles W. 1997. The Racial Contract. Ithaca, NY: Cornell University Press. ———. 2007. “White Ignorance.” In Race and Epistemologies of Ignorance, edited by Shannon Sullivan and Nancy Tuana, 11–38. Albany: State University of New York Press. Ministry of Community Safety and Correctional Services, Ontario [MCSCS]. 2015. Inmate Information Guide for Adult Institutions. Toronto: Ministry of Community Safety and Correctional Services.

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———. 2016. “Ottawa-Carleton Detention Centre Task Force Action Plan.” http:// www.mcscs.jus.gov.on.ca/english/Corrections/OCDC_task_force.html. Monture, Patricia. 2006. “Confronting Power: Aboriginal Women and Justice Reform.” Canadian Woman Studies 25 (3–4): 25–33. Neve, Lisa, and Kim Pate. 2005. “Challenging the Criminalization of Women Who Resist.” In Global Lockdown: Gender, Race and the Prison-Industrial Complex, edited by Julia Sudbury, 19–34. New York: Routledge. Parkes, Debra. 2017. “Solitary Confinement, Prisoner Litigation, and the Possibility of a Prison Abolitionist Lawyering Ethic.” Canadian Journal of Law and Society 32 (2): 165–85. Piché, Justin, Shanisse Kleuskens, and Kevin Walby. 2017. “The Front and Back Stages of Carceral Expansion Marketing in Canada.” Contemporary Justice Review 20 (1): 26–50. Rahr, Maggie. 2017. “A Prison Pregnancy.” The Deep, December 5. Ricouer, Paul. 1970. Freud and Philosophy: An Essay on Interpretation. New Haven, CT: Yale University Press. Ross, Loretta. 2006. “Understanding Reproductive Justice: Transforming the Pro-Choice Movement.” Off Our Backs 36 (4): 14–19. Seymour, Andrew. 2017. “Prisoner Suffers Miscarriage in Ottawa Cell as Her Cries for Help Were Ignored.” The Ottawa Citizen, February 3. Sudbury, Julie. 2009. “Maroon Abolitionists: Black Gender-Oppressed Activists in the AntiPrison Movement in the U.S. and Canada.” Meridians 9 (1): 1–29. The Canadian Press. 2018. “Julie Bilotta Settles Lawsuit with Province over 2012 Jailhouse Birth.” CBC News. https://www.cbc.ca/news/canada/ottawa/julie-bilotta-jailhouse-lawsuitsettled-1.4556660. Women’s Wellness Within [WWW]. 2016. “End Solitary Confinement of Pregnant Women in Nova Scotia Correctional Facilities.” https://static1.squarespace.com/static/5a17715d8 dd04195b6708c76/t/5a653ec153450a34f4f32720/1516584642006/Press+Release+WWW +Solitary.pdf.

IV

Learning to Overcoming Epistemic Injustice in Academia, Education, and Sports

Chapter Fifteen

Teaching as Epistemic Care Casey Rebecca Johnson

As philosophers work to investigate social epistemology, a wide variety of injustices come to light. Socially subordinated agents can experience epistemic oppression, testimonial injustice, hermeneutical injustice, epistemic undermining, and epistemic violence. Members of socially subordinated groups are also at risk of falling victim to unfair distributions of epistemic resources, like books, libraries, safe and successful schooling, and access to the Internet. Many of these problems invite educational solutions. The socially subordinated—the victims of these epistemic injustices—ought to have better access to educational resources. And the socially privileged—those who benefit from and sometimes perpetuate epistemic injustices—ought to be educated about epistemic justice and about their obligations to interrupt unfair systems. Education, then, is of vital importance for epistemic agents and for overcoming epistemic injustice. This tool for overcoming epistemic injustice is complicated, however, by our social attitudes toward education. 1 Our social perception of teachers and the work that they do is fraught and complicated. And the labor of educators—teaching other epistemic agents—has not received much attention from social epistemologists. (C. Elgin 2011 is among the exceptions to this. Alvin Goldman 2006 discusses teaching but only insofar as it concerns subject matter appropriate for dissemination—my focus is different.)

1. I am focused, here and throughout, on formal educational systems—from preschool through secondary education. I don’t want to suggest that this is the only educational work that is of interest, nor do I want to suggest that it is fairly distributed. I am working with formal education because it is one place to start, and because it is more easily recognized as epistemic work than some of the very earliest and least formal kinds of education. More on that in section 4.

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I have two goals in this chapter: first, I argue that the position of educational labor, relative to epistemic work more generally, is analogous to the position of care work, relative to economically recognized work more generally. Second, I argue that care ethics offers insights into our epistemic lives. Both of these goals are in the service of highlighting education work as an important aspect of an accurate picture of our epistemic lives. Epistemology is not exhausted by the experiences of independent autonomous knowers—or even by socially situated (but mature) knowers. 2 To be adequate, social epistemology must also account for how we come to be knowers and for the labor (particularly epistemic labor) involved in getting us to that point. I will proceed as follows: in the next section, I demonstrate that education work is undervalued and mostly done by those who are socially subordinated. Then, in section 3, I highlight some important lessons from care ethics. In section 4, I draw an analogy with care work. I will focus on four relevant points of analogy: first, young students, like infants and the elderly, are dependent on and vulnerable to their care providers. Second, care work must be done—a society that does not provide for the care and education of its children (and others who are vulnerable) will not last long. Third, like care work, teaching work—particularly the work that goes into teaching young children—is often unpaid and unrecognized (or underpaid and underrecognized) as labor. This situation exacerbates existing injustices. Fourth, the way forward is not at all clear—even if we agree that care work is important, it is not always clear how to incorporate it into our theories. These points of analogy suggest that some epistemic work—particularly work in education— is a kind of care work. And if I’m right that teaching is epistemic care, then the continued devaluing of teaching and the epistemic valorizing of “men’s” epistemic work has consequences for epistemic justice. This analogy will help us not only to understand teaching work as it contributes to epistemic goods but will also help us to address an epistemic injustice that has not been sufficiently central to our analyses: the unfair distribution and valuation of teaching work. UNFAIR DISTRIBUTIONS OF EPISTEMIC LABOR In this section I argue that our current educational and academic situation distributes epistemic labor unfairly. An individual might be subject to a number of unfair epistemic situations: she might not have fair access to epistemic goods like information or education; she might enjoy a surplus of 2. Epistemic experiences include things like having your testimony believed, being consulted for your views, being treated as credible. One way to see work on epistemic injustice (Fricker 2007), alternative epistemologies (Mills 1988), and the related literature is as expanding the set of experiences that are at issue/relevant for epistemological study (Medina 2013).

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perceived expertise; she might be subject to a credibility deficit. All of these unfair epistemic distributions are familiar in the literature on epistemic injustice (see, for example, Coady 2010; Dotson 2011; and Fricker 2007). However, the unfair distribution of certain kinds of epistemic labor has gone largely unnoticed. Of course, not all unequal distributions of epistemic labor are unfair or epistemically problematic. Indeed, many of our epistemic pursuits, including science and many other forms of inquiry, require that we divide epistemic labor and rely on one another. The division of epistemic labor has been the subject of quite a bit of work in epistemology (C. Z. Elgin 2008, Goldberg 2011, Kitcher 1990, Pritchard 2015). Because of our epistemic and evidential limits, we need other people to tell us about the ancient past, about our own early years, and about areas of research we’ve not had the time or ability to investigate personally. It is clear that, to some extent, dividing epistemic labor and distributing it among inquirers is both necessary and epistemically good. So, the problem is not the distribution per se. However, there is a problem when epistemic labor is distributed in a way that unfairly marginalizes groups without epistemically good reason, and when necessary epistemic labor is not valued. When the perceived value of a particular kind of epistemic labor does not match its actual epistemic importance, and when that misevaluation is paired with a history of social subordination, we have a recipe for epistemic injustice. And this, I’ll argue, has occurred with regard to teaching work: this important epistemic labor is not perceived to be as valuable as it is, in part because the labor is typically done by a socially subordinated group—women. We have good evidence that the epistemic contributions and labor of women is undervalued compared to that of men. One experiment that demonstrates this tested subjects’ perceptions of intellectual achievements by men and women (Elmore and Luna-Lucero 2017). Subjects were presented with one of a set of stories and asked to rate it for (a) whether it was credible or not, and (b) for whether the main character was an exceptional genius or normal but hardworking. In the story, the main character was a scientist with either a (stereotypically) man’s name or a (stereotypically) woman’s name. The scientist was described as making a groundbreaking discovery after either (c) nurturing the idea through many years of collaborative effort, or (d) experiencing a stroke of inspiration—a so-called “eureka” moment. Scenarios like (c) were described using a seed metaphor while scenarios like (d) were described using a lightbulb metaphor. When men’s names were paired with lightbulb metaphors, the scenario was ranked as highly credible and the main character was perceived as a genius. When women’s names were paired with the seed metaphor the scenario was credible and the main character was perceived as hardworking. Other pairings were ranked as less credible, and

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the ideas in question as less exceptional. This study suggests that we generally perceive women as less epistemically exceptional than men, and less likely to have exceptional ideas. This perception then suggests a particular pattern for the distribution of epistemic labor—women, as less likely to generate exceptional ideas, should be doing the epistemic labor that could be done by anyone; they are epistemically fungible in ways that men are not. Men, as potential geniuses, should have their epistemic labor and time protected. The attitude that we should protect men’s time so that it can be devoted to “important” epistemic labor is also reflected in a recent study regarding the amount of time men and women academics spend on service and teaching work. The study found that “on average, women faculty perform significantly more service than men, controlling for rank, race/ethnicity, and field or department” (Guarino and Borden 2017, 672). And according to a study on academics in the United Kingdom, “female academics report spending more time on teaching and public-engagement tasks, and less time on research, than their male counterparts” (Gibney 2017). While these differences are likely best explained by a complicated set of attitudes and structural features of academia, these features probably include the facts (a) that we perceive men’s independent epistemic work to be more important (or more likely to be important) and (b) that we think women are better suited to be teachers. Other findings also demonstrate a gendered difference in our perceptions of the epistemic labor for which men and women are suited. Studies of student evaluations of teaching (SETs) suggest that our perceptions of the teaching work done by men and women tend to be different (Hornstein 2017). Gender makes a significant difference to the kind of expectations students have for their college-level instructors. When presented with women faculty, students tend to expect a more nurturing role, but then judge that behavior as less than professorial. On the other hand, if a woman is more assertive, students tend to perceive her as too masculine. Furthermore, outof-class socializing has no effect on SETs of male lecturers, but female lecturers who are unfriendly out of class receive lower ratings (Andersen and Miller 1997; Boring, Ottoboni, and Stark 2016). And a recent study found that in SETs, “students tend to comment on a woman’s appearance and personality far more often than a man’s. Women are referred to as ‘teacher’ [as opposed to professor] more often than men, which indicates that students generally may have less professional respect for their female professors” (Mitchell and Martin 2018, 5). The fact that students use the epistemic honorific “professor” less for their female professors also suggests that they see male professors as more expert and their female professors as more suited to the kind of role served by their early education teachers. This indicates a gendered division in our perceptions of epistemic labor. These perceptions are correlated (at least) with a distribution of teaching labor in the United States in which gender is clearly a factor. According to

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the Bureau of Labor statistics, 98 percent of preschool teachers in the United States are female, 87 percent of primary school teachers in the United States are female, and 62 percent of secondary school teachers in the United States are female—percentages in the European Union are similar (Bureau of Labor Statistics 2015). Insofar as early education is seen as less epistemically valuable, or of requiring less intellectual talent, then, our perceptions of women and their epistemic labor suffers by comparison with that of men. We can draw several lessons from these findings and statistics. First, women do much of the early education work in the United States. Second, even when women work in higher education, they are perceived as teachers rather than professors, and are taken to be less likely to be geniuses as compared to their male colleagues. Third, women in higher education spend more time on teaching work than their male colleagues, even though this work is less valued, epistemically. CARE ETHICS In this section I will present an overview of care ethics, though my discussion should not be taken as exhaustive—readers familiar with care ethics may wish to skip to the last paragraph of this section. The positions taken by care ethicists are not uniform, however most have central commitments in common, and many are motivated by similar sets of observations. Eva Feder Kittay’s book Love’s Labor (2013) illuminates care ethics by way of a kind of work that Kittay calls “dependency work.” The beneficiaries of dependency work are dependent, in some important way, on the labor of some other(s). Prime examples are the very young and very old who are almost wholly dependent on their care providers. The provision of this kind of care, according to Kittay, goes largely unnoticed in most accounts of a functioning society. Indeed, she argues, ethical theories in general have ignored the fact that people whose behavior is to be evaluated by these ethical theories don’t come into the world or go out of it as independent, selfsufficient beings. We must be cared for before we can act in ways that are moral or immoral. An ethic of care—an ethical theory that acknowledges the particular situation and needs of providers and receivers of care—supplements traditional social theories. This improves their ability to capture morally relevant behavior, claims, and obligations (Noddings 2013). The inclusion of care into our ethics is justified, in part, by the necessity and ubiquity of dependency work. Care work must be done, or something seriously immoral is going on. It would, of course, be physically possible for us to leave all care work undone, but as a matter of moral fact, someone has to provide care. Someone has to raise children to the point they’re able to care for themselves, and we’ve all been the beneficiaries of such care. It is

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also partially justified by work from Carol Gilligan and Annette Baier demonstrating that people who provide care often subsume their own needs to the needs of their dependents (Baier 1987; Gilligan 1982). Moral theories that focus on the actions or the freedoms of autonomous individuals cannot accurately account for the experiences of these care providers. Traditional liberal theories of social organization like those from John Locke, John Stuart Mill, John Rawls, and so on, do not address the ways that dependency labor changes one’s normative position (Locke 1988; Rawls 2009). The dependent’s needs are not the needs of the provider, nor is it accurate to say that subsuming one’s needs is something the provider (always) freely chooses (Kittay 2013). Yet this work is not optional—it must be done by someone, and our lives go better when it is done well (Baier 1987). So, the care ethicist argues, we have good reason to treat care as central to our ethics. Another focus for care ethicists is on the social situation that supports (or fails to support) care workers and care work. Allowing for care work to be performed, performed well, and performed by people who are able to live reasonably good lives, is taken to be necessary for a properly functioning society. Joan Tronto, for example, argues that, “for a society to be judged as a morally admirable, it must, among other things, adequately provide for care of its members and its territory” 3 (Tronto 1993, 126). To do this, a society must (a) be structured to allow care providers to be attentive to the needs of those who depend on them; it must (b) have someone be responsible for caring when a care demand presents itself; it must (c) prepare providers to be competent to provide care; and it must (d) balance the needs of care givers and those in need of care. In practice, given our history of socially subordinating some social groups and privileging others, this will mean we must work to avoid certain situations. The comparatively powerless, as Tronto points out, are more likely to be self-sacrificial. Take, for example, the adult daughter, caring for her parents, while her brothers pursue their own lives and careers. The daughter’s comparative powerlessness contributes to her taking on the care burden for her parents. This is in part because social subordination habituates people to ignore or devalue their own immediate needs and in part because the powerless are not in a position to refuse to do care work, even if doing so requires self-sacrifice. In structuring our society, we would do well to attend to these histories—this will mean working to keep historically subordinated groups from being self-sacrificial, as well as working to interrupt histories of social subordination.

3. By “territory,” here, Tronto means the environment. She, like many other care ethicists, is committed to the view that environmental resources, like care resources, are necessary for a well-functioning society.

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We also must guard against limiting the outlooks of those who provide care. Care work requires attention and responsiveness to the day-to-day basic needs of one’s dependents. This focuses the care worker on local and immediate needs. If the care worker has no other outlets, or too few opportunities for personal development, this limits their outlook. Finally, a society must take care that the attitudes and norms that are reinforced do not valorize independence. Attitudes treating independence as the paradigm of maturity or as necessary for a good human life devalue those who need care. (When this is combined with the paucity of opportunity for self-care, the lack of recognition for care work in the economy, and the dismissal of such work as “women’s work,” the situation is dire, indeed.) So, if Tronto is right, we must take care not to perpetuate these social situations if our society is to be doing morally well. Just how to adjust the mainstream moral theorizing to accommodate these facts about care work is a matter of debate among care ethicists. Some argue that we can marry traditional liberal theory with care ethics to produce a new and better ideal for social organization (Bhandary 2010). Asha Bhandary, for example, argues that traditional liberal theory can be adjusted to accommodate the need for care (Bhandary 2010). For others, the way forward is to change our understanding of the fundamental unit of moral analysis from the individual to the relationship—Kittay, for example, argues that the fundamental ethical ideal is that of the mother–child relationship (Kittay 2013). From this (admittedly limited) discussion of care work, I’d like to draw four lessons. First, care work is not optional or supererogatory. Someone has to care for those who will become or who have been members of our moral or social communities. Second, part of why this must be done is to create new moral agents—for someone’s behavior to be (usefully) morally evaluable, they must be raised and cared for to (at least) the point that they’re an agent. Third, for this care work to be possible, society must be structured to support it—if it isn’t (and it hasn’t been) then injustices will compound and be exacerbated. Finally, the way to adjust our society to accommodate care work without exacerbating injustice is part of the ongoing work of care ethics. I’ll draw on each of these points in the next section. TEACHING AS EPISTEMIC CARE Care ethics illuminates the importance of vulnerability and dependence in social reproduction. Dependence is easiest to see in young children and the elderly who are physically dependent on those around them; however, dependence is far wider ranging than that. One adult might depend on another for physical care (like cooking a meal or cleaning clothes) because that adult doesn’t have time to perform that work herself. We also depend on one

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another for meeting our emotional needs, both when we are children and when we’re adults. The fact that dependency is varied and wide ranging is familiar from care ethics. However, I want to suggest that dependency is not just physical and emotional, it is also epistemic. Once framed in this way, this is clearly intuitive. At the earliest stages of education, students are epistemically dependent on their teachers—they rely on their teachers (as well as older siblings and parents) to teach and reinforce for them the epistemic standards, values, and starting assumptions of their communities. As students progress through their education, the degree of their epistemic dependence on their teachers decreases. Students’ increased autonomy, independence, and access to epistemic goods (like library cards) means that they are better able to satisfy their epistemic needs on their own— at least insofar as their early education has prepared them to do so. However, even into postsecondary education, students have a level of epistemic dependence on their teachers—students are not fully autonomous and may need to be told what to read, how to communicate their knowledge, and how to perform other epistemic tasks. We can also find evidence for epistemic dependence in work in social epistemology. Social epistemologists have pointed out that few of our beliefs can be justified solely on the basis of our own epistemic prowess. We rely on others for beliefs as basic and central as our own birthdates and corroboration of our memories. We rely on testimony for directions and for recommendations. Many of our epistemic goals require that we depend on one another. As Catherine Elgin (2011) argues, science cannot get along without collaboration—it is as necessary as models and technology. When we are highly dependent, we are highly vulnerable to the behavior of others. And if we’re to continue in our epistemic pursuits, someone has to address that dependency. If, for example, a young child is to contribute to inquiry, to participate in our epistemic projects, she must first be encouraged to explore, to be curious—her questions must be answered, and basic epistemic norms must be communicated to her. She must, in other words, receive an education. Education work, then, is necessary for us to continue to be subject to epistemic norms, and to continue to pursue inquiry. In these ways, education work is a kind of epistemic care work. Like other care work, education work cannot simply be ignored or treated as supererogatory. Children must be taught to be good epistemic agents. We have good epistemic reason to do educational work. Having well-educated interlocutors helps us epistemically (C. Elgin 2011, Watson 2015), and in terms of inquiry, someone will have to carry on inquiring after we’re no longer able to. As children ask questions and as students seek educations, it will fall on someone to do the work to answer those needs—otherwise we are not properly pursuing epistemic goods.

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This second point of analogy has implications for our epistemic theories as well. If our epistemic theories only focus on the justified true beliefs of autonomous agents (or even the communication of knowledge by adult epistemic agents), we’re bound to miss the experiences both of those who are epistemically dependent and those whose epistemic labor is largely devoted to the epistemic needs of others. I take my claim, here, to be similar points made by Charles Mills (1988), José Medina (2013), and others (e.g., Fricker 2007) in their discussions of what Mills calls “alternative epistemologies.” Furthermore, if we focus only on the epistemology relevant to adults, we’re not going to do very well, epistemically, in the long run. Some social epistemologists have focused on epistemic prejudices against children (Burroughs and Tollefsen 2016, Murris 2013). However, the epistemic labor done by educational-dependency workers has received little to no attention. If it is true that educational work is necessary for our continued epistemic pursuits, then we have to structure our epistemic communities to support that work. As we’ve seen in section 2, we do not currently enjoy a very fair distribution of epistemic care work, and this is to the detriment of both our epistemic care providers and the recipients of that care. We also do not appropriately perceive the expertise and epistemic skills necessary to execute that work well. Much of the structure of our current educational system does not properly address the needs of either learners or teachers. We have good evidence that the work that must be done to properly care for vulnerable epistemic agents is not properly supported in many parts of our epistemic community. As with traditional care work more generally, epistemic care has not been recognized or properly valued, either in our communities or in our theories. As in traditional care work, the subordinating structures in society make subordinated agents more likely to do the necessary but underrecognized work involved in epistemic reproduction. This explains many of the findings in section 2—women, as members of a socially subordinated group, are more likely to do the less valued work required for education. This has not yet been noticed in the literature on epistemic injustice, and further, our social epistemological work has focused on peer disagreement, expert testimony, and group doxastic states, rather than on education work. When our social epistemic theories fail to acknowledge care work, they omit an important facet of our social-epistemic lives. Social epistemology aims to give an account of knowledge as it exists in real, embodied, social people. If I’m right in the above, epistemic care is part of that. We should value the work that goes into epistemic care as a kind of epistemic work. And epistemic care work should receive far more attention in our social epistemic theories. To be adequate, social epistemology must also account for how we come to be knowers and for the labor (particularly epistemic labor) involved in getting us to that point.

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Finally, let us consider the way forward. As with traditional care work, just how to address these issues in our epistemic communities is not clear. Complicated factors involving economics, social subordination and privilege, the valorizing of particular forms of formal education, social biases of teachers themselves, and the alienation of care workers from their patients, among other things, all present challenges precluding a simple solution. We also want to avoid some of the pitfalls of attempts to address problems that themselves cause further subordination. As Nancy Fraser points out, in attempting to improve the situation of women, “liberal feminists appeared to valorize the ‘masculine’ aspiration to autonomy over the ‘feminine’ ideals of nurture” (Fraser 2016, 107). In the academic/epistemic context this would involve valorizing professors, research scientists, and those who do “men’s” epistemic work over those who provide epistemic care. As we encourage women’s attempts to gain entry and work toward epistemic justice, we should be sure not to treat this as the only matter of importance. We must also recognize that our epistemic communities depend deeply on epistemic care work. And we must do this for both epistemic and ethical reasons. If I’m right in the foregoing, this suggests a number of future projects. First, social epistemologists will need to work out the place of care epistemology in their epistemic frameworks. This might involve an integrative project, or it might involve something more revolutionary. Second, we’ll need to look to empirical work on education (both formal and informal) to see what structural needs must be in place for educational workers to be able to perform their work well, and without perpetuating subordination. In other words, we’ll need to sort out how to change the norms around early education and teaching work to change some of the unfair and damaging perceptions discussed in section two. Third, we’ll want to investigate the links between epistemology and philosophy of education. This work has already begun. Virtue epistemologists are interested in educating for the virtues (Battaly 2006; Kidd 2015; Watson 2018); philosophers interested in epistemic justice are interested in children and education (Burroughs and Tollefsen 2016; Kotzee 2017). If I’m right in the above, we should also look to see what insights about educational work can help us better understand contemporary epistemology. Fourth, if care ethics is a good model for care epistemology, we’ll want to look at both formal and informal education—in this chapter I’ve focused mostly on the former, but informal education occurs both before and outside of schools. Finally, again taking care ethics as a model, we may want to look at the epistemic situations of those who have been but are no longer contributing members of the epistemic community. The elderly are often dependent on care workers—we might investigate whether there is an analogous group for the care epistemologist and as what our epistemic obligations are to that population.

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Finally, if I’m right in the above, we will need to restructure our education system to better support epistemic care work. And here we might draw on Tronto’s requirements as read through an epistemic lens: as Tronto suggests, we will need to (a) structure formal and informal education systems to allow care providers to be attentive to the epistemic needs of those who depend on them. Notably, this will probably not involve teaching to a test. We will need to (b) make someone responsible for providing epistemic care when care demands arise. This may mean hiring more teachers to allow for smaller classes. It may mean diverting “expert” attention away from research into service classes or advising roles. This may require changing in our understanding of experts and in our rewards and recognition structures. It may require changing our funding structures and evaluation of teachers. We will need to (c) prepare educators to be competent to provide epistemic care. This will involve educating them properly, but also ensuring that they are well positioned, and have the necessary materials, time, and proper facilities for education work. Finally, we will need to (d) balance the needs of care givers and those in need of care. This will involve taking into account the emotional as well as epistemic labor that goes into properly providing epistemic care. The details of meeting these criteria will need to be worked out; we will need to see what the needs of educators and their students are—we will need to be flexible in our administration of education, and we will need to value education work. CONCLUSION Care ethicists offer several reasons to believe that care is an integral part of any correct moral theory. For one, to be candidates for moral participation in society according to traditional frameworks, we must be cared for to the point where our behavior can be morally evaluable (Fraser 2016). As Kittay puts it, “No one can survive and become a member of the human community without the interest of some mothering person(s) who has provided a degree of a preservative love, concern in fostering the individual’s growth, and a training for social acceptability” (Kittay 2013, 69). Second, care work provides moral education—it allows for what Fraser calls “social reproduction” (Fraser 2016). Social reproduction includes processes of raising children, maintaining communities, and sustaining connections between people, all of which are necessary for raising agents to be moral. Third, it makes salient an important truth about our lives: human encounter and affect is a basic fact of human existence (Noddings 2013). Without being responsive to the needs of others, and accepting their care when we need it, we are left, at best, alienated and suffering (Gilligan 1982).

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If I’m right in the foregoing, we would predict these things to be true of teaching work as well. And I think they are: first, to be part of the epistemic community, we must be taught some basic belief-forming and reasoning processes and skills. Second, as we are educated, we are taught, in part, what counts as good evidence, what kinds of testimony is trustworthy, and what kinds of epistemic mistakes we’re prone to—in other words, our epistemic values and theories are reproduced by way of education. Third, teaching work makes salient an important part of our epistemic lives: we are not alone in epistemic space—we learn many of our most central beliefs and come to have most of our knowledge by interaction with other epistemic agents. This is a basic fact of our epistemic lives. In her discussion of Carol Gilligan’s work on care, Annette Baier points out that, a moral theory . . . cannot regard concern for new and future persons as an optional charity left for those with a taste for it. If the morality the theory endorses is to sustain itself, it must provide for its own continuers. (Baier 1987, 56)

The same is true, mutatis mutandis for epistemic theories. Whatever we have to say about justification, expert testimony, trust, peer disagreement, or epistemic virtues, we’d better have a way to look out for new and future epistemic agents—to recognize that it is epistemically right to do so and wrong to fail. A project to establish and investigate care epistemology would make progress on this by emphasizing epistemic dependence, epistemic relationships, and educational work. While more needs to be said about the details of epistemic care work and relationships of epistemic dependency, I hope to have demonstrated, in this chapter, that epistemology can learn from care ethics—ethical theories are improved when care is recognized as an important factor. Epistemic theories should do the same. REFERENCES Andersen, Kristie, and Elizabeth Miller. 1997. “Gender and Student Evaluations of Teaching.” PS: Political Science & Politics 30 (2): 216–20. Baier, Annette C. 1987. “The Need for More than Justice.” Canadian Journal of Philosophy 17 (1): 41–56. Battaly, H. 2006. “Teaching Intellectual Virtues: Applying Virtue Epistemology in the Classroom.” Teaching Philosophy 29 (3): 191–222. Bhandary, Asha. 2010. “Dependency in Justice: Can Rawlsian Liberalism Accommodate Kittay’s Dependency Critique?” Hypatia 25 (1): 140–56. Boring, Anne, Kellie Ottoboni, and Phillip Stark. 2016. “Student Evaluations of Teaching (Mostly) Do Not Measure Teaching Effectiveness.” Science Open Research: 1–11. doi: 10.14293/S2199-1006.1.SOR-EDU.AETBZC.v1. Bureau of Labor Statistics. 2015. “Labor Force Statistics from the Current Population Survey.” https://www.bls.gov/cps/.

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Burroughs, Michael, and Tollefson, Deborah. 2016. “Learning to Listen: Epistemic Injustice and the Child.” Episteme: Journal of Individual and Social Epistemology 13 (3): 359–77. Coady, David. 2010. “Two Concepts Of Epistemic Injustice.” Episteme 7 (2): 101–13. Dotson, Kristie. 2011. “Tracking Epistemic Violence, Tracking Practices of Silencing.” Hypatia 26 (2): 236–57. Elgin, Catharine. 2008. “Trustworthiness.” Philosophical Papers 37 (3): 371–87. ———. 2011. “Science, Ethics and Education.” School Field 9 (3): 251–63. Elmore, Kristen C., and Myra Luna-Lucero. 2017. “Light Bulbs or Seeds? How Metaphors for Ideas Influence Judgments about Genius.” Social Psychological and Personality Science 8 (2): 200–08. https://doi.org/10.1177/1948550616667611. Fraser, Nancy. 2016. “Contradictions of Capital and Care.” New Left Review 100: 99–117. Fricker, Miranda. 2007. Epistemic Injustice: Power and the Ethics of Knowing. Oxford: Oxford University Press. Gibney, Elizabeth. 2017. “Teaching Load Could Put Female Scientists at Career Disadvantage.” Nature: Trend Watch, April 13. https://www.nature.com/news/teaching-load-couldput-female-scientists-at-career-disadvantage-1.21839. Gilligan, Carol. 1982. In a Different Voice. Cambridge, MA: Harvard University Press. Goldberg, Sandy. 2011. “The Division Of Epistemic Labor.” Episteme 8 (1): 112–25. Goldman, Alvin. 2006. “Social Epistemology, Theory of Evidence, and Intelligent Design: Deciding What to Teach.” Southern Journal of Philosophy 44 (1): 1–22. Guarino, Cassandra M., and Victor M. H. Borden. 2017. “Faculty Service Loads and Gender: Are Women Taking Care of the Academic Family?” Research in Higher Education 58 (6): 672–94. https://doi.org/10.1007/s11162-017-9454-2. Hornstein, Henry A. 2017. “Student Evaluations of Teaching Are an Inadequate Assessment Tool for Evaluating Faculty Performance.” Cogent Education 4 (1): 1304016. https:// doi.org/10.1080/2331186X.2017.1304016. Kidd, Ian James. 2015. Intellectual Virtues and Education: Essays in Applied Virtue Epistemology. New York: Routledge. Kitcher, Phillip. 1990. “The Division Of Cognitive Labor.” Journal of Philosophy 87 (1): 5–22. Kittay, Eva Feder. 2013. Love’s Labor: Essays on Women, Equality and Dependency. New York: Routledge. Kotzee, Ben. 2017. “Education and Epistemic Injustice.” In The Routledge Handbook of Epistemic Injustice, edited by Ian James Kidd, José Medina, and Gaile Pohlhaus Jr., 324–36. New York: Routledge. Locke, John. 1988. Two Treatises of Government, edited by Peter Lassett. Cambridge: Cambridge University Press. Medina, José. 2013. The Epistemology of Resistance: Gender and Racial Oppression, Epistemic Injustice, and Resistant Imaginations. Oxford: Oxford University Press. Mill, John Stuart. 1869. On Liberty. Fourth edition. London: Longmans, Green, Reader, and Dyer. https://www.bartleby.com/130/. Mills, Charles. W. 1988. “Alternative Epistemologies.” Social Theory and Practice 14 (3): 237–63. Mitchell, Kristina M. W., and Jonathan Martin. 2018. “Gender Bias in Student Evaluations.” PS: Political Science & Politics 51 (3): 1–5. Murris, Karin. 2013. “The Epistemic Challenge of Hearing Child’s Voice.” Studies in Philosophy and Education 32 (3): 245–59. Noddings, Nel. 2013. Caring: A Relational Approach to Ethics and Moral Education. Berkeley: University of California Press. Pritchard, Duncan. 2015. “Epistemic Dependence.” Philosophical Perspectives 29 (1): 305–24. Rawls, John. 2009. A Theory of Justice: Revised edition. Cambridge, MA: Harvard University Press. Tronto, Joan C. 1993. Moral Boundaries: A Political Argument for an Ethic of Care. New York: Routledge. Watson, Lani. 2015. “Why Should We Educate for Inquisitiveness?” In Intellectual Virtues and Education: Essays in Applied Virtue Epistemology, edited by Jason Baehr, 50–65. New York: Routledge.

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———. 2018. “Educating for Curiosity.” In The Moral Psychology of Curiosity, edited by Ilhan Inan, Lani Watson, Dennis Whitcomb, and Safiye Yigit, 293–310. Lanham, MD: Rowman & Littlefield.

Chapter Sixteen

When Testimony Isn’t Enough Implicit Bias Research as Epistemic Exclusion Lacey J. Davidson

In the past several years, empirical implicit bias research has been enthusiastically received by philosophers and incorporated into philosophic work on social identities, particularly in the service of explaining how individuals without explicitly held discriminatory beliefs can sometimes behave in ways that lead to discriminatory outcomes. In this chapter, I argue that this focus on implicit bias research can be harmful to the antiracist project in philosophy. My worry is not that the inclusion of empirical implicit bias literature is harmful in principle, but rather that when it is used on its own without being put in its larger context, as the main motivation for believing in unconscious racism or as a more palatable placeholder for the experience of racism, this signals that it is adequate for antiracist purposes, and this is what we should avoid. Thinking it is adequate (or even signaling so without thinking so) is an instance of what Kristie Dotson (2014) calls an epistemic exclusion. EPISTEMIC EXCLUSION In her seminal work, Black Feminist Thought, Patricia Hill Collins ([1991] 2000) develops a framework for understanding what she calls subjugated knowledges or knowledges that are kept out of dominant epistemic systems. She argues that our knowledge practices are always tied up in nonepistemic motivations. In particular, knowledge can be used as a gatekeeping practice to maintain power within a racialized system. To maintain current power structures, not everyone gets to know and be known equally. This is achieved through stratification and the enforcement of knowledge validation process269

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es, which are imposed to limit the kind of things and people that are counted as knowledge and as knowers (Collins 2000, 271–75). These validation processes epistemically marginalize and oppress individuals when they exclude in virtue of social identities like race. Furthermore, because these processes limit what is understandable within the system, the testimonies of those excluded from the knowledge-producing community are unable to effectively critique those very processes. Their testimonies appear nonunderstandable to those within the system. We have here a framework for understanding the ways in which individuals and public institutions systematically deny individuals the status of knowers on the basis of their social identities. Comprehending the testimony these individuals bring requires a shift in the dominant collective understanding, and without this shift their voices and experiences are barred. Collins argues that excluded individuals have developed strategies in response to this oppression: “subordinate groups have long had to use alternative ways to create independent self-definitions and self-valuations and to rearticulate them through our own specialists” (Collins 2000, 270). Though not commonly accepted by the dominant culture, these alternatives serve as local tools for understanding and meaning making. Thus, it is often the case that those who have been oppressed understand the conditions of oppression far more clearly than those who oppress. When failures of understanding occur, it is often because dominant groups are unwilling or not yet able to take up the epistemic resources developed within communities that have been marginalized. 1 In “Conceptualizing Epistemic Oppression,” Dotson (2014) argues that there are three distinct kinds of epistemic exclusions that lead to epistemic oppressions when persistent. She uses a theory of organizational change and the corresponding “scope of change perspective” (Bartunek and Moch 1987) to categorize the types of change that would need to occur to address each type. First-order epistemic exclusions occur when shared epistemological resources are inefficient. For example, if credibility assessments are consistently flawed due to identity prejudices (e.g., testimonial injustice), a firstorder epistemic exclusion has occurred. To address this exclusion, the collective must shift their practices of determining credibility. Second-order epistemic exclusions occur when the resources are insufficient for understanding the full range of experiences in a given community. These insufficiencies are often caused by first-order epistemic exclusions that occur due to unwarranted credibility deficits (Bartunek and Moch 1987, 127). These kinds of exclusions are captured by the expanded notions (Medina 2011, Pohlhaus

1. Within the epistemic injustice literature, Gaile Pohlhaus Jr. (2012) calls this practice willful hermeneutical ignorance. See Lugones (1987) and Alcoff (1991) for early discussions of this practice and especially strategies for shifting one’s ignorance.

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2012) of Miranda Fricker’s (2007) hermeneutical injustices. 2 To address second-order epistemic exclusions, those with relative epistemic power must recognize that the current collective resources are insufficient and direct their attention to currently available (but ignored) collective resources to shift collective resources and render a broader range of experiences intelligible to the community as a whole. Though this requires a change in epistemic resources and values, the change comes from within the epistemic system. Third-order epistemic exclusions, on the other hand, occur because the epistemic system as a whole is inadequate, that is, the collective resources are unable to account for some experiences even when first- and secondorder changes occur, and the epistemic resilience of the system prevents new resources from outside of the epistemic system from altering the epistemic system. One mechanism of resilience in epistemic systems in which thirdorder epistemic exclusions are occurring are the knowledge validation processes theorized by Collins (2000). In these cases, individuals’ testimonies are rejected because the acceptance of them would amount to a complete epistemic revolution. Widespread change within the epistemic system requires individuals, particularly those in dominant social positions, to reimagine their entire worlds with conceptual resources brought by the conceptual revolution, the third-order change. Epistemic systems are resilient. Not only is drastic change difficult to instigate, but it is hard to clearly discern when it is needed. However, these difficulties do not absolve us of our responsibilities. Dotson claims, “It is imperative that those perpetrating third-order epistemic oppression take a step back and become aware of their overall epistemological systems that are preserving and legitimating inadequate epistemic resources” (Dotson 2014, 131). One way of ignoring third-order exclusions (thus maintaining them) is to be overly focused on first- and second-order oppressions; because the latter changes are smaller in scope, they require less questioning of the collective resources and one’s own experiences and can, therefore, allow us to remain comfortably protected from the upheaval of revolution.

2. Though what is required for mitigation of oppression increases in scope from first- to third-order, this does not mean that first- and second-order change is easy or quick. Epistemic oppressions are tied up with historical social oppressions that are resilient.

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IMPLICIT BIAS RESEARCH Empirical psychological research on implicit bias dates back to the mid1990s. 3 Philosophic research on the topic, by contrast, is relatively more recent, gaining steam 4 with Daniel Kelly and Erica Roedder’s (2008) paper, “Racial Cognition and the Ethics of Implicit Bias.” However, long before the term “implicit bias” came into vogue within philosophy, academics (in philosophy and other disciplines) and cultural critics identified a disturbing phenomenon: many people (particularly those who are members of dominant social groups) have mental content 5 that a. they cannot easily and readily identify or introspectively access, b. they would not avow (i.e., report believing in, consciously assent to, agree with), c. they think they are unlikely to possess, and d. influences thoughts and behavior in a way that they would not avow. 6 With respect to race, 7 this phenomenon has been given many names: aversive racism (Kovel 1970), bad faith (Gordon 1995), unconscious disregard (Garcia 1996), epistemology of ignorance (Mills 1997), laissez-faire racism (Bobo and Smith 1998), colorblind racism (Bonilla-Silva 2003), covert ra-

3. For a history of this research, see Banaji and Greenwald’s (2013) Blindspot. Their earliest papers using a technique approximating the Implicit Association Test are from 1994 and 1995; see Banaji and Greenwald (1994), Banaji and Greenwald (1995), and Greenwald and Banaji (1995). The IAT technique is first fully articulated in Greenwald, McGhee, and Schwartz (1998) and is used there to measure implicit racial attitudes. 4. Before this, there were also philosophers within the dominant discourse working on theories of semiconscious belief (Schwitzgebel 2001; Gendler 2008a; 2008b) and applying them to racist beliefs (or aliefs). 5. For the purposes of this chapter, I will not be interested in the nature of the format and processing associated with this mental content. My argument about research on implicit bias remains the same even if the content ends up being associative, propositional, dispositional, trait-based, or structured otherwise. 6. Here I have selected what I take to be the most commonly shared features of these accounts. There will be accounts that do not share every feature or have identified additional features, but will still qualify as a similar account. For example, there are great debates about the influencing feature d. For more insight, see Hall and Payne (2010), Oswald et al. (2013), and Forscher et al. (2016). 7. Mental content with these features have been identified with respect to many social categories (gender, (dis)ability, size, nationality, etc.). However, I will focus on race both for clarity and the theoretical and empirical reasons that biases of different types might not be as comparable as we might think (see Holroyd and Sweetman 2016).

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cism (Coates 2011), and less-than-conscious racism (Zack 2003). 8 Though the terms, evidence, and motivations of each account may differ, I take it that each of these expressions, when applied to individuals, is used to talk about roughly the same set of phenomena that is now commonly discussed under the broad heading of “implicit bias.” 9 There is a long history of conceptual tools for characterizing how members of socially dominant races will behave in ways that are not in line with antiracist ideals, even when they intend to do otherwise and even when they do not know they are doing so. Even though this research was developed and thriving by the time philosophers turned to the psychological research on implicit bias, it is likely that more philosophers know about implicit bias than these theories. In other words, work using implicit bias research has gotten relatively more uptake than work grounded in experience. The increased attention on “implicit bias” within philosophy roughly correlates with the development and refinement of sophisticated tools for testing implicit associations in controlled environments, meaning that the focus is in some ways different from the accounts above. The psychological literature connects questions of cognition to race and racism explicitly. Due to this new intersection, it makes sense that more philosophers began work on race and racism. For example, if one is interested in associative processes in general, one may be interested in specific kinds of associative processes. Or, perhaps one wants to know how System-1 type processes interact with System-2 type processes (Kahneman 2013) and implicit bias seemed to be a nice example of differences in control. Furthermore, it could be that one was always committed to theorizing about race and racism and the psychological evidence-base for implicit bias fit one’s expertise and interest. Regardless of the specifics, there is a clear trend: many white philosophers (including myself) are now working on implicit bias qua “implicit bias.” After working on implicit bias for a couple of years, I came to think that something had gone awry. First, I began to notice that many people of color within philosophy were not interested in hearing about implicit bias. 10 This was for two reasons: (1) implicit bias did not seem expansive enough to 8. It is important to note that though these theories have an individual psychological story, they are often embedded in larger theories of racism that emphasize the roles of formal institutions and culture. This is often also true about theories of implicit bias, though this is at times less clear because implicit bias is often discussed separately from larger theories of injustice. This tension is highlighted in recent critiques of implicit bias that claim implicit bias is too individualistic (Alcoff 2010; Anderson 2012; Ayala-López and Vasilyeva 2015; Haslanger 2015, 2016). 9. Again, some of these theories do not have a specific term for the individual or psychological aspects of racism, but all acknowledge beliefs, patterns of thinking, and cognitive habits play a role in systems of racism. 10. This is certainly not the case within psychology. Moreover, many psychologists of color played a predominant role in the development of the IAT (e.g., Mahzarin Banaji, Irene Blair, Nilanjana Dasgupta, Philip Goff, Jerry Kang, and Kerry Kawakami).

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capture the most important and meaningful aspects of racialized experience, and (2) there are already conceptual resources for talking about unrecognized or ignored phenomena within the critical literature on race. Second, it seemed to me that white people often dominate conversations about implicit bias, which may be explained by the disinterest I noted. Finally, there are very few philosophers of color working on racial identity, race, and racism that have taken up the terminology of “implicit bias.” These observations led me to question my own interest in implicit bias, as well as the kinds of questions I was asking. I began to worry that my own implicit biases (or impoverished hermeneutic equipment) were distorting my interests and causing me to find more compelling theories developed by white people and supported by a particular kind of scientific evidence rather than the testimony of people of color. In short, I was worried that I had begun to do the very thing I was trying to explain and avoid through my research: I was biasedly researching implicit bias and epistemically excluding other people and ideas in the process. IMPLICIT BIAS RESEARCH AS EPISTEMIC EXCLUSION Philosophers working with implicit bias and implicit association test (IAT) data certainly seem to have good intentions. We can assume that these philosophers believe that their work will help unravel injustice rather than contribute to it. The nature of epistemic exclusion in this case is complex exactly because one of the goals of implicit bias research is addressing epistemic exclusion. 11 However, my skepticism has grown with my appreciation of the importance of third-order changes to epistemic systems. A third-order change in the epistemic system, one that shifts social imaginaries and provides new ways of relating to and understanding one another, is required for race-related epistemic oppressions to be eliminated. In other words, the antiracist project includes working toward third-order epistemic revolutions. The current research in philosophy on implicit bias does not promote these changes directly. Much of the original research on the phenomenon picked out by the term “implicit bias” utilizes lived experience and testimony of the marginalized as the basis for identifying and exploring the phenomenon. For example, George Yancy (2008) writes of his experience walking down the street: “The sounds of car doors locking are deafening: Click. Click. Click. Click. Click. Click. Click. . . . The click ensures their safety, effectively re-signifying their white bodies as in need of protection from blackness, that site of danger, 11. For example, we might use implicit bias to understand why identity-prejudice testimonial injustices (Fricker 2007) occur and further use empirically informed debiasing techniques to prevent these injustices.

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death, and doom” (Yancy 2008, xix). With this description, we are presented with evidence that the white individuals Yancy passes are afraid of him. Knowing nothing about him beyond his race, his black embodiment is enough for the individuals to think danger and react with click. Yancy describes these anxieties and bodily reactions as happening at the “somatic level,” a level that is not necessarily affected by changes in belief (Yancy 2008, 5). Similarly, when the average white American takes an IAT, they will likely find that they have an association between BLACK and DANGEROUS. This association persists, in both cases, whether or not the individual would avow these associations. However, with the IAT, we only get information about the individual being tested; we hear nothing about the experience of racism, the influence of click, the feeling of invoking danger. These differences highlight several important things about the use of IAT data. First, that this controlled empirical evidence received much greater uptake than experiential and testimonial evidence in the philosophical community signals that testimony about the experience of racism isn’t enough to justify claims that people show racial biases without realizing it and that additional empirical data was needed. While this is presumably not a signal philosophers mean to send, it is made clear by their patterns of interest and attention. Second, in only giving us data from one perspective, the IAT is actor-centric, 12 meaning that the epistemic attention is on those who oppress and leaves out both the experience of racism and often the context in which it arises. First-Order Change and Credibility When philosophers use the psychological findings backed by IAT in their work on racism, they typically do not include experiential and testimonial evidence or theories of unconscious racism informed by this evidence in their discussions. Rather, they use the IAT data as the primary source of evidence. Due to our current epistemic frameworks, one’s first reaction to the availability of the kind of evidence made available by the IAT may by positive. This in fact was my reaction: finally, something that people can’t reject! We can see the inclusion and primary use of this data as an attempt to shift the collective credibility assessment process for theories of unconscious racism by changing the kinds of evidence used to judge their credibility. The inclusion of this data is a first-order revision of the processes of assessing credibility. In an epistemic system in which testimony about the experience of racism is often discredited, we’ve introduced a way for this testimony to be supported. However, the revision is insufficient and has the 12. Others have noted the problems with focusing on the “actor” rather than the “target.” For an example from philosophy, see Goguen (2016) and from psychology, see Plous (2003).

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potential to distract us from third-order changes that are needed to fully mitigate epistemic exclusion. In other words, this shift in credibility assessment does very little to shift our collective epistemic resources such that testimonies about the experience of racism are accepted. The inclusion of this data is an example adhering to a knowledge validation process 13 that serves to reinforce current epistemic systems, systems that often do not accept the testimony of people of color as credible. Though a first-order change to credibility assessment practices has been made, the change shifts our attention away from the kinds of third-order changes to epistemic system needed to mitigate epistemic exclusion. In order to see why this is the case, we can look to Jeanine Weekes Schroer’s (2015) work comparing the public uptake of stereotype threat and microaggression research. She argues that when epistemic attention is directed to empirical research about specific psychological features of racism, rather than the lived experience and testimonies of those experiencing racism, it undermines the antiracist project because the antiracist project requires that we believe the testimonies of those experiencing racism and acknowledge them as knowers of their own experiences. In other words, the search for a particular kind of evidence—for example, quantitative, nontestimonial evidence—undermines the kind of third-order changes needed to fully engage in the antiracist project. What she observes in her analysis is that empirical research is regarded as less credible when it incorporates testimony about the experience of racism, as is the case with microaggression research. Microaggressions are “brief and commonplace daily verbal, behavioral, and environmental indignities . . . that communicate hostile, derogatory, or negative slights and insults to the target person or group” (Sue et al. 2007, 273). The evidence base for the existence of microaggressions is primarily testimony about the experience of microaggressions by socially oppressed groups. Stereotype threat occurs when a negative stereotype about performance on a particular task is made salient to a participant before she performs this task, and she then performs in stereotype-confirming ways. In contrast to microaggression, stereotype threat can be tested in a controlled environment and can be observed without the testimony of those experiencing it. Weekes Schroer (2015) argues that the difference in evidence base results in the public being highly skeptical of microaggression research, but not of 13. Remember, the concept of knowledge validation processes as put forth by Collins (2000) requires that the processes are used to maintain current epistemic power relations. It ought not be taken as a rejection of scholarly validation processes or careful academic work or the views of all experts. She writes, “scholarly communities that challenge basic beliefs held in U.S. cultural at large will be deemed less credible than those that support popular ideas. For example, if scholarly communities stray too far from widely held beliefs about Black womanhood, they run the risk of being discredited” (Collins 2000, 271).

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stereotype threat research. 14 She writes that the differential uptake of these research projects “reveals a flaw in the strategy of trying to translate or reframe the testimony of folks of color into more ‘credible’ forms” (2015, 93). Using Dotson’s (2012) work on cultures of justification, Weekes Schroer (2015) argues that this translation project is flawed because it is a legitimation project that accepts the current norms for credible knowledge production that excludes testimony about the experience of racism, rather than challenging these norms such that such testimony can be used as robust evidence. The first-order change in epistemic resources that occurs when we introduce empirical psychological data independently from testimony “actually serves to disguise and further entrench the idea that the people of color’s first-person accounts of the hurts and harms of racism are not credible” (Weekes Schroer 2015, 101). Her argument shows us that search for empirical evidence, even when this empirical evidence supports the existence of oppressions, can actually be a search for evidence that does not include the testimony of people of color. This framework can be used to analyze the inclusion of IAT data. IAT data is most often collected independently from testimonies about the experience of racism. This is exactly why it has been taken to be such good evidence: even if you don’t trust the testimony, you can’t reject the research. However, when we focus on gathering evidence that would convince even those who dismiss testimony of racism, we run the risk of paying too little attention to that very testimony. Because the IAT does not require one to interact with anyone that embodies the social identities for which the test is measuring an implicit preference, the outcome is somewhat independent of the actual experience of racism or other kinds of oppression. So though implicit bias research cannot be rejected in the same way testimony can be within our current epistemic resources and norms for knowledge production, it is for this reason that implicit bias research leads to first-order changes in the method of justification for theories of unconscious racism and shifts our energies away from third-order changes that shift both the social imaginary and norms in a way that might mitigate epistemic oppression. Though implicit bias research may serve to legitimize the testimony of people of color, it does so without their direct testimonies about the “hurts and harms” (Weekes Schroer 2015, 93) of racism. In this way, the introduction of and reliance on empirical implicit bias data draws attention away from thirdorder epistemic exclusions and reduces people of color’s ability to engage in dominant knowledge-production practices.

14. This is not to say that stereotype threat has not been critiqued. Weekes Schroer’s analysis focuses on the public reaction to the research.

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Second-Order Change and Epistemic Resources A possible motivation philosophers have for including IAT data is to improve the insufficient epistemic resources available for understanding the experiences of all members of the epistemic community. For example, the inclusion of IAT data may help white people to understand that their experience—for example, that they aren’t racist—doesn’t always align with the experience of others. The use of this data with this motivation is a secondorder change to the epistemic framework; it shifts collective resources in order to improve the epistemic system. However, as noted above, the IAT is actor-centric, meaning that the epistemic attention is on those who oppress and leaves out both the experience of racism and often the context in which it arises. Thus, this kind of second-order change in our epistemic system may meet some of our goals with respect to resource development—for example, it may tell us more about the cognitive function of racism or allow us to delineate the conditions of moral responsibility for unintentional behaviors— but it may lead us further away from third-order changes that would allow testimonies of oppression to shift our social imaginaries. For example, there has been a robust discussion in philosophy about whether an individual can be responsible for a behavior caused by implicit bias. This is a productive conversation in some ways: it provides pathways for moral appraisal and accountability. However, the addition of this framework brings our attention to the good or bad behaviors of individual actors, rather than to the complex system of which unconscious racism is merely a part. The addition of resources for understanding responsibility for implicitly biased behaviors is a second-order change in the social imaginary that focuses our attention on individual actors and the behaviors of those actors in a way that may lead us toward third-order epistemic exclusions about both the experiences of racism and the systemic context in which these experiences arise. 15 On the one hand, this is due to a bandwidth issue: we only have so much attention, so when we give more of our attention to one topic or framing, other topics get less of our attention. However, the bandwidth issue can have a compounding effect and serve as a signal that what matters most is developing resources for the actors of oppression to understand their implicit biases. However, as my discussion has suggested, there are good reasons to think that a complete account of oppression must include descriptions of the nature and phenomenology of that oppression. In discussing June Jordan’s (2002a) essay “Nobody Mean More to Me Than You and the Future Life of Willie Jordan,” Nancy McHugh (2005) argues that the choice between speaking in “Standard English” and “Black English” is a choice between “committing 15. Ta-Nehisi Coates (2015) call the focus on “good intentions” and “personal responsibility” the “hall pass through history, a sleeping pill that ensures the Dream” (33).

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metaphysical suicide” and “never having the currency to be heard” (McHugh 2005, 91). White standards serve as a mechanism for control over the kinds of ideas that can enter into the wider public discourse. These standards and norms are knowledge validation processes that ensure the epistemic resiliency of an epistemic system. Because ideas and concepts are not expressed in the same manner in every dialect, 16 the choice to be heard can require the truncating of one’s experience, forcing one to tell half-truths about one’s life. In contrast, the empirical work on implicit bias meets white norms for what can be included in knowledge production and refocuses attention on the actors of oppression. By introducing this new resource for understanding, an earnest second-order change to our resources for understanding unconscious racism, we’ve focused our attention on something other than the conceptual shifts needed to allow testimonies about the experience of racism to be understood and accepted as epistemic resources. The kind of data provided by the IAT allows us to get inside of the heads of people and point to the mechanisms that support all kinds of undesirable behaviors. This is a good thing. However well-meaning accounts grounded in empirical research might be (and however helpful they may be for answering some questions), they often do not directly challenge norms that dictate to whom we should be directing our epistemic attention. If we shift the focus away from those that experience the bad effects of implicit biases to those that hold implicit biases, we maintain third-order epistemic exclusions, even as we may be making some positive changes (engaging in debiasing techniques, for example). BEST PRACTICES We can shift our use of the research in ways that meet our goals of mitigating epistemic exclusions rather than further perpetuating them. The immediate worry of my project in this chapter is that readers might think I’m picking on the wrong people; why criticize those actively working on questions related to race, racism, and racial oppression? Aren’t they the good ones? Though I’m sympathetic to these worries, as well as questions about the appropriate severity and scope of moral appraisals, I don’t think these are reasons to remain uncritical of our work and the ways we choose to do it. And, this is for good reason. The philosophic work on epistemologies of ignorance (Mills 1997) predicts that we will often not be “as good” as it seems to us we are, that is, we will be getting it wrong (morally and epistemically) more often 16. Jordan (2002b) discusses the use of passive voice, which is more prevalent in some dialects, in descriptions of rape. She argues that the phrase “I was raped” shifts the responsibility away from the rapist and toward the victim in a way that doesn’t allow the speaker to tell her own truth.

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than we think we are because our epistemic resources are not meant to get it right when it comes to race. Given the nature of racial oppression, there is no such thing as being a good one when one embodies an oppressor identity (Mills 1997; Yancy 2008). Even when we have avowed commitments to being an antiracist, we still have implicit racial preferences, behave in biased ways, and participate in and benefit from systems that are not in line with these views. So, if we’d like to do our best to stop participating in perpetuating persistent epistemic exclusions, then we have a collective responsibility to improve our practices. One way forward might be to simply cease philosophic work on implicit bias. Even if all implicit bias research doesn’t lead to epistemic exclusions, one way to avoid the kind that might is to avoid it all together. However, because I think there are some important lessons to be learned from the empirical work on implicit bias, I reject this conclusion. Rather, we ought to improve our knowledge acquisition and research practices around implicit bias. Based on my analysis above, I suggest the following best practices for engaging in and with quantitative implicit bias research: 1. Be in conversation with those who occupy identities that have been and continue to be oppressed and affirm evidence given, particularly testimony. 2. Dedicate space to proper reflection on accounts of “implicit bias” that are not grounded in the quantitative empirical sciences. 3. Take up or robustly acknowledge the epistemic resources developed by those who have been and continue to be oppressed. Further, “move over” (Alcoff 1991) when those who have developed those resources are speaking (especially during in-the-flesh conversations, at conferences, etc.). 4. Conceptualize one’s project not as an existence of racism project, but as a function of racism project. Though extremely difficult in practice, suggestions one and two are fairly conceptually straightforward. Three and four deserve some explication. Good resources for understanding the nature of oppression are developed by people who have been oppressed through experiencing and dealing with the forces that oppress them (Collins 2000). These valuable epistemic tools can be passed along to others, but anyone lucky enough to have escaped the particular kinds of oppression themselves will often have to work hard to fully grasp them. As Gaile Pohlhaus Jr. (2012) argues, many failures of understanding on the part of the socially dominant are a result of willful hermeneutical ignorance or a refusal to acknowledge and use epistemic resources for understanding oppression. Overcoming this ignorance requires deep personal and relational work in getting to know others and the social

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conditions they have experienced. This will likely be uncomfortable; shifting one’s epistemic resources forces one to reinterpret one’s understanding of oneself and the world. However, this process is what allows us to begin to understand and make sense of the world using a set of resources that is not our own. María Lugones (1987) writes, “The reason I why I think that travelling to someone’s ‘world’ is a way of identifying with them is because by travelling to their ‘world’ we can understand what it is to be them and what it is to be ourselves in their eyes” (emphasis in original, 17). Getting to know another’s experience is key to understanding the resources developed within that world. Taking up these resources can be a way to move forward and mitigate epistemic exclusion. However, in many cases, those who occupy dominant social identities should “move over” and create space for the originators of these ideas to be heard. For example, this requires some research and a change in processes when planning events (getting diverse voices in the room), as well as the implementation and enforcement of new norms to govern speaking time at such events. It may also require some self-monitoring in not speaking even when you think you have important information to contribute (e.g., an understanding using the empirical work on implicit bias). Implicit bias research can be used to understand the cognitive function of racism and identify pathways for debiasing. In using this research, framing our projects as working to understand not just what racism does, but how it does it, can help limit its contribution to epistemic exclusions. On the other hand, when we use implicit bias research on its own (without utilizing the first three best practices) to prove the existence of racism, we risk changing credibility conditions and adding resources in a way that leads to third-order epistemic exclusions. To address epistemic injustices that arise from inadequate conceptual resources, we will need to employ a variety of tactics. And the necessary changes will be hard-won. Those of us that work on implicit bias need to at the very least be open that work on implicit bias will likely be insufficient to eradicate, and may work to perpetuate, third-order epistemic oppressions. By focusing on first- and second-order change, we may be giving credence to the notion that there is nothing fundamentally wrong with our collective epistemic practices and ways of knowing. Part of doing this research justly will require acknowledging the limitations of the research, particularly when done independently from testimony. REFERENCES Alcoff, Linda Martín. 1991. “The Problem of Speaking for Others.” Cultural Critique 20 (Winter 1991–1992): 5–32. ———. 2010. “Epistemic Identities.” Episteme 7 (2): 128–37. Anderson, Elizabeth. 2012. “Epistemic Justice as a Virtue of Social Institutions.” Social Epistemology 26 (2): 163–73.

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Ayala-López, Saray, and Nadya Vasilyeva. 2015. “Explaining Speech Injustice: Individualistic vs. Structural Explanation.” In Proceedings of the 37th Annual Conference of the Cognitive Science Society, edited by R. Dale, C. Jennings, P. P. Maglio, T. Matlock, D. C. Noelle, A. Warlaumont, and J. Yoshimi, 130–35. Banaji, Mahzarin, and Anthony G. Greenwald. 1994. “Implicit Stereotyping and Prejudice.” In The Psychology of Prejudice: The Ontario Symposium, edited by M. P. Zanna and J. M. Olson, 7:55–76. Hillsdale, NJ: Erlbaum. ———. 1995. “Implicit Gender Stereotyping in Judgments of Fame.” Journal of Personality and Social Psychology 68 (2): 181–98. ———. 2013. Blindspot: Hidden Biases of Good People. New York: Random House. Bartunek, Jean M., and Michael K. Moch. 1987. “First-Order, Second-Order, and Third-Order Change and Organization Development Interventions: A Cognitive Approach.” Journal of Applied Behavioral Science 23 (4): 483–500. Bobo, Lawrence D., and Ryan A. Smith. 1998. “From Jim Crow to Laissez-Faire Racism: The Transformation of Racial Attitudes.” In Beyond Pluralism: The Conception of Groups and Group Identities in America, edited by Wendy F. Katkin, Ned Landsman, and Andrea Tyree, 182–220. Chicago: University of Illinois Press. Bonilla-Silva, Eduardo. 2003. Racism without Racists: Color-Blind Racism and the Persistence of Racial Inequality in America. Lanham, MD: Rowman & Littlefield. Coates, Rodney D. 2011. “Covert Racism: An Introduction.” In Covert Racism: Theories, Institutions, and Experiences, edited by Rodney D. Coates, 1–16. Leiden: Brill. Coates, Ta-Nehisi. 2015. Between the World and Me. New York: Spiegel & Grau. Collins, Patricia Hill. (1991) 2000. Black Feminist Thought: Knowledge, Consciousness, and the Politics of Empowerment. Second edition. New York: Routledge. Citations are from the second edition. Dotson, Kristie. 2012. “How Is This Paper Philosophy?” Comparative Philosophy 3 (1): 3–29. ———. 2014. “Conceptualizing Epistemic Oppression.” Social Epistemology 28 (2): 115–38. Forscher, Patrick, Calvin K. Lai, Jordan R. Axt, Charles R. Ebersole, Michelle Herman, Patricia G. Devine, and Brian A. Nosek. 2016. “A Meta-Analysis of Change in Implicit Bias.” https://www.researchgate.net/publication/308926636_A_Meta-Analysis_of_Change _in_Implicit_Bias. Fricker, Miranda. 2007. Epistemic Injustice: Power and the Ethics of Knowing. Oxford: Oxford University Press. Garcia, J. L. A. 1996. “The Heart of Racism.” Journal of Social Philosophy 27 (1): 5–45. Gendler, Tamar S. 2008a. “Alief and Belief.” Journal of Philosophy 105: 634–63. ———. 2008b. “Alief in Action, and Reaction.” Mind and Language 23: 552–85. Goguen, Stacey. 2016. “Stereotype Threat, Epistemic Injustice, and Rationality.” In Implicit Bias and Philosophy, vol. 1, edited by Michael Brownstein and Jennifer Saul, 216–37. Oxford: Oxford University Press. Gordon, L. 1995. Bad Faith and Anti-Black Racism. Amherst, MA: Humanity Books. Greenwald, Anthony G., and Mahzarin R. Banaji. 1995. “Implicit Social Cognition: Attitudes, Self-Esteem, and Stereotypes.” Psychological Review 102 (1): 4–27. Greenwald, Anthony G., Debbie E. McGhee, and Jordan L. K. Schwartz. 1998. “Measuring Individual Differences in Implicit Cognition: The Implicit Association Test.” Journal of Personality and Social Psychology 74: 1464–80. Hall, Deborah L., and B. Keith Payne. 2010. “Unconscious Influences of Attitudes and Challenges to Self-Control.” In Self Control in Society, Mind, and Brain, edited by Ran Hassin, Kevin Ochsner, and Yaacov Trope. Oxford: Oxford University Press. Haslanger, Sally. 2015. “Social Structure, Narrative, and Explanation.” Canadian Journal of Philosophy 45 (1): 1–15. ———. 2016. “What Is a (Social) Structural Explanation?” Philosophical Studies 173 (1): 113–30. Holroyd, Jules, and Sweetman, Joseph. 2016. “The Heterogeneity of Implicit Bias.” In Implicit Bias and Philosophy, vol. 1, edited by Michael Brownstein and Jennifer Saul, 80–103. Oxford: Oxford University Press.

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Jordan, June. (1984) 2002a. “Nobody Mean More to Me Than You and the Future Life of Willie Jordan.” In Some of Us Did Not Die: New and Selected Essays of June Jordan, 157–73. New York: Basic Books. ———. (1984) 2002b. “Problems of Language in a Democratic State.” In Some of Us Did Not Die: New and Selected Essays of June Jordan, 223–32. New York: Basic Books. Kahneman, Daniel. 2013. Thinking, Fast and Slow. New York: Farrar, Straus and Giroux. Kelly, Daniel, and Erica Roedder. 2008. “Racial Cognition and the Ethics of Implicit Bias.” Philosophy Compass 3 (3): 522–40. Kovel, Joel. 1970. White Racism: A Psychohistory. New York: Pantheon. Lugones, María. 1987. “Playfulness, ‘World’ Traveling, and Loving Perception.” Hypatia 2 (2): 3–21. McHugh, Nancy. 2005. “Telling Her Own Truth: June Jordan, Standard English and the Epistemology of Ignorance.” In Still Seeking an Attitude: Critical Reflection on the Work of June Jordan, edited by V. Kinloch and M. Grebowicz, ch. 10. Lanham, MD: Rowman & Littlefield. Medina, José. 2011. “The Relevance of Credibility Excess in a Proportional View of Epistemic Injustice: Differential Epistemic Authority and the Social Imaginary.” Social Epistemology 25 (1): 15–35. Mills, Charles W. 1997. The Racial Contract. Ithaca, NY: Cornell University Press. Oswald, Frederick L., Gregory Mitchell, Hart Blanton, James Jaccard, and Phillip E. Tetlock. 2013. “Predicting Ethnic and Racial Discrimination: A Meta-Analysis of IAT Criterion Studies.” Journal of Personality and Social Psychology 105 (2): 171–92. Plous, Scott. 2003. “The Psychology of Prejudice, Stereotyping, and Discrimination: An Overview.” In Understanding Prejudice and Discrimination, edited by Scott Plous, 3–48. New York: McGraw-Hill. Pohlhaus, Gaile, Jr. 2012. “Relational Knowing and Epistemic Injustice: Toward a Theory of Willful Hermeneutical Ignorance.” Hypatia 27 (4): 715–35. Schwitzgebel, Eric. 2001. “In-Between Believing.” Philosophical Quarterly 51: 76–82. Sue, Derald Wing, Christina M. Capodilupo, Gina C. Torino, Jennifer M. Bucceri, Aisha M. B. Holder, Kevin L. Nadal, and Marta Esquilin. 2007. “Racial Microaggressions in Everyday Life: Implications for Counseling.” American Psychologist 62: 271–86. Weekes Schroer, Jeanine. 2015. “Giving Them Something They Can Feel: On the Strategy of Scientizing the Phenomenology of Race and Racism.” Knowledge Cultures 3 (1): 7–27. Yancy, George. 2008. Black Bodies, White Gazes. Lanham, MD: Rowman & Littlefield. Zack, Naomi. 2003. “Race and Racial Discrimination.” In The Oxford Handbook of Practical Ethics, edited by H. LaFollette, 245–71. Oxford: Oxford University Press.

Chapter Seventeen

Gaslighting as Epistemic Violence “Allies,” Mobbing, and Complex Posttraumatic Stress Disorder, Including a Case Study of Harassment of Transgender Women in Sport Rachel McKinnon

In my earlier work on gaslighting, I focused on explicating the epistemic harms of gaslighting in terms of epistemic injustice (McKinnon 2017). 1 I want to take this opportunity to correct what I now see to be errors in that account, and to further explicate the epistemic harms of gaslighting. In particular, rather than viewing gaslighting as a kind of epistemic injustice, we should understand it as a kind of epistemic violence. By appreciating its violent nature, I will argue that gaslighting can cause posttraumatic stress disorder (PTSD). Moreover, gaslighting can take place within organizational and institutional structures in the form of mobbing, which is increasingly connected to causing PTSD (Duffy and Sperry 2014). I first began work on gaslighting in 2013. At the time, no philosophical work was yet published. Kate Abramson’s paper was yet to be the first philosophical article published on the topic (Abramson 2014). 2 Fortunately, it is now fair to say that philosophical work on gaslighting has exploded. 3 Partly as a consequence of this, I’ve had time to revisit some of what I argued in my earlier work. More importantly, there are more philosophical interlocu1. While published in 2017, I began giving keynote addresses on the issue in March 2014, with writing beginning in 2013. 2. Kate and I spoke a number of times on the subject in 2013–2014. Without question, Kate had begun working on the topic before me. 3. An entire philosophy conference dedicated to “Gaslighting and Epistemic Injustice” is good evidence of this. Carnegie Mellon University, September 2017.

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tors available to help push on weaknesses in my earlier account. 4 In short, my earlier account did not go far enough. I want to begin here with a summary of my earlier account of gaslighting. Discussions of gaslighting focus on one of two forms: an intentional form of psychological warfare where the perpetrator tries to drive the victim “crazy,” such as in the 1938 Patrick Hamilton play and subsequent 1944 film Gaslight; or the subtler epistemic form, often unintentional, where a listener doesn’t believe, or expresses doubt about, a speaker’s testimony. In this epistemic form of gaslighting, the listener of testimony raises doubts about the speaker’s reliability at perceiving events accurately. Directly, or indirectly, then, gaslighting involves expressing doubts that the harm or injustice that the speaker is testifying to really happened as the speaker claims. (McKinnon 2017, 168)

I focused on a (real) case where a trans woman is mispronouned by a coworker, James, (who has institutional power over her) at a party. She relates the experience to an “ally” who doesn’t believe her. The “ally” says things like: I’m sure you just misheard him: you’re on edge and expect to hear mispronouning. I just don’t believe that James would do that. He won a university diversity award for his supporting queer issues, after all. Besides, he’s been a supporter of yours in the past too. He really is your ally. (McKinnon 2017, 168)

And: You say that he’s done it before, and maybe he has, but I’ve never heard him do it before. (McKinnon 2017, 168)

These are classic instances of gaslighting. The perpetrator inappropriately privileges their own experiences of James as carrying more weight than the first-person testimonial authority of the victim. I argued that “allies” routinely engage in this sort of behavior toward the very people they claim to support. In this case, it’s a cis woman who conspicuously fashions herself as an LGBTQ “ally,” gaslighting a trans woman. I offered a critique of “allies” along these lines, suggesting that we should abandon what has become “ally culture.” In its place, I suggested cultivating the active bystander. Someone can claim to be an “ally” without ever engaging in behavior to help those they claim to support. Mere expression of support, without meaningful action, is sufficient. Then, when confronted 4. I’m particularly grateful to Elena Ruiz, Nora Berenstain, Alice Maclachlan, and Gaile Pohlhaus Jr.

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with harmful behavior, the “ally” will often point to their identity as an “ally” as protection from criticism. The active bystander model avoids this: one cannot claim to be an active bystander if one was not, in that particular instance, active. If one witnessed a harm but did not act, then one is, by definition, a passive bystander. I’m not attaching normative status to active versus passive bystander. Sometimes it’s unsafe to engage. But one cannot claim to be an active bystander if one did not act, unlike those who still claim to be an “ally” but who never act. UPDATING THE EPISTEMOLOGY OF GASLIGHTING There are two parts to my earlier account of gaslighting that I want to fix. First, I didn’t go far enough in replacing “ally culture” with merely the active bystander model. Instead, I should have replaced “ally culture” with the concept of the accomplice. Perhaps the most important work on this issue is “Accomplices Not Allies: Abolishing the Ally Industrial Complex” by Indigenous Action Media (2014). They define an accomplice as “a person who helps another person commit a crime” (Indigenous Action Media 2014, 2). One persistent problem that has evolved in ally culture is that “allies” are unwilling to take real personal risks, including social risks like upsetting a “friend” or coworker. They tend to choose their own comfort over concretely helping the marginalized people they claim to support. They can take off the ally “hat” when it no longer serves their purposes, but the marginalized folx don’t have the same luxury to escape their identity-based oppression. Since much of my audience for this chapter is undoubtedly academics (although I hope that it is much wider than this), I think it is useful to quote the section on “Academics and Intellectuals” in full. Although sometimes directly from communities in struggle, intellectuals and academics also fit neatly in all of these categories. Their role in struggle can be extremely patronizing. In many cases the academic maintains institutional power above the knowledge and skill base of the community/ies in struggle. Intellectuals are most often fixated on un-learning oppression. These lot generally don’t have their feet on the ground, but are quick to be critical of those who do. Should we desire to merely “unlearn” oppression, or to smash it to fucking pieces, and have it’s very existence gone? 5 An accomplice as academic would seek ways to leverage resources and material support and/or betray their institution to further liberation struggles. 5. A good demonstration of the point would be my need here to point out the grammatical error of “it’s” instead of “its.” Grammar policing is political. We understand fully what the sentence is communicating: pushing up our nose at imperfect grammar is proving their point. If imperfect grammar contributes to discrediting the underlying message, this is epistemic injustice!

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Rachel McKinnon An intellectual accomplice would strategize with, not for and not be afraid to pick up a hammer. (Indigenous Action Media 2014, 5)

The way I like to put it is that an “ally” will put on a button, but an accomplice will grab and throw a brick. This can be literal: after all, the Stonewall Riot was a riot against police violence and harassment of queer and trans people, which involved literal brick-throwing. Far more commonly, though, “throwing a brick” is metaphorical. If someone says something racist, immediately calling that person out is “throwing a brick.” It’s standing up for and with the marginalized and taking on considerable personal risk, in whatever form (economic, physical safety, social, political, etc.). An accomplice is willing to lose friends over their being racist/sexist/homophobic/transphobic and so on. A good example of this is the many white people who participated in tearing down the confederate statue in Durham, North Carolina, in 2017 (Graham 2018). Many of them voluntarily, en masse, surrendered to the police, overwhelming them, causing the police to turn them away. All charges were eventually dismissed by the district attorney. Those are accomplices and not mere “allies.” They put their freedom on the line, perhaps their employment. To put it succinctly: fuck “allies.” “Accomplices are realized through mutual consent and build trust. They don’t just have our backs, they are at our side, or in their own spaces confronting and unsettling colonialism. As accomplices we are compelled to become accountable and responsible to each other, that is the [nature] of trust” (Indigenous Action Media 2014, 8). The second issue with my earlier account of gaslighting is that I inappropriately shoehorned my epistemic account of gaslighting into Miranda Fricker’s (2007) account of epistemic injustice. The problem is that my account explicates the epistemic nature of gaslighting as a form of credibility deficit due to an identity prejudice against the victim. For Fricker, testimonial injustice is caused, at its root, by an identity-based prejudice. For example, someone discounts a woman’s testimony because women are emotional, and emotionality is inconsistent with reliable perceptions. Fricker’s case is Marge in The Talented Mr. Ripley. In the case of the mispronouning of the trans woman by an “ally,” I suggested that it’s a core stereotype that trans women are perceived as especially overemotional due to estrogen-based hormone replacement therapy. 6 However, I’m no longer convinced that the source of the credibility deficit being an identity-based prejudice is a necessary condition for testimonial injustice (and thus gaslighting, if gaslighting is properly understood in terms 6. For a discussion of trans women stereotypes, see McKinnon (2014). Not all trans women choose, or are able, to engage in hormone replacement therapy. But even for those who do not, the stereotype still carries sway in other people’s perceptions and beliefs.

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of testimonial injustice). Some people simply give their own perceptions too much credence such that the contrastive nature of epistemic credibility— particularly when confronting information contrary to background beliefs— produces an inappropriate credibility deficit in a speaker, thus producing testimonial injustice. I think what’s more important is when we can speak to structural patterns in such credibility deficits. 7 GASLIGHTING, MOBBING, AND POSTTRAUMATIC STRESS DISORDER Now that I’ve had an opportunity to update my epistemic account of gaslighting, I’d like to extend some of gaslighting’s harms. Another issue with my previous work on gaslighting is that I simply didn’t go far enough in explicating the epistemic harm that it causes. It’s not simply a form of epistemic injustice; it’s a form of epistemic violence. And once we appreciate that fact, we’ll have a better understanding of the harms it can and does cause. Primarily, I will argue that we should understand epistemic violence much as we now understand the seriousness of emotional violence (in addition to physical violence). Kristie Dotson (2011) offers the following definition of epistemic violence: Epistemic violence in testimony is a refusal, intentional or unintentional, of an audience to communicatively reciprocate a linguistic exchange owing to pernicious ignorance. Pernicious ignorance should be understood to refer to any reliable ignorance that, in a given context, harms another person (or set of persons). Reliable ignorance is ignorance that is consistent or follows from a predictable epistemic gap in cognitive resources. According to this definition, a reliable ignorance need not be harmful. (Dotson 2011, 238) 8

Fricker (2007) suggests that epistemic injustice harms people as a knower, but since being a member of an epistemic community is central to human life, I think it’s more appropriate to say that epistemic injustice, and epistemic violence, harms people as people. As Gayatri Spivak (1998) and Dotson (2011) note, epistemic violence harms the victim’s agency. I suggest that it can also harm dignity as well as contribute to posttraumatic stress disorder. Dotson offers two new forms of epistemic violence focusing on practices of silencing: testimonial smothering and testimonial quieting (Dotson 2011). Testimonial smothering is when, typically, a marginalized person judges that their potential audience will respond to their testimony with such a severe 7. Kate Manne (2017) discusses a great many ways that women face structural violence, including epistemic violence. 8. Dotson also draws from Spivak (1988).

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credibility deficit that they might as well not speak in the first place. The marginalized person thus smothers their own potential testimony due to a perceived likelihood of suffering testimonial injustice. For example, there’s not much point bringing up the concept of white privilege to an audience of white nationalists. 9 Testimonial quieting is when, typically, a marginalized person does speak, but their audience causes them to suffer such a severe credibility deficit that it’s as if they didn’t speak at all: the deficit causes their testimony to be mere sounds, rather than words with meaning and epistemic weight. We find this in many white people’s response to the Black Lives Matter movement, saying that the people protesting police violence are “just screaming and being angry,” or that they “just want special treatment,” rather than expressing legitimate concerns about institutionalized police violence against black people. I want to expand our understanding of epistemic violence to include gaslighting. In my previous work, I focused on gaslighting as a betrayal of trust by someone who purports to support the victim—an “ally.” I noted that one of the consequences of this is isolation and withdrawal: if someone we trusted betrays that trust, we’re less likely to go to them for support again. 10 And if the people who claim to support us betray our trust, then a natural response is withdrawal and isolation. But at the time I didn’t appreciate just how serious these effects can be. Gaslighting can cause posttraumatic stress disorder (PTSD). One might initially balk at this claim (or find it obvious, as victims I speak to often do): “I thought that only singularly traumatic events like abuse, rape, or being a soldier in war cause PTSD!” Not exactly. Such events certainly can cause PTSD, often better understood as acute PTSD. One particularly traumatic event can be enough. However, psychiatrists are increasingly understanding how a number of repeated smaller micro-traumas can accumulate to produce what’s increasingly called Complex-PTSD (abbreviated to C-PTSD or CPTSD). The US Department of Veterans Affairs introduces the concept in this way: Many traumatic events (e.g., car accidents, natural disasters, etc.) are of timelimited duration. However, in some cases people experience chronic trauma that continues or repeats for months or years at a time. The current PTSD diagnosis often does not fully capture the severe psychological harm that occurs with prolonged, repeated trauma. People who experience chronic trauma often report additional symptoms alongside formal PTSD symptoms, such as

9. For an analysis of the political concept of “privilege,” see McKinnon and Sennet (2017). 10. For one particularly good account of trust, see Jones (1996, 2001, 2002, 2003, 2010, and 2012).

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changes in their self-concept and the way they adapt to stressful events. (US Department of Veteran Affairs) 11

Karatzias et al. (2017) distinguish between PTSD and CPTSD in this way PTSD is comprised of three symptom clusters including: (1) re-experiencing of the trauma in the here and now (Re), (2) avoidance of traumatic reminders (Av), and (3) a persistent sense of current threat that is manifested by exaggerated startle and hypervigilance (Th). ICD-11 CPTSD includes the three PTSD clusters and three additional clusters that reflect “disturbances in self-organization” (DSO): (1) affective dysregulation (AD), (2) negative self-concept (NSC), and (3) disturbances in relationships (DR). . . . These disturbances are proposed to be typically associated with sustained, repeated, or multiple forms of traumatic exposure (e.g. genocide campaigns, childhood sexual abuse, child soldiering, severe domestic violence, torture, or slavery), reflecting loss of emotional, psychological, and social resources under conditions of prolonged adversity. (Karatzias et al. 2017, 2)

The eleventh revision to the World Health Organization’s International Classification of Diseases (ICD-11) also includes a distinction between PTSD and CPTSD: Complex post-traumatic stress disorder (Complex PTSD) is a disorder that may develop following exposure to an event or series of events of an extremely threatening or horrific nature, most commonly prolonged or repetitive events from which escape is difficult or impossible (e.g., torture, slavery, genocide campaigns, prolonged domestic violence, repeated childhood sexual or physical abuse). The disorder is characterized by the core symptoms of PTSD; that is, all diagnostic requirements for PTSD have been met at some point during the course of the disorder. In addition, Complex PTSD is characterized by 1) severe and pervasive problems in affect regulation; 2) persistent beliefs about oneself as diminished, defeated or worthless, accompanied by deep and pervasive feelings of shame, guilt or failure related to the traumatic event; and 3) persistent difficulties in sustaining relationships and in feeling close to others. The disturbance causes significant impairment in personal, family, social, educational, occupational or other important areas of functioning. (World Health Organization 2018)

One of the primary features of CPTSD is the experience of repeated betrayals of trust by someone in authority over the victim. This can be a parent or caregiver, and chronic emotional abuse, or it can be workplace harassment, bullying, and mobbing. 12 Thus, while CPTSD is typically associated with the forms of repeated traumatic exposures quoted above, it can include more

11. The VA primarily cites Herman (1997). 12. For a landmark book, see Duffy and Sperry (2014).

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“mundane” experiences like workplace and recreational sources of trauma or micro-trauma. For the purposes of this chapter, I want to focus on the recent concept of mobbing. At the end, I will draw out an important role for gaslighting and epistemic violence. According to Maureen Duffy and Len Sperry (2014): Mobbing is not bullying. It is often far worse than bullying. Mobbing takes place within organizational or institutional settings and always includes organizational involvement. Key organizational members become involved in mobbing through overt or covert actions against a target or through failure to act to protect organizational members from abuse. Bullying is the subjecting of a targeted individual to hostile and abusive acts by one or more individuals without the presence of organizational involvement. The key distinction between bullying and mobbing is the absence of organizational involvement in bullying and the presence of organizational involvement in mobbing. (Duffy and Sperry 2014, 8)

The “presence of organizational involvement” can include a lack of engagement in stopping or responding to claims of harassment or mobbing. I firmly believe that real, detailed examples are best in elucidating issues. For this chapter, I want to focus on a case study in mobbing and harassment in competitive women’s cycling. In particular, I will focus on the experiences of a transgender woman’s experiences of bullying and harassment that eventually escalated to mobbing when she was racing at the domestic elite level in the United States. Cycling in the United States is primarily governed by United States of America Cycling (USAC) and the international cycling federation Union Cycliste Internationale (UCI). Both the UCI and USAC allow trans women to compete in women’s categories. In recent years, USAC has had an unstated policy that trans women may compete if they can present government identification consistent with their gender, such as a driver’s license. In 2017 they formally updated their policy to provide clarity to all. The details of the policy are not particularly important. What matters is that the victim of the mobbing, Victoria, unambiguously meets the UCI and USAC requirements for trans participation. 13 However, it wasn’t long until she started facing transphobic harassment, albeit indirectly on social media. Although people didn’t recognize her as trans when meeting her, it was easy enough to Google her and find out about her trans status through public activism that she has engaged in. Victoria turned out to be a relatively gifted bike racer, progressing well in her training and competing in bigger and more prestigious races. However, her success started to anger some other (cisgender) women racers. Victoria 13. Indeed, since the UCI requirements were more restrictive than USAC’s policy, Victoria meeting the UCI requirements thereby means that she meets the USAC requirements, even before USAC clarified their policy.

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was winning races that these women were used to winning: she was taking their prize money and victories, they felt. And they expressed this to USAC officials. A number of these women approached the regional USAC coordinator who oversees races in the region, and who is responsible for handling all complaints. At first the cis women (and it’s a minority of the racers Victoria has faced, let’s be clear) merely expressed displeasure at Victoria’s presence in their races: trans women shouldn’t be allowed to compete with (real) women. But as it became clear that Victoria wasn’t going anywhere, and she was steadily improving, the women felt compelled to act. The next step was to escalate to complaints to the regional USAC official that Victoria should be drug-tested for endogenous testosterone. The UCI, via the International Olympic Committee’s (IOC) 2015 policy on transgender athletes, had a maximum level of endogenous testosterone that trans women could have and still be eligible for women’s competition. (Victoria was well within these requirements.) Fortunately, this second level of complaint had no effect: the official told the complainants that the sort of testosterone testing that an antidoping test would do doesn’t measure endogenous testosterone: that can’t be done via a urine test (as is typical in antidoping tests for exogenous testosterone doping). It would require a blood test, and that is a deeply invasive procedure for an athlete for whom there is no evidence of breaking rules. The complainants were not satisfied: they repeatedly requested that Victoria be tested for testosterone. They even escalated this complaint over the regional official’s head to the national USAC coordinator. But they received the same answer: no. This begins to rise to the level of mobbing, rather than merely bullying, because the official, in their organizational capacity, does not rebuke those making the continued complaints. Although USAC has an antiharassment policy, which includes language about harassment on the basis of gender identity, those making unfounded complaints based on Victoria’s trans status face no consequences. This lack of action on the official’s part constitutes “organizational involvement,” which Duffy and Sperry note as a necessary component for mobbing. It’s the third stage of escalation where the harassment very clearly crosses a line and becomes mobbing (although I think that their actions already constitute harassment and bullying, crossing a line). The number of women involved begins to grow as what started as a small group begins to gossip and speak to each other, recruiting others (who are either willing or unwitting). They tell lies about Victoria being dangerous and trying to cause crashes. Some of the new recruits have known the complainants for a few years and haven’t known them to be liars, so why wouldn’t they believe them when they say Victoria is dangerous? At one race that Victoria won with a surpris-

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ing last lap solo attack (something she’s never done before, as she would usually wait until the finishing sprint), a small group of women in the race complain to the official. They make two complaints: first, why didn’t she (the official) tell them that Victoria was capable of an attack like that? 14 Second, they claim, falsely, that Victoria tried to cause someone to crash at the sharp corner at the bottom of the small hill. What will the official do? Will she never act to protect the (cis) women racers? The thing is, Victoria never came close to causing another rider to crash, let alone do it on purpose. Victoria happens to race with a GoPro camera (after this incident, she started racing with two) precisely to protect herself from these sorts of false allegations. She was being accused of having a rider on her outside of a sharp corner and then riding toward the curb in order to cause the other rider to crash. But this was a lie: Victoria’s GoPro camera facing behind her seat clearly showed that no such thing ever came close to happening. She was able to provide this proof to the official, who was satisfied. The women who made the complaints faced no rebuke or consequences. So far the harassment has progressed from grumblings, to demands for antidoping testing, to false claims of dangerous riding hoping to affect the results of the race (by having Victoria relegated to last place). Unsuccessful to this point, the cis women weren’t finished. However, since the USAC official has not rebuked these women for their continued harassment of Victoria on the basis of her trans status, the harassment has already risen to the level of mobbing. A few months pass, and a new season begins. Victoria starts winning early season races again, including the final race in a series. But during the wind-down lap, the second-place woman’s male teammate shouted “Congrats [Betty] on being first female!” This is a fairly famous transphobic thing to say, as the second-place rider to Michelle Dumaresq in the women’s downhill Canadian National Championships in 2006, the second-place competitor wore a T-shirt on the podium on which she had written “100% Pure Woman Champ.” The man who said this is on a team that has a history of harassing and complaining about Victoria. After being handed her winner’s prize cheque, a controversy exploded. The chief male official angrily approached Victoria and told her that she has been accused of swearing at competitors during the race (false), throwing elbows (false), and intentionally trying to ride a junior off the course (false). The official wouldn’t even entertain Victoria’s explanation that this same group of women have been waging a campaign to have her banned from competitive cycling. The official said that he had confirmation of the allegations from five women on three different teams, and that was enough for him.

14. This is a shockingly absurd complaint to make: it’s not an official’s job to help riders defeat another rider. In fact, that would be a serious rule infringement.

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Victoria was relegated to last place and the race organizers demanded that she return her winnings. Victoria happened to have a friend at the race to advocate for her and knew the head of operations of USAC because of her previous experiences with harassments. These two people finally persuaded the chief (male) official to begin an impromptu investigation, which he should have done in the first place. After asking other racers, he found that many contradicted the allegations against Victoria, and even noted that rather than trying to run racers off the course, it was the complainants who were bumping into Victoria trying to run her off the course. After his investigation, the official reported back to Victoria that the original women admitted that what they had alleged was false after all. But he did not reverse his decision to relegate Victoria to last place. He offered no explanation. It’s important to note the role that gaslighting played here. When the official first approached Victoria, his mind was already made up: he wasn’t interested in her side of the story. Within seconds, Victoria immediately began to explain that she had been subject to months of harassment from these same riders, trying all of the steps already listed to have her excluded from competitive cycling. He didn’t want to even entertain the idea: “This has nothing to do with you being trans. I’m sure that’s not the case. These women have been competing for years; we know them.” Classic gaslighting. In my earlier work, I argued that the epistemic nature of gaslighting involves inappropriately prioritizing the gaslighter’s perceptions and inappropriately discounting the speaker’s. As José Medina (2011) notes, epistemic injustice is contrastive: in order for a victim to suffer an inappropriate credibility deficit, someone else must inappropriately enjoy a credibility excess. Two sets of people inappropriately enjoyed a credibility excess here: the women engaging in mobbing and lying about Victoria and the official who trusted his own judgment and perceptions of those women over even entertaining Victoria’s side of things. 15 The official’s immediate response, cutting Victoria off, “This has nothing to do with you being trans,” is classic gaslighting. So far Victoria has faced at least two sets of false allegations about being a dangerous rider. In the second case, the complainants admitted to lying. But in both cases none of the cis women faced formal (or informal) consequences. Even when caught lying, and successfully having Victoria’s win vacated, they received no punishment. This likely emboldened them: there was no cost to trying this at every race, which continued to happen throughout the season, and there continued to be no consequences. The women continued to tell lies and misleading statements about Victoria to other racers, often unwittingly recruiting these women to their cause of opposing 15. See Medina (2011).

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Victoria’s participation in the sport. They would message racers and “warn” them about Victoria. Victoria has now been a clear victim of mobbing due to multiple officials’ inaction. Recall part of the description from Duffy and Sperry: “Key organizational members become involved in mobbing through overt or covert actions against a target or through failure to act to protect organizational members from abuse.” USAC continually failed to protect Victoria from the harassment. There were no consequences for the perpetrators, even when caught lying. This is a failure to act to protect a member of USA Cycling from abuse. And Victoria had tried, but her pleas were dismissed: well, that’s just how those women are. It starts small and spreads. With each risk-free attempt at exclusion and harassment, the original perpetrators become emboldened. No one is there to counter the lies. Those who engage in mobbing often trade on their organizational credibility. And this is most effective against those already marked as “new” or “outsiders” (as a trans woman athlete certainly is). Her experiences of harassment have had a number of serious effects on Victoria. She developed, and was diagnosed with, CPTSD. She feels isolated at races, not knowing who will be friendly if she strikes up a conversation— or who will be friendly to her face and then engage in harassing behaviors behind her back. One aspect of PTSD is hypervigilance and difficulty trusting others. I suggest that another aspect is heightened attributional ambiguity (McKinnon 2014). Attributional ambiguity is when a person behaves in a way toward us where it’s unclear what motive or reason that we should attribute as the cause of the behavior. For example, if you’re an attractive woman and a man chooses to hold a door open for you, is it because he’s being chivalrous and the attendant sexism that comes with it, or is he just being polite because he holds open doors for everyone regardless of gender? It’s ambiguous. Queer and trans people (and I suggest any socially marginalized intersectional identity) face this all the time. Is that person staring at me because they think that I’m queer and they may want to harass me, or do they think I’m cute and they want to be nice to me? It’s ambiguous. Here, that ambiguity causes stress. And those with CPTSD, due to the attendant hypervigilance of the disorder, will sometimes attribute the worst motive to resolve the ambiguity. They feel unsafe taking a risk that it’s the positive motive. When people’s motive for their behavior toward us is ambiguous in a stressful situation, it requires trust for us to be charitable in assuming positive motives. But those with CPTSD regularly experience exactly this lack of trust in terms of feeling close to others.

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I suggest that one key mechanism for successful mobbing is gaslighting or epistemic injustice, whether testimonial or hermeneutical. 16 Let’s consider Victoria’s case where the USAC officials did not participate themselves in the mobbing, but they did not adequately act to protect Victoria. One reason for this is that they systematically (though plausibly unintentionally) devalue Victoria’s own pleas and testimony about what she’s suffering, even if she happens to be an expert on the phenomena. Consider the official who relegated her (to last place) in the race where a group of women ganged up and lied about her racing. He wouldn’t even entertain Victoria’s testimony that those very racers had been engaging in a months-long campaign of harassment to have her banned from racing for being trans. When she tried to plead her case and explain the presence of mobbing, she was gaslit: “This has nothing to do with you being trans,” he said. And when he eventually did his due diligence to investigate the allegations, they were found to be lies, yet there were no repercussions for the perpetrators: someone with institutional power failed to act in a case of mobbing. Part of what’s going on here, with mobbing in general, is what Gaile Pohlaus Jr. has called willful hermeneutical ignorance. 17 “Hermeneutical” resources are concepts that are sufficiently socially shared such that we can use them to communicate with others. “Mobbing,” “gaslighting,” and “epistemic violence” are all hermeneutical resources. Sometimes, though, people (and typically those with more social power) refuse to adopt new hermeneutical resources. This has been the case with the concept of “white privilege” and the Black Lives Matter (BLM) movement. The “#AllLivesMatter” response is an active rejection of the idea that BLM isn’t about nonblack lives not mattering, or about only black lives mattering: it’s about the systematic devaluation of black bodies and lives in the United States. Those who respond to BLM with “AllLivesMatter” are actively rejecting the hermeneutical resources: that’s willful hermeneutical ignorance. One way that mobbing is successful is when a victim knows that they’re being mobbed, but those with institutional power to whom they complain reject that mobbing is a real phenomenon. If they only understand harassment or bullying as overt, obvious, and intentional, they will fail to understand how sincere “good” people can unintentionally participate in mobbing and harm. And since they reject the critical hermeneutical resources to understand the harm to the victim, they will likely place the blame on the victim themself: “If there’s this much smoke, there must be fire somewhere.” Even if Victoria could prove that every single allegation against her is a lie, an official thought that there must be something she was responsible for doing wrong to cause all the lies. But all she did was exist. This is a form of 16. C.f. Friedlaender and McKinnon (forthcoming). 17. Drawing importantly from Mills (2007).

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epistemic bootstrapping. Every claim is falsified, but the existence of false claims is taken as evidence of an underlying (nonexistent) “truth” causing the claims. 18 No: victims are not responsible for their harassment and mobbing. Sometimes there’s smoke due to prejudice. A common outcome to workplace mobbing, for example, is firing the victim since they’re perceived as the “source” of the problem (the smoke). To an extent, the discord in the workplace will be resolved simply by firing the victim, but this comes at the cost of a deep injustice and often long-standing harm to the victim. 19 OVERCOMING GASLIGHTING AND MOBBING I’d like to close with some preliminary thoughts on what can be done to overcome the epistemic violence of gaslighting and mobbing. Unfortunately, discussing CPTSD caused by gaslighting often involves a kind of metagaslighting: people gaslight victims of gaslighting when the victim claims PTSD as a result of gaslighting. This happens when people complain of gaslighting and mobbing, as well. In a sense, there’s little the victim can do to overcome it: it’s systemic. One concrete solution to overcome this, though, is for marginalized folx to have a network of accomplices. One of the features of mobbing and gaslighting is that the victim isn’t able to credibly advocate for themselves: they’re often suffering from testimonial quieting. Victoria could not successfully advocate for herself to the official since he wouldn’t even entertain the idea: it was only when others stepped in and spoke entirely on her behalf that anything happened. I think that this is typical. Meta-gaslighting is endemic. So is the epistemic circle of hell: emotionality is used as an excuse not to believe someone, which makes them (more) emotional, which is used as further evidence not to believe them. The phenomenology of this is infuriating. People suffering this need to be able to turn to their “brick-throwers” to step in. I have a few, and the rare instances that they’ve been present have made all the difference. It also helps alleviate the feelings of isolation that those with CPTSD from gaslighting experience; furthermore, it can help rebuild the capacity to trust others. I don’t think there’s good reason, presently, to be optimistic about the ability to “overcome” gaslighting and mobbing. We’re still only just developing the hermeneutical resources to name and circumscribe the phenomena, let alone have the concepts propagate through the social imaginary to the point where they’re not routinely met with willful hermeneutical ignorance. 18. See Vogel (2000). 19. The other common outcome is for the victim to quit and (hopefully!) find another job. This is particularly troubling for marginalized people, especially those for whom finding employment is difficult, such as trans people.

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But one concrete way for people, even other marginalized folx, to help others is to provide what’s known as a sanity check. While the term is widely used in database management, it has a different meaning in activist communities. Think back to the last time that you saw something a little racist/sexist/ transphobic and you weren’t entirely sure if what you think is happening is really happening. A look to another person who reciprocates with a “Yeah, I saw that too” look can make a massive difference: oh good, I’m not just imagining it. This often happens in situations where there’s attributional ambiguity. I distinctly remember an incident at an American Philosophical Association conference. It was a session on decision theory (a topic that I had done a great deal of graduate work on), and a topic I was very familiar with, as I nearly wrote my dissertation on it. The speaker made a large unstated assumption early in his presentation. I thought that this assumption was not one his interlocutor in the literature would grant, and that this assumption seemed to be doing all the work in producing his conclusion. So I asked about that: isn’t this unstated assumption what produces your conclusion, and isn’t that exactly the claim that the [other view in the debate] won’t grant? So aren’t you essentially begging the question? He didn’t understand the question. I restated. Still nothing. I restated one more time. Nothing. Oh, I should note that I was the only woman in the room of about twenty to thirty people. Someone else (a man) immediately asks his question which is a very slight rewording of my original question (nearly verbatim). The speaker now understands and gives an answer (though, I think, an unsatisfactory one). This is classic epistemic injustice: a question from a woman is thought incomprehensible, but the same question from a man is comprehensible and worthy of reply. Immediately after the session, I asked the man who asked the follow-up question if what I thought just happened really happened. “Oh yeah, obviously! I couldn’t believe it.” We became friends, bonding over our shared understanding of what just happened. He provided a sanity check for me: yeah, I didn’t just imagine it. While the sanity check took the form of a conversation, they’re most effective immediately in the moment. I’ve found that (when possible) simple eye contact with a look of recognition (maybe a slight nod, subtle “what the fuck” look in the eyes or mouthing the words) goes a long way in resisting the self-doubt that accompanies marginalized people suffering oppression. It’s perhaps not as good as speaking up and confronting the source of harm, but it’s far better than nothing, and it’s cost-free. It’s an effective way to show solidarity. Seriously, though: speak up. Throw a “brick.”

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REFERENCES Abramson, Kate. 2014. “Turning up the Lights on Gaslighting.” Philosophical Perspectives 28: 1–30. Dotson, Kristie. 2011. “Tracking Epistemic Violence, Tracking Practices of Silencing.” Hypatia 26 (2): 236–57. Duffy, Maureen, and Len Sperry. 2014. Overcoming Mobbing: A Recovery Guide for Workplace Aggression and Bullying. Oxford: Oxford University Press. Friedlaender, Christina, and Rachel McKinnon. Forthcoming. “The Fundamental Attribution Error, Microaggressions, Harassment, and Gaslighting of Transgender Athletes: A Bi-Directional Analysis of the Role of Stereotypes in Transmisogynist Harassment in Single-Gender Sports.” In Microaggressions and Philosophy, edited by Lauren Freeman and Jeanine Weekes Schroer. New York: Routledge. Fricker, Miranda. 2007. Epistemic Injustice: Power and the Ethics of Knowing. New York: Oxford University Press. Graham, David. 2018. “How the Activists Who Tore Down Durham’s Confederate Statue Got Away with It.” The Atlantic, February 21. https://www.theatlantic.com/politics/archive/ 2018/02/durham-confederate-monument-charges-dismissed/553808. Herman, Judith. 1997. Trauma and Recovery: The Aftermath of Violence from Domestic Abuse to Political Terror. New York: Basic Books. Indigenous Action Media. 2014. “Accomplices Not Allies: Abolishing the Ally Industrial Complex, An Indigenous Perspective & Provocation.” Version 2, May 2. http:// www.indigenousaction.org/accomplices-not-allies-abolishing-the-ally-industrial-complex. Jones, Karen. 1996. “Trust as an Affective Attitude.” Ethics 107 (1): 4–25. ———. 2001. “Trust: Philosophical Aspects.” In International Encyclopedia of the Social and Behavioral Sciences, edited by Neil Smelser and Paul Bates, 15917–22. Amsterdam: Elsevier Science. ———. 2002. “The Politics of Credibility.” In A Mind of One’s Own: Feminist Essays on Reason and Objectivity, second edition, edited by Louse Antony and Charlotte Witt, 154–76. Boulder, CO: Westview Press. ———. 2003. “Emotion, Weakness of Will, and the Normative Conception of Agency.” In Philosophy and the Emotions, Royal Institute of Philosophy Supplement, 54, edited by A. Hatzimoysis, 181–200. Cambridge: Cambridge University Press. ———. 2010. “Counting on One another.” In Trust, Sociality, Selfhood, edited by Arne Gron and Claudia Welz, 67–82. Tubingen: Mohr Siebeck. Karatzias T., M/ Cloitre, A. Maercker et al. 2017. “PTSD and Complex PTSD: ICD-11 Updates on Concept and Measurement in the UK, USA, Germany and Lithuania.” European Journal of Psychotraumatology 8 (sup7): 1–6. Kidd, Ian James, José Medina, and Gaile Pohlhaus Jr., eds. 2017. The Routledge Handbook of Epistemic Injustice. New York: Routledge. Manne, Kate. 2017. Down Girl: The Logic of Misogyny. Oxford: Oxford University Press. McKinnon, Rachel. 2014. “Stereotype Threat and Attributional Ambiguity for Trans Women.” Hypatia 29 (4): 857–72. ———. 2015. “Trans*formative Experiences.” Res Philosophica 92 (2): 419–40. ———. 2016. “Epistemic Injustice.” Philosophy Compass 11 (8): 437–46. ———. 2017. “Allies Behaving Badly: Gaslighting as Epistemic Injustice.” In Routledge Handbook on Epistemic Injustice, edited by Ian James Kidd, José Medina, and Gaile Pohlhaus Jr., 167–75. New York: Routledge. ———. 2018. “The Epistemology of Propaganda.” Philosophy and Phenomenological Research 96 (2): 483–89. McKinnon, Rachel, and Adam Sennet. 2017. “Survey Article: On the Nature of the Political Concept of Privilege.” Journal of Political Philosophy 25 (4): 487–507. Medina, José. 2011. “The Relevance of Credibility Excess in a Proportional View of Epistemic Injustice: Differential Epistemic Authority and the Social Imaginary.” Social Epistemology 25 (1): 15–35.

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———. 2012. The Epistemology of Resistance: Gender and Racial Oppression, Epistemic Injustice, and Resistant Imaginations. Oxford: Oxford University Press. Mills, Charles. 2007. “White Ignorance.” In Race and Epistemologies of Ignorance, edited by Shannon Sullivan and Nancy Tuana, 11–38. Albany: State University of New York Press. Spivak, Gayatri. 1988. “Can the Subaltern Speak?” In Marxism and the Interpretation of Culture, edited by Cary Nelson and Lawrence Grossberg. Urbana: University of Illinois Press. US Department of Veteran Affairs. n.d. “Complex PTSD.” https://www.ptsd.va.gov/profes sional/treat/essentials/complex_ptsd.asp (accesssed January 21, 2018). Vogel, J. 2000. “Reliablism Leveled.” Journal of Philosophy 97 (11): 602–23. World Health Organization (WHO). 2018. “6B41 Complex Post Traumatic Stress Disorder.” In International Statistical Classification of Diseases and Related Health Problems, 11th Revision (ICD-11). https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/585833559.

Afterword Miranda Fricker

Thankfully there can be moments at which an epistemic injustice is overcome. The correcting of a prejudice that has depressed a speaker’s level of credibility, where the correction means her testimony comes to be properly assessed after all, would constitute such a moment. In this case we would see a testimonial injustice done and undone—if undone only in terms of its practical significance, insofar as undoing the intrinsic insult is likely unachievable by credibility correction alone. Alternatively, to take a case of hermeneutical injustice now, we can imagine the hermeneutical marginalization that fuels any given instance of hermeneutical injustice being eroded as the formerly hermeneutically marginalized group succeeds in spreading their concepts and social meanings to other groups, thereby rendering their own interpreted experiences more widely intelligible across social space. The first moment of overcoming corrects a wrongful deficit of credibility; the second moment corrects a wrongful deficit of intelligibility. Such moments of overcoming epistemic injustice can take less than a minute, or more than a century. These possibilities inspire a certain optimism-in-principle about our chances of overcoming epistemic injustice. Perhaps a given moment’s overcoming might partly depend upon an increased epistemic virtue on the part of an individual or a collective interlocutor (a doctor, a court of law, a university). Or perhaps, in the case of a hermeneutical injustice being overcome, it might depend on some concerted conceptual or hermeneutical activism on the part of the hermeneutically marginalized group; or again, more passively, simply a more fortuitous opening up of hermeneutical channels due to some independent social sea change. As ever, individual, collective, and abstractly structural possibilities are all in the mix, and fundamentally interdependent. No one has a prejudice, or virtuously overcomes one, except in a social 303

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context that creates the conditions both of the prejudice and its extinction. No group is hermeneutically marginalized except in the context of sociohistorical forces, notably social power and vested interests, that make it so. There again, the converse equally applies: no sociohistorical force takes its hermeneutical effect without individuals participating—assisting and resisting— and no institution represses hermeneutical resources essential to one group’s experience of the world without individuals turning the institutional cogs. There is therefore no exclusive philosophical choice to make between individual, collective, and structural analysis, for these things are thoroughly interdependent. Each implies the other. There can of course be a choice to prioritize one level of explanation in a given theoretical enterprise or in relation to a particular range of cases, where perhaps one set of forces (an individual’s attitude, an institution’s policy, a nation’s history) constitutes the most proximate or most powerful or most interesting explanation. But the diverse phenomena of epistemic injustice, which different philosophers are so richly theorizing and approaching from so many different theoretical or political perspectives, are nonetheless phenomena that generally have all of individual, collective, and structural aspects. As regards the overcoming of a moment of testimonial injustice, what is required for it to be overcome is the neutralization of whatever prejudice is causing the credibility deficit. As regards the overcoming of a moment of hermeneutical injustice, it will require the eradication of the background hermeneutical marginalization that renders the deficit of intelligibility unjust. But enough talk of “moments.” The notion of overcoming epistemic injustice is also a broader idea and invites us to ask whether we might entertain an inprinciple optimism not only about specific corrections and ameliorations, but rather about the wider idea that “we”—a given society or culture perhaps— might aspire to get past an era of epistemic injustice and pass into one of epistemic justice. Perhaps (it might be thought) if we could achieve a situation in which there were no prejudices anymore and no hermeneutical marginalization that would create blockages in the epistemic flow from self to other, from one group to another, perhaps that would provide the basis for a society in which epistemic injustice in general is overcome for good? This is a wholly different question, and I do not see grounds for any optimism. Indeed, I would argue that an in-principle pessimism is in order as regards this broader ideal of epistemic justice, for only pessimism will keep us safely alert to the ordinary injustices that, I believe, are bound to reoccur and reinvent themselves in new contexts and new mutated guises. Utopian fictions notwithstanding, there is no genuine hope of overcoming epistemic injustice once and for all any more than there is a genuine prospect of overcoming nonepistemic injustice once and for all. We may perhaps find it imaginatively helpful to orient ourselves toward an ideal; but we should be skeptical of that too, once again on the grounds that a focus on ideals quickly

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tends to obscure the ever-self-reinventing forms of injustice that are bound to reassert themselves. Aspiration to ideal can certainly inform and guide; but it can equally lead to wishful thinking and delusion. Wherever there are human societies there will be relations of power, and wherever there are relations of power there will be prejudices that distort our perceptions of one another, and pressures that marginalize the meanings associated with the experiences of some groups. These considerations recommend a healthy pessimism about any generalized ideas of overcoming epistemic injustice, and they also recommend that we should work instead to cultivate the social-epistemic agility and diagnostic powers that are needed to create ever new preventions and corrections from moment to moment. The chapters in this volume are testament to how we might do just that as we aim, clear-eyed, to keep on identifying and overcoming new forms of epistemic injustice.

Index

ableism, 60. See also disability/disabled people; mental health abolitionism. See prison abolition abolitionist epistemology. See prison abolition Abramson, Kate, 285 admiration. See exemplarism, admirationemulation model adolescents. See age adults. See age aesthetics, 204, 208, 214n3, 231 aesthetic disruption, 213 African Americans, 64–65, 66, 68, 69, 71, 203, 211, 215. See also black people/ blackness; stereotypes, about black people AIDS. See healthcare age, 69–71, 171–172, 176, 177, 189, 190, 197; adolescents/teenagers, 39, 79, 95, 210; adulting, 36, 41; adults/middleage, 67, 69–71, 72, 132, 154, 189, 190, 242, 243, 260, 261–262, 263; childhood abuse/assault, 147, 291; children’s effects on careers/finances, perceptions of, 37, 68, 72; children/young, 22, 51, 67, 69–71, 73, 75–76, 78–80, 126, 131, 145, 189, 190, 191, 197, 210, 256, 259–260, 261, 262–263, 264, 265; elders/elderly, 153–154, 186, 187, 189, 256, 259, 261, 264; epistemic injustice against children, 124n6, 263. See also

care ethics, care work agency. See epistemic agency; moral agency Alfano, Mark, 10, 11, 106–107, 107–108, 110, 110n10, 113–114 Alim, H. Samy, 214–215 alternative epistemologies. See knowledges, types of ally culture, critique of, 286, 287, 288 ambivalence. See exemplarism, ambivalence-avoidance model American Philosophical Association (conference), 299 amplification, 27 anchoring effect, 94 Anderson, Elizabeth, 96, 160 Andrews, Julie, 195 Anno, B. Jaye, 227–228 Ansari, Aziz, 59 anti-blackness. See racism; violence, antiblack/racist anticolonial projects. See colonialism antiracist projects, 3, 269, 274, 276, 280; antiracist art, 13 Antony, Louise, 72–73 artists, 23, 216, 222; hip-hop artists, 212, 214 attributional ambiguity, 296, 299 Augustine of Hippo, 19 authority, 57, 133, 175–176, 223, 228, 229, 241, 291; epistemic authority, 123, 141, 307

308

Index

144, 146, 148, 150, 159, 178–179, 206, 211, 245n7, 286 autonomy, 25, 37, 256, 260, 262, 263, 264. See also epistemic agency; moral agency aversive racism. See racism Ayala-López, Saray, 11–12, 86 Azalea, Iggy, 217 Baehr, Jason, 102 Baier, Annette, 224, 225–226, 259–260, 266 Baldwin, James, 103 Banaji, Mahzarin, 11, 78, 78n4 Bartky, Sandra, 1 base rates, 77–78, 78n4 Battaly, Heather, 161–162 Bayesianism, 77–78, 78n4 The Beastie Boys, 216 Beauchamp, Tom, 224–225 Beeghly, Erin, 34, 35n3, 43 Belief in Social Determinism, 79n5 beliefs, 1, 4, 27, 64, 92, 102, 104, 223, 231, 262, 263, 272n4, 273n9, 275, 288n6, 291; background/basic beliefs, 230, 240, 266, 276n13, 289; collective/ shared belief, 96, 112, 141, 230, 231, 276; false/mistaken belief, 150, 173, 230; prejudicial/discriminatory beliefs, 64, 112, 140, 222, 228, 269; revising/ changing beliefs, 65, 72, 101, 103n2, 213, 275; true/real belief, 150, 161, 263. See also essentialism; evidentialism; reliabilism Bettcher, Talia, 49–50 Bhandary, Asha, 261 bias, 17–18, 20, 27, 29, 37n6, 55, 76, 79n5, 85n1, 87, 94, 96, 101, 102, 108, 110–112, 112, 113, 114, 128, 130, 176–178, 179–180, 183, 195, 198, 226, 264; bias blind spot, 85, 87, 94; debiasing, 87, 91, 93n3, 95, 279, 281; explicit bias, 17, 108n9, 127; relationship to epistemic injustice, 93, 192, 214, 274; relationship to epistemologies of ignorance, 103–107, 109, 116. See also gender; implicit bias; implicit bias research; oppression; patients; racism

Bilotta, Julie, 237–239, 242, 245, 246–247 biomedical sciences, 12, 154, 163, 164, 165, 172, 173, 175, 176–179, 222, 224–225. See also healthcare; science Black English, 278 Black Liberation movement, 232 Black Lives Matters (movement), 290, 297 black people/blackness, 7, 53–54, 93, 103, 113, 125–127, 173, 203, 204–207, 204n1, 210, 211, 215, 217, 221, 232, 232–233, 245n7, 274–275, 276n13; testimony of, 12, 204; violence against, 7, 208, 212–214, 215–218, 290. See also African-Americans; stereotypes, about black people Blanchard, Thomas, 73 Bloom, Harold, 23 Blum, Larry, 34, 35n3, 43 Bok, Sissela, 224, 225 Boorse, Christopher, 163 borderline personality disorder. See mental health Broockman, David, 89 brown ignorance. See epistemology of ignorance Brown, Michael, 210 brownness (social category), 7 bullying. See harassment Burns, Mason, 113 Bush, George W., 229 Butler, Judith, 12, 203, 205–206, 210, 211, 212 Cahill, Anna, 59, 60 Cao, Jack, 78, 78n4 capitalism, global, 230 care ethics, 256, 259–262, 264, 266 care work, 13, 196, 256, 259–261, 262, 263, 264, 291; childcare, 79–80, 196, 233–234, 256, 259–260, 261, 265; epistemic care/care epistemology, 256, 264–265; dependency work, 259–257, 261–262; critiques of individualism within, 259, 261 Carel, Havi, 12, 122, 123n4, 174–175 children. See age Childress, James, 224–225 Christie, Nils, 230

Index chronic illness. See disability/disabled people; healthcare Church, Ian, 109–110 CK, Louis, 58–59 class/classism, 8, 43–44, 123, 171–172, 176, 177, 185, 210, 230; poverty, 37, 160, 165, 223, 224; socioeconomics, 57, 66, 68–69; wealth inequality, 86–87. See also economic analysis; stereotypes about class Clifford, W. K., 1 Code, Lorraine, 1–2, 88–89, 248 coercion, 49, 50, 56, 59, 242 cognitive dissonance, 85–86, 87, 94, 247 collective responsibility. See responsibility Collins, Patricia Hill, 1, 43, 53–54, 269–270; controlling images, 1, 33, 36–37, 43; knowledge validation processes, 269–271, 275–276, 276n13, 278–279; subjugated knowledges. See knowledge, types of colonialism, 53, 54, 101, 208, 226; anticolonial struggles, 226, 288. See also epistemic injustice; implicit bias; indigenous people; stereotypes; violence combat/war, 139, 145, 146, 147; combat trauma, 139, 140, 142, 145; combat veterans, 139, 139n1, 140–141, 144, 144n6, 145, 147, 148, 149, 149–150. See also mental health, Post-Traumatic Stress Disorder; stereotypes, about the military consent, 288; in medicine, 186, 190, 194; in sex and sexual assault, 49–50, 51–53, 52n1, 55–61. See also sexual assault/ misconduct Continental philosophy. See philosophy contributory injustice. See epistemic injustice, types of controlling images. See Collins, Patricia Hill counterstereotypical examples, 34n2, 41 Cramwinckel, Florien, 20 Crichton, Paul, 175 credibility, 54, 74, 91, 147, 188, 192, 193–194, 223, 257, 275, 281, 296, 298, 303; and people of color, 7, 88, 276, 277; credibility assessments /

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judgments, 2, 4, 6, 10, 64, 74, 75–76, 87, 88, 108–109, 108n9, 115–116, 150, 169–170, 183, 186, 228, 229, 240, 245, 256n2, 257, 270, 275–276; credibility asymmetry, 246; credibility deficit / deflated credibility judgment, 1, 2, 3, 4, 9, 86, 91, 93, 107, 124, 126, 128, 129, 130, 139, 140, 141, 144, 145, 160, 169, 183, 189–190, 192, 194, 197, 226, 229, 231, 239, 257, 270, 276, 276n13, 288–289, 290, 295, 303–304; credibility excess/inflated credibility judgement, 4, 17n2, 101, 128, 142, 145–146, 190–191, 194, 196, 197, 295; credibility stereotype, 171–174, 174–180. See also epistemic injustice, types of, testimonial injustice; epistemic trust Critchley, Harry, 13 critical philosophy of race. See philosophy cues for control, 113 cultural differences/features, 23, 24, 53, 158, 159, 209, 304 Curry, Tommy, 54 Daniels, Stormy, 52, 56–57 Davidson, Lacey, 13, 65–66 Davis, Angela, 229–230, 232–234, 249 deadnaming. See transphobia dehumanization. See oppression de Moya, Dorothy, 231 Department of Veteran Affairs (U.S.), 290–291 Diagnostic and Statistical Manual of Mental Disorders (DSM), 176 disability/disabled people, 53, 53–55, 121, 194–195, 230, 244, 272n7; ability/ inability, 67, 134, 140, 144–145, 146, 157, 164, 176, 193, 195–196, 197, 203, 206, 210, 211, 213–214, 215, 216, 218, 243–244, 245–246, 259, 277, 298; chronic illness, 156–160. See also healthcare; mental health; stereotypes, about disability and mental health Discipline Committee of the College of Nurses of Ontario, 245 discrimination, 63, 64, 65–66, 73–74, 79n5, 133, 184, 242, 269 DJ (pseudonym), 55–56, 56

310

Index

doctors, stereotypes about. See stereotypes about doctors. domestic abuse. See sexual assault/ misconduct Doris, John, 10, 106n8 Dostoyevsky, Fyodor, 20 Dotson, Kristie, 92, 124n6, 132, 241n4, 269–271, 276–277, 289–290; epistemic exclusion, 269, 270–271, 279, 280–281. See also epistemic oppression double consciousness. See Du Bois, W. E. B. doxastic. See beliefs. Doyne, Bronte, 128–131, 128n8 dual process theory (System 1 and System 2), 90, 109, 110, 273 Du Bois, W. E. B., 1, 203–204, 206–207, 208–209, 211, 232–233; double consciousness, 1; the veil, 1, 203, 206–207, 208, 211, 218 Duffy, Maureen, 292, 293, 296 Dusenbery, Maya, 176 Eberhardt, Jennifer L., 211 economic analysis, 3, 7, 208, 209, 231, 249, 256, 264, 288. See also class/ classism education, 3, 17, 87, 171, 255, 264, 291; access to, 123, 255; early education, 258, 262; educational labor/work, 256, 262–263, 264–266; epistemology of and epistemic norms within, 209, 210, 230; higher/postsecondary education, 161, 259, 262; high school / secondary education, 172, 255n1, 258; medical education and training, 154, 180, 184, 233; professors, 39, 40–41, 49, 55–57, 72, 208, 258, 259, 264; teachers/ educators, 73, 89, 161, 171–172, 208, 222, 255, 258–259, 262, 263, 264, 265 Ehrenreich, Barbara, 158 Eighth Amendment (U.S. Constitution), 221 elders/elderly. See age Elgin, Catharine, 255, 262 The Elizabeth Fry Society, 239, 248, 249 embodied knowledge. See knowledge, types of Eminem, 216–217

environmental justice, 260n3 envy. See exemplarism, envy-agonism model the episteme, 205–206, 209–210, 212, 214 epistemic agency, 2, 18, 28–29, 39, 40, 76, 90, 91, 96, 101, 129n9, 160, 203–204, 207, 240, 244–245, 250, 255, 262–263, 266, 289; hermeneutical agency, 156, 157, 158, 159. See also autonomy; exemplarism; moral agency; virtue epistemology epistemic authority. See authority epistemic care. See care ethics epistemic dependency, 262. See also care ethics epistemic exclusion. See Dotson, Kristie epistemic friction. See Medina, José epistemic humility, 10, 24, 40, 90–91, 92, 96, 211. See also virtue theory; virtue epistemology epistemic injustice, types of: contributory injustice, 64; epistemic bootstrapping, 297–298; gaslighting, 2, 13, 130, 285–286, 289, 290, 295; hermeneutical injustice, 5–6, 6, 7, 9, 11, 49–52, 57, 60–61, 64, 73–74, 95, 140–141, 142–145, 155–156, 158, 159–160, 163, 164, 165–166, 172, 179, 197, 255, 270–271, 274, 297, 303–304; testimonial injustice, 3–5, 5, 6, 9–11, 17–18, 21, 26–28, 54, 64, 74, 86, 87, 88, 95, 107–108, 108–109, 115, 124, 127, 134, 140–141, 142, 144, 145, 148, 160, 170, 172, 194, 203–204, 206, 210, 211, 212, 213, 218, 229, 229n7, 239, 255, 270, 274n11, 288–289, 290, 297, 303–304; testimonial quieting, 289–290, 298; testimonial smothering, 132, 289–290; unfair epistemic distributions, 17, 21, 64, 73, 239, 244, 255, 255n1, 256–257; unfair hermeneutical climates, 36; willful hermeneutical ignorance, 7–8, 9, 64, 144n6, 270n1, 280, 297, 299. See also epistemic oppression; epistemic violence; epistemology of ignorance

Index epistemic justice, 19–21, 24–25, 36, 38, 45, 73–76, 88, 89, 148, 154, 160–161, 166, 170, 180, 255–256, 264, 304; hermeneutical justice, 148; hermeneutical resistance, 36; sanity check, 299; testimonial justice, 9–10, 17–18, 19–22, 26–27, 28, 64, 74–76, 85, 88, 91, 107–108, 111–112, 115, 116, 210, 211; testimonial justice, naive, 17, 19; testimonial justice, corrective, 18, 19–22, 26–27, 28–29, 64, 74–76, 87, 107–108 epistemic labor, 43, 196, 198, 256–258, 263; division of, 257, 258; educational labor/teaching work, 255–256, 262, 266 epistemic luck, 4, 143–144, 169–170, 171, 179 epistemic oppression, 89, 91, 255, 269–271, 271n2, 274–275, 276–281. See also Dotson, Kristie; epistemic injustice, types of; oppression epistemic peers, 96, 129, 129n9; peer disagreement, 263, 266 epistemic resources, 64, 223, 245, 250, 255, 270, 271, 277, 278, 279, 280, 281; collective, 271, 276 epistemic systems, 40, 269, 271, 273–274, 275–276, 278 epistemic trust, 3, 13, 19, 75, 110, 116, 125, 129, 131–133, 141, 145, 150, 171, 174, 178, 189, 203, 208, 222–223, 224–226, 227, 228, 233, 266, 277, 288, 290, 290n10, 291–292, 296, 298; selftrust, 2, 36, 38–42, 295; trustworthiness, 39, 74, 75, 139, 144, 210, 212, 223, 229, 231, 266. See also credibility; Jones, Karen epistemic violence, 1, 122n3, 132, 226, 255, 285, 289–290, 292, 297, 298. See also Dotson, Kristie; epistemic injustice, types of; Spivak, Gayatri; violence epistemic virtues. See virtue epistemology; virtue theory epistemology of ignorance, 6–7, 12–13, 101, 104, 109, 112, 116, 212, 223, 240–241, 242–245, 246, 247–248, 272, 278, 279, 289; active/willful ignorance, 1, 60, 162, 204n1, 270n1; brown

311

ignorance, 7; male ignorance, 6, 7; white ignorance, 6–7, 44, 50, 223. See also epistemic injustice, types of, willful hermeneutical ignorance; epistemic oppression essentialism, 33–34, 35n3, 43, 67–68, 69, 73, 77; psychological essentialism, 67–68, 69, 73, 77 Estelle v. Gamble (U.S. Supreme Court ruling), 221, 225, 233 ethnicity. See race European Americans, stereotypes about. See stereotypes about, white people Evans, Jonathan, 109 evidentialism, 102–103, 103n2, 105, 105–106, 106n7 Ewell, Mayella (character in To Kill a Mockingbird), 54 exemplarism, 18–29; admiration-emulation model, 18–22, 23, 26, 27–28, 28–29; ambivalence-avoidance model, 25–29; envy-agonism model, 22–25, 29 existentialism, 203; black existentialism, 208, 211 faith. See religion/faith Fanon, Frantz, 1, 203, 204–205, 206, 207–209, 211, 226, 228, 232 fatness. See weight/body size Ferber, Abby, 54 Fetterolf, Elianna, 12 Fiander, Sarah, 245 Fiasco, Lupe, 216 Foucault, Michel, 1, 12, 203, 205–206, 209–210, 212, 214 framing effects, 110 Frankfurt, Harry, 25 Frankowski, Alfred, 214 Fraser, Nancy, 264, 265 Freeman, Lauren, 12, 122n2, 131n12, 131n15 Freud, Sigmund, 23 Fricker, Miranda, 4, 12, 13, 140, 148, 171, 193n4, 208, 228n6; critiques or limitations of her work, 54, 57, 90, 124–125, 205–206, 213, 288, 289; on epistemic injustice, 2–6, 9, 17, 49–50, 51, 64, 127, 142, 143, 143–144, 158, 159, 169–170, 183, 184, 192, 193, 194,

312

Index

203, 212, 229n7, 271, 288, 289; on epistemic justice and virtue theory, 9–11, 17, 19–20, 64–65, 74, 85–90, 91, 93, 95, 107–108, 109, 111–112, 116n17, 210–211; influence of, 3, 124n6. See also epistemic injustice; epistemic justice; virtue epistemology Frye, Marilyn, 1 Garlow, Dakota, 238 gaslighting. See epistemic injustice, types of gender, 37, 53, 54, 65, 121, 128, 171–172, 178, 186, 190, 196, 197, 203, 212, 224, 230, 258, 272n7, 292, 296. See also microaggressions; sexism; social identity; stereotypes; transphobia; women gender pay gap, 183–184 generics (linguistics), 33, 35n5, 67–68, 69, 71, 76–77, 80. See also stereotypes genocide. See violence Gigerenzer, Gerd, 65, 65n1 Gilligan, Carol, 260, 266 Gilmore, Ruth Wilson, 230–231 Gionni Lee, 238 Goguen, Stacey, 11, 39, 45n10 Goldman, Alvin, 105n6, 255 Gopnik, Alison, 69–71, 80 Greenwald, Anthony, 11, 272n3 harassment, 52, 288, 293, 294–295, 296–298; mobbing vs. bullying, 285, 291–292, 293, 296, 297. See also epistemic injustice, types of; sexual harassment Harris-Perry, Melissa, 37–38 Haslanger, Sally, 64–65, 69 Hawley, Katherine, 183, 194, 196–198 healthcare, 121–134, 153–163, 221–224, 225–234, 241, 247; electronic health records, 244; and epistemic injustice, 123–124, 124n6, 127, 153, 154, 155n2, 159, 164, 174, 229n7; HIV/AIDS, 232; illness narratives, 153; patient-centered care, 154; Patients Association, 154; pregnancy, 13, 124n6, 237, 239, 242, 243–245, 250. See also biomedical science; mental health;

microaggressions, by healthcare providers Heidegger, Martin, 164 hermeneutical agency. See epistemic agency hermeneutical injustice. See epistemic injustice, types of hermeneutical justice. See epistemic justice heuristics, 64, 65, 67, 110, 112; inherence heuristic, 67; availability heuristic, 112 hip-hop, 12–13, 205, 206, 206n2, 214–218; history of, 215; underground hip-hop, 206, 214, 215, 217. See also artists, hiphop HIV/AIDS. See healthcare human rights, 221. See also Ontario Human Rights Code Hurricane Maria, 101 Husserl, Edmund, 139n2, 148 Hutchison, Katrina, 12 Ice Cube, 215 ideology, 36, 217 ignorance. See epistemology of ignorance International Statistical Classification of Diseases and Related Health Problems (ICD): 10th edition, 176; 11th edition, 291 implementation intentions, 113 Implicit Association Test (IAT), 113, 272n3, 273, 273n10, 274–279 implicit bias, 11, 13, 17, 64–66, 75, 109, 113n14, 127, 185, 203, 214, 228, 280; related phenomena, 269, 270–273, 272n4. See also bias; oppression, systematic oppression/bias; patients implicit bias research, 269, 272–273; actor vs target emphasis, 275, 275n12, 278; critiques and limitations of, 273–274; history of, 272, 272n3. See also bias; oppression, systematic oppression/bias; patients Independent Mental Health Advocacy, 154 Independent Review of Ontario Corrections, 241, 243–244, 247 Indigenous Action Media, 287, 288 indigenous people, 221. See also colonialism; stereotypes, about indigenous people

Index internalism (psychological), 66–67, 70–72, 73–74, 79, 79n5 International Classification of Diseases (ICD). See World Health Organization intersectionality/intersectional identities, 37n6, 53, 123n4, 155, 172, 178, 296 inverted epistemology, 223, 226, 230 Jackson, Jennifer, 225–226 Jenkins, Katharine, 51–52 Jensen, Anthony, 23 Johnson, Casey, 13 Jordan, June, 278, 279n16 judges. See legal system jurors. See legal system justice. See epistemic justice Kahneman, Daniel, 94, 110, 112 Kalanithi, Paul, 154 Kalla, Joshua, 89–90 Kalma, Xeph, 131–132 Karatzias et al., 291 Kawall, Jason, 91 Kelly, Dan, 66, 272 Kerr, Lisa, 245, 246 Kidd, Ian James, 12, 122, 123n4, 174–175 King, Rodney, 205 Kipnis, Laura, 57, 59, 60 Kittay, Eva Feder, 259, 261, 265 Kleiman-Weiner, Max, 78, 78n4 knower, status of. See epistemic agency knowledge, types of: alternative epistemologies, 256n2, 263; embodied knowledge, 41–42, 124, 129, 195, 263; knowledge-how, 183, 194–196; propositional knowledge, 194–195; subjugated knowledges, 206, 214, 218, 269 knowledge validation processes. See Hill, Patricia Collins Kyratsous, Michalis, 124n6, 175 language games, 209 lawyers, 51, 53, 172, 238, 239. See also stereotypes, about lawyers legal system, 2, 3, 49, 57, 131n14, 154, 210, 212, 225, 239, 242, 245, 246; Canadian, 49, 56; judges, 86, 171, 249; jurors, 51, 95; Supreme Court (U.S.),

313

221, 225; trials, legal, 51, 237, 237n2; U.S., 227. See also lawyers Lepock, Christopher, 114, 115 Leslie, Sarah-Jane, 68, 69 liberal theory/liberalism, 259, 261; individualism, critiques of. See care ethics; liberal feminism, 264 Lippman, Walter. See stereotypes, history of the term in psychology Locke, John, 259 Lombrozo, Tania, 70–71, 73, 80 Lorde, Audre, 44 Luce, Sandro, 208 Lugones, María, 1, 280–281 Lydon, Jason, 224 MacEachern, Darlene, 249 Madva, Alex, 12, 66 male ignorance. See epistemology of ignorance manifest concepts, 50–52, 55 Manne, Kate, 60, 289n7 Marge Sherwood (character in The Talented Mr. Ripley), 93, 288 McDonald, MaryCatherine, 12, 141 McHugh, Nancy, 278 McKinnon, Rachel, 13, 286–289 McMahan, Jeff, 55 McNally, Richard J., 147 McWilliams, Emily, 12 Medina, José, 17n2, 54, 90, 95, 124n6, 156, 159–160, 203, 212, 213, 229, 231, 263, 295; epistemic friction, 36, 38, 89, 96, 213; hermeneutical death, 159; hermeneutical resistance, 36 men, 19, 24, 27, 35, 39, 41, 43, 49, 53–55, 59, 65, 69, 78, 78n4, 93, 123, 125, 126–127, 130, 140, 141, 170, 172, 177, 184, 188, 189, 190, 191, 193, 194, 197, 204, 205, 207, 207–208, 210, 212, 215, 217, 256, 257–258, 264, 294–295, 296, 299. See also gender; sexism; sexual assault/misconduct; stereotypes, about men; transphobia mental health, 12, 125–127, 130, 133, 139, 140–141, 142, 142–143, 144, 146, 155, 175–176, 178, 222, 249; borderline personality disorder, 175; Mental Health Act of 1983, 154; post-traumatic

314

Index

stress disorder, 139, 139n1, 140–142, 143n5, 144–146, 144n6, 146–147, 149, 285, 290–291, 296; psychiatry, 124n6, 125–126, 127, 153–154, 171, 174, 175–176, 178, 290. See also disability/ disabled people; healthcare; stereotypes, about disability and mental health Merleau-Ponty, Maurice, 139–140, 139n2, 148–149, 150 microaggressions, 121–134, 276; epistemic microaggressions, 12, 121, 122–134 Mid-Staffordshire Inquiry, 154 Mill, John Stuart, 260 Mills, Charles, 6–7, 11, 12, 223, 226, 240, 240n3, 245n7, 247, 263 The Ministry of Community Safety and Correctional Services (Canada), 239, 243–245 The Ministry of Correctional Services Act (Canada), 241, 243 The Ministry of Correctional Services Regulations (Canada), 241, 243, 244 The Ministry of Health and Long-Term Care (Canada), 243–244, 245, 247 misgendering. See transphobia misogyny, 60. See also sexism Mitchell, Claudia, 195 mobbing. See harassment Montieth, Margo, 94, 113 moral agency, 224, 261, 265. See also autonomy; epistemic agency moral responsibility. See responsibility Moran, Richard, 116n16 Morris, David, 147–148 mother/motherhood, 37, 250, 261, 265 Muller-Lyer figure, 110 music. See hip-hop natural kinds, 67 Neblett, Toure, 217 neoliberalism, 212, 214 Nietzsche, Friedrich, 23–24, 157 nonideal victims, 52–55 objectification, 149, 162, 193; epistemic objectification, 193 old age. See age The Ontario Human Rights Code, 242

operative concepts, 50–52 oppression, 1, 8, 33, 36, 37, 40–41, 43, 60, 88, 92, 95–96, 101, 122, 123n4, 203, 208–209, 211, 216, 221, 224, 228, 232, 249, 287, 299; dehumanization, 33; internalized, 39–40; slavery, 162, 166, 173, 233, 240; social subordination, 256, 257, 260, 264; structural, 226, 233; systematic oppression/bias, 122, 128, 142, 144, 154, 158, 198, 270, 297. See also epistemic oppression; knowledge, types of, subjugated knowledge; marginalization Ottowa Carleton Detention Centre, 237–239, 247 Parker, Laura, 113 pathography, 153, 156, 157, 159 patients, 77, 122–123, 123n4, 143n5, 146, 147, 153–154, 171–172, 174, 221–222, 230; biases from, 190, 191; biases towards, 12, 127; injustices against, 121, 124–125, 128, 130, 132, 134, 142, 155, 183n1; injustices and biases from, 186–192; microaggressions against, 121n1, 132; relationships with, 121n1, 123, 129, 131, 133, 157, 163, 183, 184, 186, 187–188, 193, 197, 222, 223, 226, 227, 231–233; testimony by, 12, 122, 124, 147–148, 149–150, 172–173, 178–179, 192. See also healthcare; stereotypes, about patients Pean, Alan, 125–128 peer disagreement. See epistemic peers people of color, 44, 88, 112, 126, 172, 173, 223, 229, 232, 273–274, 276, 277. See also African-Americans; black people/ blackness; race/ethnicity; stereotypes, about people of color phenomenology, 116, 139–140, 139n2, 148–149, 163, 164, 178, 214, 278, 298 philosophy, 13, 41, 43n9, 55, 59, 67–68, 155, 183, 213, 269, 272, 273, 274, 275n12, 278, 285n3; analytic, 1; Chinese, 19; Christian, 19; Continental philosophy, 204; critical philosophy of race, 204; of education, 264; of medicine, 163; moral philosophy, 222, 225; of psychology, 142, 169. See also

Index education; phenomenology; postmodernism/postmodern philosophy; underrepresentation phronimos, 115 Pierce, Chester, 121 Pitts, Andrea J., 13 Pohlhaus, Gaile, Jr., 8, 38, 50, 129, 144n6, 183, 192, 196, 198, 280, 297. See also epistemic injustice, types of, willful hermeneutical injustice Pont, Jörg, 227–228 postmodernism/postmodern philosophy, 203, 205 post-traumatic stress disorder. See mental health poverty. See class/classism power-over relationships, 49, 56 prejudice. See bias prison, 13, 65, 68, 69, 71, 210–215, 221–234, 242, 245, 246, 247, 248–250 prison abolition, 222, 224, 230, 230–231, 232–234, 241; abolitionist epistemology, 248–250 privilege, 1, 3, 6, 7–8, 34n2, 43, 44, 57, 88, 92, 123, 124, 129, 140, 162, 204n1, 209, 210, 223, 255, 264, 286, 289–290, 290n9; of science, 139, 157, 163, 164, 166; white privilege, 297 professors. See education Prolonged Exposure (PE) therapy, 146, 147 propositional knowledge. See knowledge, types of Protasi, Sara, 22, 24 psychiatry. See mental health PTSD. See mental health Puerto Rico, 101 queer community/issues, 44, 221, 286, 288, 296. See also sexuality; transphobia race/ethnicity, 121, 171, 258. See also racial profiling; racism; stereotypes racial profiling, 231 racism, 3, 19, 60, 101, 197, 203–206, 204n1, 207, 208, 210, 212, 214, 215, 216, 224, 229, 273, 273n8, 275, 276–278, 279, 280, 281, 288, 299; in

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academia, 209; aversive/unconscious, 269, 270, 273; racist jokes, 94; verbal blackface, 217; white supremacy/racial domination, 6, 240. See also black people/blackness; episteme; epistemic injustice; ideology; implicit bias; microaggressions; race/ethnicity; stereotypes; violence, anti-black/racist rape. See sexual assault/misconduct rap music. See hip-hop Rawls, John, 260 R.E.A.C.H. Coalition, 222–224, 234 Reagan, Ronald, 215 refugees, 95 reliabilism, 102, 103–106, 104n3, 105n4, 105n6, 106n7 religion/faith, 171, 222, 227 Remote Associates Test, 106 replication crisis, 11 representativeness heuristic, 94 Research Excellence Framework, 161–162 resources. See epistemic resources responsibility, 73, 75, 159, 229–230, 237, 278n15, 279n16; collective responsibility, 280; epistemic responsibility, 2, 89; medical responsibility, 163, 184, 241, 243, 247; moral responsibility, 80n6, 278 Riverbend Maximum Security Institution, 222 Roberts, Robert, 109, 110–111, 112 Robinson, Tom (character in To Kill a Mockingbird), 54–55, 193 Roedder, Erica, 272 Roma (ethnic group), 95 Rorty, Amélie Oksenberg, 25–26 Samuelson, Peter, 109, 110 Sanati, Abdi, 124n6, 175 Schoenly, Lorry, 230 Schroer, Jeanine Weekes, 276–277, 277n14 science, 41, 53, 68, 139n2, 142, 143, 145, 147, 149, 163, 164, 257, 262, 263, 280; natural science, 157, 165; social science, 11, 116. See also biomedical science; privilege, of science self-doubt, 39–41, 41–42, 43, 299

316

Index

sexism, 8, 12, 13, 19, 27, 39, 41, 49, 53, 58, 59, 72, 93, 97, 128, 130, 173, 186–196, 243–244, 249–250, 256, 257–259, 260–261. See also underrepresentation; sexual assault/misconduct; sexual harassment; stereotypes, about women; transphobia sexual assault/misconduct, 11–12, 49, 51–53, 54–56, 58, 59, 72–73, 147, 212–213, 279n16, 290; domestic abuse/ violence, 51, 291; policies and laws, 53; rape myths, 51–52. See also age, childhood sexual abuse sexual harassment, 5, 7–8, 49–50, 51, 57, 142, 184, 187–188, 197–198, 198; sexualization, 186, 187, 188, 193–194, 197; sexual objectification, 193; sexuality, 3, 53, 60, 121, 185, 224; heteropatriarchal violence, 249; heterosexism, 210, 212; heterosexual people, 59, 123; homophobia, 288; of people with a disability, 53, 54; sexual agency/autonomy/consent, 37, 51, 52n1, 53, 56, 57, 59, 60, 134; sexual desire, 52, 53, 54, 56–57, 133–134; sexual stereotypes/hypersexualized bodies, 52, 53–54 Shakur, Tupac, 205, 213 Sherman, Ben, 9–11, 17, 18, 28, 75, 87–88, 107, 115–116, 166 Sherwood, Marge. See Marge Sherwood Shields, Kristine, 231 Shotwell, Alexis, 183, 195–196, 198 Singer, Peter, 55 Situational Attribution Training, 93–94 situationism, 10, 85, 86–87, 88, 90, 96, 102, 106–107, 109–110, 111; epistemic situationism, 102, 106–107 size, body. See weight/body size Skitolsky, Lissa, 12 slavery. See oppression social identity, 6, 52, 53, 107, 123, 156, 172, 197, 269, 270, 277, 281 social kinds, 67 social subordination. See oppression socioeconomics. See class/classism Spelman, Elizabeth, 103, 104 Sperry, Len, 292, 293, 296 Spivak, Gayatri, 1, 289

Stanley, Jason, 195 Stanovich, Keith, 109 Steele, Claude, 11 stereotypes, 1, 4, 33–45, 53–56, 73, 78, 79n5, 86, 93, 94, 121–122, 124, 126, 128, 130, 140, 141, 144, 155, 157, 169–180, 184, 191, 192, 208, 211; about Asian people, 35; about black men, 53–55; about black people, 53–55, 65, 126, 211; about black women, 37; about class, 44, 171, 172; about disability or mental health, 35; about doctors, 172, 173–174, 177–178, 184; about geographic areas, 35, 35n4, 43, 45; history of the term in psychology, 34; about indigenous people, 35, 36; about lawyers, 172; about men, 35, 170, 172; about the military, 140; about patients, 12, 172–174, 175–176, 178–179; about people of color, 35, 172, 173; about white people, 43, 65, 172; about women, 35, 36, 37, 39, 41, 44, 65, 69, 121, 128, 170, 172, 173, 176–177, 179, 191, 192. See also class/ classism; colonialism; disability/ disabled people; epistemic injustice, types of; generics (linguistics); implicit bias; microaggressions; racism; sexism; stereotype threat; transphobia; underrepresentation stereotype threat, 11, 33, 43, 44–45, 45n10, 276–277, 277n14 Stewart, Heather, 12, 122n2, 131n12, 131n15 Stonewall riots, 288 Stöver, Heino, 227–228 student evaluations of teaching, 258, 265 students, 49, 56, 57, 59, 60, 69–71, 80n6, 94, 127, 171–172, 184, 222, 256, 258, 262, 265 structuralism, 63, 65–66, 65n1, 68–80, 79n5, 80n6, 85, 86–87, 88, 89, 90, 96 structuring causes, 72–73 Stubblefield, Anna, 55–56, 55n3, 56 subjugated knowledges. See knowledge, types of Sudbury, Julia, 233 Sue, Derald, 122 Sullivan, Emily, 11

Index Supreme Court. See legal system surgeons. See healthcare System-1 and System-2 thinking. See dual process theory teachers. See education teenagers. See age testimony, 269–270; expert, 266. See also epistemic injustice, types of; epistemic justice; patient, testimony T.I. (hip-hop artist), 217 trans athletes, 13, 293, 296 trans community, 49–50, 221 transphobia, 89–90, 288, 292, 294, 295, 296, 298n19, 299; deadnaming, 131–132, 131n14; misgendering, 131–132; mispronouned, 286, 288. See also epistemic injustice, types of, gaslighting; implicit bias; microaggressions; stereotypes; violence trauma. See mental health Tremain, Shelley, 54 trials. See legal system Tronto, Joan, 260–261, 260n3, 265 Trump, Donald, 52, 57, 101 trustworthiness. See credibility; epistemic trust Tversky, Amos, 112 ultimate attribution error, 93 underrepresentation, 67, 68, 183–184 The United Nations Rules for the Treatment of Women Prisoners and Noncustodial Measures for Women Offenders, 242 utopian fictions, 304 Vanier Centre for Women, 244 Vasilyeva, Nadya, 12, 70–71, 73, 80 the veil (of race). See Du Bois, W. E. B. veteran. See combat violence, 91, 122n3, 145, 213, 222, 237; antiblack/racist, 208, 211, 212, 214, 215–216, 217–218, 232; combat/war, 145, 146; existential harm/pain, 122n3, 125, 133; genocidal violence, 215, 291; medicalized, 233; police/state-

317

sanctioned violence, 7, 203, 204, 204n1, 210, 212, 218, 221, 232, 237, 288; structural, 289. See also epistemic violence; racism; transphobia; sexual assault/misconduct virtue epistemology, 29, 40, 85, 88, 89, 90–92, 94–97, 101, 102, 105–109, 110–112, 113–116, 154, 160–162, 166, 228, 264, 266, 303; vice epistemology, 154, 160, 161–162, 166; virtue reliabilism, 105; virtue responsibilsm, 105–106, 109, 110–112, 113–116. See also epistemic humility; virtue theory virtue theory, 9–10, 17–29, 85–96, 102, 105–109, 110–112, 113–116, 154, 160–162, 166, 169–170, 210–211, 211, 224–225, 228. See also epistemic humility; virtue epistemology voters/voting, 89, 91, 95, 171 Walls, Melissa, 132–133 war. See combat The War on Drugs, 215 wealth inequality. See class/classism weight/body size, 53, 171, 177, 242, 272n7 Weil, Simone, 95 West, Ryan, 109, 110–111, 112 Whitehorn, Laura, 232 white ignorance. See epistemology of ignorance white people/whiteness, 6, 7, 8, 12–13, 88, 101, 113, 126–127, 172, 188, 204, 204n1, 205, 206, 207, 208, 216, 216–217, 232, 240, 245n7, 273, 274, 274–275, 278, 288, 290; perceptual capacities/sensibility of, 6, 204–208, 204n1, 208, 211, 216, 217; white nationalists, 290; White Western normality, 53. See also stereotypes, about white people Whitt, Matt S., 229, 231 willful hermeneutical ignorance. See epistemic injustice, types of Williamson, Timothy, 195 Wilson, Darren, 210 Wittgenstein, Ludwig, 209 Wolff, Hans, 227–228 women, 5, 8, 12–13, 19, 27, 35, 37, 37n6, 38, 39, 41, 43–44, 49, 52–53, 54, 55,

318

Index

58–59, 65, 67–68, 69–73, 78, 78n4, 79n5, 93, 126, 128, 129, 129n9, 130, 131, 140, 170, 172–173, 176–177, 179, 183–184, 185, 186, 189, 190, 191–192, 193–194, 196–198, 210, 213, 214, 217, 232, 237, 239, 242, 243–244, 245, 248, 249–250, 257–259, 263–264, 286, 288, 288n6, 289n7, 292–293, 293–297, 299. See also gender; underrepresentation; sexism; sexual assault/misconduct; stereotypes, about women; trans athletes; transphobia; women’s cycling

women’s cycling, 292 Women’s Wellness Within, 250 Wood, Carmita, 49 World Health Organization, 225, 291 Yancy, George, 204n1, 206n2, 274–275 Yap, Audrey, 11, 17n2 Yoffe, Emily, 72 young age/youth. See age Zagzebski, Linda, 18, 19, 21, 29, 114 Zheng, Robin, 65

About the Contributors

Mark Alfano’s work in moral psychology encompasses subfields in both philosophy (ethics, epistemology, philosophy of science, philosophy of mind) and social science (social psychology, personality psychology). He also brings digital humanities methods to bear on both contemporary problems and the history of philosophy (especially Nietzsche). He has experience working with R, Tableau, and Gephi. Saray Ayala-López works at California State University, Sacramento. After working on embodied, situated, and minimal cognition, Saray decided to address the social justice hiccup that was deliberately banned from their philosophical armchair, and started including moral questions into their research. Saray’s current work applies conceptual tools from the philosophy of cognitive science and the philosophy of language, together with empirical insights from cognitive psychology, to understand and explain episodes of discrimination and injustice. Havi Carel is professor of philosophy at the University of Bristol. She is a Wellcome Trust Senior Investigator, leading the Life of Breath project (www.lifeofbreath.org). She was awarded the Health Humanities’ Inspiration Award 2018 for her work on the project. Her third monograph, Phenomenology of Illness, was published by Oxford University Press in 2016. Havi was voted a “Best of Bristol” lecturer in 2016. Havi is the author of Illness (2008, 2013, 2018), shortlisted for the Wellcome Trust Book Prize, and of Life and Death in Freud and Heidegger (2006). She is the coeditor of Health, Illness and Disease (2012) and of What Philosophy Is (2004). In 2009–2011 Havi led an AHRC-funded project on the concepts of health, illness, and disease. 319

320

About the Contributors

In 2011–2012 she was awarded a Leverhulme Fellowship for a project entitled “The Lived Experience of Illness.” In 2012–2013 she held a British Academy Mid-Career Fellowship. Harry Critchley completed his master’s in political and legal thought jointly between the Department of Philosophy and the Faculty of Law at Queen’s University under the supervision of Dr. Lisa Guenther, Queen’s National Scholar in Political Philosophy and Critical Prison Studies. Harry has spent many years working and volunteering in provincial jails and federal prisons in Nova Scotia. He is the cofounder and director of the Burnside Education Program, a registered not-for-profit society that delivers tutoring, book clubs, and other educational programs at the Central Nova Scotia Correctional Facility. He also works closely with and serves on the boards of directors for the Elizabeth Fry Society of Mainland Nova Scotia and the East Coast Prison Justice Society, a legal advocacy organization for prisoners in the Maritimes. Lacey J. Davidson is a PhD candidate in the Department of Philosophy at Purdue University. She works on philosophy of race, philosophy of mind, and social epistemology. She’s particularly interested in accounts of racism, individual and collective accountability for racism and racist outcomes, epistemic oppression and exploitation, social norms, and social trust. Her recent publications include “Minding the Gap: Bias, Soft Structures, and the Double Life of Social Norms” (Journal of Applied Philosophy, 2018) with Daniel Kelly and “Category Matters: The Interlocking Moral and Epistemic Costs of Implicit Bias” (Teoria, 2017). Elianna Fetterolf is a visiting postdoctoral fellow at the Graduate Center CUNY working on the project Towards Professional Virtues and Vices of Epistemic Justice based at the University of Groningen. Previously, Dr. Fetterolf was a postdoctoral fellow at the University of Oxford, where her research focused on the application of epistemic injustice to psychiatry and mental illness. Lauren Freeman is an associate professor of philosophy at the University of Louisville. She is also an affiliated faculty member in the Department of Women’s, Gender, and Sexuality Studies and a core faculty member in the MA program in Bioethics and Medical Humanities. She works in the areas of feminist bioethics, analytic feminism, phenomenology, and philosophy of emotion. She also has written on implicit bias and stereotype threat. Lauren has coedited a special issue of Phenomenology and the Cognitive Sciences on the topic of the phenomenology and science of emotions and has edited a special issue of the International Journal of Feminist Approaches to Bioethics on the topic of feminist phenomenological approaches to bioethics, medi-

About the Contributors

321

cine, and health. She is currently coediting Microaggressions and Philosophy (Routledge, 2019) and cowriting Microaggressions in Medicine. Miranda Fricker is Presidential Professor of Philosophy at The Graduate Center, CUNY, and an honorary professor at the University of Sheffield. Her work is primarily in moral philosophy and social epistemology, with a special interest in virtue and feminist perspectives. She is the author of Epistemic Injustice: Power and the Ethics of Knowing (2007); coauthor and editor of Reading Ethics: Selected Texts with Interactive Commentary (2009); coeditor of The Epistemic Life of Groups: Essays in the Epistemology of Collectives (2016); and The Cambridge Companion to Feminism in Philosophy (2000). She was director of the Mind Association, which oversees the philosophy journal MIND, from 2010–2015; and currently serves as Moral Philosopher on the Spoliation Advisory Panel, a UK government body of expert advisers that considers claims concerning loss of cultural property during the Nazi era. She is an associate editor of the Journal of the American Philosophical Association, and a fellow of the British Academy. Stacey Goguen is an assistant professor of philosophy at Northeastern Illinois University in Chicago. She works on feminist epistemology and philosophy of social psychology, specifically on stereotypes, bias, epistemic injustice, and epistemology of ignorance. Her recent publications include “Is Asking What Women Want the Right Question? Underrepresentation in Philosophy and Differences in Interests” (Dialogue, 2018) and “Stereotype Threat, Epistemic Injustice, and Rationality” in Implicit Bias and Philosophy, Volume One (Brownstein and Saul, eds., 2016). Katrina Hutchison has a PhD in philosophy from the Australian National University and is currently a research fellow in the Department of Philosophy at Macquarie University. Her research focuses on topics in bioethics, moral psychology, and feminist philosophy. In previous research roles at Macquarie University and Monash University, she has investigated ethical issues in surgical innovation and advanced implantable devices; the implications of social inequality for philosophical theories of moral responsibility; and the underrepresentation of women in academic philosophy. She is editor (with Fiona Jenkins, ANU) of Women in Philosophy: What Needs to Change? (2013). Dr. Hutchison’s chapter in this volume is a product of a larger research project investigating gender biases in surgery affecting both surgeons and patients. Much of her research is applied. She employs qualitative empirical methods to deliver philosophical work that reflects lived experience.

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About the Contributors

Casey Rebecca Johnson is an assistant professor of philosophy in the Politics and Philosophy Department at the University of Idaho. Dr. Johnson’s research focuses on the effects of social position and power on testimonial knowledge transmission and on conversation. Dr. Johnson has published articles on the norm of assertion, epistemic injustice, and illocutionary force. She also edited Voicing Dissent: The Ethics and Epistemology of Making Disagreement Public (2018). Ian James Kidd is a lecturer in philosophy at the University of Nottingham. His current research includes social and applied epistemology, the philosophy of illness and healthcare, and epistemic injustice. He was coeditor (with José Medina and Gaile Pohlhaus Jr.) of The Routledge Handbook of Epistemic Injustice (2017) and is currently coediting (with Heather Battaly and Quassim Cassam) Vice Epistemology (2020). Such work informs his practical efforts in trying to help improve the intellectual and demographic diversity of the discipline. His website is www.ianjameskidd.weebly.com. Alex Madva is an assistant professor of philosophy at California State Polytechnic University, Pomona. His research centers on the questions that developments in social psychology raise for philosophy of mind, philosophy of race and feminism, and applied ethics, especially prejudice and discrimination. Alex has written or cowritten articles on these topics for journals including Noûs, Ethics, Pacific Philosophical Quarterly, Ergo, Synthese, and Mind and Language. He is coediting two book volumes, An Introduction to Implicit Bias: Knowledge, Justice, and the Social Mind and Philosophers on the Movement for Black Lives. Alex is also actively engaged in collaborative empirical research. One project explores the underlying psychological structure of stereotypes, while another tests interventions to reduce achievement gaps and increase belonging for students from underrepresented groups in disciplines such as physics, economics, mathematics, biology, and philosophy. His research on these topics has appeared in journals including Ratio and the International Journal of STEM Education. Alex has also led numerous workshops and training sessions on intergroup bias, stereotype threat, impostor syndrome, and faculty recruitment for schools, courts, and wider audiences. MaryCatherine McDonald was drawn into the study of philosophical psychology because of her interest in healing suffering posttrauma. After receiving her master’s degree at The New School, where she researched traumatic loss and mourning from both philosophical and psychological perspectives, she went on to complete her PhD at Boston University. She has been researching, lecturing, and publishing on the neuroscience, psychology, and phenomenology of trauma since completing her PhD in 2016. She has

About the Contributors

323

just finished her first book, Haunted, which aims to rethink the nature and experience of traumatic memory from a prismatic approach—one which brings together disciplines to better understand both the phenomenon and one another. Rachel McKinnon is a philosopher, athlete, and activist for trans rights. She is the 2018 UCI Masters Track Cycling world champion in the Women 35-44 Sprint, giving her a unique perspective on trans athlete rights. She has published widely on topics ranging from epistemology, philosophy of language, and metaphysics, to trans* studies, psychology, and ethics. This includes her 2015 book, The Norms of Assertion: Truth, Lies, and Warrant, and dozens of journal articles and book chapters. She is currently working on a variety of issues surrounding barriers to trans athlete rights, including antitrans harassment. Emily McWilliams is an assistant professor of philosophy at Duke Kunshan University, where she teaches courses in a variety of different disciplinary and interdisciplinary courses. She received her PhD in philosophy from Harvard University in 2016. Dr. McWilliams’s research starts from the idea that the processes by which we form beliefs are often played out interpersonally, by individuals with complex social identities. Given this, McWilliams investigates how social and political factors like social power and authority can impact the way that people reason, and asks what we can do about it. Her work draws on research in epistemology and feminist philosophy, on interdisciplinary scholarship in women’s and gender studies, and on empirical work in the cognitive sciences. Beyond her research and teaching McWilliams is passionate about ethics and public philosophy, and about using philosophical analyses to gain insight into contemporary issues. Andrea J. Pitts is assistant professor of philosophy at University of North Carolina, Charlotte. Their research interests include social epistemology, philosophy of race and gender, Latin American and US Latinx philosophy, and critical prison studies. Their publications appear in IJFAB: The International Journal of Feminist Approaches to Bioethics, Hypatia, Radical Philosophy Review, and Inter-American Journal of Philosophy. Andrea is also coeditor of Beyond Bergson: Examining Race and Colonialism through the Writings of Henri Bergson (2019). Benjamin R. Sherman is a visiting research scholar at Brandeis University and works at the nonprofit workforce development agency JVS Boston, helping housing-insecure clients find stabilizing jobs. His research interests focus mainly on the overlap between ethics and epistemology, especially questions about circumstances that make it wrong and unreasonable to be confident in

324

About the Contributors

beliefs and judgments. He has published papers on epistemic injustice and epistemology of disagreement in Social Epistemology, the Canadian Journal of Philosophy, and the Journal of Ethics and Social Philosophy. Lissa Skitolsky is an associate professor of philosophy at Susquehanna University. Her research in the fields of Continental philosophy and genocide studies aims to interrogate our cultural and political responses to state-sanctioned suffering. She is currently working on a manuscript for Lexington Books, “Hip-Hop as Philosophical Text and Testimony: Can I Get a Witness?” about the importance of hip-hop culture as a form of knowledge about and resistance to systemic antiblack violence. Heather Stewart is currently a doctoral student in philosophy and member of the Rotman Institute of Philosophy at the University of Western Ontario, where she works on issues in bioethics, social and political philosophy, feminist philosophy, and queer theories. With Lauren Freeman, Heather is currently working on a book manuscript, Microaggressions in Medicine, which expands the work they started in their article “Microaggressions in Clinical Medicine” (Kennedy Institute of Ethics Journal, 2019) to reconceptualize how microaggressions are understood and to develop a novel taxonomy for their classification. Outside of her work on microaggressions, Heather also researches epistemic harms prevalent in the #MeToo movement (South Central Review, forthcoming) and human/nonhuman animal relationships (Analize: Journal of Gender and Feminist Studies 11 (25), 2018). Heather is also involved with an interdisciplinary research team, Time to Attach (https:// timetoattach.com) that is advocating for additional parental leave time for adoptive parents in Canada. Heather has argued that the current parental leave benefits system is discriminatory against adoptive parents (see her blog at Impact Ethics, October 2018). Emily Sullivan (Delft University of Technology) is a postdoctoral researcher. Her research focuses on our practices of giving and receiving explanations. This encompasses the nature of scientific explanation and understanding, the epistemology of technology, and how normativity is intertwined with epistemology and scientific inquiry. Her work has appeared in Philosophical Studies, Australasian Journal of Philosophy, and Oxford Studies in Experimental Philosophy, among others. Nadya Vasilyeva is a postdoctoral researcher at Princeton University, studying explanation, causal reasoning, and categorical representation in adults and across development. Nadya investigates cognitive consequences of generating different types of explanation (categorical, causal-mechanistic, teleological, mathematical, and structural, of different levels of complexity) and

About the Contributors

325

examines how acknowledging instability, or lack of robustness of causal and categorical relationships across background circumstances affects learning, inductive inference, language, and decision making. Audrey Yap is an associate professor in the Philosophy Department at the University of Victoria, in Canada, which stands on unceded Lekwungen territory. She is a lapsed philosopher of mathematics who now works primarily in feminist epistemology, and antioppressive philosophy more generally. One particular issue she is interested in has to do with how we might think of perpetrators and victims of violence and oppression using nonideal theories; her chapter in this volume is a contribution to that.