Treatment in Psychiatry: Patient Inclusion and Epistemic Justice




Pulido, Bianca Trinidad

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The concept of 'treatment' has been underexamined in psychiatry and philosophy of psychiatry. Psychiatrists, philosophers of psychiatry and patients all have different and at times, conflicting, understandings and expectations of what counts as 'psychiatric treatment'. To the extent that there are models of treatments in psychiatry and philosophy of psychiatry, they sidestep the patient's conceptualization of what constitutes their treatment. This thesis draws attention to the epistemic and ethical implications of patient minimization, through which patient perspectives are epistemically excluded both in the treatment room and the process of making psychiatric treatment decisions. Patient minimization also has ethical implications, some of which may extend to dehumanizing practices in clinical contexts. The thesis addresses these problems by developing a conceptual framework for understanding treatment in psychiatry. In conversation with feminist work in the continental tradition, social and standpoint epistemology, and recent developments in the medical humanities and philosophy of psychiatry, I argue for a framework that makes central patient inclusion in conceptualizing treatment. This means that both patient and psychiatrist offer situated expert testimony, which, if taken in conjunction with each other, would maximize objectivity, rigor, and patient-psychiatrist trust. In practice, patient negotiation must be clinically required in the psychiatric treatment decision-making process on epistemic grounds. Once patient-situated testimonies are included in decisions about treatment, the mental healthcare provider is able to promote the four principles of medical ethics: autonomy, nonmaleficence, beneficence and justice.


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epistemic exclusion, epistemic justice, patient inclusion, patient minimization, psychiatric treatment