‘Isn’t Everyone a Little OCD?’
The Epistemic Harms of Wrongful Depathologization
This article develops the concept of wrongful depathologization, in which a psychiatric disorder is simultaneously stigmatized (because of sanist attitudes towards mental illness) and trivialized (as it is not considered a “proper” illness). We use OCD as a case study to argue that cumulatively these two effects generate a profound epistemic injustice to OCD sufferers, and possibly to those with other mental disorders. We show that even seemingly positive stereotypes attached to mental disorders give rise to both testimonial injustice and wilful hermeneutical ignorance. We thus expose an insidious form of epistemic harm that has been overlooked in the literature.
American Psychiatric Association. 2013. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed. Arlington, VA: American Psychiatric Association.
Barnes, Elizabeth. 2016. The Minority Body: A Theory of Disability. Oxford: Oxford University Press.
BBC News. 2018. “Gower Wedding Venue Sorry for ‘Slightly OCD’ Wanted Tweet.” BBC News, 19 March. https://www.bbc.com/news/uk-wales-south-west-wales-43463065.
Bonnington, Oliver and Diana Rose. 2014. “Exploring Stigmatisation among People Diagnosed with Either Bipolar Disorder or Borderline Personality Disorder: A Critical Realist Analysis.” Social Science & Medicine 123: 7–17. https://doi.org/10.1016/j.socscimed.2014.10.048.
Bueter, Anke. 2019. “Epistemic Injustice and Psychiatric Classification.” Philosophy of Science 86, no. 5: 1064–1074. https://doi.org/10.1086/705443.
Chapman, Robert. 2019. “Neurodiversity Theory and Its Discontents: Autism, Schizophrenia, and the Social Model of Disability.” In The Bloomsbury Companion to Philosophy of Psychiatry, edited by Şerife Tekin and Robyn Bluhm, 371–390. London: Bloomsbury Academic. http://dx.doi.org/10.5040/9781350024090.ch-018.
Cochran, Susan D., Jack Drescher, Eszter Kismödi, Alain Giami, Claudia García-Moreno, Elham Atalla, Adele Marais, Elisabeth Meloni Vieira, and Geoffrey M. Reed. 2014. “Proposed Declassification of Disease Categories Related to Sexual Orientation in the International Statistical Classification of Diseases and Related Health Problems (ICD-11).” Bulletin of the World Health Organization 92, no. 9: 672–679. https://doi.org/10.2471/blt.14.135541.
Crichton, Paul, Havi Carel and Ian James Kidd. 2017. “Epistemic Injustice in Psychiatry.” British Journal of Psychiatry Bulletin, 41, no. 2: 65–70. https://doi.org/10.1192/pb.bp.115.050682.
Davis, Emmalon. 2016. “Typecasts, Tokens, and Spokespersons: A Case for Credibility Excess as Testimonial Injustice.” Hypatia 31, no. 3: 485–501. https://doi.org/10.1111/hypa.12251.
Davis, Emmalon. 2018. “On Epistemic Appropriation.” Ethics 128, no. 4: 702–727. https://doi.org/10.1086/697490.
Dawson, David Laing. 2018. “A Psychiatrist Looks at Recovery and Finds It Wanting.” In Mind You: The Realities of Mental Illness; A Compilation of Articles from the Blog Mind You, edited by David Laing Dawson and Marvin Ross, 92–95. Dundas, ON: Bridgeross Communications.
Drescher, Jack. 2015. “Out of DSM: Depathologizing Homosexuality.” Behavioral Sciences 5, no. 4: 565–575. https://dx.doi.org/10.3390%2Fbs5040565.
Drummond, Lynne M. 2018. Obsessive Compulsive Disorder: All You Want to Know about OCD For People Living with OCD, Carers, and Clinicians. Cambridge: Cambridge University Press.
Fennell, Dana and Michael Boyd. 2014. “Obsessive-Compulsive Disorder in the Media.” Deviant Behavior 35, no. 9: 669–686. https://psycnet.apa.org/doi/10.1080/01639625.2013.872526.
Fricker, Miranda. 2007. Epistemic Injustice: Power and the Ethics of Knowing. Oxford: Oxford University Press.
Good Morning Britain. 2015. “Michelle Mone on Her OCD and New Title.” Good Morning Britain, 13 October. https://www.youtube.com/watch?v=RGwKmt5Gdwc.
Graby, Steve. 2015. “Neurodiversity: Bridging the Gap between the Disabled People’s Movement and the Mental Health System Survivors’ Movement.” In Madness, Distress and the Politics of Disablement, edited by Helen Spandler, Jill Anderson, and Bob Sapey, 231–44. Bristol: Policy Press.
Greenberg, Gary. 2013. The Book of Woe: The DSM and the Unmaking of Psychiatry. Victoria: Scribe.
Halfmann, Drew. 2012. “Recognizing Medicalization and Demedicalization: Discourses, Practices, and Identities.” Health 16, no. 2: 186–207. https://doi.org/10.1177%2F1363459311403947.
Huang, Yanshu, Paul G. Davies, Chris G. Sibley, and Danny Osborne. 2016. “Benevolent Sexism, Attitudes toward Motherhood, and Reproductive Rights: A Multi-Study Longitudinal Examination of Abortion Attitudes.” Personality and Social Psychology Bulletin 42, no. 7: 970–984. https://doi.org/10.1177%2F0146167216649607.
Kay, Aaron C., Martin V. Day, Mark P. Zanna, and A. David Nussbaum. 2013. “The Insidious (and Ironic) Effects of Positive Stereotypes.” Journal of Experimental Social Psychology 49, no. 2: 287–291. https://doi.org/10.1016/j.jesp.2012.11.003
Kidd, Ian James. 2019. “Pathophobia, Illness, and Vices.” International Journal of Philosophical Studies 27, no. 2: 286–306. https://doi.org/10.1080/09672559.2019.1612625.
Krafft-Ebing, Richard Von. 1899. Psychopathia Sexualis. London: Hogarth Press.
Kurs, Rena and Alexander Grinshpoon. 2018. “Vulnerability of Individuals with Mental Disorders to Epistemic Injustice in Both Clinical and Social Domains.” Ethics & Behaviour 28, no. 4: 336–346. https://doi.org/10.1080/10508422.2017.1365302.
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, no. 1: 59–78. https://doi.org/10.26522/ssj.v10i1.1324.
Li, Ang, Dongdong Jiao, and Tingshao Zhu. 2018. “Detecting Depression Stigma on Social Media: A Linguistic Analysis.” Journal of Affective Disorders 232: 358–362. https://doi.org/10.1016/j.jad.2018.02.087.
McCarty, Ryan J., Andrew G. Guzick, Lawton K. Swan, and Joseph P.H. McNamara. 2017. “Stigma and Recognition of Different Types of Symptoms in OCD.” Journal of Obsessive-Compulsive and Related Disorders 12: 64–70. https://doi.org/10.1016/j.jocrd.2016.12.006.
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, no. 1: 15–35. https://doi.org/10.1080/02691728.2010.534568.
Mental Health Foundation. 2015. “Stigma and Discrimination.” Last modified 2015. https://www.mentalhealth.org.uk/a-to-z/s/stigma-and-discrimination.
Pavelko, Rachelle L. and Jessica Gall Myrick. 2019. “Measuring Trivialization of Mental Illness: Developing a Scale of Perceptions That Mental Illness Symptoms Are Beneficial.” Health Communication 35, no. 5: 1–9. https://doi.org/10.1080/10410236.2019.1573296.
Perlin, Michael L. 1992. “On Sanism.” SMU Law Review 46, no. 2: 373–408. https://doi.org/10.1037/10379-002.
Pfohl, Bruce and Nancee S. Blum. 1991. “Obsessive-Compulsive Personality Disorder: A Review of Available Data and Recommendations for DSM-IV.” Journal of Personality Disorders 5, no. 4: 363–375. https://psycnet.apa.org/doi/10.1521/pedi.19184.108.40.2063.
Pohlhaus Jr, Gaile. 2012. “Relational Knowing and Epistemic Injustice: Toward a Theory of Wilful Hermeneutical Ignorance.” Hypatia 27, no. 4: 715–735. https://doi.org/10.1111/j.1527-2001.2011.01222.x.
Rashed, Mohammed Abouelleil. 2019. “In Defense of Madness: The Problem of Disability.” Journal of Medicine and Philosophy 44, no. 2: 150–174. https://doi.org/10.1093/jmp/jhy016.
Sanati, Abdi and Michalis Kyratsous. 2015. “Epistemic Injustice in Assessment of Delusions.” Journal of Evaluation in Clinical Practice 21: 479–485. https://doi.org/10.1111/jep.12347.
Scrutton, Anastasia Philippa. 2017. “Epistemic Injustice and Mental Illness.” In The Routledge Handbook of Epistemic Injustice, edited by Ian James Kidd, José Medina, and Gaile Pohlhaus Jr. Abingdon: Routledge.
Seah, Xin Yi, Xiang Cong Tham, Netty Ryanie Kamaruzaman, and Piyanee Klainin Yobas. 2017. “Knowledge, Attitudes and Challenges of Healthcare Professionals Managing People with Eating Disorders: A Literature Review.” Archives of Psychiatric Nursing 31, no. 1: 125–136. https://doi.org/10.1016/j.apnu.2016.09.002.
Shakespeare, Tom. 2018. Disability: The Basics. Abingdon: Routledge.
Sheldrick, Giles. 2019. “Richard Branson Cruise Line Says Sorry for Mocking OCD.” Express, 30 July. https://www.express.co.uk/news/uk/1159506/Richard-Branson-cruise-line-mocking-OCD.
Sholl, Jonathan. 2017. “The Muddle of Medicalization: Pathologizing or Medicalizing?” Theoretical Medicine and Bioethics 38, no. 4: 265–278. https://doi.org/10.1007/s11017-017-9414-z.
Thornicroft, Graham. 2006. Shunned: Discrimination against People with Mental Illness. Oxford: Oxford University Press.
Time to Change. 2012. “So, Why Don’t You Drive Then?” Time to Change, 9 February. https://www.time-to-change.org.uk/blog/so-why-dont-you-drive-then.
Time to Change. 2019. “Some People Are High-Functioning, but That Doesn’t Invalidate Their Mental Health.” Time to Change, 16 March. https://www.time-to-change.org.uk/blog/some-people-are-high-functioning-doesnt-invalidate-their-mental-health.
Walker, Nick. 2013. “Throw Away the Master’s Tools: Liberating Ourselves from the Pathology Paradigm.” Neurocosmopolitanism, 16 August. https://neurocosmopolitanism.com/throw-away-the-masters-tools-liberating-ourselves-from-the-pathology-paradigm/.
West, Lindsey M., Roxanne A. Donovan, and Amanda R. Daniel. 2016. “The Price of Strength: Black College Women’s Perspectives on the Strong Black Woman Stereotype.” Women & Therapy 39, no. 3–4: 390–412. https://doi.org/10.1080/02703149.2016.1116871.
Wikipedia. 2021. “Monk (TV Series).” Last edited 19 March 2021. https://en.wikipedia.org/wiki/Monk_(TV_series).
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