Epistemic Injustices and Mental Health : Can Peer Support Workers Help Bridging the Hermeneutical Gap between Service Users and Health Practitioners ?

This paper presents the first results of a research funded by the Social Science and Humanities Research Council (SSHRC) on experiential and professional knowledge in mental health. The reflection takes place within the theoretical framework of epistemic injustices borrowed from constructivist feminist and postcolonial epistemologies. For these epistemologies, as conceptualized among others by Miranda Fricker, Nancy Tuana and Boaventura de Sousa Santos, the recognition and production of knowledge are the product of the systemic inequalities and oppressions that structure social relations.

The concepts of testimonial and hermeneutic injustice seem relevant in the context of oppressive psychiatric treatment. People with mental health problems (PWMHP) are vulnerable to testimonial injustice through the presumptive attribution of characteristics like cognitive unreliability and emotional instability. The lack of first-hand knowledge from the majority of health practitioners also creates a gap in collective hermeneutical resources. These epistemic injustices affect the quality of the care.

By providing a better understanding of mental health problems, peer support workers employed in intensive case management teams (ICM) and assertive community treatment (ACT), can help reducing these kind of injustices between health practitioners and PWMHP. In some teams, however, peer support workers’ knowledge is kept at the margin, which contributes to maintain epistemic injustices and professional boundaries. The qualitative data presented are based on a field work (2017) combining direct observations of peer support workers’ employed in various ICM and ACT teams in Montreal and Grenoble (France) and 40 semi-directed individual interviews with PWMHP and health practitioners.