Abstract
Socially extended knowledge has recently received much attention in mainstream epistemology. Knowledge here is not to be understood as wholly realised within a single individual who manipulates artefacts or tools but as collaboratively realised across plural agents. Because of its focus on the interpersonal dimension, socially extended epistemology appears to be a promising approach for investigating the deeply social nature of epistemic practices. I believe, however, that this line of inquiry could be made more fruitful if it is connected with the critical notion of epistemic responsibility, as developed in feminist responsibilism. According to feminist responsibilists, at the core of epistemic responsibility is a critical disposition toward correcting epistemic injustice. This epistemic idea is highly relevant to the epistemological context of illness, where patient testimony is often disregarded. Hence, though restricted to the epistemological context of the experience of illness, this chapter delves into epistemic injustice and its robust mechanisms. I thus explore what responsible epistemic practices should involve in order to redress that injustice and how epistemic responsibility should be socially extended. The discussion proceeds as follows. First, by relying on Arthur Frank’s innovative work on illness narratives, I focus on chaotic bodily messages from patients overwhelmed by suffering and then explain why these messages should count as genuine narratives or testimonies despite their inarticulateness. Second, I elaborate on how epistemic injustice concerning such narratives (i.e., chaos narratives) is produced or reproduced, in particular how both a dominant sociocultural norm and our inherent vulnerability can contribute to their production or reproduction. Finally, I propose an extended form of epistemic responsibility that ameliorates this aspect. Laying particular emphasis on the epistemic role of mature empathy, I characterise the extended epistemic responsibility in terms of extended empathic knowledge.
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Notes
- 1.
The term “feminist responsibilism” is borrowed from Grasswick (2017).
- 2.
See also Medina (2013).
- 3.
For a related idea, see Medina (2013), who has argued for an idea of shared epistemic responsibility in the domain of racial injustice. His argument highlights the importance of socially extended epistemic responsibility in rectifying racial oppression, although he himself does not use the term “extended epistemic responsibility.”
- 4.
Kidd and Carel (2017: 185) point out the inarticulate (or ineffable) dimension of illness experience; however, my claim is that a patient’s testimony itself—not just her/his experience—should be understood as involving an inarticulate (or ineffable) dimension as an integral part.
- 5.
For example, William Styron, who was tormented by severe depression, laments the following:
[T]he word “indescribable” should present itself and is not fortuitous, since it has to be emphasized that if the pain were readily describable most of the countless sufferers from this ancient affliction would have been able to confidently depict for their friends and loved ones (even their physicians) some of the actual dimensions of their torment, and perhaps elicit a comprehension that has been generally lacking … For myself, the pain is most closely connected to drowning or suffocation—but even these images are off the mark. (Styron 1992: 16–7)
- 6.
True, narrative-based medicine currently receives more emphasis in medical epistemic practice than it once did (see Charon 2006). However, unless the chaotic narrative or testimony of the afflicted body can be more explicitly acknowledged as genuine (although a body or body-self is testifying as to how much that person suffers), there is still a danger that the chaotic messages will continue to be ignored.
- 7.
In addition, this case suggests how the dominant norm of restitution leads to a socially extended ignorance of the lived experience of chaotic suffering. This ignorance is collaboratively realised and maintained across multiple agents, including Ivan’s family, colleagues, and others, who subscribe to the logic of restitution.
- 8.
The original is written in French. “Certains nous accusaient de nous complaire dans le pessimisme. Ça les indignait. Mes douleurs n’existaient pas. J’étais folle sans doute. Cela arrive quand on réfléchit trop. Vous devriez penser à autre chose. Ce n’est rien. Cette douleur aiguë n’est rien. Vous n’êtes plus rien quand on vous nie à ce point. Quand ce qui dévore toute votre énergie n’existe pas. Quand cette violence qui s’exerce en vous, contre vous, est oubliée. C’est vous, tout entière, qui êtes reniée, désavouée” (Marin 2014: 96).
- 9.
For the dehumanizing aspect of epistemic injustice, see Fricker (2007: 44)
- 10.
On the basis of empirical findings, Cramer (2006) convincingly shows that these defence mechanisms are pervasive and are almost unavoidable in human life.
- 11.
This phenomenon is associated with what has been called empathic over-arousal in the literature on empathy (see, e.g., Hoffman 2000).
- 12.
Most analytic philosophers of action tend to focus on responsibility as deriving from voluntarily self-initiated actions. I suspect, however, that this restrictive conception of responsibility cannot explain the interpersonal and social dimensions of our responsibility for other people. For arguments that cut against voluntaristic views of responsibility, see Goodin (1982) and Kittay (1999).
- 13.
We can suppose here that the idea of epistemic justice regarding illness requires the kind of epistemic responsibility that enables restoring a wounded sense of self-respect of chaotic patients. Note that there is an intrinsic connection between the ideas of justice and self-respect. John Rawls, for example, states, “the most important primary good is that of self-respect” (1999: 386); and justice requires “social bases of self-respect” (2005: 181). Thus, according to Rawls, social conditions must ensure—not undermine—the development and maintenance of people’s self-respect. Thanks to Michael Slote for pointing out the relationship between my viewpoint and Rawls’s.
- 14.
See also Medina (2013: 80–3).
- 15.
The term “empathic/empathetic knowing” is borrowed from Code (1995: 122).
- 16.
The term “empathy” is broad, and it encompasses multifaceted phenomena. Thus, it permits a wide range of conceptions, depending on the precise aspect of empathy that the given researcher is emphasising (Coplan and Goldie 2011: xxxi). As it has been studied from many angles by researchers in various fields (including cognitive psychology, moral theory, neuroscience, personality theory, ethology, and so on), it is difficult to provide it with a simple definition (ibid.). However, despite the differences in the details of its definition, empathy is typically regarded as an other-oriented affective response rather than a self-oriented one. Researchers usually share the assumption that a (relatively) typical function of empathy is to orient one’s attention toward another’s situation, experiences, feelings, thoughts, or perspective and respond to the other in a manner that is appropriate to this knowledge (see Coplan and Goldie 2011). For example, Martin Hoffman, a key figure in empathy research, indicates that empathy is an “affective response more appropriate to another’s situation than ones’ own” (2000: 4). According to him, “the key requirement of an empathic response … is the involvement of psychological processes that make a person have feelings that are more congruent with another’s situation than with his own situation” (2000: 30). Heidi Maibom also underlines the other-orientedness of empathy: one’s affective responses in empathy reflect what and how another person is experiencing or might reasonably be expected to experience in a given situation (2014: 4). Similarly (but slightly differently from Hoffman and Maibom), Daniel Batson defines empathic emotions as other-oriented, particularly “those elicited by and congruent with the perceived welfare” (2011: 11) of someone else.
- 17.
I owe this distinction to Code (1995).
- 18.
Following Code (1995: 23) and Greco (2010: 79–80), I presuppose here that our ordinary concept of knowledge is typically context-sensitive rather than context-invariant. As Greco finds, what we mean by knowledge is inseparable from our practical concerns and interests when knowledge-ascription is at issue (ibid.).
- 19.
The abundant literature on human development has convincingly shown that empathic feedback from significant others plays a vital role in enabling and sustaining a sound sense of self-worth, without which healthy social life would become almost impossible (Bowlby 1988; Fonagy et al. 2004; Halpern 2001; Howe 2011; Howe 2013; Stern 1985).
- 20.
For the idea of “thickening” a concept, I am indebted to Battaly (2015: 27).
- 21.
- 22.
I am indebted to Young (2011) for this distinction, although she does not discuss empathy or illness.
- 23.
For a related point, see Carel (2016).
- 24.
The discussion here has benefited from the work of Kittay (1999); but I carry her idea one step further by clarifying its epistemic implications in the following paragraphs.
- 25.
I presented a much earlier version of this material on May 15–17, 2019, at the Fifth East–West Philosophers Forum: “Extended cognition: how re-thinking cognition helps enlarge epistemology.” The forum was organised by Karyn L. Lai and Chienkuo Mi at University of South Wales in Sydney. That version was also presented at Uehiro-Carnegie-Oxford Annual Conference: “Rethinking Bioethics for the twenty-first Century”, on May 21–22, 2019, which was organised by The Uehiro Foundation on Ethics and Education, Carnegie Council for Ethics in International Affairs, and Oxford Uehiro Centre for Practical Ethics at University of Oxford. I am grateful to these organisers. I also thank Heather Battaly, Rie Iizuka, Katsunori Miyahara, Kengo Miyazono, Clifford Samuel Roth, Ilina Singh, and Michael Slote for their helpful comments.
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Hayakawa, S. (2022). Illness Narratives and Epistemic Injustice: Toward Extended Empathic Knowledge. In: Lai, K.L. (eds) Knowers and Knowledge in East-West Philosophy. Palgrave Studies in Comparative East-West Philosophy. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-030-79349-4_6
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