‘Isn’t everyone a little OCD?’: the epistemic harms of wrongful depathologisation

In this paper we identify a new and distinct form of epistemic harm we term 'wrongful depathologisation': the devaluing of the epistemic status of people with mental disorder by reducing their symptoms to mere personality traits and denying them a fully recognised psychiatric identity. We argue that wrongful depathologisation involves simultaneously stigmatising and trivialising a mental disorder and that therein lies its harmfulness. This creates a twilight zone of mental disorder, where the ill person is deemed to both exaggerate their difficulties (trivialisation) and to be epistemically suspect because of their psychiatric diagnosis (stigmatisation). Thus, people with certain types of mental illness are judged to be too ill to be free of stigma but not ill enough to be taken seriously.

In the paper we define the terms and explain the difference between ‘pathologisation’ and ‘medicalisation’. We then expand Fricker’s understanding of epistemic injustice to include cases of credibility deficit motivated by positive stereotypes. We demonstrate how the trivialisation caused by positive stereotypes, combined with pathophobic stigmatisation, can lead to the wrongful depathologisation of OCD.

We consider the testimonial injustice that can arise from this wrongful depathologisation and finally explore a unique form of Gaile Pohlhaus Jr.’s ‘wilful hermeneutical ignorance’, through which hermeneutical resources that are used to capture the pathological experience of OCD are misappropriated to describe the experiences of dominantly situated people who do not have a mental disorder. We conclude that the depathologisation of psychiatric illnesses has epistemic and social ramifications that have gone unrecognised and that require careful articulation.