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Open Access 29-01-2025 | Scientific Contribution

Silence as epistemic agency in mania

Author: Dan Degerman

Published in: Medicine, Health Care and Philosophy

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Abstract

Silence is a byword for socially imposed harm in the burgeoning literature on epistemic injustice in psychiatry. While some silence is harmful and should be broken, this understanding of silence is untenably simplistic. Crucially, it neglects the possibility that silence can also play a constructive epistemic role in the lives of people with mental illness. This paper redresses that neglect. Engaging with first-person accounts of mania, it contends that silence constitutes a crucial form of epistemic agency to people who experience mania and that the prevailing failure to recognise this may harm them. The paper proceeds as follows. After briefly examining the negative understanding of silence in the epistemic injustice literature, it outlines three epistemically agential silences: communicative silence, listening silence, and withholding silence. It then deploys these concepts to explore how the ability to perform epistemically agential silence is impaired in mania and why such silences are vital to people. The penultimate section highlights two ways that the failure to recognise the epistemic value of silence can harm people with mania. The paper concludes by drawing out implications for future research on epistemic injustice in psychiatry.
Footnotes
1
For a comprehensive survey of the literature on epistemic injustice in psychiatry, see Kidd et al. (2023).
 
2
Pertinently, Karl Landstrom (2024) identifies silencing as a prominent theme in the epistemic injustice literature, which is shared with a literature on epistemic freedom.
 
3
I reserve the term withholding silence for these sorts of cases. However, people can also withhold knowledge by speaking about something other than what they want to withhold, and we sometimes refer to this as a type of silence as well. The silence in such cases is metaphorical rather than literal. For the sake of distinction, we might refer to withholding by being metaphorically silent as intentional omissive silence (Klieber 2023). While I focus here on articulating withholding silence as a mode of epistemic agency, much of what I say plausibly applies to omissive silence as well.
 
4
Relatedly, not sharing knowledge and, indeed, not seeking knowledge about certain things in certain social situations is also central to developing epistemic goods, such as trust, and virtues, such as epistemic restraint (see e.g. Manson 2012; Hannon and Kidd 2024). For example, if a person could not restrain themselves from disclosing their friends’ secrets in social situations, their friends would not be able to trust them. Notably, this ability resonates with what Goffman (1971) called the norm of ‘civil inattention’. He thought the flaunting of civil inattention– through, for example, speaking to strangers– is a key characteristic of those with mania (389–390). I am grateful of the anonymous reviewers for drawing my attention to this connection.
 
5
As with listening silence, I am arguing only that withholding is an important form of epistemic agency, not that withholding silence is always epistemically beneficial for the agent, other people, or collectively knowledge. For example, withholding silence can be epistemically detrimental to others (Carmona 2021). It can also be the outcome of such severe epistemic oppression that it would be misleading to conceive it as an exercise of epistemic agency, as might be the case in some instances of testimonial smothering (Dotson 2011).
 
6
By ‘unwarranted challenges’, I mean challenges that are made from a position of ignorance about mental illness. But, as the readers of this journal will be well aware, it is of course perfectly possible make warranted challenges to the medical status of mania, bipolar disorder, and other mental illnesses.
 
7
Arguably, the epistemic harms of mania provide further reasons for why we should consider mania or the disposition to become manic an illness and properly managed with the help of psycho- and pharmaceutical therapy.
 
8
The second type of frustration is adapted from Klieber’s (2023) account of how non-communicative silence can be frustrated.
 
Literature
go back to reference Acheson, K. 2008. Silence as gesture: Rethinking the nature of communicative silences. Communication Theory 18(4): 535–555.CrossRef Acheson, K. 2008. Silence as gesture: Rethinking the nature of communicative silences. Communication Theory 18(4): 535–555.CrossRef
go back to reference American Psychiatric Association. 2022. Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), 5th ed., text revision. Washington, DC: American Psychiatric Association. American Psychiatric Association. 2022. Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), 5th ed., text revision. Washington, DC: American Psychiatric Association.
go back to reference Applebaum, B. 2016. Listening silence and its discursive effects. Educational Theory 66(3): 389–404.CrossRef Applebaum, B. 2016. Listening silence and its discursive effects. Educational Theory 66(3): 389–404.CrossRef
go back to reference Bailey, A. 2007. Strategic ignorance. In Race and epistemologies of ignorance, ed. S. Sullivan, and N. Tuana. 77–94. New York: State University of New York, 77–94. Bailey, A. 2007. Strategic ignorance. In Race and epistemologies of ignorance, ed. S. Sullivan, and N. Tuana. 77–94. New York: State University of New York, 77–94.
go back to reference Berenstain, N. 2016. Epistemic exploitation. Ergo 3(22): 569–590. Berenstain, N. 2016. Epistemic exploitation. Ergo 3(22): 569–590.
go back to reference Binswanger, L. 2012. On the manic mode of being-in-the-world. In The Maudsley Reader in Phenomenological Psychiatry, ed. M. R. Broome, R. Harland, G. S. Owen, and A. Stringaris. 197–202. Cambridge: Cambridge University Press. Binswanger, L. 2012. On the manic mode of being-in-the-world. In The Maudsley Reader in Phenomenological Psychiatry, ed. M. R. Broome, R. Harland, G. S. Owen, and A. Stringaris. 197–202. Cambridge: Cambridge University Press.
go back to reference Carel, H., and I. J. Kidd. 2014. Epistemic injustice in healthcare: A philosophical analysis. Medicine Health Care and Philosophy 17: 529–540.CrossRef Carel, H., and I. J. Kidd. 2014. Epistemic injustice in healthcare: A philosophical analysis. Medicine Health Care and Philosophy 17: 529–540.CrossRef
go back to reference Carmona, C. 2021. Silencing by not telling Testimonial Void as a New Kind of Testimonial injustice. Social Epistemology 35(6): 577–592.CrossRef Carmona, C. 2021. Silencing by not telling Testimonial Void as a New Kind of Testimonial injustice. Social Epistemology 35(6): 577–592.CrossRef
go back to reference Catala, A. 2020. Metaepistemic injustice and intellectual disability: A pluralist account of epistemic agency. Ethical Theory and Moral Practice 23(5): 755–776.CrossRef Catala, A. 2020. Metaepistemic injustice and intellectual disability: A pluralist account of epistemic agency. Ethical Theory and Moral Practice 23(5): 755–776.CrossRef
go back to reference Catala, A., L. Faucher, and P. Poirier. 2021. Autism, epistemic injustice, and epistemic disablement: A relational account of epistemic agency. Synthese 199(3): 9013–9039.CrossRef Catala, A., L. Faucher, and P. Poirier. 2021. Autism, epistemic injustice, and epistemic disablement: A relational account of epistemic agency. Synthese 199(3): 9013–9039.CrossRef
go back to reference Cheney, L. 2009. Manic: A memoir. New York: William Morrow & Company. Cheney, L. 2009. Manic: A memoir. New York: William Morrow & Company.
go back to reference Coady, D. 2010. Two concepts of epistemic injustice. Episteme 7(2): 101–113. Coady, D. 2010. Two concepts of epistemic injustice. Episteme 7(2): 101–113.
go back to reference Cutting, J. 1997. Principles of psychopathology. Oxford: Oxford University Press.CrossRef Cutting, J. 1997. Principles of psychopathology. Oxford: Oxford University Press.CrossRef
go back to reference Cutting. 2019. Thought, Speech, and Language disorders. In The Oxford Handbook of Phenomenological Psychopathology, ed. G. Stanghellini, M. R. Broome, A. V. Fernandez, P. Fusar-Poli, A. Raballo, and R. Rosfort. 450–458. Oxford: Oxford University Press. Cutting. 2019. Thought, Speech, and Language disorders. In The Oxford Handbook of Phenomenological Psychopathology, ed. G. Stanghellini, M. R. Broome, A. V. Fernandez, P. Fusar-Poli, A. Raballo, and R. Rosfort. 450–458. Oxford: Oxford University Press.
go back to reference Degerman, D. 2024. Experiences of silence in mood disorders. Erkenntnis 89: 2783–2802.CrossRef Degerman, D. 2024. Experiences of silence in mood disorders. Erkenntnis 89: 2783–2802.CrossRef
go back to reference Degerman, D. 2025. Silence, depression, and bodily doubt: Toward a phenomenology of silence in psychopathology. Philosophical Psychology 31(1): 126–149.CrossRef Degerman, D. 2025. Silence, depression, and bodily doubt: Toward a phenomenology of silence in psychopathology. Philosophical Psychology 31(1): 126–149.CrossRef
go back to reference Dotson, K. 2011. Tracking epistemic violence, tracking practices of silencing. Hypatia 26(2): 236–257.CrossRef Dotson, K. 2011. Tracking epistemic violence, tracking practices of silencing. Hypatia 26(2): 236–257.CrossRef
go back to reference Dotson, K. 2012. A cautionary tale: On limiting epistemic oppression. Frontier 33(1): 24–47. Dotson, K. 2012. A cautionary tale: On limiting epistemic oppression. Frontier 33(1): 24–47.
go back to reference Elgin, C. Z. 2008. Word giving, word taking. In Truth: Engagements across philosophical traditions, ed. D. Wood, and J. Medina. 271–286. London: Wiley. Elgin, C. Z. 2008. Word giving, word taking. In Truth: Engagements across philosophical traditions, ed. D. Wood, and J. Medina. 271–286. London: Wiley.
go back to reference Farr, J. 2021. Understanding the Experience of Mood change and Early Intervention for People Diagnosed with Bipolar Disorder. (PhD thesis) Birkbeck, University of London. Farr, J. 2021. Understanding the Experience of Mood change and Early Intervention for People Diagnosed with Bipolar Disorder. (PhD thesis) Birkbeck, University of London.
go back to reference Fernandez, A.V. 2014. Reconsidering the affective dimension of depression and mania: towards a phenomenological dissolution of the paradox of mixed states. Journal of Psychopathology 20(4): 414–422. Fernandez, A.V. 2014. Reconsidering the affective dimension of depression and mania: towards a phenomenological dissolution of the paradox of mixed states. Journal of Psychopathology 20(4): 414–422.
go back to reference Fox, A. B., B. N. Smith, and D. Vogt. 2018. How and when does mental illness stigma impact treatment seeking? Psychiatry Research 268: 15–20.CrossRef Fox, A. B., B. N. Smith, and D. Vogt. 2018. How and when does mental illness stigma impact treatment seeking? Psychiatry Research 268: 15–20.CrossRef
go back to reference Fricker, M. 2007. Epistemic injustice: Power and the ethics of knowing. Oxford: Oxford University Press.CrossRef Fricker, M. 2007. Epistemic injustice: Power and the ethics of knowing. Oxford: Oxford University Press.CrossRef
go back to reference Fricker, M. 2012. Silence and institutional prejudice. In Out from the shadows, ed. A. M. Superson, and S. L. Crasnow. 287–306. Oxford: Oxford University Press. Fricker, M. 2012. Silence and institutional prejudice. In Out from the shadows, ed. A. M. Superson, and S. L. Crasnow. 287–306. Oxford: Oxford University Press.
go back to reference Fricker, M. 2016. Epistemic injustice and the preservation of ignorance. In The epistemic dimensions of ignorance, ed. R. Peels, and M. Blaauw. 160–177. Cambridge: Cambridge University Press.CrossRef Fricker, M. 2016. Epistemic injustice and the preservation of ignorance. In The epistemic dimensions of ignorance, ed. R. Peels, and M. Blaauw. 160–177. Cambridge: Cambridge University Press.CrossRef
go back to reference Fuchs, T. 2014. Psychopathology of depression and mania: Symptoms, phenomena and syndromes. Journal of Psychopathology 20: 404–413. Fuchs, T. 2014. Psychopathology of depression and mania: Symptoms, phenomena and syndromes. Journal of Psychopathology 20: 404–413.
go back to reference Ghaemi, N. 2013. Understanding mania and depression. In The Oxford Handbook of Philosophy and Psychiatry, ed. K.W.M. Fulford, M. Davies, R. Gipps, G. Graham, and J. Z. Sadler. 803–819. Oxford: Oxford University Press. Ghaemi, N. 2013. Understanding mania and depression. In The Oxford Handbook of Philosophy and Psychiatry, ed. K.W.M. Fulford, M. Davies, R. Gipps, G. Graham, and J. Z. Sadler. 803–819. Oxford: Oxford University Press.
go back to reference Goffman, E. 1971. Relations in Public. New York: Basic Books. Goffman, E. 1971. Relations in Public. New York: Basic Books.
go back to reference Gottlieb, N., and A. H. Young. 2024. Antidepressants and bipolar disorder: The plot thickens. American Journal of Psychiatry 181(7): 575–577.CrossRef Gottlieb, N., and A. H. Young. 2024. Antidepressants and bipolar disorder: The plot thickens. American Journal of Psychiatry 181(7): 575–577.CrossRef
go back to reference Hess, J. 2024. Bipolar in the Academy: A case of Testimonial Smothering. Disability Studies Quarterly, 43(2). Hess, J. 2024. Bipolar in the Academy: A case of Testimonial Smothering. Disability Studies Quarterly, 43(2).
go back to reference Hornbacher, M. 2008. Madness: A bipolar life. New York: Houghton Mifflin Harcourt. Hornbacher, M. 2008. Madness: A bipolar life. New York: Houghton Mifflin Harcourt.
go back to reference Houlders, J. W., L. Bortolotti, and M. R. Broome. 2021. Threats to epistemic agency in young people with unusual experiences and beliefs. Synthese 199(3): 7689–7704.CrossRef Houlders, J. W., L. Bortolotti, and M. R. Broome. 2021. Threats to epistemic agency in young people with unusual experiences and beliefs. Synthese 199(3): 7689–7704.CrossRef
go back to reference Ikpi, B. 2019. I’m lying but I’m telling the truth. New York: Harper. Ikpi, B. 2019. I’m lying but I’m telling the truth. New York: Harper.
go back to reference Jackson, J. 2017. Patronising Depression: Epistemic Injustice, Stigmatising attitudes, and the need for Empathy. Journal of Social Philosophy 48(3): 359–376.CrossRef Jackson, J. 2017. Patronising Depression: Epistemic Injustice, Stigmatising attitudes, and the need for Empathy. Journal of Social Philosophy 48(3): 359–376.CrossRef
go back to reference Jamison, K. R. 2011. An unquiet mind. New York: Picador. Jamison, K. R. 2011. An unquiet mind. New York: Picador.
go back to reference Kendler, K. S. 2017. The clinical features of mania and their representation in modern diagnostic criteria. Psychological Medicine 47(6): 1013–1029.CrossRef Kendler, K. S. 2017. The clinical features of mania and their representation in modern diagnostic criteria. Psychological Medicine 47(6): 1013–1029.CrossRef
go back to reference Kenny, C. 2011. The power of silence: Silent communication in daily life. London: Routledge. Kenny, C. 2011. The power of silence: Silent communication in daily life. London: Routledge.
go back to reference Kidd, I. J., and H. Carel. 2019. Pathocentric epistemic injustice and conceptions of health. In Overcoming Epistemic Injustice, ed. B. R. Sherman, and S. Goguen. 153–168. London: Rowman & Littlefield. Kidd, I. J., and H. Carel. 2019. Pathocentric epistemic injustice and conceptions of health. In Overcoming Epistemic Injustice, ed. B. R. Sherman, and S. Goguen. 153–168. London: Rowman & Littlefield.
go back to reference Kidd, I., and M. Hannon. 2024. Is intellectual humility compatible with political conviction? Journal of Ethics and Social Philosophy 27(2): 211–233.CrossRef Kidd, I., and M. Hannon. 2024. Is intellectual humility compatible with political conviction? Journal of Ethics and Social Philosophy 27(2): 211–233.CrossRef
go back to reference Langton, R. 1993. Speech acts and unspeakable acts. Philosophy & Public Affairs 22(4): 293–330. Langton, R. 1993. Speech acts and unspeakable acts. Philosophy & Public Affairs 22(4): 293–330.
go back to reference Mackin, P., and A. Young. 2011. Bipolar disorders. In Core Psychiatry, ed. P. Wright, J. Stern, and M. Phelan. 3rd ed., 313–334. London: Saunders Ltd. Mackin, P., and A. Young. 2011. Bipolar disorders. In Core Psychiatry, ed. P. Wright, J. Stern, and M. Phelan. 3rd ed., 313–334. London: Saunders Ltd.
go back to reference Manson, N. C. 2012. Epistemic restraint and the vice of curiosity. Philosophy 87(2): 239–259.CrossRef Manson, N. C. 2012. Epistemic restraint and the vice of curiosity. Philosophy 87(2): 239–259.CrossRef
go back to reference McGlynn, A. 2021. Epistemic objectification as the primary harm of Testimonial injustice’. Episteme 18(2): 160–176.CrossRef McGlynn, A. 2021. Epistemic objectification as the primary harm of Testimonial injustice’. Episteme 18(2): 160–176.CrossRef
go back to reference Medina, J. 2017. Varieties of hermeneutical injustice. In The Routledge Handbook of Epistemic Injustice, ed. I. J. Kidd, J. Medina, and G. Pohlhaus. 41–52. London: Routledge.CrossRef Medina, J. 2017. Varieties of hermeneutical injustice. In The Routledge Handbook of Epistemic Injustice, ed. I. J. Kidd, J. Medina, and G. Pohlhaus. 41–52. London: Routledge.CrossRef
go back to reference Moore, A., T. Hope, and K. W. M. Fulford. 1994. Mild mania and well-being. Philosophy Psychiatry & Psychology 1(3): 165–177. Moore, A., T. Hope, and K. W. M. Fulford. 1994. Mild mania and well-being. Philosophy Psychiatry & Psychology 1(3): 165–177.
go back to reference Notess, S. E. 2019. Listening to people: Using social psychology to spotlight an overlooked virtue. Philosophy 94(4): 621–643.CrossRef Notess, S. E. 2019. Listening to people: Using social psychology to spotlight an overlooked virtue. Philosophy 94(4): 621–643.CrossRef
go back to reference Olson, P. R. 2015. Epistemic burdens and the value of ignorance. In The future of Social Epistemology, ed. J. Collier. 107–116. London: Rowman & Littlefield. Olson, P. R. 2015. Epistemic burdens and the value of ignorance. In The future of Social Epistemology, ed. J. Collier. 107–116. London: Rowman & Littlefield.
go back to reference Pohlhaus Jr, G. 2014. Discerning the primary epistemic harm in cases of testimonial injustice. Social Epistemology 28(2): 99–114.CrossRef Pohlhaus Jr, G. 2014. Discerning the primary epistemic harm in cases of testimonial injustice. Social Epistemology 28(2): 99–114.CrossRef
go back to reference Puddifoot, K. 2019. Disclosure of mental health: Philosophical and psychological perspectives. Philosophy Psychiatry & Psychology 26(4): 33–348. Puddifoot, K. 2019. Disclosure of mental health: Philosophical and psychological perspectives. Philosophy Psychiatry & Psychology 26(4): 33–348.
go back to reference Rabaey, B. 2023. Language Gone Mad. (PhD thesis) Ghent University. Rabaey, B. 2023. Language Gone Mad. (PhD thesis) Ghent University.
go back to reference Radden, J. 2013. The self and its moods in depression and mania. Journal of Consciousness Studies 20(7–8): 80–102. Radden, J. 2013. The self and its moods in depression and mania. Journal of Consciousness Studies 20(7–8): 80–102.
go back to reference Rehm, L. P., A. L. Wagner, and C. Ivens-Tyndal. 2002. Mood disorders: Unipolar and bipolar. In Comprehensive handbook of psychopathology, ed. P. B. Sutker, and H. E. Adams. 3rd ed., 277–308. London: Kluwer.CrossRef Rehm, L. P., A. L. Wagner, and C. Ivens-Tyndal. 2002. Mood disorders: Unipolar and bipolar. In Comprehensive handbook of psychopathology, ed. P. B. Sutker, and H. E. Adams. 3rd ed., 277–308. London: Kluwer.CrossRef
go back to reference Ratcliffe, M. 2022. Trauma, language, and trust. In Empathy, Intersubjectivity, and the Social World, ed. A. Bortolan and E. Magri. 323–341. Berlin: De Gruyter. Ratcliffe, M. 2022. Trauma, language, and trust. In Empathy, Intersubjectivity, and the Social World, ed. A. Bortolan and E. Magri. 323–341. Berlin: De Gruyter.
go back to reference Sakakibara, E. 2023. Epistemic injustice in the therapeutic relationship in psychiatry. Theoretical Medicine and Bioethics 44(5): 477–502.CrossRef Sakakibara, E. 2023. Epistemic injustice in the therapeutic relationship in psychiatry. Theoretical Medicine and Bioethics 44(5): 477–502.CrossRef
go back to reference Sass, L., and E. Pienkos. 2015. Beyond words: Linguistic experience in melancholia, mania, and schizophrenia. Phenomenology and the Cognitive Sciences 14: 475–495.CrossRef Sass, L., and E. Pienkos. 2015. Beyond words: Linguistic experience in melancholia, mania, and schizophrenia. Phenomenology and the Cognitive Sciences 14: 475–495.CrossRef
go back to reference Schneck, C. 2011. Bipolar phenomenology: Have we learned all we can learn? American Journal of Psychiatry 168(1): 4–6. Schneck, C. 2011. Bipolar phenomenology: Have we learned all we can learn? American Journal of Psychiatry 168(1): 4–6.
go back to reference Spencer, L., and H. Carel. 2021. ‘Isn’t everyone a little OCD?’: The Epistemic Harms of Wrongful Depathologization. Philosophy of Medicine 2(1). Spencer, L., and H. Carel. 2021. ‘Isn’t everyone a little OCD?’: The Epistemic Harms of Wrongful Depathologization. Philosophy of Medicine 2(1).
go back to reference Tanesini, A. 2018. Eloquent silences. In Voicing dissent, ed. C. R. Johnson. 109–128. London: Routledge.CrossRef Tanesini, A. 2018. Eloquent silences. In Voicing dissent, ed. C. R. Johnson. 109–128. London: Routledge.CrossRef
go back to reference Weiner, L., N. Doignon-Camus, G. Bertschy, and A. Giersch. 2019. Thought and language disturbance in bipolar disorder quantified via process-oriented verbal fluency measures. Scientific Reports 9(1): 14282.CrossRef Weiner, L., N. Doignon-Camus, G. Bertschy, and A. Giersch. 2019. Thought and language disturbance in bipolar disorder quantified via process-oriented verbal fluency measures. Scientific Reports 9(1): 14282.CrossRef
Metadata
Title
Silence as epistemic agency in mania
Author
Dan Degerman
Publication date
29-01-2025
Publisher
Springer Netherlands
Published in
Medicine, Health Care and Philosophy
Print ISSN: 1386-7423
Electronic ISSN: 1572-8633
DOI
https://doi.org/10.1007/s11019-025-10256-9