Epistemic negotiations on a closed psychiatric ward

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ABSTRACT On a closed psychiatric ward, conflict and disagreement may exist between patients and psychiatrists on how to interpret the patient’s condition. This forms a complexity for implementing contemporary ideals such as shared decision making, which would require a substantial degree of epistemic flexibility from both psychiatrists and patients. Recently, authors have argued that psychiatrists are pluralistic and pragmatic in their interpretation of the patient’s condition, implying a space for this flexibility in the clinical encounter. In this article we present an empirical study in which we aim to describe, understand, and explain this epistemic space and the dynamics between the psychiatrist’s and patient’s interpretation. We aim to explore and contextualize philosophical discussions through empirical research. We performed a qualitative inquiry on a closed psychiatric ward and found that both patients and psychiatrists were epistemically flexible, but epistemic negotiations were more complex and variegated than often presumed. We constructed an empirically grounded typology of different types of epistemic interaction, which shows that this interaction can only be properly understood if one acknowledges that it is shaped by different professional, societal and personal norms and values. We conclude by discussing the scope and limits of the epistemic space that we found.