Epistemic Privilege, Phenomenology and Symptomatology in Functional/Dissociative Seizures

Abstract

ABSTRACT Much work on clinical testimony assumes that none can know better than the patient what they experience. We show that in certain contexts this assumption is unwarranted; clinician expertise encompasses disease phenomenology, to the extent that the clinician may know better than the patient what the patient is experiencing or has experienced. Conversations between clinicians and people with functional/dissociative seizures (FDS) show that initial phenomenological reports of FDS (what we call ‘surface’ phenomenology) are often inconsistent with more fine-grained descriptions produced after detailed inquiry (‘reflective’ phenomenology). Assuming the initial reports are made in good faith, this process involves the clinician showing the patient something about their experience they did not already (explicitly) know. Failure to engage in this reflective process can result in misdiagnosis and mistreatment. Thus, uncritical acceptance of patient testimony – an unwarranted credibility excess – may be as harmful as its unwarranted dismissal. We conclude that: the epistemically just clinician cannot rely on expertise in le corps objectif alone, they must also cultivate an understanding of le corps propre for the patients they encounter; and epistemic (in)justice cannot be considered solely something a clinician does to the patient. Instead, epistemic justice in the clinical encounter is an intrinsically collaborative process.