On the Limits of Diversity

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On the Limits of Diversity Anke Bueter*, PhD (bio) In an ideal world, being diagnosed with a mental disorder would provide the affected person with a means to make sense of their experiences and pave the way to successful treatment. In the real world though, receiving a psychiatric diagnosis might not be helpful to achieve either of these goals. Even worse, it may create additional problems, since the psychopathologized (to borrow Knox's well-coined term) suffer from structural discrimination and social stigmatization. Furthermore, they have a high risk of experiencing epistemic injustice in health care contexts and beyond. Büter (2019) argues that an exclusion of lays with experiences of mental illness from the revision process of the Diagnostic and Statistical Manual of Mental Disorders (DSM) constitutes a preemptive testimonial injustice, as it ignores relevant perspectives and experiential knowledge. In their excellent article, Knox (2022) shows that the problem does not end there. Rather, failing to integrate the psychopathologized can also amount to hermeneutical injustice, when it excludes alternative conceptualizations of their experiences that differ radically from current psychiatric interpretations. For example, this would concern the neurodiversity paradigm, which understands phenomena such as autism in terms of (valuable) difference, not dysfunction or disorder. Not only would this hermeneutical injustice harm the psychopathologized; according to Knox, it also threatens the success of DSM revisions if viewed through the lens of Longino's (1990) model of social objectivity. Social objectivity is enhanced by the discursive presence of a diversity of perspectives, as this diversity allows for the detection and discussion of background assumptions in a transformative critical process. To allow for such a process, the relevant scientific community needs to fulfill the following conditions. There must be 1) recognized avenues for criticism, 2) shared standards for criticism, 3) uptake of criticism, and 4) tempered equality of intellectual authority (i.e., allocating authority to participants based on their qualification and the significance of their arguments, rather than based on their gender, race, or health status). I agree that we should apply a social, procedural model of objectivity to psychiatric research and DSM revisions. However, Knox's argument to include radically different perspectives into the DSM revision process to further social objectivity raises an interesting question about Longino's model: How much diversity does it require, and where are the limits of such diversity? Knox makes a convincing case for including the psychopathologized into DSM-revisions, especially if their perspective is critical of mainstream psychiatry. Such critical voices come in a wide [End Page 271] variety—from a moderate, reformist version of critical psychiatry to the neurodiversity movement, psychiatric abolitionism, and anti-psychiatry. Knox argues that the DSM should even include those "hostile" to psychiatry, that is, those who reject the very idea of mental illness, argue that psychiatry failed as a scientific discipline, or consider current psychiatric care as utterly harmful violation of human rights. On the one hand, it seems plausible that it is exactly an inclusion of radically critical voices that might be valuable in terms of identifying shared background assumptions, which would otherwise pass unscrutinized. On the other hand, this raises a worry about whether too much diversity might undermine the critical process. Would the inclusion of "hostile" critics threaten to make constructive deliberation impossible? Does social objectivity require to include just about everyone? To answer this question of where to draw the limits of diversity, it is helpful to consider Hicks's (2011) discussion of what they call Longino's "Nazi problem," This problem arises from the question of whether Longino's account requires the active cultivation of anti-feminist (or racist) perspectives in science (presuming a feminist, antiracist majority position) for the sake of diversity. Abstracting from the Nazi case (i.e., focusing on the radical opposition of critics to a certain scientific endeavor such as psychiatric classification), their arguments can be applied to the question of who should be excluded from the process of social objectivity. Hicks discusses two ways of limiting diversity, which are helpful here. To start with, the behavior of participants of the critical process needs to live up to the norms of social objectivity—in particular, to the requirements of uptake...