Anke Bueter

Attention-deficit/hyperactivity disorder (ADHD) is diagnosed more often in males than females. Recently, this gap has narrowed, a development often framed as overcoming gender bias. This framing rests on two problematic assumptions: (1) more equal diagnostic rates approximate truth and (2) there is such a truth in the first place. Option (1) is questionable because male populations are set as standard but potentially reflect overdiagnosis. Option (2) presumes ADHD to be a stable, discrete disease entity, which is epistemically and ontologically problematic. I argue that understanding (gender) bias here should focus on deviations from best practices and deliberative norms rather than a relation to truth.

The value-freedom of scientific knowledge is commonly hold to be a necessary condition for objectivity. Helen Longino’s contextual empiricism aims to overcome this connection. She questions the suitability of the normative ideal of value-freedom and develops an alternative conception of objectivity, which integrates social and epistemic aspects of scientific enquiry. The function of this notion of ‘social objectivity’ is to make value-laden assumptions assessable through a process of criticism, even if there cannot be any guarantee of their elimination. This assessability requires common standards of evaluation, which are threatened by Longino’s rejection of the distinction between cognitive and non-cognitive values guiding theory choice. I will argue that in order to resolve this inherent tension, social objectivity has to be understood as based on a procedural epistemology and, differing from Longino’s own approach, must include the normative requirement to strive for consensus instead of allowing for epistemological pluralism.

This supplement serves a double purpose. It presents, on the one hand, a selection of papers devoted to the title question “How much philosophy in the philosophy of science?”. On the other hand, it signalizes the newly established cooperation between the German Society for the Philosophy of Science and the Journal for General Philosophy of Science.The GWP was founded in Hannover in 2011 and had its inaugural conference in March 2013 [for a report on the “GWP.2013” by H. Lyre see EPSA Newsletter 2 2013]. The society was launched for several reasons. Albeit the German community of philosophers of science is quite large, it is at the same time a rather distributed and dispersed community. This has to do with the university landscape in Germany, which is dispersed rather t..

In seinem Traktat über Prädestination diskutiert Ockham die philosophischen Schwierigkeiten, die das christliche Dogma der Vorherbestimmung des Menschen zu ewiger Seligkeit oder Verdammnis aufwirft als einen spezifischen Fall des Problems des logischen Determinismus. Es gelingt Ockham nicht, dieses Problem zu lösen, was einerseits in seinem semantischen Wahrheitsbegriff, andererseits in einer fehlenden Differenzierung zwischen einem ontologischen und einem logischen Verständnis von Kontingenz begründet liegt. Diese Punkte führen zu einer Reihe von Ambivalenzen in Ockhams Argumentation, die darauf hindeuten, dass dieser zwar über die Grundlagen einer möglichen Lösung verfügt, diese aber aufgrund seiner ontologischen Sparsamkeit nicht kohärent umsetzt.In his treatise on predestination, Ockham discusses the philosophical riddles caused by this Christian dogma as a specific case of the problem of logical determinism. Ockham does not succeed in solving this problem, which is due to his semantic notion of truth as well as to a missing differentiation between an ontological and logical interpretation of contingency. These points lead to a number of ambivalences in his argumentation, which suggest that Ockham has the conditions of a possible solution available but his ontological parsimony inhibits their coherent implementation.

Die Wertfreiheit der Wissenschaft gilt als Bedingung ihrer Objektivitat. Eine Analyse des entsprechenden Wertfreiheitsideals zeigt jedoch, dass dieses auf einer Reihe von Voraussetzungen beruht wie der Trennbarkeit kognitiver von anderen Werten und der epistemischen Unabhangigkeit der Rechtfertigung die sich als problematisch erweisen. Eine Fallstudie zur Frauengesundheitsforschung untermauert zudem, dass die Moglichkeiten fur Werteinflusse in der Wissenschaft weit komplexer sind, als dieses Ideal zu erfassen vermag. Daher bietet ein sozialepistemologischer Ansatz, der auf Wertvielfalt statt Wertfreiheit setzt, die bessere Grundlage fur Objektivitat: Epistemische Vertrauenswurdigkeit erfordert nicht Neutralitat, sondern einen pluralistischen und konsensorientierten kritischen Prozess."

Multi-professional teams have become increasingly common in healthcare. Collaboration within such teams aims to enable knowledge amalgamation across specializations and to thereby improve standards of care for patients with complex health issues. However, multi-professional teamwork comes with certain challenges, as it requires successful communication across disciplinary and professional frameworks. In addition, work in multi-professional teams is often characterized by medical dominance, i.e., the perspective of physicians is prioritized over those of nurses, social workers, or other professionals. We argue that medical dominance in multi-professional teams can lead to institutional epistemic injustice, which affects both providers and patients negatively. Firstly, it codifies and promotes a systematic and unfair credibility deflation of the perspectives of professionals other than physicians. Secondly, it indirectly promotes epistemic injustice towards patients via leading to institutional opacity; i.e., via creating an intransparent system of credibility norms that is difficult to navigate. To overcome these problems, multi-professional teamwork requires institutional settings that promote epistemic equity of team members.

Gender-medicine has been very successful in discovering gaps in medical knowledge, disclosing biases in earlier research, and generating new results. It has superseded a more androcentric and sexist medicine. Yet, its development should not be understood in terms of a further approximation of value-freedom. Rather, it is a case of better value-laden science due to an enhanced pluralism in medicine and society. This interpretation is based on an account of the origins of gender-medicine in the feminist women’s health movement and an analysis of the debate on inclusion of women in clinical trials. Consequently, the history of gender-medicine provides support for a procedural account of objectivity that stresses the importance of a diversity of perspectives.

Psychiatric classification is highly controversial, as could be witnessed again with the latest revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM). These controversies comprise multiple kinds of critiques by a variety of actors. It is unlikely that all these issues will be overcome by one perfect solution in the future. Rather, it is precisely the DSM’s “one-size-fits-all-approach” that lies at the root of many of the current problems. To restore the scientific and public credibility of psychiatric classification, a multi-dimensional pluralist response is thus needed: (1) theoretical pluralism, meaning a promotion of different research projects and heuristic strategies, (2) taxonomic pluralism, which allows for different classifications used in research versus clinical practice, and (3) participatory pluralism, which concerns the diversity of perspectives and stakeholders in DSM-revisions.

Feminist scholars have identified pervasive gender discrimination in science as an institution, as well as gender bias in the very content of many scientific theories. An ameliorative project at heart, feminist philosophy of science has inquired into the social and epistemological roots and consequences of these problems and into their potential solutions. Most feminist philosophers agree on a need for diversity in scientific communities to counter the detrimental effects of gender bias. Diversity could thus serve as a unifying concept for a potential consensus of the field. Yet there are substantial differences in the kinds and roles of diversity envisaged. This element argues that we need diversity, both in terms of social locations and of values, to overcome former biases and blind spots. Diversity as such, however, is insufficient. To reap its epistemic benefits, diversity also needs to be institutionalised in a way that counters various forms of epistemic injustice.

The distinction between ‘disease’ and ‘illness’ has played an important role in the debate between naturalism and normativism. Both employ these notions, yet disagree on whether to assign priority to ‘disease’ or ‘illness’. I argue that this discussion suffers from implicit differences in the underlying interpretations: While for naturalists the distinction between ‘disease’ and ‘illness’ is one between a descriptive and a prescriptive notion, for normativists it is one between cause and effect. This discrepancy is connected to different interpretations of priority, which also tend to be conflated in the debate. I disambiguate these different usages and develop a distinction between ‘disease’ and ‘illness’ that is theoretically neutral with regard to naturalism or normativism. Moreover, I propose a concept of heuristic priority that could serve as a common focus. This framework can avoid common confusions by providing a shared terminology and thereby help to make debates on disease-concepts more fruitful.

People with mental illnesses have higher prevalence and mortality rates with regard to common somatic diseases and causes of death, such as cardio-vascular conditions or cancer. One factor contributing to this excess morbidity and mortality is the sub-standard level of physical healthcare offered to the mentally ill. In particular, they are often subject to diagnostic overshadowing: a tendency to attribute physical symptoms to a pre-existing diagnosis of mental illness. This might be seen as an unfortunate instance of epistemic bad luck, where particular features of a group of patients make a timely and correct diagnosis unlikely. While this can explain some cases of diagnostic overshadowing, I argue that in other cases, epistemic injustice is involved. Analyzing the case of diagnostic overshadowing, I distinguish two kinds of testimonial injustice. For one, there are classic cases of transactional testimonial injustice resulting from prejudices against the mentally ill. In addition, there are cases of structural testimonial injustice resulting from features of health care systems. To overcome diagnostic overshadowing, remedies on the individual as well as structural level are thus needed.

Psychiatric classification, as exemplified by the Diagnostic and Statistical Manual of Mental Disorders, is dealing with a lack of trust and credibility—in the scientific, but also in the public realm. Regarding the latter in particular, one possible remedial measure for this crisis in trust lies in an increased integration of patients into the DSM revision process. The DSM, as a manual for clinical practice, is forced to make decisions that exceed available data and involve value-judgments. Regarding such decisions, public epistemic trustworthiness requires that these value-judgments should be representative of those of the affected public, and that the public has a reason to believe such a representation to be realized. Due to the long tradition of distrust in psychiatry, such a reason can in this case best be provided by an actual integration of patients into the decision-making process, rather than by their representation through scientific experts.

This article supports calls for an increased integration of patients into taxonomic decision making in psychiatry by arguing that their exclusion constitutes a special kind of epistemic injustice: preemptive testimonial injustice, which precludes the opportunity for testimony due to a wrongly presumed irrelevance or lack of expertise. Here, this presumption is misguided for two reasons: the role of values in psychiatric classification and the potential function of first-person knowledge as a corrective means against implicitly value-laden, inaccurate, or incomplete diagnostic criteria sets. This kind of epistemic injustice leads to preventable epistemic losses in psychiatric classification, diagnosis, and treatment.