Dan Degerman

Nielsen et al. (2025) have recently argued that the study of epistemic injustice in healthcare is subject to issues that, left unaddressed, threaten the ongoing research programme. One of their central worries is a lack of appropriate empirical evidence to support claims about the ubiquity and seriousness of these epistemic injustices which are commonly endorsed and rehearsed in publications on the topic. As researchers on the project Epistemic Injustice in Healthcare (EPIC), we offer responses to their concerns. While we sympathise with and develop some of their concerns, we express caution regarding others. We argue for an ongoing research agenda which is empirically-informed but maintains a pluralistic approach to research methods and approaches. This, we argue, is necessary in order to accommodate the complex social phenomenon of epistemic injustice in healthcare contexts.

This paper clarifies the experiential profile of depressive rumination, a form of repetitive and persistent negative thinking that is phenomenologically and aetiologically central in depression. Phenomenological analyses of depression have generally remained too high-level to account for this centrality. Drawing on first-person depression narratives and recent philosophy of psychiatry and psychology, we elucidate an underexplored phenomenological aspect of depressive rumination: a disruption in the capacity for inner silence. This disruption captures ruminating individuals’ yearning for but inability to initiate and maintain inner silence. It also explains the distress involved in rumination and the effectiveness of therapies such as meditation.

Calls to break silence pervade public discourse on mental health. Silence can of course be harmful if it results from stigma and prevents people from getting the support they need. Such socially imposed, harmful silence should be broken. But we need to stop talking as though all silence in mental illness is like that. Although such oversimplification lends itself to punchy campaign slogans, it does not reflect the lived experience of patients. More importantly, it can inadvertently harm people already in severe distress.