Eleanor Byrne

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.

The ways in which we interact with healthcare institutions and contribute to understandings of health and illness are influenced by uneven and often invisible power relations in the social world. One of the key mechanisms that dictate how healthcare interacts in the sociopolitical arena is the distribution of epistemic power. This chapter offers an in-depth examination of the unique epistemic injustices that arise in the medical context, within both somatic and psychiatric healthcare. As healthcare is a domain that is constantly evolving and facing ever-new social issues and developments, an overview of recent developments in epistemic injustice in healthcare is much needed. While there has been a surge of literature on epistemic injustice and healthcare in recent years, this chapter draws out some of the more subtle forms of epistemic injustice that have heretofore been overlooked. The chapter sections are as follows: (1) Epistemic Injustice, (2) Epistemic Injustice in Healthcare, (3) Epistemic Injustice in Psychiatry Across Conditions and Contexts, (4) Unexplained Condition, (5) Intersectional Epistemic Injustices in the Medical Context, and (6) Phenomenology, Epistemic Injustice, and Medicine.

Recent work on distributed cognition and self-narrative has emphasised how autobiographical memories and their narration are, rather than being stored and created by an individual, distributed across embodied organisms and their environment. This paper postulates a stronger form of distributed narration than has been accommodated in the literature so far, which I call narrative deference. This describes the phenomena whereby a person is significantly dependent upon another person for the narration of some significant aspect of their own autobiographical self-narrative. I suggest that a person is more likely to narratively defer where they suffer a mnemonic impairment regarding some significant adverse life experience like trauma, illness or injury. Following a recent turn in the literature towards investigating the harmful aspects of distributed cognition as well as its many advantageous features, this paper explores how the benefits of autobiographical self-narrative deference within close personal relationships are complexly related to its harms.

PurposeThrough an evaluation of the information technology (IT) adoption and diffusion models and the free and/or open source policy of the South African Government, the underlying assumption is that the developmental divide between those with and those without access to technology is purely technical. This paper aims to illustrate that if Free and/or Open Source Software is to be used as a building block to bridge the “digital divide” a more social and environmental perspective, which embraces the philosophy behind the software, needs to complement the technical perspective. The human environmental model is presented as a useful alternative which, if embraced, can inform more holistic information and communication technology (ICT) policies.Design/methodology/approachThrough a review of diffusion of innovations models an alternative diffusion framework is described and applied to an interpretive open source case study in South Africa.FindingsContemporary diffusion and innovation models are narrowly focused on IT as a purely technological linear phenomenon. This perspective also underlies many ICT policies. A more socio‐technical adoption model can assist in providing a more holistic approach to ICT policy development.Originality/valueThe application of a new innovation model, the human environmental model, to ICT policy provides a holistic framework in which the complexity of the innovation process can be reflected in policy. Such an approach to ICT policy formulation will assist with broadening the perspective of policy makers from IT as a technical solution to IT as part of a socio‐technical solution and recognise the duality of the innovation process.

Various claims have been made concerning the role of narrative in grief. In this paper, we emphasize the need for a discerning approach, which acknowledges that narratives of different kinds relate to grief in different ways. We focus specifically on the positive contributions that narrative can make to sustaining, restoring and revising a sense of who one is. We argue that, although it is right to suggest that narratives provide structure and coherence, they also play a complementary role in disrupting established structure and opening up new possibilities. We add that both of these roles point to the importance of interpersonal, social and cultural factors in shaping the trajectory of grief. We conclude by briefly considering the implications for distinguishing between typical and pathological forms of grief.

This paper points to a more expansive conception of grief by arguing that the losses of illness can be genuine objects of grief. I argue for this by illuminating underappreciated structural features of typical grief — that is, grief over a bereavement — which are shared but under-recognized. I offer a common chronic illness, chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME), as a striking case study. I then use this analysis to highlight some clinical challenges that arise should this claim receive uptake in clinical practice. Extant literature on CFS/ME tells us that rates of comorbid depression are atypically high. If one accepts that people with CFS/ ME can grieve over losses associated with the condition, and that grief can be easily mistaken for depression in this context, this might suggest that rates of comorbid depression are inflated. I show, however, that the challenge of distinguishing between healthy and pathological grief arises in its place, and is just as tricky to solve.