Testimonial injustice against people with mental disorders in health care. A conceptual and ethical analysis

Statistically, people with mental disorders die prematurely due to preventable and treatable somatic illness. We analyze testimonial injustice as one mechanism which contributes to poor quality of health care for people with mental disorders. Practices in somatic health care are structured by ableist networks of social meaning. This leads to a systemic downgrading of the epistemic capacities of people with mental disorders and to a disproportionate focus on psychic disability and mental disorder in diagnostic processes. As a consequence, people with mental disorders are at high risk of suffering testimonial injustice in somatic health care. Testimonial injustice refers to the unjustified downgrading of a speaker's credibility based on a prejudice against their social identity. Testimonial injustice has important epistemic and ethical implications. It can lead to medical errors with serious health consequences for those affected. It can also lead to a loss of trust in the health system by people with mental disorders. Testimonial injustice against people with mental disorders reproduces structural discrimination and is ethically problematic. Practices of somatic health care need to be improved to reduce discrimination.