Testimonial Injustice works subtly but powerfully here. Abuse histories are acknowledged on the surface, but the pathologisation of understandable emotional sequelae, and a treatment focus on controlling emotions in the present, rather than foregrounding the testimony of survivors, reinforces the abuser’s attacks on survivors’ epistemic subjectivity (‘noone will believe you’, ‘it’s your fault for seducing me’). Category inclusion undermines the fundamental right to speak and be heard.
These credibility slurs are experienced viscerally by survivors. Many people report, for example, a sudden shift to kindness, understanding and empathy after a change of diagnosis from ‘BPD’ to ‘Bipolar Affective Disorders’. Self-harm and suicide attempts are suddenly reacted to with compassion and care. By contrast, those who cannot get their diagnosis changed feel branded for life.
We must campaign to get rid of the diagnosis of ‘BPD’. But we must not simply create a new label – Chronic PTSD – for the same prejudices will slide on to it. To really change the negative stereotypes, we need a new language, a new social understanding of why and how people end up in deep distress, and how contact with psychiatric services can damage.
Fricker offers a pertinent example. In the 1960s, society did not recognise sexual harassment, so the behaviour of harassers was typically tolerated or even excused. As a result, women were victimised because the wider social context did not label such behaviours as sexual harassment. Indeed such women were seen as troublemakers until they had a chance to meet together, to forge a new language that would come to give a discursive platform for other women to speak from.
We need a similar consciousness-raising, language-generating process in mental health. One where professionals step back from imposing understanding, imposing labelling, and wait to be led by frameworks that develop from survivors.
We need, in doing this, to acknowledge the historical wrongs done to survivors in the mental health system, wrongs that continue today. We need to do this in acknowledgment that professionals have often squashed survivor initiatives into a shape services recognise, and further pathologised those who object. We need to do this, urgently, ethically, to redress the silencing of survivors, a testimonial injustice the psychiatric professions have inadvertantly colluded with.