MedHums 101: Leo Gunn explores the idea of epistemic injustice, “a wrong done to someone specifically in their capacity as a knower” (Fricker 2007, 1), as it relates to chronic illness.
I am 16 years old, and for the first time, I am ill, and I am not getting better. I see specialists, expecting that someone will diagnose and cure me, but something strange keeps happening instead. These doctors don’t believe that anything is ‘really wrong’ with me. Some think I’m exaggerating everyday aches and pains, some think I’m making it up for attention, some think I’m mentally ill. Some want to believe me, but as test results keep turning up more or less normal, the simplest explanation must surely be that I am wrong about what is going on in my own body.
I hadn’t realised that this was an option. I am a child, exhausted and in pain, and I never imagined that the adults whose job it was to help me could simply decide that I didn’t need help. Yet as this happens again and again, I start to wonder if they are right. I ask myself: Am I not really ill? Is it all in my head? Am I even in pain at all? My self-esteem plummets.
When patients doubt their own reality
What I was experiencing is often called ‘medical gaslighting’ (Chronic Illness Inclusion 2021). ‘Gaslighting’, a word which comes from the 1938 play Gas Light, in which a husband attempts to convince his wife that she is mad, refers to a kind of psychological manipulation that usually takes place in the context of abusive relationships, undermining a victim’s sense of reality. In the context of doctor-patient interactions, ‘medical gaslighting’ does not necessarily imply that doctors have abusive intentions, although it does reflect patients’ powerlessness relative to their doctors. What it really captures is the disorienting effect this disbelief has, leaving patients doubting their own reality.
Women experience this disbelief much more frequently than men. Maya Dusenbery (2018) calls this the ‘trust gap’, which she explains often results in women being misdiagnosed or waiting longer than men for diagnosis. This trust gap is exacerbated by the fact that most doctors’ knowledge of women’s bodies and illnesses is limited because female bodies are underrepresented in biomedical research, and because health problems that are mostly experienced by women are under-researched. Dusenbery calls this the ‘knowledge gap’ and, as I experienced, this affects all doctors, even those who believe their patients. The trust gap and the knowledge gap are ‘mutually reinforcing’:
Women’s symptoms are not taken seriously because medicine doesn’t know as much about their bodies and health problems. And medicine doesn’t know as much about their bodies and health problems because it doesn’t take their symptoms seriously.
Dusenbery 2018, 12
Fricker’s concept of epistemic injustice
The trust gap, the knowledge gap, and ‘medical gaslighting’, can all be understood through the lens of what Miranda Fricker (2007, 1) calls ‘epistemic injustice’, which is a “wrong done to someone specifically in their capacity as a knower”.
Fricker describes two kinds of epistemic injustice, the testimonial and the hermeneutical. In testimonial injustice, person A, who is trying to communicate something, is wrongly perceived as less credible than average by person B because of prejudice. Typically, this is an ‘identity prejudice’, a prejudice B has against a group of people to which A belongs. This clearly describes the trust gap: women’s reports of their symptoms are given less credibility than they deserve because of unconscious gender bias.
Hermeneutical injustice occurs when there is a gap in the concepts that most people have on hand to make sense of the world, our ‘shared hermeneutical resources’ (Fricker 2016), which unfairly disadvantages some people when trying to communicate or understand an important aspect of their experiences. These gaps usually happen because marginalised people have been prevented from contributing equally to these resources. Fricker gives the example of sexual harassment: before this concept existed, many women struggled to understand or communicate their experiences of sexually inappropriate workplace behaviour as anything more than harmless ‘flirting’ (Fricker 2007, 153).
Although the knowledge gap is a gap in our specialised medical knowledge, not our ‘shared hermeneutical resources’, and is really about doctors’ ignorance of women’s bodies, not women struggling to understand or communicate their own bodily experiences, the knowledge gap is still a manifestation of hermeneutical injustice. It is caused in the same way, by women’s unequal participation as test subjects, as researchers, or in determining research funding (Dusenbery 2018), and the fact that doctors are affected by the knowledge gap doesn’t mean that it isn’t a form of hermeneutical injustice. As Fricker notes, hermeneutical gaps affect everyone, in this case both doctors and patients; they just don’t disadvantage everyone.
Additionally, patients are disadvantaged in the way Fricker describes. We all rely on specialist medical concepts like ‘hypoglycaemia’ or ‘executive dysfunction’ filtering down into our shared hermeneutical resources to help us make sense of our experiences. It can be impossible to communicate or even understand experiences like fatigue without the right language. After all, doesn’t everybody get tired? This is why concepts developed by patient communities such as ‘spoon theory’ and ‘brain fog’ are so important: they empower people to understand and express what is going on in their own bodies. They are what Kristie Dotson (2012) calls ‘alternative hermeneutical resources’.
Many intersecting trust and knowledge gaps
It’s also important to note that anyone who is seen as a woman by medical professionals is affected by the trust gap, and anyone who is assigned ‘female’ is affected by the knowledge gap. This means that many transgender patients are affected too. There are also trans-specific trust and knowledge gaps – medical professionals can be prejudiced against trans patients, and there is insufficient medical research into trans bodies.
Really, there are many trust and knowledge gaps; there are trust and knowledge gaps for people of colour, for people in poverty, for disabled people, etc. Just having a contested diagnosis like ME/CFS can mean a person is disbelieved by medical professionals (Blease et al. 2016). Many people experience testimonial and hermeneutical injustices in healthcare, and for people who are multiply marginalised, like black women, these different trust and knowledge gaps intersect and compound one another.
In fact, simply being a patient can be enough for someone to experience testimonial injustice. Not only because ‘sick’ or ‘ill’ people are seen as less rational or reasonable, but also because patients are treated not as knowers, but as objects of knowledge in medical encounters (Carel and Kidd 2017, Hale et al. 2025). Patients’ knowledge of their own bodies is weighed up against and often dismissed in favour of more ‘objective’ physical evidence like blood tests and CT scans; as I experienced, if the test results are ‘normal’, then the patient must be wrong. All patients are disempowered as knowers.
These epistemic injustices do harm. Many patients receive no treatment, or inappropriate psychological treatments, which often worsen their symptoms. Patients may then be blamed for this, as though they just didn’t try hard enough (Gunn et al. 2022). Many become so traumatised by these experiences that they avoid seeking healthcare altogether (Evans et al. 2023).
These injustices also result in uniquely epistemic harms, such as the harm of ‘gaslighting’.
The impact of epistemic injustice on chronically ill people
Participants in Chronic Illness Inclusion’s research (Evans et al. 2023, 2:3) explained that disbelief from medical professionals ‘knocked [their] self-confidence’ and caused them to ‘query’ and ‘doubt’ themselves. They ‘questioned [their] sanity’ and were left wondering if they were ‘making things up’. Ultimately many were left feeling ‘worthless’.
These participants were harmed as knowers, some to such an extent that they literally lost knowledge: they lost the ability to believe confidently in their own bodily experiences and so they no longer knew that they were ill or fatigued or in pain. Because giving and receiving knowledge is such an important human practice, and ‘rationality’ is considered necessary for personhood, when they were harmed as knowers, these participants were symbolically degraded as human beings (Fricker 2007). This symbolic degradation explains the ‘worthlessness’ that so many feel. They feel that they have ‘failed’ as people by ‘failing’ as knowers.
Some even lose knowledge about something many philosophers think it is impossible to be mistaken about: pain. You can be wrong about whether you are seeing a duck or whether it is warm in this room, but you cannot be wrong about whether you are in pain. To feel that you are in pain is to be in pain (Kripke 1980). Losing such fundamental self-knowledge is a devastating way to be degraded as a knower, not only in the eyes of other people, but in your own perception of yourself. If you can’t know whether or not you are in pain, what can you possibly know? No wonder this leaves so many feeling worthless.
What I wish I could tell my 16-year-old self, and what I would tell anyone who has ever experienced this, is that we aren’t worthless. This self-doubting isn’t something that is wrong with us, it is something wrong that was done to us. If we can understand this wrong, then maybe we can start finally to heal, and take back the knowledge of our own bodies that was taken from us.
About the author
Leonora (Leo) Gunn is currently completing a PhD in the philosophy of disability at the University of Leeds. She works with Chronic Illness Inclusion, and recently served on the advisory group of the project ‘Cripping the Exhaustion Economy’, which explored the experiences of people with energy limiting conditions working in academia. In her free time, Leo likes to read widely, write strange little stories, and is a rather negligent parent to a growing army of succulents.
About MedHums 101
The Polyphony‘s ‘MedHums 101’ project explores key concepts, debates and historical points in the critical medical humanities for those new to the field. View the full ‘MedHums 101’ series.
References
Blease, Charlotte, Havi Carel and Keith Geraghty. 2016. “Epistemic injustice in healthcare encounters: evidence from chronic fatigue syndrome.” Journal of Medical Ethics 43(8), 549-557.
Carel, Havi. and Ian J. Kidd. 2017 “Epistemic Injustice in Medicine and Healthcare.” In The Routledge Handbook of Epistemic Injustice, edited by Ian James Kidd, José Medina and Gaile Pohlhaus, Jr. Routledge.
Chronic Illness Inclusion. 2021. “Women’s Healthcare Survey reveals ‘medical ableism’.” Accessed November 20, 2025. https://chronicillnessinclusion.org.uk/2021/06/13/womens-health-survey/
Dotson, Kristie. 2012. “A Cautionary Tale: On Limiting Epistemic Oppression.” Frontiers: A Journal of Women Studies 33 (1): 24-47.
Dusenbery, Maya. 2018. Doing Harm: The Truth About How Bad Medicine and Lazy Science Leave Women Dismissed, Misdiagnosed and Sick. HarperOne.
Evans, Bethan, Alison Allam, Catherine Hale et al. 2023. “Disbelief and Disregard: Gendered experiences of healthcare for people with energy limiting conditions”. Disbelief Disregard. https://disbeliefdisregard.uk/wp-content/uploads/2023/09/ELC-Report.pdf
Fricker, Miranda. 2007. Epistemic Injustice: Power & the Ethics of Knowing. Oxford University Press.
Fricker, Miranda. 2016. “Epistemic Injustice and the Preservation of Ignorance.” In The Epistemic Dimensions of Ignorance, edited by M. Blaauw and R. Peels. Cambridge University Press.
Gunn, Leonora, Catherine Hale, Ana Ruddock et al. 2022 “Chronic Illness Inclusion’s Submission to the UNCRPD Shadow Report.” Chronic Illness Inclusion. https://chronicillnessinclusion.org.uk/wp-content/uploads/2022/08/CII-UNCRPD-submission.pdf
Hale, Catherine, Anna Ruddock and Ana Bê. 2025. “Introducing “Energy Limiting Conditions”: The Emergence and Evolution of a New Impairment Concept”. International Journal of Disability and Social Justice 5 (2): 136-158.
Kripke, Saul A. 1980. Naming and Necessity. Harvard University Press.
