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Pre-Print, Accepted Feb 11, 2021 - Forthcoming in Hypatia
Standpoint Theory and the Psy Sciences:
Can Marginalization and Critical Engagement Lead to an Epistemic Advantage?
Phoebe Friesen, Jordan Goldstein
Abstract
As participatory research practices are increasingly taken up in health research, claims related to
experiential authority and expertise are frequently made. Here, in an exploration of what grounds
such claims, we consider how feminist standpoint theory might apply to the psy sciences.
Standpoint theory claims that experiences of marginalization and critical engagement can lead to
a standpoint which offers an epistemic advantage within a domain of knowledge. We examine
such experiences of marginalization and critical engagement in the mental health system, as well
as evidence for epistemic advantages resulting from these experiences. This evidence, found in
the identification of problematic assumptions and the development of new tools and theories in
the field, grounds our argument that standpoint theory is indeed relevant to the psy sciences and
that many of those that have experienced marginalization and engaged critically have an
epistemic advantage when it comes to knowledge production. The implications of this argument
are significant: those who have attained a standpoint within the psy sciences ought to be included
in research and given both tools and funding to develop research programs. However, we must
be weary of the risks of tokenization, cooptation, and essentialization that are likely to
accompany such a transformation.
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The Participatory Shift
A participatory shift is taking place across health research, as the contributions that those
impacted by research might make to research are beginning to be recognized, and the familiar
refrain of ‘nothing about us without us’ is beginning to be heard
1
. In mental health research, this
growth in consumer/survivor/stakeholder involvement demonstrates an increased receptivity to
experiential perspectives and their potential implications for theory and practice. This is an
important shift; biomedical psychiatry has historically, and by its own estimates, come up short
in producing satisfactory models, evidence and treatments for its own disorders, while many
diagnosed with them have put forth near constant resistance to all facets of mental health systems
and knowledge. Beyond a moral case for incorporating the viewpoints and demands of service
users, such perspectives would seem to offer epistemic benefits to a field in need of them. This
shift towards recognizing that some form of expertise may be on offer from those on the other
side of the mental health system raises many questions: How are we to account for the relative
benefits and the types of knowledge that might be available from those with lived experience as
psy-subjects? What is the basis for the epistemic advantage held by these subjects, if there is
one? What implications fall out of the recognition of such an advantage? How are we to theorize
the incorporation of perspectives in an area of research from which service users have been
historically excluded, even objectified and symptomatized? We hope to make a start on
answering some of these questions by applying the lens of feminist standpoint theory to the psy
sciences (psychiatry/ psychology/ psychotherapy/ psychoanalysis/ etc).
Below, we seek to build on existing work that has pointed to standpoint theory as grounding for
service user involvement and leadership in mental health research
2
, notably by leading survivor
1
This growth can be seen in the emergence of large organizations focused on participatory
research (NIHR (National Institutes for Health Research) Involve in the United Kingdom) or
patient-oriented outcome measures (PCORI (Patient-Centered Outcomes Research Initiative) in
the United States) and dedicated funding streams for inclusive research (e.g. SPOR (Strategy for
Patient-Oriented Research) in Canada).
2
A variety of terms are used to refer to participatory forms of research. Some reflect
geographical preferences or histories (e.g., PPI (public and patient involvement) is most common
3
scholars Alison Faulkner and Diana Rose (Faulkner 2017; Diana Rose 2014, 2017) as well as
other philosophical arguments for greater inclusion in the psy sciences (Bueter 2019; Cooper
2017; Tekin 2020; Sadler and Fulford 2004)
3
. Here, we consider how and whether feminist
standpoint theory can provide a basis for the inclusion of service users in knowledge projects
within the psy sciences. In section one, we unpack the basic claim of standpoint theory, and the
meanings of its three components: a ‘marginalized social location’, a process of ‘critical
engagement’, and an ‘epistemic advantage’. In the second section, we discuss how this theory
might apply to the realm of the psy sciences, and what the components of marginalization and
critical engagement might look like in application. The third section considers what evidence we
have for the claim that standpoints offer an epistemic advantage within the psy sciences, looking
to case studies of participatory, survivor, and user-led research, and argue that we have good
reason to think that a standpoint offers an epistemic advantage in the psy sciences. Finally, in the
last section, we consider both implications of, and objections to, the claim that standpoints in the
psy sciences offer an epistemic advantage.
Standpoint Theory
Feminist standpoint theory has its roots in the work of Karl Marx, who recognized the way in
which knowledge can be significantly shaped by those in positions of power, while at the same
time appearing to be entirely inevitable (Harding 2004b). In The German Ideology, Marx and
Engels observe how “the class which has the means of material production at its disposal, has
control at the same time over the means of mental production, so that thereby, generally
speaking, the ideas of those who lack the means of mental production are subject to it” (Marx
in the United Kingdom, whereas participatory research is more common in North America).
Others reflect different rungs on Arnstein’s ladder of citizen participation (e.g., user-led or
survivor-led research implies that the project is not merely involving, but led by those who are
typically the subjects of research) (Arnstein 1969). Others refer to specific methodologies that
have developed in this space (e.g., CBPR (community-based participatory research) or PAR
(participatory action research)). Many of these terms are used throughout this paper, depending
on the context or project being discussed.
3
A related argument put forward by Peter Beresford suggests that within mental health research,
“the shorter the distance between direct experience and its interpretation, then the less likely
resulting knowledge is to be inaccurate, unreliable and distorted” (Beresford 2005).
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and Engels 1970, 172). Furthermore, they emphasized how, as facts are brought into being by
those at the top of the hierarchy, they become embedded in our way of life, and we tend to
“detach the ideas of the ruling class from the ruling class itself and attribute to them an
independent existence” (Marx and Engels 1970, 173). Anticipating standpoint theory, Marx
further argued that the proletariat alone has the potential to recognize this distorted reality from
the unique position they hold at the bottom of the social and material hierarchy. Drawing on the
insights of Marx, Nancy Hartsock, one of the first standpoint theorists, argued that since
women’s lives are radically unlike those of men, with regards to the social and material
conditions they exist within, women alone have the potential to recognize the partiality and
perversity that is contained in the dominant vision of reality produced by men (Hartsock 1983).
While many standpoint theorists since Hartsock have moved away from the essentialism implied
in her analysis, what has been taken up from her work is the observation that those who are
marginalized are uniquely capable of observing the way in which knowledge is shaped in
relation to power (Collins 1986; Haraway 1994; Harding 1995)
4
.
Standpoint theorists have since drawn upon and developed the claims of Marx and Hartsock,
demonstrating how they rest on both the thesis of socially situated knowledge, which claims that
knowledge is shaped by social forces, and the thesis of epistemic advantage, which holds that
experiences within some social locations offer advantages when it comes to particular knowledge
projects (Haraway 1988). Standpoint theorists have also added an additional thesis, that of
critical reflection, which holds that in order to attain a standpoint, which confers an epistemic
advantage, one must both have experienced marginalization and have engaged in a process of
critical reflection. Taken together, these theses lead to the basic claim of standpoint theory: a
standpoint is arrived at as a result of two necessary components, a marginalized social location
and a process of critical reflection, and once arrived at, a standpoint offers an epistemic
advantage over other positions with regards to relevant scientific pursuits (Intemann 2010;
Hartsock 1983; Harding 1992; Wylie 2003). In this section, we unpack this claim, by offering an
exploration of how standpoint theorists have understood the meanings of a ‘marginalized social
location’, a process of ‘critical reflection’, and an ‘epistemic advantage’.
4
It is also worth acknowledging a significant body of feminist scholarship that engages critically
with Marxism (Federici 2004; Hochschild 2015; Mies 2014).
5
Marginalized Social Locations
A marginalized social location is important to standpoint theory in conjunction with the thesis of
socially situated knowledge. This thesis holds that knowledge is at all times formed in relation to
the social conditions that provided the environment for its establishment (Wylie 2003; Intemann
2010; Harding 2004a; Haraway 1988). In Alison Wylie’s words, the situated knowledge thesis
states that, “social location systematically shapes and limits what we know, including tacit,
experiential knowledge as well as explicit understanding, what we take knowledge to be as well
as specific epistemic content” (Wylie 2003, 31)
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. Wylie describes a social location as a position
in society that is structurally defined; central to such a position are relations of power that
individuals exist within that alter the material conditions, the relations of production and
reproduction, as well as the conceptual resources available to them (Wylie 2003). Kristen
Intemann affirms this view, explaining that the social position one occupies draws the boundaries
of that which one can possibly know because it inevitably influences the kinds of experiences
available to oneself (Intemann 2010). Importantly, the thesis of socially situated knowledge has
implications both on individual and societal levels. While an individual’s social location
inevitably shapes what one knows and is able to know, structures of power also shape what is
known by a society as a whole. As Berit Britz explains, “the language and questions asked by
those most embedded in a dominant culture will always contain presuppositions shaped by that
dominant culture’s values, beliefs, and motivation for maintaining its systems and structure”
(Britz 2017).
Once the thesis of socially situated knowledge has been established, it is then argued within
standpoint theory that some social locations have a unique epistemic potential that others do not.
These locations are those that are marginalized. A marginalized social location is one that holds
little power relative to other positions within society. Those who are marginalized are often those
who are most stigmatized, who are socioeconomically most disadvantaged, and who are least
5
Linda Alcoff takes this even further, suggesting that “a speaker's location (which I take here to
refer to their social location, or social identity) has an epistemically significant impact on that
speaker's claims and can serve either to authorize or disauthorize one's speech” (Alcoff 1991).
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likely to hold positions that allow them to create or contribute to the dominant collective
knowledge (e.g., scientists, judges, politicians, academics, etc). The reason that marginalization
leads to a unique epistemic potential is that those in positions of power have a vested interest in
maintaining the structure of knowledge that exists, while those in marginalized positions do not.
As Wylie puts it, there is an irony in this: “those who are economically dispossessed, politically
oppressed, socially marginalized and are therefore likely to be discredited as epistemic agents –
e.g., as uneducated, uninformed, unreliable – may actually have a capacity, by virtue of their
standpoint, to know things that those occupying privileged positions typically do not know, or
are invested in not knowing” (Wylie 2003, 32).
It is important to note here that, according to standpoint theory, a marginalized social location is
not enough to grant one an epistemic advantage over others within a scientific project. There is
no particular knowledge attached to womanhood, to indigeneity, or to having a diagnosis of
bipolar disorder, that connects an identity essentially to a scientific question. Rather, the
experience of marginalization offers individuals the potential to see particular knowledge
projects in a new light, but in order to fulfill this potential, one must engage in a process of
critical engagement. In this sense, in Sandra Harding’s words, “each oppressed group can learn
to identify its distinctive opportunities to turn an oppressive feature of the group’s conditions into
a source of critical insight about how the dominant society thinks and is structured” (Harding
2004a, 7).
Critical Engagement
The second component necessary for achieving a standpoint is critical engagement. As
highlighted before, there is no automatic epistemological benefit that arises from simply
occupying a particular social location. Many standpoint theorists have pointed to the importance
of gaining a standpoint through a conscious effort to understand how knowledge comes to be
within the unique material and social conditions that exist within a certain time and place. Wylie
argues that standpoints, unlike social locations, are “struggled for, achieved, by epistemic agents
who are critically aware of the conditions under which knowledge is produced and authorized”
(Wylie 2003, 31). Intemann suggests that standpoints are attained “only when there is sufficient
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scrutiny and critical awareness of how power structures shape or limit knowledge in a particular
context” (Intemann 2010, 785). This suggests that it is crucial not only to occupy a marginalized
social location that allows one to see the benefits being gained by those outside one’s own
position, but also to critically examine the way in which social locations relate to knowledge
within the community. This critical examination can come in many forms: attending
consciousness raising meetings, getting a degree, spending time with others and reflecting on the
ways in which power dynamics are shaped around one’s (shared) marginalized identity.
Importantly, this critical work must be taken up by those who have experienced oppression in
order to truly attain a standpoint and the epistemic advantage that comes with it. Wylie puts it
well: “some standpoints (as opposed to locations) have the especially salient advantage that they
put the critically conscious knower in a position to grasp the effects of power relations on their
own understanding and that of others” (Wylie 2003, 34, emphasis in original). As Harding points
out, unlike a social location, “a standpoint is an achievement” (Harding 2004a, 8)
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.
The Epistemic Advantage
While the epistemic advantage that arises from a standpoint has been described in different ways
by different theorists, often the epistemic tasks most emphasized are those of identifying dubious
assumptions, developing new hypotheses, or accessing objectivity (Haraway 1988; Wylie 2003;
Harding 1992)
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. The ability to identify assumptions underlying a knowledge project stems
directly from the recognition of how power shapes knowledge that takes place during the period
of critical engagement that leads to the attainment of a standpoint. Given that knowledge
produced by those in power tends to benefit those in power, there is little motivation for those
receiving these benefits, regardless of their awareness of them, to consider alternatives or engage
in critique of the dominant paradigm. Such critical engagement, which often involves the
identification of hidden premises that underlie theoretical conclusions, or the ways in which
6
More recently, Harding has suggested that standpoint can be simultaneously thought of as a
methodology, epistemology, a philosophy of science, and a sociology of knowledge (Harding
2015) (p.31). Here, we focus on standpoint as a normative, epistemological theory.
7
More recently, Wylie has described the epistemic advantage of a standpoint as involving three
dimensions: evidence, inferential heuristics and explanatory models, and critical distance (Wylie
2011).
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values are guiding the direction of research projects, often comes easier to those who are
marginalized in relation to the particular knowledge project. Intemann emphasizes how
“scientific communities that include members of oppressed groups with experiences relevant to
the research” are often able to “identify problematic background assumptions” that guide the
research (Intemann 2010, 789).
Similarly, those who are not invested in maintaining the status quo in terms of what we know are
uniquely able to develop alternative hypothesis, consider novel phenomena of study, and develop
research programs and methodologies that have not been thought up yet. Their positions away
from the center of power allow them to “access a wider range of empirical evidence”, as well as
to “generate new hypotheses, models, and explanations” (Intemann 2010, 789). Similarly, those
who are marginalized are “capable of conceptualizing phenomena that were heretofore invisible
because they start off from outside the dominant paradigms and conceptual schemes” (Harding
1992, 344). This is an inevitable result of the thesis of socially situated knowledge, which
acknowledges how material, social, and economic conditions impact the ways of seeing and
thinking available to individuals and communities.
Additionally, several standpoint theorists have emphasized how standpoints can contribute to
increases in objectivity. Most famously, Harding has argued that standpoint theorists gain an
epistemic advantage through ‘strong objectivity’, a term which reclaims objectivity, distancing it
from the traditional ‘view from nowhere’ (Nagel 1989) and instead defining it as involving a
sense of reflexivity and awareness of the role of values. Strong objectivity, according to Harding,
is constituted by communities of knowers “outside” of a discipline who are able to identify the
values and interests embedded in scientific projects, and in which cases those values and
interests serve as a help or hindrance to the project at hand (Harding 1995, 2015). She suggests
that “standpoint approaches provide a map, a method, for maximizing a strong objectivity that
can function more effectively for knowledge projects faced with the problem of sciences that
have been constituted by values and interests of the most powerful social groups” (Harding 1992,
346). In this sense, the work of standpoint theory has been to locate the subject of knowledge
within all scientific accounts, generating a commitment to reflexivity that allows one to see the
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values and interests that inevitably shape knowledge seeking projects, generating a stronger
objectivity in the end (Harding 1992).
Wylie suggests, alternatively, that objectivity ought to be understood as a “a loosely defined
family of epistemic virtues that we expect will be maximized, in some combination, by the
claims we authorize as knowledge”, including qualities like empirical adequacy, explanatory
power, and inferential robustness (Wylie 2003, 33). If we think of objectivity as constituted by
these virtues, but changing shape depending on the particular questions being asked and
phenomena being investigated, then along with the thesis of socially situated knowledge, it is
easy to see how those with standpoints have an advantage within particular epistemic contexts.
Others have emphasized the objectivity gained through standpoints as well; Donna Haraway
suggests that subjugated standpoints “seem to promise more adequate, sustained, objective,
transforming accounts of the world” (Haraway 1988, 584), while Intemann examines how
objectivity arises at the level of community, arguing that including diverse voices in scientific
projects is of central importance, since “objectivity is promoted by structuring scientific
communities in ways that minimize the negative influence of individual biases” (Intemann 2010,
783).
While these three epistemic capacities can be pulled apart – the ability to identify problematic
assumptions, develop new hypotheses, or access objectivity – it is important to also note that
they are often entangled with and parasitic on each other. As a result of identifying problematic
assumptions, one may then seek to fill in the gaps with more promising avenues of research, and
by reflecting on the values that tend to shape different research programs and excluding those
that are problematic, one is likely to produce more objective knowledge. Finally, it is worth
noting that according to standpoint theory, a marginalized social location gives one a unique
potential for an epistemic advantage in particular knowledge projects, which can be attained
through critical engagement and reflection. This does not mean, however, that what might be
visible to those who have attained a standpoint is necessarily inaccessible to those without a
standpoint; it only suggests that they are less likely to see it.
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Evidence for Standpoint Theory
Evidence for standpoint theory has primarily been given through accounts of shifts that have
taken place in epistemic landscapes after individuals who had achieved a standpoint entered the
scene. These accounts document how individuals from marginalized social locations (often
women) who have attained a standpoint are able to uncover biases, assumptions, and faulty
reasoning within a scientific domain, develop novel research pathways, and to offer more
objective accounts of the world. Harding outlines a number of assumptions guiding scientific
work that were only identified once feminist critics entered the disciplines. Such assumptions
included beliefs that reproduction was inherently pathological, that hunters not gatherers were
the primary ‘breadwinners’ among our ancestors, and that politics and work could only take
place outside the home. In place of these assumptions, new theories were developed, mapping
the unique contributions that gatherers made within history and the previously invisible forms of
labour that appear within a household (Harding 2015).
In Primate Visions, Haraway describes the faulty assumptions that ran through primatology
when the discipline was dominated by men and became apparent when women began to examine
the same data, as well as how these women pioneered new methodologies that re-shaped the field
(Haraway 1989). Patricia Hill Collins documents the rich body of scholarship that developed
when black women entered the domain of sociology, and began to write about the intersectional
nature of their oppression, that had been left out of white feminist scholarship (Collins 1986).
Wylie argues that standpoint theory offers a frame for the “hard-won shift in collective
understanding” of women’s underrepresentation in the academy, and the sciences in particular,
“that was mobilized by insights from the margins” (Wylie 2011). After decades of explanations
focused on women’s innate lack of capacity and productivity, marginalized voices began to
document how the unsupportive climates in these contexts provide an alternate explanation for
such underrepresentation.
Research documenting how critical, marginalized voices have led to the identification of
problematic assumptions within scientific projects and the development of more promising lines
of enquiry in place of them, offer evidence that standpoints can contribute to greater objectivity
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within science. Crucially, these three components of an epistemic advantage are not easy to
disentangle. While not always characterized as a standpoint project, the work of Carol Gilligan
offers a useful example with which to understand how a critical and marginalized knower can
significantly impact a research programme. After working as a research assistant for Lawrence
Kohlberg and collecting data from children to score them according to the Kohlberg scale of
moral development, Gilligan was struck by how the young boys she spoke to, who often thought
of ethical considerations in terms of rules, consistently scored higher on the moral scale than the
girls she interviewed, who tended to focus on relationships. This led Gilligan to reject the scale
developed by Kohlberg, which privileged some forms of moral reasoning over others, and
develop a research program examining ethical deliberation centered around the notion of care
(Gilligan 1982). This demonstrates how the epistemic advantages of identifying assumptions,
developing new theories, and attaining a greater stance of objectivity, are likely to be bound up
together in many cases of standpoints impacting scientific projects
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.
Standpoint Theory in the Psy Sciences
This section explores the question of who might be considered to have attained a standpoint in
relation to research in the psy sciences. We suggest that the two conditions of having a
marginalized social location and engaging in critical reflection are both necessary and sufficient
for having a standpoint related to the psy sciences, and we consider how those conditions are
fulfilled on a practical level. The following section considers what evidence there is to support
the claim that such a standpoint confers an epistemic advantage in the realm of the psy sciences.
A Marginalized Social Location in Mental Health Services
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While not often understood as such, both narratives of and empirical data related to
participatory health research could be construed as further evidence for standpoint theory. Such
research has documented how patients have, for a start, helped to identify relevant outcome
measures, improve the accessibility of clinical trials, and point funders and investigators towards
avenues of research that are likely to have a greater impact on what matters to patients (Brett et
al. 2012; Forsythe et al. 2019; Epstein 1996; Dresser 2001).
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A marginalized social location in the realm of mental health can take many forms. In many
cases, such a location will arise from having lived experience of receiving a psychiatric diagnosis
and experiencing the mental health system as a service user
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. In some, but not all such cases,
individuals may experience stigma, discrimination, paternalism, forced treatment, and/or a denial
of one’s agency, all of which involve taking power away from the individual and contributing to
the marginalization of their social position. These effects may be mediated by existing identities
and their intersections, including, but not limited to, class, race, gender, sexuality, and perceived
disability. As expressed by Mary O’Hagan, the experience of being diagnosed as disordered can
have a significant impact on one’s sense of agency:
Once I was labelled with ‘mental illness’ I was seen as a helpless bundle of needs without
competence and rationality. I was handed over to experts who colonized my story of
suffering and condemned me to a predetermined pathway of recurring or deteriorating
illness. They had exclusive rights to administer powerful treatments and to remove my
freedom if they perceived me as a danger to myself or others. All they required of me was my
passivity and compliance. I knew this regime was the logical consequence of the mental
illness label and the belief system that underpinned it. (O'Hagan 2015, 115)
The marginalizing effects of diagnosis and experiences with the mental health system are
produced in relationship to an associated set of defining features and stereotypes. These
stereotypes include irrationality, unpredictability and a lack of self-awareness as a priori aspects
of those seen as disordered. Violence, unmotivated behavior, ineptitude and dependency are
often thought to follow
10
. These stereotypes are rooted in sources spanning public media and
9
While we focus here on service users, it is worth noting that marginalization can also be
experienced by those who may not have been diagnosed or treated within the mental health
system. These could include friends who have felt helpless while trying to support their loved
ones in navigating the mental health system, those who have witnessed the inhumane treatment
of their family members by police or mental health workers, and psychiatric residents who are
afraid to speak up for fear of disrupting the hierarchy of medical training. Some of our analysis
will extend to others who have experienced marginalization within the psy sciences, but not all
of it will.
10
Of note is that biological explanations of mental disorders have been shown to increase
perceptions of violence and irrationality in those diagnosed with such disorders (Read et al.
2006; Kvaale, Gottdiener, and Haslam 2013).
13
political discourse to personal and second hand experiences, as well as conceptual associations
with the notion of ‘mental illness’ itself
11
(Varshney et al. 2016).
Stereotypes related to the agentive and cognitive capacities of those labelled as ‘mentally ill’ lead
directly to damages to social recognition, as a diagnosis often immediately leads one to be
considered less capable of knowing and speaking for oneself. Miranda Fricker’s concept of
epistemic injustice, in which stereotypes lead to individuals and groups being deemed to lack
credibility and the ability to speak as legitimate knowers, offers a productive framework for
understanding these effects (Fricker 2007). One particularly applicable form of Fricker’s concept
is testimonial injustice, in which the capacity of individuals to give knowledge is undermined by
the hearer’s prejudice and subsequent judgment of credibility, such as when one’s words are
characterized as mere symptoms of illness rather than a meaningful attempt at communication
(Fricker 2007)
12
.
LeBlanc and Kinsella have traced this social construction of mad people as illegitimate knowers
to sanism, or the systematic discrimination and oppression of those who have, or are perceived as
having, a psychiatric diagnosis (LeBlanc and Kinsella 2016). Liegghio further characterized
these delegitimizing structural forces as epistemic violence in which existent subjectivities and
identities are erased and replaced with stigmatized social and professional constructions
(Liegghio 2013). This form of systematic discrimination results in neglect, silencing and erasure,
in which an agentive subject is reconstructed as an object hijacked by irrationality. Thus, the
marginalized social location that is often experienced by those diagnosed with ‘mental disorders’
is inherently linked to a denial of rationality and agency. Such forms of disempowerment around
mental health may then shape one’s degree of access to economic, material or emotional
11
These quotations reflect persistent doubts around the validity and effectiveness of these
categories, amongst psychiatric survivor and mad activists as well as those within the psy
sciences (Estroff, Penn, and Toporek 2004; Jablensky 2016).
12
Assigning credibility deficits to epistemic agents may not be the only form of epistemic
injustice resulting from a marginalized social location, however. In settings promoting peer
involvement in services and research, tokenization can lead to expectations surrounding the
scope of service users’ perceived credibility, promoting the view that any individual can speak
for all members of the group they are sought to represent. See (Dotson 2011) for a discussion of
the harms that can result from assigning ‘credibility excess’ to marginalized individuals.
14
resources, as well as social or political recognition, further marginalizing individuals beyond the
stigma of their experiences. Importantly, this disempowerment is also used to exclude those with
lived experience from participating in knowledge practices for which they are the subjects and
presumed beneficiaries. As Jan Wallcraft describes it, “many of us have suffered from the
misunderstanding of our needs by people who have been taught to see us as by definition
incapable of rational thought” (Jan Wallcraft 2009).
It is worth noting that these are by no means experiences of marginalization shared by all
individuals who have come face to face with a system of mental health care, and many
experience gratitude for their time in care. Additionally, some may recognize their position as
marginalized and accept this marginality as a necessary, if undesirable, corollary to receiving
mental health care, disability payments, institutional accommodations and housing (Estroff et al.
1991; Estroff 1981). It may also be seen as the underside of the social recognition and attitudes
perceived as helpful that being labelled ‘mentally ill’ can afford. In other words, marginalization
does not only accompany negative experiences, but may be experienced as a necessary evil or
comforting form of recognition and erasure simultaneously.
Critical Engagement with the Psy Sciences
The second component necessary for attaining a standpoint, after occupying a marginalized
social location, entails critically engaging with the relationship between power and knowledge.
For those with experiences of mental health diagnosis, services or hospitalization, attaining a
standpoint in the psy sciences may mean engaging with how institutional and social structures
shape knowledge regarding their own construction as ‘objects’ in the psy sciences and as
‘mentally ill’ subjects in society. In this sense, critical reflection helps individuals attain a more
critical understanding of the structural forces that render their social existence and subject
positions. As a mode of reflection, critical engagement can occur on one’s own or in community,
whether a formal institutional setting (e.g., a university), or a more social one (e.g., a support
group).
15
Critical engagement that occurs on one’s own may be preceded by experiences of
disempowerment and/ or harm within mental health services, or a more conceptual disjuncture
between firsthand experiences and conventional psychiatric knowledge (Shimrat 1997;
Chamberlin 1978; O'Hagan 2015). Numerous examples describe traumatic or alienating
experiences of treatment followed by a subsequent search for literature that challenges status-quo
mental health discourses and reflects one’s existing concerns. In her memoir “Madness Made
Me,” Mary O’Hagan describes how, while mobilizing a ‘middle class’ sense of personal security
and nonconformity, she developed an awareness of the value of madness after years of
psychiatric services. Subsequently reading the work of Thomas Szasz, Michel Foucault and RD
Laing helped her look critically at the social and historical construction of mental illness and to
ultimately see the medicalization of her experiences as a sort of colonization (O'Hagan 2015,
116). Similarly, Laura Delano speaks to how thirteen years of disillusionment, despair and
labelling in psychiatric treatment ended when she read Whitaker’s Anatomy of an Epidemic: “All
it took was an openness, and a readiness, to try out a different way of thinking,” namely the
liberating notion that her experiences might be seen not as symptoms of an organic disease, but a
rational response to experiences (Delano 2013; Whitaker 2011). In both cases, individual
experiences of marginalization and oppression necessitated critical engagement as a means of
both survival and curiosity, with and without the aid of liberatory texts. The impetus to develop
these new perspectives stemmed from the very consequences of not doing so, of leaving one’s
social position unexamined.
Critical engagement can also occur in group settings, where consciousness-raising is taking place
(Zinman, Howie the Harp, and Budd 1987; Chamberlin 1978). Judi Chamberlin, cofounder of
Boston’s Mental Patient Liberation Front noted that, “many patients were still into the head-trip
of feeling that they deserved what happened to them – they were ‘psychologized’ into believing
it” (Chamberlin 1978). She describes how former patients gained a markedly new strength and
self-respect through consciousness-raising groups, while sharing previously undiscussed
negative experiences in psychiatric hospitals, engaging in discussions that linked mental health
systems to broader functions of social control, and offering each other insights into alternative
forms of support. For Chamberlin, these critical discussions and the development of novel
practices of support are entangled. She notes that, “along with the recognition of the
16
antitherapeutic nature of much psychiatric treatment comes the formulation of what does make a
good place for a person to come to in times of emotional distress” (Chamberlin 1978). Tehseen
Noorani describes how collective knowledge is built in service user communities: “experiences
become more ‘weighty’ as they collectivise over time, that is, as self-helpers identify similarities
and differences in stories they share with one another, about their respective engagement with
their distress and the effects of their distress” (Noorani 2013, 62). This process, Noorani
suggests, grounds the notion of experiential authority in service user communities.
Beyond individual and group settings, critical engagement can occur within more formalized
research contexts. Researchers Brown and Jones note the problem, exemplified in conventional
psychiatric research, that such formal engagements seek to correct: “the consenting research
subject at once symbolically concedes ‘understanding’ of his or her disorder to the academic
researcher while at the same time reifying his or her position as an informant or provider of data
that will only become ‘externally valid’ once it has been combined with dozens of other
narratives, reports or data points and ‘transformed’ by expert clinical scientists” (Jones and
Brown 2013). Survivor led research, a participatory research framework led by those with
experiences of madness, distress, and/or treatment, is an example of such formal critical
engagement, one which seeks to correct the systematic exclusion of those who have lived
experiences in the production of knowledge about those very experiences by centering their
voices, priorities and perspectives (Sweeney et al. 2009; Russo and Sweeney 2016). Speaking to
the critical engagement required for such research, Alison Faulkner, drawing on Jasna Russo and
Diana Rose, acknowledges that “for survivor research to transform knowledge, those involved
need more than the experience of being mad or of using services” (Faulkner 2017, 513). Such an
experience, according to Rose, must be complimented by “a political dimension that derives
from other social movements” or according to Russo, a shift away from clinical research and the
strengthening of alternative methodologies and theories (Faulkner 2017, 513; Diana Rose 2014;
Russo 2014).
Evidence for Standpoint Theory in the Psy Sciences
17
Following traditional discussions of standpoint theory, we propose that the best evidence for an
epistemic advantage in the psy sciences will be found in examples of problematic assumptions
being displaced and promising theories being developed by those who have attained a standpoint
within the domain
13
. Before offering several such examples below, two caveats are in order.
First, while we outline some significant contributions that individuals who have attained a
standpoint have made to the psy sciences below, these contributions are only a small portion of
the contributions made by those with such standpoints. Knowledge is constantly created and
extended in mad communities and most of this knowledge will never reach the psy sciences.
While all forms of knowledge generation and sharing in communities of service users or by
individuals with standpoints is important and worthy of further discussion, we focus here on
contributions that have had some impact within the psy sciences, because of the history of
standpoint theory and because of the immense power, held within these disciplines, with regards
to funding, policies, and care for those deemed within their purview.
Second, the majority of the examples below are taken from the context of the Global North. In
part, this is the result of our limited language abilities and our unfortunate ignorance of global
efforts related to the psy sciences. The focus also stems from the different ways in which the psy
sciences are known and make themselves known outside of the Global North. In many low and
middle income countries (LMICs), resources for the psy sciences and its associated interventions
are limited, so care for those in crisis is often sought out within the community (e.g. with
traditional healers, at church) as opposed to within formal health care institutions (Luhrmann and
Marrow 2016)
14
. As a result, mad advocacy and knowledge production taking place in these
contexts often focuses on preventing human rights abuses, ensuring the Convention on the Rights
of Persons with Disabilities is respected, and building community-centered forms of care (Grech
and Soldatic 2016; MindFreedom Ghana, MindFreedom International, and Foundation 2011;
13
We do not offer a comprehensive history of service user movements or mad resistance here.
For resources on this topic, which are unfortunately largely focused on Euro-American contexts,
see (Crossley 2006; L.J. Morrison 2013; Campbell 1985; Robb 2008).
14
See Nabbali for an interesting analysis of what Mad Pride discourse might represent in Ghana,
given the tenuousness of psychiatry in the country (Nabbali 2013).
18
Minkowitz 2012)
15
. This impacts the terminology used to describe service user efforts across the
globe, which varies significantly (Beresford 2020). As Kalathil and Jones have pointed out,
“both user/survivor research and ‘mad theory’ remain Euro-American phenomena” (Jayasree
Kalathil and Jones 2016). A Statement of Purpose from the Trans Asian Strategy Group
on Persons with Psycho-Social Disabilities points out that “where there are no services, there are
no ‘Users’ or ‘Survivors’ of services, as found in large parts of Asia” (Trans Asian Strategy
Group of Persons with Psycho-Social Disabilities 2014), while in 2008 the Pan African Network
of Users and Survivors of Psychiatry changed its name to The Pan African Network of People
with Psychosocial Disabilities, recognizing that ‘users and survivors of psychiatry’ “does not
adequately reflect representation and the lived reality of this voiceless group in Africa” (Robb
2008).Given these differences, knowledge production and activism related to mental health,
while important and impactful, may have less of a direct influence on the psy sciences, whose
power is largely consolidated in wealthy nations, and the impact that it does have may be less
likely to be recorded in scholarly works that are visible to researchers in the Global North
16
.
Identifying Assumptions
Cases of the identification of problematic assumptions within the psy sciences by individuals or
communities that have attained a standpoint are not hard to find. One significant contribution
that service users have made within this domain is to challenge the assumption, deeply
embedded within the field, that wellbeing is equivalent to symptom reduction (Friesen 2019).
Service users have long pointed towards the vast distance between the goal of simply reducing
symptoms and the goal of living an engaging, meaningful life as defined by the individual living
it (Deegan 1997; S. Mead and Copeland 2000; Young and Ensing 1999). As Vanessa Jackson
puts it, the experience of “being continuously asked about symptoms but never about her life” is
15
It is noteworthy that service users played a significant role in influencing the development of
the Convention on the Rights of Persons with Disabilities (CRPD), which may not fall squarely
within the psy sciences, but is importantly entangled with them (Minkowitz 2012).
16
An ongoing project led by EURIKHA is mapping the contributions of those involved in user-
led research, rights-based activism, community organising, advocacy, self-help, and the arts
across the globe, and how these efforts shape knowledge and movements (EURIKHA 2020).
19
not an unusual one (Jackson 2001). What a narrow focus on symptom reduction as the goal of
treatment neglects, however, are a number of aspects that many consider central to a good life,
and do not always co-occur with symptom reduction. These include social support, meaningful
involvement, and a life free from debilitating side effects. Those involved in user-led research,
the recovery movement, and patient-run initiatives have pushed towards closing this gap and
developing both mental health services and supports that help individuals to attain more than an
asymptomatic state, as well as research that focuses on measuring wellbeing in its more
expansive forms (Anthony 1993; Del Vecchio and Blyler 2009).
Survivor led research has also identified problems with standard methodologies used in research
in the psy sciences. When a group of service users conducted a systematic review of
electroconvulsive therapy (ECT), but rather than following the standard model of such reviews,
they chose to include qualitative data and grey literature, the results differed substantially from
what had been found in previous systematic reviews. The researchers found that a smaller
proportion of recipients of ECT felt that they had benefitted from the treatment than previously
reported, and that issues related to informed consent and memory loss were of central importance
to participants, concerns that had been neglected in the previous reviews (Diana Rose et al. 2003;
D.S. Rose et al. 2005; D Rose, Fleischmann, and Wykes 2004).
Service users have also played a significant role in documenting the role the pharmaceutical
industry has played in shaping knowledge in the psy sciences (Faulkner 2017). While patient
advocacy groups are certainly not strangers to pharmaceutical funding, those deemed patients
have also sought to expose such alliances (McCoy et al. 2017; Batt et al. 2020). In a detailed
series of articles, Sera Davidow has documented the conflicts of interests deeply embedded
within the NAMI, the National Alliance on Mental Illness, which calls itself the “largest
grassroots mental health organization” in the United States (National Alliance on Mental Illness ;
Davidow 2017, 2014, 2019). Speaking from India, Bhargavi Davar has also noted the presence
of pharmaceutical interests in the push towards Global Mental Health, which is likely to lead to a
much larger market for pharmaceutical products (B.V. Davar 2017; Mills and Davar 2016).
20
Another assumption that has been challenged by those entering the psy sciences from a position
of oppression is that madness should always be construed as pathological. Individuals with lived
experience who have thought deeply and critically about the psy sciences have suggested that
rather than viewing ‘mental disorders’ as such, they might be better thought of as ‘dangerous
gifts’ (DuBrul 2014), or experiences that can ground ‘mad pride’ (Hoffman 2019; Beazer 2017;
Schrader, Jones, and Shattell 2013). The neurodiversity movement, which has grown out of self-
advocacy by autistic people, has questioned medicine’s tendency to pathologize and attempt to
cure experiences that may better be thought of as differences worth accommodating (Graby
2015). Critical disability studies, including the social model of disability, which seeks to
counteract the exclusive focus on individual ‘impairments’ through an examination of how
structural forces shape experiences of disability, has also proved useful in highlighting the source
of our dis-ease with madness (Beresford, Nettle, and Perring 2010; B. Lewis 2006; Castrodale
2017). Others have documented the links between madness and creativity, including poetry,
music, and art (Hankir et al. 2012; Jamison 1996, 2011; Chadwick 1997), and highlighted how
much can be gained from experiences of madness; the peer-run organization Intentional Peer
Support is guided by the notion of ‘crisis as opportunity’, while increasing evidence documents
the potential for post-traumatic growth following experiences of psychosis
17
(Jordan, Malla, and
Iyer 2019; Shery Mead). As Bhargavi Davar has put it, “if living life from a non-rational creative
space is ‘insanity’, I accept that as a gift and a blessing” (B.V. Davar 2015).
Developing Novel Tools and Theories
Similarly, ample evidence suggests that those who have attained a standpoint in the psy sciences
are capable of developing novel avenues of research, promising theories and hypotheses, and
new tools for support. In direct response to the resistance to defining wellbeing as merely an
improvement on a symptom scale, survivor led research has sought to balance such research with
more expansive knowledge projects. Inspired by the voices of service users demanding research
17
Relatedly, Rachel Liebert, drawing on Gloria Anzaldua, has suggested that we could benefit
from recognizing not only the negative, but the positive potential of paranoia, including the extra
sensory capacities it might promote in individuals, and the way in which it might represent an
appropriate and fruitful response to experiences of oppression (Liebert 2018).
21
that maps onto what is meaningful to them, service user led research has spurred countless
research programs seeking to understand the many factors that contribute to wellbeing on a wider
scale. In just the realm of research involving treatments and support for those who have
experienced psychosis and/ or received a diagnosis of schizophrenia, research has been taken up
which examines the important, but often neglected role of factors like side effects, peer support,
self-esteem, exercise, personal agency, and goal attainment, in contributing to quality of life
(A.P. Morrison et al. 2013; Ritsner et al. 2003; Resnick, Rosenheck, and Lehman 2004).
Similarly, topics that are significant to service users, but that are rarely taken up in mainstream
psychiatry, such as involuntary treatment, coercion, and police brutality, have been examined in
detail in anthologies, zines, and other works written and compiled by survivors (Green and
Ubozoh 2019; LeFrançois, Menzies, and Reaume 2013; Cuijpers 2019; Janet Wallcraft, Read,
and Sweeney 2003; Sweeney et al. 2009). It is worth noting that much of this literature points
away from the individual, who is often the focus within the psy sciences, as both of the source
of, and solution to, their suffering. Rather than examining each individual as a site of symptoms
and treatments, many who have attained a standpoint in the psy sciences look beyond the
individual and towards broader structural issues, related to trauma, neoliberalism, various forms
of oppression, stereotypes, and the loss of agency that can accompany diagnosis (Voronka 2019;
Jayasree Kalathil and Faulkner 2015b; B.V. Davar 2015; Beresford and Menzies 2014).
This is especially the case in service user communities in the Global South, where colonial
histories and the material conditions of poverty impose themselves frequently, making them
much harder to sweep them under the rug. As the Cape Town Declaration of the Pan African
Network of People with Psychosocial Disabilities states, “The history of psychiatry haunts our
present. Our people remain chained and shackled in institutions and by ideas which our
colonisers brought to our continent” (The Pan African Network of People with Psychosocial
Disabilities 2011). The Trans Asian Strategy Group on Persons with Psycho-Social Disabilities
asserts that it is essential to look beyond issues related to medical treatment and to focus on
“social security and inclusion, safety, self-dignity and the fulfillment of human rights, liberty and
freedoms, education, independent living, employment” (Trans Asian Strategy Group of Persons
with Psycho-Social Disabilities 2014).
22
The Hearing Voices Network (HVN) is one of the best known examples of a new theory and
research program stemming from the lived experiences of service users (Hearing Voices
Network 2020). Aligning with those who sought to push against the view that an experience of
mental distress is necessarily harmful and pathological, the HVN takes a step back and views
experiences of voice hearing through a much wider lens than the psy sciences typically do.
Seeking to understand the role that traumatic experiences play in contributing to experiences of
voice hearing, and working actively to develop ways in which one can improve the relationships
they have with the voices they hear, this network challenges the status quo in theories of
psychosis and auditory hallucinations, and has had an enormous impact (Ruddle, Mason, and
Wykes 2011; Oakland and Berry 2015; Longden, Read, and Dillon 2018). Not only has the
movement produced novel research programs, theories, tools, and communities of support all
over the globe, but it has been felt deep within the academy, and is reshaping the questions
asked, and the forms of expertise acknowledged, within research on hallucinations
("International Consortium on Hallucination Research" 2018; Miller Tate 2018; Powers, Bien,
and Corlett 2018; Kay, Kendall, and Dark 2017).
Countless tools for support have been developed by service users, drawing on their experiences
of suffering and mistreatment in order to construct options for others that look different.
Dialectical Behavior Therapy, widely accepted as one of the most promising tools of support for
those thinking about suicide or diagnosed with Borderline Personality Disorder, was developed
by Marsha Linehan in light of her own experiences as a service user (McCauley et al. 2018; van
den Bosch et al. 2005). Recounting her early experiences in seclusion, she says “I was in hell..
And I made a vow: when I get out, I’m going to come back and get others out of here” (Carey
2011). Mary Ellen Copeland created the Wellness Recovery Action Plan, which helps
individuals identify their early warning signs, what things look like when they are breaking
down, and a crisis plan, so that they can dictate what happens to them if they are in need of
support (Advocates for Human Potential ; Cook et al. 2011). In Pune, India, survivor Bhargavi
Davar has established the Bapu Trust, which runs the Seher program, a form of local support
which aims to create conversations about well-being with those in low-income communities
23
(Mills and Davar 2016), as well as Sanchit, an oral history archive of individuals diagnosed with
mental illnesses and collection of resources related to survivor experiences (B. Davar 2016).
The Icarus Project, a support and education project developed by and for service users, has
created support groups all over the world and released multiple tools to help those in crisis.
These include a collective document called Friends Make the Best Medicine: A Guide to
Creating Community Mental Health Support Networks, as well as Mad Maps, documents
inspired by advance directives that allow individuals to reflect on their challenges, gifts, and
triggers, in order to develop “strategies for self-determined well-being” (DuBrul 2014; "Mad
Maps" 2015). Over 50 collaborators from within the Occupy Wall Street movement, including
many mental health activists, collectively wrote the book Mindful Occupation: Rising Up
without Burning Out, a manual for organizers focused on maintaining wellbeing, offering
support, and healing from the harms that can be caused by participating in protests and
experiencing police violence (Mindful Occupation: Rising Up Without Burning Out 2012)
18
. In
order to support those hoping to withdraw from psychiatric medications, the Freedom Center, in
collaboration with the Icarus Project, released the Harm Reduction Guide for Coming off
Psychiatric Drugs (Hall et al. 2007).
Objectivity
These examples offer evidence of the important role that individuals with lived experience can
play in identifying problematic assumptions and developing novel tools and theories within the
psy sciences. This suggests that user involvement in the psy sciences is likely to contribute to a
more objective view of mental health and distress, as the values and assumptions that have long
guided the field are uncovered and rejected, and as novel research programs and interventions
are developed to better support those in crisis or receiving services. These contributions, in
which assumptions are identified and new research programs are developed, can also help those
within the field to reflect on how values have shaped the field over time, leading to greater
reflexivity, and in turn, strong objectivity (Harding 1992). Furthermore, the diversification of the
18
For a fascinating ethnographic and reflexive account of the development of this book, see
(Bossewitch 2016).
24
field, occurring through the expansion of who is permitted to take part in knowledge projects, is
likely to bring to light biases that are present, which can then, ideally, be expunged (Intemann
2010).
Taken together, this evidence substantiates the claim that arriving at a standpoint gives one an
epistemic advantage within the psy sciences. In the following section, we consider some
implications that might fall out of this claim.
Implications
If it is the case that critically reflecting on one’s experience of marginalization within the psy
sciences offers one an epistemic advantage in relation to knowledge projects in this domain, then
what follows? First and foremost, the psy sciences ought to incorporate the views, skills, and
expertise of those who have attained standpoints in all stages and domains of research
19
. While
there are already good ethical reasons to involve service users in mental health research
(Beresford 2002; Friesen et al. 2019), the evidence for standpoint theory in the psy sciences
offers an additional and compelling epistemic reason for such involvement. If those who have
attained a standpoint in the psy sciences have a unique epistemic potential with regards to
identifying problematic assumptions plaguing the field, developing promising avenues of
research, and contributing to the objectivity of ongoing research, serious efforts should be made
to increase the amount of service user led and participatory research taking place. What this
involvement should look like is a complex and multi-faceted question. A promising first step in
answering this question is to consider the substantial barriers and challenges that have been
encountered in efforts to date. While participatory methods have been taken up in some domains
19
An interesting additional question is whether the epistemic advantage one gains with a
standpoint in the psy sciences extends from the domain of research to that of practice. While we
do not have space to consider this question in detail here, there is good reason to think that this
may be the case. Evidence for such an extension stems from the many effective clinical tools that
have been developed by individuals with lived experience mentioned above, as well as growing
evidence demonstrating the effectiveness of peer support, peer run centers, and the inclusion of
peers on clinical teams (Simpson and House 2002; S.E. Lewis, Hopper, and Healion 2012; Druss
et al. 2010; Vayshenker et al. 2016; Adame 2008).
25
of the psy sciences more than others (e.g. qualitative research, but not clinical trials), and in some
countries more than others (e.g. the United Kingdom more than the United States), there are
challenges across the board (Jayasree Kalathil and Jones 2016).
In places like the United Kingdom, where service user involvement in mental health research and
decision-making is much more common than elsewhere, since it is required by major funding
bodies, issues related to tokenism, role confusion, and harmful instances of participation are
common (Department of Health 2009; J Kalathil 2010). Examples abound of investigators failing
to reflect on what and how service users might contribute to their research before bringing them
to a table, strategically selecting service users who already agree with the directions of the
research, or dismissing the input of participants with reference to their diagnoses (Russell et al.
2018; L. Lewis 2009; Brett et al. 2012; Jones et al. 2014). This suggests that the involvement of
those who have attained a standpoint in research needs to be well thought through and not merely
a box-ticking exercise. This also means sharing authority with those who have a standpoint,
engaging in co-production, funding user-led research, and delegating spaces for clear
contributions within traditional research projects.
Pushback against the notion of a ‘professionalized’ participant is also interesting to reflect upon
(Brett et al. 2012). Many moans can be heard in discussions of public and patient involvement
(PPI) about the number of mental health service users who partake in research regularly;
concerns that they have lost their ‘lay’ or ‘community member’ status are common. These
worries about professionalism reflect a paradox that arises for many who have attained a
standpoint in the psy sciences. If they are not well versed in research methods and familiar with
the contours of participatory projects, they are thought to lack credibility, but if they are
experienced in and familiar with research settings, they are considered to be too
‘professionalized’ and no longer representative of other service users. This create a lose-lose
situation for many. Importantly, however, involving those with standpoints in the psy sciences is
different than involving anyone with lived experience of receiving mental health services.
Because those who have attained a standpoint have engaged in a period of critical reflection on
the power structures that shape the psy sciences, they are not merely patient representatives, but
experts on how knowledge is shaped and impacts daily lives within mental health services. Thus,
26
the involvement of those who have attained a standpoint does not mean all service users are
represented within a project; it means that someone with a unique ability to understand the psy
sciences is involved in the project. In a discussion of the ‘double identity’ that those who are
both researchers and community members have, Diana Rose notes that “I do not define a ‘user
researcher’ as someone who is a researcher and just happens to have received mental health
services. A ‘service user researcher’ is someone who uses their experience of being in receipt of
services to inform their research practice from start to finish” (Diana Rose 2014, 154).
A related worry concerns co-optation. The ways in which the recovery movement and peer
support initiatives have been co-opted by neoliberal institutions has been widely recognised
within service user communities and beyond (Beresford and Russo 2016; Morrow and Weisser
2012; Penney and Prescott 2016; Morrow 2013). Eriksson describes the way in which
organizations engaged in service user involvement used processes of bonding, framing the
activities, and controlling the activities to restrict the influence of users involved in their projects.
While service users resisted these forms of cooptation, this resistance was limited by the
boundaries of involvement laid out by the organizations, resulting in a ‘sanctioned resistance’
that both pushed against and supported the existing institutional logic (Eriksson 2018). Costa and
colleagues describe another form of cooptation that occurs frequently within involvement
initiatives: “It is now commonplace for mental health organizations to solicit personal stories
from clients—typically, about their fall into and subsequent recovery from mental illness. These
stories function to garner support from authority figures such as politicians and philanthropists,
to build the organizational “brand” regardless of program quality, and to raise operating funds
during times of economic constraint” (Costa et al. 2012). These examples should serve as
warnings of the risk of virtue signalling through participatory approaches or what could be called
‘involvement washing’, in a time when projects and organizations are increasingly rewarded for
highlighting the ways in which they take up the views of service users in their work.
Placing those who have attained a standpoint in leadership positions in research will require
facilitating opportunities for individuals to receive training that will prepare them for such
positions. Nev Jones and Robyn Brown’s discussion of the lack of c/s/x (consumer, survivor, ex-
patient) voices in academia highlights a variety of barriers that appear in this domain (Jones and
27
Brown 2013). Stereotypes about those who have received a mental health diagnosis loom large,
including fears that individuals with standpoints might be biased, ‘too close’ to research,
incapable or irrational. The authors discuss a recent survey of graduate admissions directors for a
psychology program in which “disclosures of personal mental health issues [came to be known]
as a "kiss of death" in the admissions process” ((Appleby and Appleby 2006) cited in (Jones and
Brown 2013)). Additional difficulties for those seeking to attain a standpoint through academic
pathways include accommodations, mentoring, climate, and discrimination (Jones and Brown
2013). This suggests that working towards appropriate and deserved inclusion in institutions
engaged in the psy sciences will be a long and transformative process. Given these barriers,
Bonnie Burstow has reflected on how adult education could be revised to better support
psychiatric survivors, including building in safety and advocacy, allowing for sporadic
attendance, and learning about and connecting with resistance efforts (Burstow 2003).
Importantly, recognizing the epistemic advantages that those with standpoints have to offer to the
psy sciences will mean revising research significantly. While it is clear that in most domains of
health research, democratization is taking place and lived experience is being recognized as a
valuable foundation for knowledge, participatory research projects still often resemble the status
quo with a slight ‘twist’. As we have seen, however, the insights provided by standpoints have
the potential to identify problematic assumptions that may be deeply embedded in a field and
develop new research programs that were previously unthought of. In order to ensure that the
benefits of these standpoints are captured within research, the participatory shift cannot be
merely a gesture of recognition, but must also involve shifts in power. It is crucial to have those
who have attained a standpoint leading research projects and running centers, so that the field
can evolve towards more fruitful lines of inquiry (Russo 2012).
Objections
Whose Values?
An objection one might raise in response to our claim that lived experience of marginalization
and critical engagement with the psy sciences leads to an epistemic advantage within relevant
28
knowledge projects is that standpoint theory appears to favor some values (those of the
oppressed) over others, but hasn’t made an argument in favor of those particular values. This
critique stems from Susan Hekman who argues that standpoint theorists successfully make the
case that all knowledge is socially situated, but fail to demonstrate that there is one standpoint
that is better than others (Hekman 1997). This concern is linked to the shift towards feminist
empiricism taken up by some standpoint theorists, as a result of the bias paradox (Antony 1993;
Intemann 2010)
20
. An extension of this objection is the worry that the oppressed are likely to
enter scientific investigations with their own biases and values that may also distort research
21
.
However, standpoint theory does not involve a privileging of particular values, but rather a
recognition that the capacity to identify problematic assumptions and develop novel theories
guiding the production of knowledge, a capacity that arises along with the attainment of a
standpoint, is valuable. An objection often posed in response to feminist empiricism, that all
values, no matter how morally or politically problematic (e.g. those of the neo-nazis) ought to be
given consideration
22
, are not relevant to standpoint theory, which explicitly highlights the link
between oppression and the ability to think through how power shapes knowledge (Hicks 2011).
Those with standpoints are certain to have biases and values, as the thesis of socially situated
knowledge holds that there is no neutral, objective view from nowhere, but what’s important is
that such a standpoint offers one the ability to see the dominant paradigm in a different light.
Importantly, the values and interests of those with a standpoint are currently not well represented
at the table, and so objectivity will be strengthened through their representation. As Wylie
argues, “it is the political commitment that feminists bring to diverse fields that motivates them
to focus attention on lines of evidence others have not sought out or thought important; to discern
20
The bias paradox falls out of the tension between critiquing impartiality as an androcentric
goal of science, while also critiquing androcentric values as partial. As Intemann puts it,
“feminists want to assert that male bias is bad because it is partial, while arguing that that the
norm of scientific impartiality is wrong” (Intemann 2010). Rather than choosing one or the other,
feminist empiricists opt for a form of ‘balanced partiality’ in which everyone is invited to the
table.
21
Thanks to ________ for emphasizing this point.
22
One response given to this objection from feminist empiricists has been to emphasize that, in
order to be given consideration, a view or value must not conflict with formal egalitarianism and
promote the standing of one group or subgroup over another (Rolin 2017).
29
patterns others have ignored; to question androcentric or sexist framework assumptions that have
gone unnoticed and unchallenged; and, sometimes, to significantly reframe the research agenda
of their discipline in light of different questions, or an expanded repertoire of explanatory
hypotheses” (Wylie 2003, 38).
Assuming Essentialism?
A second objection one might raise is that standpoint theory as applied to the psy sciences
assumes that there is a shared perspective to be found among all consumer/ survivors/ ex-
patients, while no such perspective exists. Indeed, the risks of essentialism that fall out of claims
that ‘those with lived experience’ have experiential authority and can represent all of those
within the experiential category has been well explicated by Jijian Voronka (Voronka 2016).
However, alignment or agreement between those with lived experience is neither expected nor
necessary for standpoint theory to pertain to the psy sciences (Jones and Kelly 2015). Individual
standpoints will look different depending on unique intersecting identities, and these differences
will further contribute to the advancement of knowledge. A person of colour who has accessed
mental health services may well have had different kinds of experiences than a white person, and
these differences will contribute to their potential to contribute to epistemic projects related to
the psy sciences; this means that involving those with intersectional identities and diverse
experiences of marginalization will further contribute to advancing knowledge projects (Jayasree
Kalathil and Faulkner 2015a; Jayasree Kalathil 2008; Beresford 2020). Importantly, standpoint
theory is not aligned with claims about essential knowledge that is derived from a particular
social location. Rather, one’s social location shapes one’s own particular knowledge and critical
engagement hones that knowledge in order to help one develop an epistemic capacity in the
domain in which one has experienced marginalization. Importantly, this does not mean that
someone with a particular diagnosis or experience can be expected to / should be asked to speak
for all others who share that diagnosis or experience (Voronka 2016; Davis 2016).
A Distinct Knowledge Project?
30
Another objection holds that there is no sense in asking who has an epistemic advantage within
the psy sciences, since those working within the dominant medical model and those within
communities of service users are engaged in two distinct knowledge projects within two meta-
epistemological frameworks. What counts as a successful instance of research in one domain is
unlikely to count as successful in another, since different values shape what questions,
methodologies, and research formats, count. In line with this, one might suggest that what arises
from standpoints in the psy sciences is simply an “alternative form of knowledge” (Weedon
1987). However, in the psy sciences, the goal in either domain is arguably to improve the
wellbeing of those experiencing mental distress. Crucially, how to go about achieving this task
can only be answered with reference to the subjectivity of individuals with lived experience of
that mental distress. While this is the case in all health sciences, this is especially important in
the psy sciences, because there are no biomarkers through with clinicians can avoid such
subjectivity (e.g., as with a test for tuberculosis). This suggests that the projects taking place in
the dominant research paradigm and service user communities cannot be disentangled.
Furthermore, this indicates that an epistemic advantage in the psy sciences is an epistemic
advantage in either of these knowledge projects.
Is this Relativism?
Standpoint theory is often objected to with claims that it is relativistic. Relativism holds that
there is no view that is better than another, since each perspective is unique, and we have no
tools with which to evaluate one over the other. However, this objection is misplaced, and stems
from conflating the thesis of socially situated knowledge, a starting point for standpoint theory,
with relativism (Wylie 2003). However, the thesis of socially situated knowledge is merely a
descriptive claim about how people come to know what they know, emphasizing the social
aspect of this process, but it does not claim that each viewpoint is equal. On the contrary,
standpoint theory explicitly claims that some viewpoints, resulting from different social
situations, are better than others, in that they lead to the potential to develop a standpoint, which
offers an epistemic advantage with regards to particular knowledge projects. This normative
component of standpoint theory draws upon experiences of power and oppression, and how these
can lend themselves to unique insights, but never makes a relativistic claim with regards to
31
knowledge. As Harding points out, the onus is on the objector to show why relativism is a threat
to this theory: “Standpoint theory provides arguments for the claim that some social situations
are scientifically better than others as places from which to start off knowledge projects, and
those arguments must be defeated if the charge of relativism is to gain plausibility” (Harding
1992, 131).
Taking Standpoints into Account?
Another objection that might be raised is whether the argument that’s been put forward truly
justifies the conclusion we’ve come to. Indeed, one reviewer for this manuscript wondered
whether some individuals with a standpoint may be less epistemically trustworthy in connection
with their lived experience, because irrationality may be part and parcel of a mental disorder,
while another expressed concern that many who have attained a standpoint may not have
sufficient research skills to contribute to the psy sciences. As a result, they argued, it may be
preferable for those within the academy to continue to do this work, but from the point of view
of, or with guidance from, those with a standpoint. This would be a more efficient way to ensure
that their epistemic insights are taken into account and would not require such a radical
reconstruction of how we’ve set up our institutions of knowledge.
First, with regards to the epistemic trustworthiness of those who have attained a standpoint,
while it is the case that some extreme states can lead to a loss of one’s ability to contribute to a
research project, the simple association of madness and unreason is far too easy. As evidenced
above, individuals who have attained a standpoint are capable of making significant
contributions to the psy sciences. Some will, of course, require additional training before being
able to conduct particular kinds of research, and this is why reducing the barriers to access for
those with lived experience, as discussed above, is so important. It is worth acknowledging that
research involving service users may well include unexpected pauses and challenges, if an
individual is struggling to contribute to the project at a given time (Jones and Shattell 2016). Of
course, such roadblocks are not exclusive to research that involves those with a standpoint, and
probably most projects would be better off if they built accommodations for wellbeing into their
research plans for the start.
32
What about the suggestion of merely taking standpoints into account, so that these extra
challenges could be avoided? As mentioned above, it isn’t the case that only those who have
attained a standpoint are able to see the problematic assumptions underlying the psy sciences,
develop new tools and theories, and contribute to (strong) objectivity within the field, but that
those with a standpoint are likely to have an epistemic advantage over others when it comes to
these activities. While it is an open question as to whether those who have lived outside of such
experiences would be able to successfully take on such a point of view, given the limits of our
imaginations (Mackenzie and Scully 2007), such a route risks maintaining current power
structures and is likely to lead to further harms. Beyond the epistemic reasons we have offered to
include those who have attained a standpoint in knowledge practices in the psy sciences, there
are many compelling ethical reasons to share power with those who are the subjects of those
knowledge practices. These include an enduring history of human rights abuses committed by
the psy sciences, the many ways in which these knowledge practices have been and continue to
be used as tools of oppression (e.g. classifying homosexuality, drapetomania as mental
disorders), and the frequency with which assessments of incapacity have been used to justify
coercion and paternalism in the treatment of those considered mad (Friesen et al. 2019). For
these reasons, merely speaking for those with standpoints, while continuing to exclude them
from the conversation, is likely to only reinforce stereotypes, produce epistemic injustice, and
silence those who have long lacked a voice.
Takeaways
In light of an examination of the intersection between feminist standpoint theory and the psy
sciences, we have argued that individuals who have lived experience of the mental health system
from a position of marginalization, and who have thought critically about knowledge production
within the field, are likely to have attained a standpoint that provides them with an epistemic
advantage within the psy sciences. This argument rests upon evidence that demonstrates a
positive impact on these sciences as a result of the involvement and critical work of service users
and survivors. This impact involves contributions to identifying problematic assumptions,
33
building up new methodologies and research questions, and therefore contributing to stronger
objectivity within the field. The implications of this argument are significant: those who have
attained a standpoint within the psy sciences ought to be included in research in this domain and
given the tools and funding to develop their own research programs. However, we must be wary
of risks of cooptation, essentialization and tokenization that come with the act of privileging such
first-hand experience.
34
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