Epistemic thinking refers to a cognitive and metacognitive process by which we reason about ‘knowledge’. Here, we aim to discuss the necessary and sufficient features of ‘knowledge’ insofar as they connect with our relational and intellectual ethics (in other words, ‘how we interact with others & ideas in practice’).
- What constitutes knowledge?
- How is it generated?
- Do specific social agents (i.e individuals) possess more epistemic authority?
- Why? Why not?
- What attributes of epistemic reasoning (in other words, what epistemic attitudes or higher order epistemic constructs) are conducive to identifying theories or ideas of relevance?
- What are the limitations of ‘knowledge’ and thinking about how we think about what constitutes ‘knowledge’?
- What ethical implications do epistemics and meta-epistemics have in connection to professional knowledge domains and the practice of everyday living?
- What ethical issues are implied by a healthcare system, built upon theoretical maps characterized by high epistemic uncertainty, where individual providers have more epistemic & decision-making power than the clients whom they serve?
In the mental health domain, where–not only are the DSM constructs lacking in reliability and predictive validity which reflects flaws in the categorical structure of the taxonomy itself–the detection of disorder can implicitly undermine personhood, what kind of ethical implications does this have for ‘practitioner-client’ interactions? Are sufficient ethical principles really underlying the evaluation and treatment of clients? Or do we have some problems that we need to address in terms of how we conceptualize and implement these ethics? Is the evaluation and treatment process more likely to be driven by the institutional desire to manage risk rather than to relationally engage ? Is it ethical to make such diagnostic claims in light of such statistical and conceptual gaps? If a diagnosis must be made for practical reasons (insurance, for instance), then how should a ‘diagnosis’ be communicated? To be clear, we are not implying that professionals who engage in the act of diagnosis are behaving unethically: not only is the purpose of such diagnostic constructs to shed light on the pathophysiology of disorder in order to reverse engineer the problem (though, we could certainly debate the extent to which this process does or does not function in this way), many clients seek closure and comfort in such declarations. The needs of providers and client stakeholders are critically important; however, what if an excessive psychological need for closure, actually undermines the capacity for critical thinking & balanced appraisals in some situations? What if a pervasive psychological intolerance of uncertainty undermines our individual and collective capacities for sense-making? Here, the specific pain point that we seek to address is the problem that presents when diagnostic claims are made in the absence of enough information to make such epistemic & ontological claims.
Barring clear structural damage (you know, shattered bones, dead tissue, etc), most health information is rarely so simple and unidimensional . Appraising ‘diagnosis’ as ‘predictive prognosis’ might be a comforting crutch, but we wonder if this is epistemically dishonest to an some extent? Perhaps the point at which scientific and medical information is communicated, is where we need to consider an ethic of ambiguity upon which to deploy the use of appropriate language that would allow us to receive, integrate, and express messages about the strengths & limitations of our knowledge. Maybe it is in the light such an honest ‘unknowing’, that we could learn to find meaning, value, and maybe even some conceptually creative solutions, to our continuous problems.
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