Philosophy SIG Conference: Implicit bias in Psychiatric Practice: What lessons can Philosophy offer to practitioners, learners & educators?

The phenomenon of implicit bias, and the way it impacts delivery of mental health services, has attracted a lot of interest in recent years. Efforts to tackle its presence have been proposed but this is shown to be quite difficult for various reasons. The Philosophy SIG of the Royal College of psychiatry invites you this one-day online conference, where a mix of philosophers and researchers working in the field of mental health, and psychiatrists with a keen philosophical mind, bring a rich array of reflections and proposals on how to approach it as a phenomenon emerging in practice, and how to address it within it and through medical education in mental health.

Two experienced psychiatrists, Dr Stewart and Dr Hubbeling, will start the conference reflecting on the extremely difficult, if not impossible, task to practice entirely free of bias and how philosophy can offer a way to unmask its presence and a pragmatic approach in delivering care. The moral philosophers, Dr Chappell and Prof Jeppsson will illustrate with the use of examples a pro-normality bias hidden within the recovery framework and will invite us to recognise it and fight it. Dr Radoilska, a philosopher working in the intersection of philosophy of action, ethics and epistemology, will explore how epistemic injustice and moral luck shape implicit bias and will propose how rethinking expertise can help towards addressing it. Dr Ritunnano, Dr Fernandez and Prof Broome explore how psychiatric diagnoses such as in the case of delusions and psychotic phenomena, are implicitly value-laden and in that way obfuscate the testimony as provided by the patient, often concealing the meaning it may hold for their life. Dr Markham will explore how mental health stigma and notions of risk impact patients in secure and forensic mental health settings. Will trace some of the phenomena to Beck’s concept of risk society and will invite for remediation strategies. A further dive into the concepts of risk and causation will be made by Dr Bhandari, Prof Thomassen and Prof Nathan, who in their presentation will propose a modified approach to Root Cause Analysis that will potentially account for implicit factors that are often overlooked when this takes place. 

Prof Tim Thornton will start the afternoon sessions with his talk on “implicit bias: the ‘dark side’ of hinge epistemology?” Prof Thornton has worked and published on tacit knowledge and psychiatric expertise over the years. In his talk he will unpack the concept of implicit bias, separating the negative value terms that are rightly attribute to it, from what at its core is a necessary component for building clinical expertise. His talk will be followed by Dr Awais Aftab, who is going to offer a detailed educational proposal on how conceptual competence in psychiatry can mitigate the presence of implicit bias by promoting a kind of epistemic humility. Dr Wodzinski and Prof Moskalewicz will present us an impressive amount of research that they have conducted in Poland that explores the discursive sources of epistemic injustice towards people with autism based on a corpus of 1300 press articles. Dr Reed and Dr Olaciregui will illustrate how an implicit neurodetermisnistic causal privilege impacts the assessment and treatment of Psychogenic Non-Epileptic Seizures (PNES). Dr Thompson will close the conference exploring the epistemic injustice in adult protection cases. He uses clinical material to illustrate how this takes place and suggests a series of interventions to mitigate it. 

Our rich offer does not end there though. Following the main event, and in collaboration with the WPA Section for Philosophy and Humanities, we organised a Satellite webinar on Shared Decision-Making in Psychiatry. The presenters, Dr Bergqvist, Alana Wilde, and Dr Crepaz-Keay will look at implicit bias and the challenges it poses to Co-production.  A set of challenging questions will be asked that will invite all participants to reflect on current mental health policies that champion co-production as a core component of their strategy.

How do we attain a better informed and realistic view of the value of stakeholders as knowers in translational research and co-production in psychiatry? What is the value of knowledge and social epistemology in this domain?

Ethical involvement of those with lived experience of mental health concerns, particularly with regard to mental ill-health prevention, mental health and well-being promotion, and collaborative treatment design, raises a whole host of questions that are both theoretically, and practically important.

This seminar addresses some of the doubts regarding credibility of individuals with lived experience – how EbE ought to be included in discussions, in planning, and in implementation of shared decision-making in psychiatry. Research has indicated that thus far, even well-intentioned researchers exclude the views of EbE in producing summary reports and policies, raising the question: if the narratives of those with lived experience are ignored, how are we to truly considered any approach to public mental health ‘co-produced’? What is the moral significance of the first-person perspective? And how do epistemic violence and social injustices impede or impact upon our knowledge-gathering capacities?