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Testimonial injustice: considering caregivers in paediatric behavioural healthcare
  1. Michelle Trang Pham1,
  2. Eric A Storch2,
  3. Gabriel Lázaro-Muñoz1,3
  1. 1 Center for Bioethics, Harvard Medical School, Boston, Massachusetts, USA
  2. 2 Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
  3. 3 Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Michelle Trang Pham, Center for Bioethics, Harvard Medical School, Boston, MA 02115, USA; michelletrang_pham{at}

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Harcourt argues that in clinical contexts, children and young people (CYPs) with mental health illness can experience epistemic, specifically testimonial, injustice when their perspectives are unjustifiably discounted by health service providers.1 Our goal in this commentary was to illustrate how caregivers, a critical component of CYP treatment triad (patient–caregiver–clinician), can also engage in testimonial injustice towards CYP patients.

Testimonial injustice occurs when one (1) suffers a credibility deficit and (2) that credibility deficit is based on prejudice.2 Harcourt expands Fricker’s account of testimonial injustice by arguing that for CYPs, the credibility deficits attributed to them by clinicians, for example, may result from epistemic arrogance in that CYPs are viewed as having unreliable knowledge about their condition. Harcourt writes: ‘Being a CYP is treated as a heuristic for epistemic unreliability across a wide range of domains’ (p3), including clinical settings. Harcourt’s expansion of Fricker’s account thus includes epistemic arrogance as an alternative necessary condition, in addition to prejudice, to apply the concept of testimonial injustice.

We think Harcourt’s argument can also be extended to caregivers, who are central to the CYP treatment triad. We illustrate how this may be the case by drawing from research we conducted to understand the perspectives of clinicians and prospective families, both caregivers and paediatric patients with obsessive–compulsive disorder (OCD) about the possibility of …

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  • Funding Research for this work was supported by BRAIN Initiative grants from the US National Institutes of Health (award numbers R01MH114854 and R01MH121371).

  • Disclaimer The views expressed are those of the authors alone and do not necessarily reflect the views of the National Institutes of Health, Harvard Medical School, Massachusetts General Hospital or Baylor College of Medicine.

  • Competing interests Dr. Storch receives book royalties from Elsevier, Wiley, Oxford, American Psychological Association, Jessica Kingsley, Springer, and Lawrence Erlbaum. He is a consultant for Biohaven. He co-founded Rethinking Behavioral Health which is a healthcare consulting group. He owns stock in NView. He receives research support from NIH, Ream Foundation, IOCDF, and Texas Higher Education Coordinating Board.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Also note that clinical characteristic (eg, insight) may impact CYPs’ ability to make effective decisions. See Selles et al 4.

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