Disorder or distress? The hermeneutical injustices of overdiagnosis within psychiatry

Abstract Epistemic injustices within diagnostic practices in health care have increasingly been the object of research in recent years. However, most accounts focus on either under- or misdiagnosis resulting from epistemic injustices and have largely neglected the issue of overdiagnosis. This paper explicates what overdiagnosis entails in psychiatry and outline several structural problems within diagnostic practices that enable overdiagnosis. Afterwards, it is argued that overdiagnosis constitutes an instance of hermeneutical injustice. The overdiagnosed are wronged by being classified, perceived, and treated as sick by themselves, healthcare, and society due to problematic diagnostic practices within psychiatry, though their distress might be non-pathological, or they do not stand to benefit from medical treatment. Consequently, the overdiagnosed experience difficulties in being understood, making themselves understood, and understanding themselves, which leads to cognitive disablement and hermeneutical marginalization. Such epistemic injustices indicate the need for less diagnose-centric healthcare systems where help and recognition does not hinge on the ascription of labels.