Discursive Injustice in Healthcare Contexts: Between Microaggressions, Epistemic Injustice, and Silencing
The workshop explores a range of themes closely connected to Lauren Freeman’s work on microaggressions in medicine, including discursive and epistemic injustice, silencing, and the interactional dynamics through which harm is produced in healthcare contexts.
Organisation: Maria Grazia Rossi (ArgLab) & Cristina Ganz. Those who are interested in joining the workshop are invited to get in touch with Maria Grazia Rossi: mgrazia.rossi@fcsh.unl.pt.
Programme
15:00–15:10
Welcome and Introduction
15:10–15:40
Lauren Freeman (University of Louisville)
“Introductory Remarks: Microaggressions in Medicine — Conceptual Foundations, Collaborative Practice, and Clinical Uptake”
15:40–16:10
Elena Piccinelli (Instituto Universitário de Lisboa)
“Gender Microaggressions and Intersectional Power Relations: Insights from the Portuguese Healthcare Context and Beyond”
16:10–16:40
Mara Floris (Università Vita-Salute San Raffaele), Cristina Ganz (Università Vita-Salute San Raffaele) & Margherita Grassi (Universitat de Barcelona)
“The Psychologisation of Pain as Testimonial Injustice in Endometriosis”
16:40–17:10
Cristina Ganz (Università Vita-Salute San Raffaele), Mara Floris (Università Vita-Salute San Raffaele), Monica Consolandi (Fondazione Bruno Kessler), Noemi Paciscopi (Università Vita-Salute San Raffaele) & Maria Grazia Rossi (Universidade Nova de Lisboa)
“Discursive Injustice as Interactional Harm: Microaggressions in Pancreatic Cancer Care”
17:10–17:40
Final Discussion and concluding remarks
Abstracts
Lauren Freeman (University of Louisville), “Introductory Remarks: Microaggressions in Medicine — Conceptual Foundations, Collaborative Practice, and Clinical Uptake”
This contribution is structured around three main components. First, it offers a summary of the content of Microaggressions in Medicine, with the aim of motivating a philosophical discussion of the book. Second, it reflects on the genesis of the project and on the writing process, which emerged from a 10-year collaboration and mentorship relationship between professor and graduate student. Third, it addresses the uptake of the book, focusing in particular on how to talk to healthcare providers—and more broadly to non-philosophers—about applied philosophy.
Elena Piccinelli (Instituto Universitário de Lisboa), “Gender Microaggressions and Intersectional Power Relations: Insights from the Portuguese Healthcare Context and Beyond”
Microaggressions occur everywhere and every day in the lives of stigmatized and socially disadvantaged groups. Due to their subtle, ambiguous, and socially normalized nature, they have been consistently associated with negative consequences for mental health and psychological well-being. Consequently, scholars have increasingly argued for framing microaggressions as a form of subtle, perceived discrimination, situated within broader structures of power and inequality. Since these subtle forms of discrimination are rooted in context-specific beliefs and sustained by intersectional power dynamics, a comprehensive understanding of their manifestation requires examining them as embedded in, and shaped by, the cultural and societal contexts in which they occur. Drawing on findings from multiple qualitative studies, this presentation will explore the manifestation of gendered and intersectional microaggressions within the Portuguese healthcare context. In addition, it will highlight how vertical power relations, such as those between patients and healthcare providers, facilitate the occurrence of microaggressions and reinforce their harmful impact. The findings presented will further situate these dynamics within the broader Portuguese social context, paying particular attention to the role of post-colonial beliefs. To conclude, recommendations for interventions aimed at raising awareness and fostering cultural competence in healthcare settings and beyond will be discussed.
Mara Floris (Università Vita-Salute San Raffaele), Cristina Ganz (Università Vita-Salute San Raffaele), Margherita Grassi (Universitat de Barcelona), “The Psychologisation of Pain as Testimonial Injustice in Endometriosis”
Endometriosis is a chronic inflammatory condition characterised by lesions in and around the pelvis containing tissue similar to the uterine lining (Young et al., 2018: 2). It affects approximately 10–15% of individuals assigned female at birth and is characterised by chronic pelvic pain and significant diagnostic delays, often ranging from five to eleven years in Europe (Ballard et al., 2006; Giudice & Kao, 2004; Smolarz et al., 2021). Because imaging tools such as ultrasound and MRI frequently fail to detect lesions, clinical assessment depends heavily on patients’ pain reports (Becker et al., 2022). In this context, believing patients becomes epistemically central. Yet evidence shows that women’s reports of pelvic pain are often dismissed or reframed as emotional or psychological (Fernley, 2021; Paganini et al., 2023). For this reason, recently, endometriosis has been analysed through the lens of epistemic injustice (Hallström, 2024; Langmann et al., 2025), especially testimonial injustice – where a credibility deficit is attributed to individuals due to their actual or perceived social identity (Fricker, 2007). Drawing on semi-structured interviews (HEGOA project), we show the need to introduce complementary conceptual tools to better capture essential aspects of the cases under analysis, such as discursive injustice (Kukla, 2014; Bianchi & Caponetto, 2025) and gaslighting (Sweet, 2019; Manne, 2023). By introducing these complementary tools, we show how people with endometriosis are subjected to the psychologisation of pain, a process that relocates suffering from the body to the patient’s mind, thereby reinforcing patterns of epistemic marginalisation in clinical encounters.
Cristina Ganz (Università Vita-Salute San Raffaele), Mara Floris (Università Vita-Salute San Raffaele), Monica Consolandi (Fondazione Bruno Kessler), Noemi Paciscopi (Università Vita-Salute San Raffaele), Maria Grazia Rossi (Universidade Nova de Lisboa), “Discursive Injustice as Interactional Harm: Microaggressions in Pancreatic Cancer Care”
Drawing on the influential concept of epistemic injustice (Fricker, 2007), discursive injustice, also referred to as speech injustice, has been introduced to capture forms of harm affecting individuals in their capacity as discursive agents rather than as knowers (Kukla, 2014; Ayala, 2016). Discursive injustice arises when speakers’ contributions are systematically misrecognised, distorted, or rendered ineffective within interaction. Philosophical accounts distinguish two core manifestations of discursive injustice: silencing and illocutionary distortion, also referred to as interpretative injustice (Langton, 1993; Peet, 2015; Bianchi & Caponetto, 2025). Although epistemic injustice can be understood as a form of discursive injustice, existing work in healthcare has predominantly addressed epistemic harms at the level of credibility, knowledge attribution, or moral testimony, rather than as interactionally enacted discursive phenomena. Consequently, much of the literature relies on third-person case descriptions or patient testimonies, failing to capture how epistemic – and more broadly discursive – harms are produced, negotiated, and sustained within clinical interactions themselves (Nielsen et al., 2025). Against this background, a framework for analysing discursive injustice in patient-provider communication is advanced. Previous work in discourse studies suggests that discursive analysis is particularly suited to capturing the micro-processes through which epistemic – and, we suggest, more broadly interactional – forms of injustice are enacted and stabilised in interaction (Lee et al., 2019; Lakemann, 2010). Within this framework, microaggressions are examined as a central mechanism through which harms are discursively produced in healthcare contexts. Focusing on microaggressions as interactional mechanisms of discursive injustice, the analysis examines how patients’ communicative contributions are silenced, distorted, or undermined in clinical encounters, giving rise to problematic discursive trajectories. Drawing on recorded consultations in pancreatic cancer care (Consolandi et al., 2020; 2024), the study illustrates how such trajectories generate cumulative harm for patients.