{
  "abstract": "Psychiatry combines clinical expertise with substantial institutional authority over diagnosis, treatment access, coercion, clinical records and the credibility assigned to people receiving care. This Essay examines how that authority can impede learning from recurrent warnings across professional misconduct, coercive care, diagnostic practices and iatrogenic harm. We propose institutional non-learning as a cross-cutting problem: professional interpretation can shape whose testimony is believed, which harms are measured, how events are recorded and whether reform is evaluated. Drawing on epistemic injustice, psychiatric survivor research, treatment-safety research, publication and outcome-reporting bias, and empirical studies of diagnostic bias, we develop a framework for epistemic reciprocity and accountability. It distinguishes occurrence from prevalence, recognises that treatment risk varies across populations and contexts, separates benefit from safety, applies reflexive scrutiny across clinical, academic and lived experience expertise, and extends representativeness to both research participants and the published evidence base. We use ignorance culture, exclusion culture, defensiveness and diagnostic weaponisation to describe recurring institutional functions. A responsibility culture requires independent scrutiny, prospective harm surveillance, lived experience governance, remedy and redress, and publicly evaluable evidence that practice has changed and safety has improved.",
  "abstract_shown": true,
  "affiliations": [
    "Independent Researcher, Sydney, New South Wales, Australia",
    "National PTSD Research Centre, Thompson Institute, University of the Sunshine Coast, Birtinya, Queensland, Australia",
    "Independent Researcher, Cardiff, United Kingdom",
    "University of Melbourne, Melbourne, Victoria, Australia",
    "University of Sydney, Sydney, New South Wales, Australia"
  ],
  "article_type": "Essay",
  "arxiv": null,
  "author_total": 5,
  "authors": [
    {
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        0
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      "name": "Laurence Cobbaert"
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      "name": "Rosiel Elwyn"
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    {
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        2
      ],
      "name": "James Downs"
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    {
      "affs": [
        3
      ],
      "name": "Sandi James"
    },
    {
      "affs": [
        4
      ],
      "name": "Matthew Jackman"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/44nyedakac4jg.bib",
  "cited_by": 0,
  "doi": "10.1371/journal.pmen.0000741",
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  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
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  "native_subjects": [
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      "3312|Feminist Epistemology and Gender Studies"
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      "/Medicine and health sciences/Mental health and psychiatry/Mental health therapies/Psychotherapy"
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      "/Medicine and health sciences/Mental health and psychiatry/Personality disorders"
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      "/Social sciences/Psychology/Cognitive psychology/Learning/Human learning"
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  "pdf_url": "https://journals.plos.org/mentalhealth/article/file?id=10.1371/journal.pmen.0000741&type=printable",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-05",
  "publisher": "Public Library of Science",
  "ris": "https://research.draconitic.com/paper/44nyedakac4jg.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:37Z",
      "native_id": "10.1371/journal.pmen.0000741",
      "source": "plos",
      "url": "https://journals.plos.org/mentalhealth/article?id=10.1371/journal.pmen.0000741"
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  "subjects": [
    {
      "field": "medicine",
      "origin": "plos:clinical psychology",
      "subfield": "psychiatry"
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  "title": "When psychiatry does not learn: Epistemic humility, ignorance culture, exclusion culture and diagnostic weaponisation",
  "title_text": "When psychiatry does not learn: Epistemic humility, ignorance culture, exclusion culture and diagnostic weaponisation",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:17:37Z",
  "url": "https://research.draconitic.com/paper/44nyedakac4jg",
  "venue": "PLOS Mental Health",
  "versions": []
}