When psychiatry does not learn: Epistemic humility, ignorance culture, exclusion culture and diagnostic weaponisation
5 affiliations
- 1Independent Researcher, Sydney, New South Wales, Australia
- 2National PTSD Research Centre, Thompson Institute, University of the Sunshine Coast, Birtinya, Queensland, Australia
- 3Independent Researcher, Cardiff, United Kingdom
- 4University of Melbourne, Melbourne, Victoria, Australia
- 5University of Sydney, Sydney, New South Wales, Australia
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.
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BibTeX
@article{cobbaert2026when,
title = {{When psychiatry does not learn: Epistemic humility, ignorance culture, exclusion culture and diagnostic weaponisation}},
author = {Laurence Cobbaert and Rosiel Elwyn and James Downs and Sandi James and Matthew Jackman},
journal = {PLOS Mental Health},
year = {2026},
month = oct,
doi = {10.1371/journal.pmen.0000741},
url = {https://journals.plos.org/mentalhealth/article?id=10.1371/journal.pmen.0000741},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - When psychiatry does not learn: Epistemic humility, ignorance culture, exclusion culture and diagnostic weaponisation
AU - Laurence Cobbaert
AU - Rosiel Elwyn
AU - James Downs
AU - Sandi James
AU - Matthew Jackman
PY - 2026
DA - 2026/10/05
JO - PLOS Mental Health
DO - 10.1371/journal.pmen.0000741
UR - https://journals.plos.org/mentalhealth/article?id=10.1371/journal.pmen.0000741
AB - 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.
SN - 2837-8156
ER -