Ten years ago, in Being With and Saying Goodbye, I described the term Medically Unexplained Symptoms as “grandiose on the part of medicine because it implies that medicine should be able to explain everything, and anything it cannot explain falls somehow into a special category.” I went on to suggest that this is a stigmatised category which includes the idea of placebo, for similar reasons. Medicine is encouraged in its belief that it can explain everything, and it doesn’t very much like things that undermine this believe.

When, some decades ago, I trained in medicine and psychiatry, Miranda Fricker had not yet coined the term “epistemic injustice” and the concept – the process – was not thought about. As with racial blindness, I suppose, the perpetrators of the injustice do not notice what they are doing. The phrase is a commonly used one now, and I think it is a useful one, even if the choice of words is itself a little exclusive.

We were, though, exposed to some of the ideas of Karl Jaspers. He believed that the patient’s subjective experience was key to understanding and treating their condition. I don’t think that phenomenology limits us to an interest in subjective experience but the rise of phenomenology in psychiatry coincided, broadly speaking, with a rise in the importance of subjective experience. So far, so good. But then this idea that medicine can understand, know, and explain everything gets in the way.

Clinical empathy is a highly regarded concept in medicine and related disciplines. The concept is variously described and used. It might mean the ability to understand and communicate a patient’s experience, or the act of correctly acknowledging the emotional state of another.

Note the different language and its implications.

How does this sit alongside the idea of epistemic injustice? Between finding words to describe someone else’s experience and helping them to find their own words, there is a chasm masquerading as a thin line. The idea that I can know someone else’s experience is a form of arrogance, and a misunderstanding of subjectivity. Perhaps it is a small step for medicine which expects itself to know everything about the workings of a human, to believe that it can – and should – know their experience.

If we step away from the jargon and think of common language we will recognise how common it is for people – particularly when they are striving to help someone – to say, “I know how you feel.”

The truth of the matter is that I don’t know, but I am trying. I am listening with all my faculties, and as best I can. I hope I am getting the gist. I may be wrong, but… And is this helping?

And, broadening it out again to clinical humility, let us continue to have clinical supervision, even when we have reached exalted status in our professions. And not just in psychiatry. “Supervisor” is not a comfortable word. It smacks of bureaucracy, infantilising, lack of autonomy. But let’s emphasise the special nature of Clinical Supervision, overcome the desire to be the top monkey, and acknowledge that we don’t always know and that we, ourselves, may need help in our attempts to help someone else.

For the time being, at least, this is what I mean by clinical humility.