{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T17:59:11Z","timestamp":1791223151513,"version":"4.1.0"},"reference-count":105,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosmentalhealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Ment Health"],"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.1371\/journal.pmen.0000741","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T17:37:12Z","timestamp":1791221832000},"page":"e0000741","update-policy":"https:\/\/doi.org\/10.1371\/journal.pmen.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["When psychiatry does not learn: Epistemic humility, ignorance culture, exclusion culture and diagnostic weaponisation"],"prefix":"10.1371","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0457-6907","authenticated-orcid":true,"given":"Laurence","family":"Cobbaert","sequence":"first","affiliation":[{"name":"Independent Researcher","place":["Sydney, New South Wales, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosiel","family":"Elwyn","sequence":"additional","affiliation":[{"name":"University of the Sunshine Coast","place":["Birtinya, Queensland, Australia"],"department":["National PTSD Research Centre, Thompson Institute"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Downs","sequence":"additional","affiliation":[{"name":"Independent Researcher","place":["Cardiff, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6454-1533","authenticated-orcid":true,"given":"Sandi","family":"James","sequence":"additional","affiliation":[{"name":"University of Melbourne","place":["Melbourne, Victoria, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1639-3879","authenticated-orcid":true,"given":"Matthew","family":"Jackman","sequence":"additional","affiliation":[{"name":"University of Sydney","place":["Sydney, New South Wales, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,10,5]]},"reference":[{"issue":"2","key":"pmen.0000741.ref001","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1080\/02691728.2011.652211","article-title":"Epistemic justice as a virtue of social institutions","volume":"26","author":"E Anderson","year":"2012","journal-title":"Soc Epistemol"},{"issue":"4","key":"pmen.0000741.ref002","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1007\/s11019-014-9560-2","article-title":"Epistemic injustice in healthcare: a philosophial analysis","volume":"17","author":"H Carel","year":"2014","journal-title":"Med Health Care Philos"},{"issue":"2","key":"pmen.0000741.ref003","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1192\/pb.bp.115.050682","article-title":"Epistemic injustice in psychiatry","volume":"41","author":"P Crichton","year":"2017","journal-title":"BJPsych Bull"},{"key":"pmen.0000741.ref004","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/j.socscimed.2018.10.003","article-title":"Epistemic struggles: The role of advocacy in promoting epistemic justice and rights in mental health","volume":"219","author":"K Newbigging","year":"2018","journal-title":"Soc Sci Med"},{"issue":"5","key":"pmen.0000741.ref005","doi-asserted-by":"crossref","first-page":"1064","DOI":"10.1086\/705443","article-title":"Epistemic injustice and psychiatric classification","volume":"86","author":"A Bueter","year":"2019","journal-title":"Philos Sci"},{"key":"pmen.0000741.ref006","article-title":"Epistemic injustice in psychiatric practice: epistemic duties and the phenomenological approach","author":"A Dro\u017cd\u017cowicz","year":"2021","journal-title":"J Med Ethics"},{"issue":"5","key":"pmen.0000741.ref007","doi-asserted-by":"crossref","first-page":"848","DOI":"10.1111\/jep.13971","article-title":"Sense-making and hermeneutical injustice following a psychiatric diagnosis","volume":"30","author":"R Hassall","year":"2024","journal-title":"J Eval Clin Pract"},{"issue":"4","key":"pmen.0000741.ref008","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1080\/10508422.2017.1365302","article-title":"Vulnerability of Individuals With Mental Disorders to Epistemic Injustice in Both Clinical and Social Domains","volume":"28","author":"R Kurs","year":"2017","journal-title":"Ethics & Behavior"},{"key":"pmen.0000741.ref009","doi-asserted-by":"crossref","first-page":"1114725","DOI":"10.3389\/fpsyt.2023.1114725","article-title":"Epistemic injustice and mental health research: A pragmatic approach to working with lived experience expertise","volume":"14","author":"C Okoroji","year":"2023","journal-title":"Front Psychiatry"},{"issue":"3","key":"pmen.0000741.ref010","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1177\/0022167805277107","article-title":"How do we Recover? 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