When psychiatry does not learn: Epistemic humility, ignorance culture, exclusion culture and diagnostic weaponisation

Laurence Cobbaert; Rosiel Elwyn; James Leonard Downs; Sandi James; Matthew Jackman

doi:10.1371/journal.pmen.0000741

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When psychiatry does not learn: Epistemic humility, ignorance culture, exclusion culture and diagnostic weaponisation

Journal article

Open access

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When psychiatry does not learn: Epistemic humility, ignorance culture, exclusion culture and diagnostic weaponisation

Laurence Cobbaert, Rosiel Elwyn, James Leonard Downs, Sandi James and Matthew Jackman

PLOS Mental Health, Vol.3(10), pp.1-14

2026

DOI: https://doi.org/10.1371/journal.pmen.0000741

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Abstract

Psychiatry (incl. psychotherapy)

Clinical psychology

psychiatry

mental illness

iatrogenic harm

lived experience

epistemic justice

accountability

trauma-informed care

adverse events

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.

Details

Title: When psychiatry does not learn: Epistemic humility, ignorance culture, exclusion culture and diagnostic weaponisation
Authors: Laurence Cobbaert (Corresponding Author)
Rosiel Elwyn (Author) - University of the Sunshine Coast
James Leonard Downs (Author)
Sandi James (Author) - The University of Melbourne
Matthew Jackman (Author) - The University of Sydney
Publication details: PLOS Mental Health, Vol.3(10), pp.1-14
Publisher: Public Library of Science
Date published: 2026
DOI: 10.1371/journal.pmen.0000741
ISSN: 2837-8156
Copyright note: © 2026 Cobbaert et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Organisation Unit: Thompson Institute
Language: English
Record Identifier: 991263896202621
Output Type: Journal article

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