Who is allowed to be confident? Psychiatry, humility, and epistemic double standards.
Australasian psychiatry : bulletin of Royal Australian and New Zealand College of Psychiatrists July 13, 2026 Laurence Cobbaert
Psychiatry often scrutinizes patients' confidence and certainty as symptoms of poor insight or overconfidence, especially in psychosis research, while its own institutional confidence escapes similar examination. Drawing on epistemic injustice, phenomenology, and lived experience expertise, the article argues that professional confidence becomes ethically consequential when it shapes diagnosis, detention, treatment access, and responses to reported harm. It calls for epistemic reciprocity: if psychiatry interrogates patients' insight, it must also examine how its own certainty is authorized and operationalized. A humbler psychiatry would distinguish evidence from inference, dissent from pathology, and disengagement from non-compliance, centering experiential knowledge, cultural context, uncertainty, safety, and accountability in ethical practice.