Strategic certainties: epistemic habitus and the performance of knowledge in psychiatric practice

Uncertainty is a structural condition of psychiatry, yet it is routinely concealed by practices that transform ambiguity into apparent clarity. Diagnostic categories remain provisional and culturally variable, but health systems demand resolution. This article develops the concept of strategic certainties to describe how institutions perform knowledge where doubt persists but cannot be admitted. Complementing McGoey’s notion of strategic ignorance, the concept highlights a parallel logic of legitimacy: ignorance manages accountability by suppressing knowledge, while certainty manages authority by asserting it under conditions of indeterminacy. Drawing on two ethnographic studies in Catalonia (community-based care for psychosis and psychiatric responses to workplace harassment) the analysis shows how certainty is enacted through diagnostic anchoring and pharmacological routines in the first case, and through the reframing of structural violence as individual pathology in the second. Across both settings, strategic certainties operated as expressions of an epistemic habitus that channels ambiguity into forms compatible with institutional order and social control. They render action possible and sustain institutional order but often foreclose recognition. The findings show that strategic certainties are patterned institutional mechanisms rather than isolated errors. Understanding certainty as a socio-epistemic practice opens possibilities for care cultures able to sustain uncertainty ethically.