Medicalisation, de-medicalisation and stigma: an investigation into the ethical purposes of disease designation, 2025, Walker & Rogers

Dolphin

Dolphin

Senior Member (Voting Rights)

Medicalisation, de-medicalisation and stigma​

an investigation into the ethical purposes of disease designation​

Authors​

  • Mary Jean WalkerLa Trobe University
  • Wendy RogersMacquarie University

DOI:​

https://doi.org/10.4454/mefisto.9-1.1425

Keywords:​

Medicalisation, Stigma, Health, Disease, Obesity, Chronic Fatigue, Autism Spectrum Disorder

Abstract​

This paper examines the range of ways that medicalisation and de-medicalisation can affect stigma.

We seek to extend the ways that stigma has been conceptualised by connecting it to a pragmatic, pluralist analysis of the meaning of ‘disease’, which identifies disease’s typical features as in-principle explainability in biological terms, dysfunction, harmfulness, and lack of direct conscious control.

We analyse three case studies of de/medicalisation using this framework.

Drawing on results of this analysis, we argue that de/medicalisation may rely strongly on the features of dysfunction and biological explainability, but that the interpretation of a condition as a dysfunction is moderated by views about intrinsic harmfulness.

While biological explainability and dysfunction can work to block some drivers of stigma and reduce attributions of blame, they can also drive stigma in other ways via labelling, encouraging essentialist thinking and implying that a condition should be negatively evaluated.

Walker MJ, Rogers W. Medicalisation, de-medicalisation and stigma - An investigation into the ethical purposes of disease designation. J Med Phil Hist. 2025 Oct 24; 9(1).
 
I’ll be interested to see which way this one goes

Of course one issue I worry about is that stigma includes the input from bigots and ignorants - and knowing we have to deal with presumptions coming from those whose source isn’t either logical or due to some sort of reasoned thinking - even if post-hoc they might claim that even to themselves, so not all of it is more than childish ‘look funny’ or ‘weird name’ or ‘knew one of my mums friends and never liked her and she had it’ level stuff.

And a lot of it is just permission to get away with being mean , group psychology and ongoing issues we want to pretend don’t drive some like misogynistic ideas being ingrained in certain ways and then not recognizing that as the source of it and ‘learn by rote’ and ‘in training’ producing hand-me-down bias hard to differentiate from real knowledge except the first one gets firmly enforced.

So a gap analysis would be more interesting to see the max ‘how much’ could even be explained by these things that are actually intrinsic to different illnesses (and you have to understand them well to know what they really are and how they exhibit symptoms) and the biological stuff, but also just how ill people are in what way, I often think the issue for me/cfs is just that we have been cut out if health service obligations because we are too much burden as seen by some in the sense it’s chronic and long term. Years and years of being very ill.


And how much therefore is just jumping the queue on this due to initiatuves like Bps and their articles videos guidelines etc

Sad that because of how they’ve treated us they’ve made that a bigger % than necessary and probably higher support than they underestimate at earlier would make getting severer rarer and shorter if it was spotted and big support got in quickly rather than it almost deliberately harming and then leaving people to drain-circle deliberately making access to the basics other illnesses might get supported either impossible and an energy draw whilst being played or too late after too much so people are made that x more ill and then it’s longer term too. We will never know.

But is the stigma a coincidence of the job they don’t fancy doing or did the cherry picking come first and the ‘they never deserved it anyway’ necessary blag
 
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