We proposed a model to examine the relationship among different types of weight-related stigmas and their relationship to quality of life. We recruited 430 dyads of elementary school children [mean age = 10.07 years; nboy = 241 ; noverweight = 138 ] and their parents. Parents completed QoL instruments about their children assessing generic QoL and weight-related QoL. Children completed QoL instruments assessing generic QoL and weight-related QoL and stigma scales assessing experienced weight stigma, (...) weight-related self-stigma, and perceived weight stigma. Experienced weight stigma was significantly associated with perceived weight stigma, and in turn, perceived weight stigma was significantly associated with weight-related self-stigma. However, experienced weight stigma was not directly associated with weight-related self-stigma. In addition, experienced stigma was negatively associated with both child-rated and parent-rated QoL. Perceived weight stigma was associated only with parent-rated weight-related QoL but not child-rated QoL. Self-stigma was associated with child-rated QoL but not parent-rated QoL. Moreover, perceived weight stigma and weight-related self-stigma were significant mediators in the association between body weight and children's QoL; experienced weight stigma was not a significant mediator. The study findings can be used to inform healthcare providers about the relationship among different types of stigmas and their influence on child-rated and parent-rated QoL and help them develop interventions to address the global trend of overweight/obesity in youth and pediatric populations. (shrink)

Individuals who are overweight or obese encounter frequent weight-related stigma experiences, which are associated with negative health outcomes. In this regard, the Brief Coping Responses Inventory was developed as a measure of core coping responses to weight stigma, with 10 items loading on two subscales of reappraisal and Disengagement coping. The current study aimed to examine the psychometric properties of the Persian BCRI with 253 Iranian school-attending youth who had BMI score over 30. The results of (...) the confirmatory factor analysis supported the originally proposed two-factor model, which yielded acceptable internal consistency based on various reliability measures such as Cronbach’s alpha coefficients and demonstrated the expected convergent and divergent associations with external correlates of interest. This study was also the first one worldwide to examine and report that the originally proposed two-factor model of the BCRI is invariant across gender groups, which allows for examining mean differences in BCRI scores across gender groups. Overall, our results indicated that the BCRI is a valid and reliable measure with a solid factor structure, which could be used to examine the coping reactions to weigh related stigma experiences among youth samples in Iran. Our results may encourage future studies on the psychometrics of the BCRI with other Iranian samples. (shrink)

Over time, there has been a steady increase of workplace health promotion programs that aim to promote employees’ health and fitness. Previous research has focused on such program’s effectiveness, cost-savings, and barriers to engaging in workplace health promotion. The present research focuses on a downside of workplace health promotion programs that to date has not been examined before, namely the possibility that they, due to a focus on individual responsibility for one’s health, inadvertently facilitate stigmatization and discrimination of people with (...) overweight in the workplace. Study 1 shows that the presence of workplace health promotion programs is associated with increased attributions of weight controllability. Study 2 experimentally demonstrates that workplace health promotion programs emphasizing individual rather than organizational responsibility elicit weight stigma. Study 3, which was pre-registered, showed that workplace health promotion programs emphasizing individual responsibility induced weight-based discrimination in the context of promotion decisions in the workplace. Moreover, focusing on people with obesity who frequently experience weight stigma and discrimination, Study 3 showed that workplace health promotion programs highlighting individual responsibility induced employees with obesity to feel individually responsible for their health, but at the same time made them perceive weight as less controllable. Together, our research identifies workplace health promotion programs as potent catalysts of weight stigma and weight-based discrimination, especially when they emphasize individual responsibility for health outcomes. As such, we offer valuable insights for organizations who aim to design and implement workplace health promotion programs in an inclusive, non-discriminatory way that benefits all employees. (shrink)

We examine stigma and how it operates, then develop a novel framework to classify the range of positions that are conceptually possible regarding how stigma ought to be handled from a public health perspective. In the case of weight stigma, the possible positions range from encouraging the intentional use of weight stigma as an obesity prevention and reduction strategy to arguing not only that this is harmful but that weight stigma, independent of (...) obesity, needs to be actively challenged and reduced. Using weight stigma as an illustrative example, we draw on prior theoretical work on stigma mechanisms and intervention strategies to develop a framework for improving the understanding, evaluation, and planning of anti-stigma interventions. This framework has the potential to help public health actors to map out how protest, contact, education, and regulation strategies can be used to reduce direct discrimination, structural discrimination, and internalized stigma. (shrink)

In this article, the author reviews the ways that the microaggressions framework has been taken up with regard to weight stigma by academics and activists and offers insight into its value for conceptualizing and challenging weight stigma.

How should we interpret the popular objection that stigmatised subjects are not treated as individuals? The Eidelson View claims that stigma, because of its connection to stereotypes, violates an instance of the general requirement to respect autonomy. The Self-Presentation View claims that stigma inhibits the functioning of certain morally important capacities, notably the capacity for self-presentation. I argue that even if we are right to think that stigma violates a requirement to respect autonomy, this is insufficient to (...) account for the full weight of the charge that stigmatised subjects are not treated as individuals. We need the Self-Presentation View to explain a special threat to agency. I then address the worry that focusing on a concern with being treated as individuals opens the door to the suggestion that treating as superior can be just as morally troubling as stigma. This objection is fatal for the Eidelson View. But the Self-Presentation View has a number of resources for deflating the worry. We should not exclude the possibility of a moral symmetry between some cases of stigma and some cases of treating as superior. Rather, we should provide a nuanced account of the circumstances in which either phenomenon is detrimental for self-presentation. (shrink)

Fat stigma is pervasive. Being fat is widely regarded a bad thing, and fat persons suffer numerous social and material disadvantages in virtue of their weight being regarded that way. Despite the seriousness of this problem, it has received relatively little attention from analytic philosophers. In this paper, I set out to explore whether there is a reasoned basis for stigmatizing fatness, and, if so, what forms of stigmatization could be justified. I consider two lines of reasoning that (...) might be advanced to defend fat stigma. The first is broadly consequentialist. It seeks to justify stigmatizing fatness based on the public health benefits that might be produced by doing so. The second argument takes stigmatizing fatness to be a warranted response to the morally blameworthy failure to slim down exhibited by fat persons. Clarifying and assessing each of these two lines of reasoning is the main task of this paper. I argue that, upon careful examination, both these attempts to justify the stigmatization of fatness fail. (shrink)

Weight stigma internalization among adolescents across weight categories leads to adverse psychological consequences. This study aims to adapt and validate a Chinese version of the Weight Bias Internalization Scale for Mainland Chinese children and adolescents. A total of 464 individuals aged 9 to 15 years participated in the present study. Based on item response theory and classical test theory, we selected the items for the C-WBIS and evaluated its reliability and validity. The item response theory yields (...) support for the one-dimensional factor mode. All item parameters fit the IRT model, eight items were adopted. No evidence of significant differential item functioning was found for gender and age groups. The C-WBIS was correlated with the Core Self-Evaluation Scale and two subscales of the Social Anxiety Scale for Children, which indicated an acceptable criterion-related validity. The C-WBIS is a reliable and valid measure that can be used as a psychometrically sound and informative tool to assess weight bias internalization among children and adolescents. (shrink)

This article critically explores the tension between perceptions of weight loss surgery as a last resort and as a tool. This tension stems from patients’ doubt and insecurity whether expectations for a healthy life will come through. Thus, even after surgery, traditional weight loss methods, including diets and exercise, are considered paramount. Drawing on a series of interviews with Norwegian women, we argue that the commercialization of weight loss surgeries as well as the moral stigmas attached to (...) such operations serve to perpetuate this tension. More specifically, the women were advised to leave their old habits behind, and embrace a healthier and more active lifestyle. In such a climate, we argue that undergoing surgery without subsequently embodying dietary and exercise norms is hardly an option. On the contrary, these become a moral obligation that modern women need to relate to—and perhaps negotiate—in order to repudiate stigmas attached to weight loss surgeries as a quick fix for those incapable of losing weight in the “proper” manner. (shrink)

This article examines the discourses that are used by the British press to represent obesity in its coverage of coronavirus disease 2019 (COVID-19). Obesity is understood to be a risk factor for COVID-19, with people with obesity being more likely to die from the virus. This study adopts a corpus-based approach to Critical Discourse Studies and utilises a novel approach to keyword analysis, based on comparing analysis corpora against two reference corpora in order to yield keywords that are, in this (...) case, characteristic compared to general coverage of both COVID-19 and obesity. It is argued that the context of the pandemic has produced a range of discourses around obesity that are more stigmatising than usual in both the tabloids and the broadsheets, with people with obesity being construed, for example, in especially fatalistic terms and as being responsible for the problems facing the country’s healthcare system. At the same time, the pandemic context also seems to have given rise to some more positive changes to press coverage of obesity, with race-related health disparities receiving more focus than usual and the right-leaning press being more likely to critique the Conservative Government than it usually is, resulting in an arguably more balanced style of reporting. (shrink)

Given the plethora of weight loss interventions, Devine and Barnhill rightly propose to also investigate unintended consequences. I agree. Some questions need to be raised: unintended consequences is a messy concept. How to distinguish between surprises and pseudo-unintended consequences? How to make sure that such research is not a box-ticking formality? And will results be implemented?

Several recent anti-obesity campaigns appear to embrace stigmatization of obese individuals as a public health strategy. These approaches seem to be based on the fundamental assumptions that (1) obesity is largely under an individual’s control and (2) stigmatizing obese individuals will motivate them to change their behavior and will also result in successful behavior change. The empirical evidence does not support these assumptions: Although body weight is, to some degree, under individuals’ personal control, there are a range of biopsychosocial (...) barriers that make weight regulation difficult. Furthermore, there is accumulating evidence that stigmatizing obese individuals decreases their motivation to diet, exercise, and lose weight. Public health campaigns should focus on facilitating behavioral change, rather than stigmatizing obese people, and should be grounded in the available empirical evidence. Fundamentally, these campaigns should, first, do no harm. (shrink)

Responsibility is a moral quality of caring that is central to child health policies. In contemporary UK these policies are based on behavioural psychology and underpinned by individualism, an ideology central to neoliberal governance. Amid the complexities of “obesity” and inequalities, there is a multi-layered stigmatisation of parents as moral associates. Few studies consider the lived realities of food policy processes from the standpoint of class. This critical qualitative research draws on theorists who explain processes of power and class: Foucault, (...) Gramsci, Bourdieu and Marx. Its objectives are: (a) to understand the lived experience of parents as they interact with food policy; (b) to explore how parents resist stigmatisation; and (c) to reflect on implications for policy and practice. Methods: Using purposive sampling, 31 ethnographically-informed interviews were carried out in a London borough, with policy actors: policymakers, implementers and parents as policy recipients, including 12 working-class mothers. Results: A core theme of “responsibilities” emerged with four interconnecting sub-processes that provide insight into how stigmatisation and resistance evolve through policy. Discussion: As have others, this study reveals the idea of responsibility as fundamental to the processes of soft power. Child health is a priority for participants and a “ruling idea”. The diffusion of responsibility throughout policy leads to confusion about where it lies. New subjectivities are formed in line with ideas of governmentality. Parents engage with policy at multiple sites that elicit symbolic violence, and stigma sows social divisions. Against this background, working-class parents are left in a state of cognitive dissonance between being made responsible (responsibilisation), and feeling responsible (self-blaming) for their children’s weight while lacking the material resources to provide an optimal nutritious diet. Resistance is interwoven and is essentially found in parents’ policy alternatives that diverge from UK government policy. Conclusion: Critical qualitative research using multiple theorists is valuable in understanding how parents interact with policy in a complex social world. With UK policy failing, useful insights are provided into how involving parents in policymaking might determine a meaningful collective responsibility, with a political ethic of care and unity between parents that would advance health equity. (shrink)

This case study considers the ethical defensibility of recommending weight loss as a treatment for patients with higher body mass indexes. Recommending weight loss may be motivated by clinicians’ biases toward people living in larger bodies, misperceptions about weight and its relevancy to overall health, and a failure to consider other ethical factors such as those related to equity and the social determinants of health.

In this study we explore how a selection of Norwegian women account for their decision to undergo weight loss surgery. We argue that women’s descriptions of their experiences leading up to this choice of action illuminate issues regarding social norms of bodily appearance and personal responsibility. The starting point is women’s own experiences within a cultural context in which opting for WLS often attracts moral scrutiny. Inspired by Merleau-Ponty’s notion of consciousness as embodied and de Beauvoir’s ideas concerning women’s (...) situation, we argue that bodily as well as socio-cultural aspects intertwine with women’s choice of surgery as a means of losing weight. Although society’s stigmatization of women with obesity has been well challenged by scholars in the field of critical fat studies, women with obesity still experience the bodily hindrances associated with being overweight in an intense and subjective way. The findings suggest that women confronting the option of WLS do so in a context of pain, dysfunction and social stigma, a combination which illuminates the intricate ambiguity of the obese body as both subject and object. (shrink)

Developmental origins of health and disease and epigenetics have expanded understanding of how the environment affects the health of women before and during pregnancy—with lifelong health consequences for the fetus. This has translated to a narrow focus on women’s lifestyle during pregnancy, especially for women classified as obese. In this study, we show that psychosocial harms such as distress or shame felt by pregnant women are rarely countenanced in these endeavors. To demonstrate this, we examine published documents about a large (...) set of trials of lifestyle interventions united through an international consortium. Yet there is now a literature in which pregnant women with large bodies report feeling humiliated and a wider literature on the stigma of obesity. We argue that shame is produced and reproduced through the discursive and material knowledge-making scientific practices of DOHaD translation. Interventions that intensify the shame of large body size in pregnancy may be stressful, and neurophysiological stress pathways are well-known within DOHaD to have consequences for fetal development, so these interventions potentially undermine the very processes they set out to protect. A feminist response may protect women from shame and redirect attention to the social and structural determinants of health. (shrink)

This chapter examines the case for health care policies aimed at holding obese individuals responsible for their weight and for obesity-related health issues. In particular, it considers the merits of two arguments for policies that would seek to make obese individuals bear some of the higher health care costs associated with being that way. On the fairness argument, it is claimed that such policies would serve the interests of fairness by holding obese individuals to account for irresponsible lifestyle choices (...) that are linked to their higher weight and its associated health risks. On the public health promotion argument, it is claimed that adopting such policies could produce impressive public health benefits: encouraging people to make healthier lifestyle choices, reducing obesity rates, and reducing obesity-related health care spending. Both arguments face serious objections. Contrary to the fairness argument, policies aimed at holding obese individuals responsible for their weight or for related health problems would neither treat people as they deserve to be treated nor make the distribution of health care resources fairer. And contrary to the public health promotion argument, those policies would not produce better health outcomes for society at large. Indeed, they would tend to do just the opposite. Reflection on the shortcomings of those arguments reveals that their conclusion is false: society should not adopt policies aimed at holding obese individuals responsible for their weight or for obesity-related health problems. (shrink)

Abnormal body weight has been subject to varying assessments over time. The stigmatization of obesity for aesthetic reasons only began in the Western world in the second half of the 19th century, and in the 20th century its association with increased mortality was recognized. Body weight is associated with social and cultural meanings that affect human identity, and discussions about it generate considerable emotion. Words used to refer to body weight can influence people's self-perceptions, attitudes and behavior. (...) Experimental studies have shown that even brief exposure to body-related words can trigger automatic judgements and evaluations about body shape and weight. These negative and often implicit associations are symptomatic of a wider social stigma associated with weight. Recent evidence points to globalization and the presence of weight stigma in both developed and developing countries around the world. Numerous studies further indicate that weight shaming does not lead to weight reduction but rather to weight gain. Therefore, from a public health perspective, it is important to develop messages that are at least non-stigmatizing. The aim of this article is to present existing research on stigmatizing content in the media, as well as to analyze three selected social campaigns related to obesity. (shrink)

This essay argues that the discrimination that fat patients face is an issue of health justice. Insofar as this is the case, bioethicists and health care providers should not only care about it but also work to dismantle the systematic, institutional, social, and individual factors that are contributing to it to ensure that fat patients receive high‐quality health care, free of stigma and discrimination. The essay discusses a variety of ways in which fat patients are discriminated against and considers (...) the false assumptions that fuel such discrimination. It concludes by considering the structural and social issues that contribute to fatness and pushes health care providers to abandon the assumption that being fat is an individual moral failing. Ultimately, the paper argues, “fat” is not necessarily a bad word, nor one that health care providers should avoid. (shrink)

Many philosophers argue that religious schools are guilty of indoctrinatory harm. I think they are right to be worried about that. But in this article, I will postulate that there are other harms for many individuals that are more severe outside the religious school. Accordingly the full scope of harm should be taken into account when evaluating the harm that some religious schools may do. Once we do that, I suggest, justice may require that we choose the lesser harm. To (...) simplify matters, I focus my attention on the stigmatic harm done to Muslims, and the role that Islamic schools might be expected to play in mitigating that harm. If the full weight of stigmatic harm is factored into the ethical analysis concerning Islamic schools, then I suggest that there are sufficiently weighty pro tanto reasons for Muslim parents to prefer an Islamic school over the alternatives, notwithstanding the potential indoctrinatory harm. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Being the Right Kind of Parent:Conceiving PeopleCamisha Russell (bio)Daniel Groll's Conceiving People makes one central claim regarding the ethics of using egg or sperm donations to create a child (that one intends to parent): "[P]arents should use an open donor because doing so puts their resulting child in a good position to satisfy the child's likely future interest in having genetic knowledge" (Groll 2021, 12, original italics).Amid myriad thorny (...) ethical questions surrounding assisted reproduction, Groll's decision to focus on a choice that intended parents in need of donor gametes must make before their future child is even conceived—a choice that is typically taken very seriously—makes a lot of sense. The question is live, rarely completely determined as a matter of policy or law, and, as Groll demonstrates, important to most donor-conceived people (and therefore to the families of which they are a part). For this increasing number of individuals and families, a cultural shift in how we think about open versus anonymous donors would have a significant (and as Groll argues, positive) impact.Groll's carefully built argument is important not only for the paths of ethical reasoning that it highlights, but for those common rationales it gently but firmly sets aside (e.g., the donor-conceived person's medical need to know their genetic history or the idea that knowledge of one's genetic origins is the best or only way to truly know oneself). Groll's work is attentive to the types of relationships that foster the emotional health of families, and it's grounded in the experiences and desires articulated by donor-conceived people themselves. For this reader, these are the book's greatest strengths, along with the fact that Groll is often quite funny in his examples, which makes the examples highly relatable.Of course, the challenge for philosophers in writing books of ethical importance for "laypeople" is to offer something an average educated adult can understand while addressing the more technical theoretical issues that matter to ethicists. I would expect Groll's text to satisfy ethicists because his definitions and distinctions are scrupulously clear, and he engages the existing philosophical literature well. As for laypeople, there are surely a few moments in which they will find themselves in the theoretical weeds, so to speak, but Groll has [End Page 193] successfully made the book largely modular, such that they should get a lot from just reading the chapters of direct interest (Groll 2021, 29).Chapter 2, "Keeping Secrets," is essential for intended parents seeking ethical guidance. Groll notes that professional opinion on donor conception has shifted from seeing nondisclosure of a child's donor-conceived status as a moral requirement (to protect privacy and avoid family stigma) to recommending disclosure. He then reviews standard arguments for disclosure: (1) the "profound importance" of known genetic origins to health identity formation, (2) the medical importance of knowing to whom you are (and are not) genetically related, and (3) the harm that keeping secrets can do to family members and family functioning. While Groll agrees with the latter two arguments, he introduces and emphasizes a new argument: the Intimacy argument, in which he convincingly argues that keeping a child's genetic origins secret "violates norms of intimacy by creating distance between parents and children that is at odds with the demands of intimacy in the parent-child relationship" (Groll 2021, 44, original italics). Though, in many ways, this chapter's argument is separate from the central argument for the use of open donors constructed in the rest of the book, I find it compelling and wonder whether it could hold up more of the open donor argument, placing less weight on the Significant Interest view that Groll introduces in the next chapter (and the concerns regarding bionormativity that emerge from that view).In the third chapter, Groll moves from disclosure to the information that's available to be disclosed. That is, it is one thing to commit to telling a child they were donor-conceived after conception. It is another to commit before conception to choosing a donor willing to be known to the future child when... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Shame is Not an Effective Diet PlanJudith BrukThe stigma of being obese is so strong that it is assumed that anyone with the condition is (or should be) deeply ashamed. After all, it’s really easy to lose weight, right? Just cut out dessert and walk around the block three times a week. If you can’t even do that, then you are definitely a moral failure, have succumbed (...) to Gluttony and Sloth, and deserve to be shunned by society.The problem is that shame is not a very effective diet plan; quite the opposite. It’s no surprise that recent research shows that shame leads to depression that leads to isolation, which, in the morbidly obese, leads to a suicide rate twelve times that of healthy–weight people.Unfortunately, it is indeed true that many obese people feel a great deal of shame, even if we occasionally put on a façade of bravado or seeming shamelessness, e.g., the “large and in charge” sitcom staple trope. The bottom line is that our shame about our weight does keep us from engaging with other people, limits our willingness to participate in physical activities, and generally makes us reluctant to simply exist out in public. None of these are behaviors conducive to positive lifestyle changes.For years I engineered my life so I would only go out of my house when absolutely necessary: grocery shopping and the occasional meeting at work were pretty much it (I usually work from home). I went for years without going to a movie, shopping for clothes in a store, eating in a restaurant, gardening, or any of the other activities I once enjoyed. I was ashamed to be seen. And since I had tried and tried and tried and tried to lose weight for three decades and only ended up more overweight as the years went by, I finally, truly gave up. I convinced myself my psychological makeup was so flawed (or was missing whatever ingredient it was that made someone succeed at sustained weight loss) that I just hoped my inevitable heart attack would be instantaneously fatal. This thinking is irrational, or at least unhealthy. (I am an otherwise fairly smart person with an advanced degree and am professionally employed.) Yet, it is basically the path that both societal attitudes and medical treatment lead us down at this point in time.Here are a few examples that illustrate how the path to irrationality evolved for me.About twelve years ago, I decided to see a psychotherapist to get to the bottom of my subconscious psychological issue that was keeping me overweight. This therapist suggested I see a nutritionist who gave me a list of detailed thyroid tests to take to my doctor so she could order the labs and we could get a full profile of how my thyroid was functioning. Upon presenting the list to my doctor’s PA (my doctor was not available that day), she rolled her eyes, gave a very deep sigh and said to me, “Every fat woman wants to believe it’s because of her thyroid and it never, ever is.” I was so embarrassed for having even brought the subject up that in an effort to save face, I reacted to my shame by replying, “Yeah, I just assume my extreme lack of energy and excess weight is simply because I eat too much.” She said, “Right, so let’s not even bother running these tests.” It was at least ten years later that I finally had the thyroid panel run and found out it was very low functioning.After about a year of seeing that shrink, she declared me “cured” and sent me on my way, though I had not lost any weight. It was about this time I first began thinking that throwing in the towel [End Page 91] was a good option. That didn’t mean that I went out and ate pizza and ice cream every day. Not at all. In fact, given the fact that I had been vegetarian and general health–food freak beginning in my mid–twenties, I rarely had anything in the house that contained sugar... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Ambiguities of Mild Cognitive ImpairmentTim Thornton (bio)Keywordsclassification, disease, mild cognitive impairment, normative, valuesCorner and Bond's paper (2006) raises some key ethical questions about the classification and diagnosis of mild cognitive impairment (MCI). In this commentary, I wish to revise some of the general issues about the classification of mental disorder raised by this particular classificatory concept. The central issue raised is the connection between the pathologic status of (...) a condition and what I term the plain facts about the frequency and nature of its symptoms.There are a number of ethical questions raised by applying the label of MCI. Centrally, perhaps, is the concern, illustrated by the case vignettes, that a diagnosis carries negative repercussions that might outweigh the more narrowly medical advantages of an early diagnosis. But although that concern may be appropriate, such ethical complications are a danger of any psychiatric classification or diagnosis, even the most well grounded. Any psychiatric diagnosis can carry a danger of stigma, for example.What seems to make such ethical concerns more serious in this case—at least to a philosopher outsider—is the implicit further concern that MCI is not a real, objective, or, to use a more medical term, valid category or classification. If it is not valid, then any negative connotations of the diagnosis will not be outweighed by medical technological achievements. In other words, the further ethical issues are given much greater weight if the question of validity is not satisfactorily resolved.The question of the reality, objectivity, or validity of MCI can be divided into two issues:1. Is MCI a real, objective, or valid feature of psychological phenomenology?2. Is MCI a real, objective, or valid psychological illness, disease, or pathology?A condition might be a real, objective, or valid feature of psychological phenomenology without being a real illness. It might be some other aspect of human living. Szasz (1960) suggests that this is the case with mental illness (he might more properly say "so-called mental illness") as a whole. But, less controversially, the unusual ability to calculate, mentally and in a flash, the date of future Easter Sundays is a genuine feature of human living—some people possess the ability even if most do not—without either it, or its lack, being an illness. Being real as an illness is a very specific kind of being. It is this, I suggest, that raises difficulties in the case of MCI by contrast with the easier question of whether something is a genuine feature of human living in some other way. [End Page 21]From "normal" and "normative" to "correct" and "incorrect"Corner and Bond (2006) usefully suggest that the question of whether MCI is real is made more difficult by an ambiguity in the sense of the word normal. They suggest that although "physiologic and cognitive decline is assumed to be a normal experience" this still leaves "boundary problems" about "distinguishing normal aging from disease" (Corner and Bond 2006, 3–4). Thus, if the symptoms of MCI are continuous with the ordinary phenomena of physiologic and cognitive decline, then they might also be merely normal. But this does not settle the status of MCI because normal can mean either "normative, that is, usual; or it can mean nonpathologic" (Corner and Bond 2006, 4).On the assumption that MCI is at least continuous with phenomena that are normal, then its symptoms might be normal in the sense of usual but nevertheless pathologic: an inevitable illness. Or they might be usual and nonpathologic, that is, merely a feature of aging that, although regrettable, lacks the connotations of illness (e.g., the appropriateness, if not the possibility, of treatment). (In principle on the assumption in play—that the symptoms of MCI are normal—they might be unusual but nonpathologic akin, for example, to an improved ability to solve crosswords with age that might affect a small lucky proportion of the population. Perhaps such a crossword puzzler might be reassured by their doctor: "Well that is very unusual but there is no need to worry: it is not a symptom of any illness. You are perfectly normal.")Thus the question "Is MCI normal... (shrink)

A good deal of concern is generated when a person with dementia wanders. One putatively easy technological remedy is to consider electronic tagging. This possibility, however, raises a dif erent set of ethical concerns. In this paper we report the results of a survey that was intended to elicit people’s views about the ethical issues surrounding the topic of tagging in dementia. There was broad agreement in response to the scenario used in the survey that electronic tagging could be an (...) ethically reasonable way to deal with wandering in people who are confused. It was seen as considerably better than locking doors as a way to maintain a person’s safety. There were, however, concerns and uncertainties about principles relating to civil liberties, stigma and dignity. And there appeared to be some weight behind the view that electronic tagging of confused people who wander requires professional involvement, the nature of which would need to be decided. population in general. (shrink)

The psychopathological analysis of hysteria is a victim of narrow conceptualizations. Among these is the inscription of hysteria in the feminine sphere, about body and sexuality, which incentivized conceptual reductionism. Hysteria has been mainly considered a gendered pathology, almost exclusively female, and it has been associated with cultural and/or religious features over time rather than treated as a psychopathological world. Further, hysteria has been dominated by conceptual inaccuracies and indecision, not only in terms of clinical features but also in terms (...) of its definition. For this reason, it seems necessary to “undress” hysteria from this feminization, sexualization, and corporealization with which it has been abundantly clothed over the years. “Undressing” hysteria will make possible a reconfiguring and deconstructing of the explanatory-causal model of Charcot and Freud. However, if we take out this cultural heritage, the stigma accompanying this diagnosis, and the weight of the enormous historical tradition that hysteria carries, the world of hysteria continues to constitute a domain full of complexity and nosographic challenges. Hysteria has been considered a sum of psychological behaviors and states illustrated by drama, mystery, or falsity. The difficulty in understanding the multiple somatic manifestations which characterize this clinical condition created several controversies and much confusion. In the current nosography, the personological component of hysteria has been separated from its symptomatic manifestation, in the Histrionic Personality Disorder and Conversion Disorder categories, respectively. This segmentation by descriptive nosography does contribute to a unitary understanding of the phenomenon and, consequently, of daily clinical practice. Clinical complexity can be grasped and deciphered only if the symptom is inscribed in the patient’s lifeworld and his/her subjective life history. Clinical practice is thus thought of in terms of a structural aggregation of a homogeneous set of phenomena, together constituting a specific way of being in the world. The starting point of this article is the evident modalities characterizing this life-world, taking care not to confuse the point of origin with the point of expression. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Calling Obesity a Disease Is A Terrible DecisionMoose FinklesteinFactsThe medical world struggles to see the difference between health and body weight. It is still mostly combined with the strong belief that there is no way a fat person can be fit and healthy. Despite repeated studies and work to show differently, this prejudice remains. This has become part of what I call “Everyone Knows” pseudoscience, where data that (...) have no scientific basis become “fact” due to constant repetition.Obesity is already the cause of great stigma in our society. Fat people are considered “ugly,” fat jokes are acceptable in everyday life, and being called ‘fat’ is, to many, as big an insult as a racial slur. Fat prejudice can approach the levels of racial prejudice (Puhl, Andreyevea & Brownell, 2008). Fat children are bullied, sometimes to the point of suicide. Some studies have found children as young as five trying to diet for being fat, no matter their actual weight. Fat people are more likely to be unemployed or underemployed, and there are prejudicial beliefs that fat workers are more problematic, despite research saying otherwise (Roehling, Roehling, & Odland, 2008).Obesity is seen by the masses as something people choose. However, science disagrees. There has long been a link between depression and obesity. Mental health is tightly tied to obesity, where those who experience weight discrimination are more likely to gain weight, although unhealthy behaviours such as binge eating and exercise avoidance are sometimes seen as a coping mechanism (Sutin & Teracciano, 2013).It has been reported in a number of journals that 90–95% of the people who lose weight regain the weight within 10 years (Mann et al., 2007; Miller, 1999). “Everyone Knows” claims that this is because people go back to bad habits. Science, however, says that there are complex ways the body wants to regain the weight (Sumithran & Proietto, 2013; Sumithran et al., 2011). Worse, dieting may contribute to obesity. Adolescent girls who diet are at 324% greater risk for obesity than those who do not diet (Stice, Cameron, R. P., Killen, J. D., Hayward, C. & Taylor, C. B. 1999). Weight loss dieting may cause other health problems as well, such as immune system problems (Shade ED, et al. 2004).In the medical world, doctors are encouraged to talk to patients about their weight. Every fat person has heard, “What are we going to do about your weight?” The “we” is supposed encourage the patient to feel that the doctor is on the patient’s side in their battle. Yet what many patients hear is, “I don’t see you as a patient, I see you as fat.” Science says that the higher a patient’s BMI the less respect a doctor has for the patient (Huzinga, Cooper, Bleich, Clark, & Beach, 2009).Horror stories about fat people trying to get decent health care are everywhere. For a good example, see Bruce Taylor Seeman’s piece, “The Perils of Obesity May Include the Doctor” (2006). [End Page E1] There are many blogs and stories on the internet about the way patients are not just shamed for their weight, but actively bullied by medical professionals. One blog, The Well Rounded Mama (wellroundedmama.blogspot.com), discusses the bias of doctors against pregnant fat women, who are told things like, “You cannot have a healthy baby when you are this fat” and encouraged to abort. Tales from people told that their weight is the cause for everything and anything can be found on sites like First Do No Harm (fathealth.wordpress.com). Reading blogs by medical professionals can show the disdain they have for fat people. In one, an emergency room nurse declared that all fat diabetics have poor control, based solely on perceptions from her job. Comments were mostly other nurses agreeing with how “disgusting” fat people are to have to deal with. However, Yale University’s Rudd Center for Food Policy & Obesity not only recognizes the problem but aims to help medical professionals eliminate the bias.If obesity becomes a disease, weight loss surgery (WLS) becomes a bigger gold mine. Medical insurance will be more likely to cover weight loss surgery. WLS is an ever-changing target: there... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Psychiatric Treatment and the Problem of Equality:Whose Justice, Which Rationality?Floris Tomasini (bio)KeywordsInvoluntary treatment, democracy, equality, impartialityCraig Edwards in his article "Ethical Decisions in the Classification of Mental Conditions As Mental Illness" provides the reader with a socially normative, rather than a naturalistic understanding of mental illness, one that, in particular, promotes a normative understanding of mental illness as a form of evaluating dysfunctional personhood. In doing so, Edwards is (...) not interested in undermining psychiatric expertise, but exploring some of the practical consequences that flow from it, such as involuntary psychiatric treatment.My concern about psychiatric treatment in general and involuntary psychiatric treatment in particular, is three-fold, the third concern adding to the arguments already rehearsed by Edwards and others. The first concern is about the value neutrality of mental illness. Any dysfunctional conception of mental illness is not value neutral according to Fulford; dysfunction is, straightaway, a normative concept and is heavily influenced by a patient's desires and values. The second concern is about competing and conflicting values that arise in a person's psychiatric treatment. Again, there exists a legitimate variation in people's evaluative judgments about mental health conditions, for which a degree of democratic compromise might be required in negotiating conflicting values in a person's psychiatric treatment (Fulford and Colombo 2004). Without wishing to examine any of the philosophical foundations or counter-arguments to these claims in this short discussion paper, my third concern is about how to ethically negotiate between conflicting values in a person's psychiatric treatment. In other words, what might democratic compromise consist in? How might democratic compromise be implemented in terms of an ethically relevant principle?Any democratic enterprise, by definition, favors or is characterized by social equality and is egalitarian in nature (New Oxford English Dictionary 1999, 490). To be able to negotiate in the spirit of democratic compromise between competing and conflicting values in the process of psychiatric treatment, a principle of equal consideration of interests is vital.The essence of the principle of equal consideration of interests is that we give equal weight in our [End Page 101] moral deliberation to the like interests of all those affected by our actions (Singer 1979, 19). In other words, an interest is an interest whoever's interest that may be. So, for example, if the principle is about relieving pain, then the moral principle is about relieving the undesirability of pain as such, and not the undesirability of A's pain, which might be different from the undesirability of B's pain. Naturally, one may be able to distinguish that A's pain is greater than B's pain, in which case, under the equal consideration of interests principle, A's pain should be given greater weighting than B's pain in any conflict of interests. In short, in the evaluation of like interests, major interests outweigh minor interests.The significance of the principle of equal consideration of interests in decisions about mental health treatment in general, and about involuntary psychiatric detention and treatment more specifically, is that it should be possible (in theory at least) to able to democratically arbitrate on the basis of utility, whose interests take precedence when legitimate conflicts arise. The great practical advantage to the principle of equal consideration of interests is that it weighs' interests impartially—like well-balanced weighing scales; they favor where the interest is stronger or where several interests combine to outweigh a smaller number of similar interests. Most important, in the case of psychiatric treatment, it is a principle that takes no account of whose interests they are, avoiding any discriminatory stigma that may arise because of having made certain assumptions about being mentally ill. From the point of view of the equal consideration of interests, who the bearer is and how they are classified is, in itself, incidental to what the actual bearer's interests are and how they compete and conflict with others who have like interests. There are a number of practical consequences that flow from the principle of equal consideration when applied to psychiatric treatment (voluntary and involuntary) that need to be pinned down.Simple Negative DiscriminationClearly... (shrink)

Particularists in ethics emphasize that the normative is holistic, and invite us to infer with them that it therefore defies generalization. This has been supposed to present an obstacle to traditional moral theorizing, to have striking implications for moral epistemology and moral deliberation, and to rule out reductive theories of the normative, making it a bold and important thesis across the areas of normative theory, moral epistemology, moral psychology, and normative metaphysics. Though particularists emphasize the importance of the holism of (...) the normative, however, it is not something that they have been able to explain. In this paper I’ll show how to use a small number of simple and, I’ll argue, independently compelling assumptions in order to both predict and explain the holistic features of the normative with respect to the non-normative. The basic idea of the paper is simple. It is that normative claims are holistic because they are general, rather than because they defy generalization. (shrink)

According to a dominant view of stigma, a person is stigmatized within a community if sufficiently many people within that community hold a bad view of her. I call this the 'Bad View Model'. In this paper, I argue against the Bad View Model on the grounds that such beliefs are neither necessary nor sufficient for stigma, and that the account cannot explain the distinctive phenomenology of stigma, including certain vulnerabilities to shame. I then develop an alternative (...) that explains these features of stigma, which I call the 'Shaming Model'. On this view, a person is stigmatized within a community if she is shamed by members of that community, and this is explained by their belief that she has deviated from some social norm and/or standard. (shrink)

In this article, I address the question of the apportionment of the consequences of organizational misconduct to individual members of the organizational elite. I argue that this process can be best understood by marrying the behavioral aspects of stigma theory to the economic mechanisms of ex post settling up. Viewed in conjunction with stigmatization, ex post settling up following organizational misconduct can be seen as the result of attempts to avoid stigma by association. Efforts at stigma avoidance (...) on the parts of various stakeholders produce the diminished social interaction associated with ex post settling up: departure from the focal firm, and loss of seats on other boards. This also suggests that the process of stigmatization, and hence ex post settling up, can be influenced by characteristics of social interaction unrelated to the misconduct itself. (shrink)

Would a just society or government absolutely refrain from shaming or humiliating any of its members? "No," says this essay. It describes morally acceptable uses of shame, stigma and disgust as tools of social control in a decent (just) society. These uses involve criminal law, tort law, and informal social norms. The standard of moral acceptability proposed for determining the line is a version of perfectionistic prioritarian consequenstialism. From this standpoint, criticism is developed against Martha Nussbaum's view that to (...) respect the dignity of each person, society absolutely must refrain from certain ways of shaming and humiliating its members and rendering them objects of communal disgust. (shrink)

This paper proposes a theoretical framework for understanding fat stigma and its impact on people’s well-being. It argues that stigma should never be used as a tool to achieve public health ends. Drawing on Bruce Link and Jo Phelan’s 2001 conceptualization of stigma as well as the works of Hilde Lindemann, Paul Benson, and Margaret Urban Walker on identity, positionality, and agency, this paper clarifies the mechanisms by which stigmatizing, oppressive conceptions of overweight and obesity damage identities (...) and diminish moral agency, arguing that the use of obesity-related stigma for public health ends violates the bioethics principles of nonmaleficence, autonomy, and justice. (shrink)

Although the quality and effectiveness of mental health treatments and services have improved greatly over the past 50 years, therapeutic revolutions in psychiatry have not yet been able to reduce stigma. Stigma is a risk factor leading to negative mental health outcomes. It is responsible for treatment seeking delays and reduces the likelihood that a mentally ill patient will receive adequate care. It is evident that delay due to stigma can have devastating consequences. This review will discuss (...) the causes and consequences of stigma related to mental illness. (shrink)

The consequences of stigma are preventable. We argue that individual attention should be provided to patients when dealing with stigma. Also, in order to deal with the impact of stigma on an individual basis, it needs to be assessed during routine clinical examinations, quantified and followed up to observe whether or not treatment can reduce its impact. A patient-centric anti-stigma programme that delivers the above is urgently needed. To this end, this review explores the experiences, treatment (...) barriers and consequences due to stigma. We also offer putative solutions to this problem. (shrink)

The concept of self-stigmatization is guided by a representational account of selfhood that fails to accommodate for resilience against, and recovery from, stigma. Mainstream research on self-stigma has portrayed it only as a reified self, that is, as collectively shared stereotypes representing individuals’ identity. Self-stigma viewed phenomenologically, however, elucidates what facilitates a stigmatized self. A phenomenological analysis discloses the lived phenomenon of stigma as an act of self-objectification, as related to the experiential self, and therefore an (...) achievement of subjectivity. Following a phenomenological account, the stigmatized self can thus return to a state-of-being, similar to that Jean-Paul Sartre once referred to as bad faith. Regarding your identity as analogous to an inanimate thing is ultimately self-deceptive. Self-stigma is here phenomenologically illuminated as constituted by basic discretion, that is, as a minimal form of agency. The study found that basic discretion can uphold the possibility for emancipation from a stigmatized self. (shrink)

Stigma has become an important concept in public health law. It is widely accepted that certain diseases are disfavored in society, leading to discrimination against people identified with them, which in turn has the tendency to drive an epidemic underground—i.e., to make it more difficult for voluntary public health programs to reach and succeed among populations bent on concealing their disease or risk status. The need to reduce stigma and its effects has been used to justify the passage (...) of privacy and antidiscrimination law to protect people with HIV. More recently, stigma has been part of the arsenal of justification for special genetic antidiscrimination and privacy law. Despite its importance, however, there is no single widely accepted definition of stigma in social science, and its relationship to law has been generally under-theorized and unsupported by data, reducing our ability to effectively deploy law and other tools in the anti-stigma cause. (shrink)

The word stigma comes from ancient Greece, and was initially used in reference to signs or symbols physically cut into or burned onto the bodies of those deemed to be of an inferior status. It was a marking of one's tarnished and flawed character. Today, stigma is more often attached to one's social standing, personality traits, or psychological makeup. "People are no longer physically branded; instead they are societally labeled—as poor, as criminal, homosexual, mentally ill, and so on. (...) These labels influence public perceptions and behavior and lead to devaluation and denigration of those who are so labeled" (Wahl 1999, 11–12).The modern usage of the term stigma and contemporary focus on the concept as a topic of .. (shrink)

Addictions are commonly accompanied by a sense of shame or self-stigmatization. Self-stigmatization results from public stigmatization in a process leading to the internalization of the social opprobrium attaching to the negative stereotypes associated with addiction. We offer an account of how this process works in terms of a range of looping effects, and this leads to our main claim that for a significant range of cases public stigma figures in the social construction of addiction. This rests on a social (...) constructivist account in which those affected by public stigmatization internalize its norms. Stigma figures as part-constituent of the dynamic process in which addiction is formed. Our thesis is partly theoretical, partly empirical, as we source our claims about the process of internalization from interviews with people in treatment for substance use problems. (shrink)

Stigma has become an important concept in public health law. It is widely accepted that certain diseases are disfavored in society, leading to discrimination against people identified with them, which in turn has the tendency to drive an epidemic underground—i.e., to make it more difficult for voluntary public health programs to reach and succeed among populations bent on concealing their disease or risk status. The need to reduce stigma and its effects has been used to justify the passage (...) of privacy and antidiscrimination law to protect people with HIV. More recently, stigma has been part of the arsenal of justification for special genetic antidiscrimination and privacy law. Despite its importance, however, there is no single widely accepted definition of stigma in social science, and its relationship to law has been generally under-theorized and unsupported by data, reducing our ability to effectively deploy law and other tools in the anti-stigma cause. (shrink)