Medicalisation, de-medicalisation and stigma

an investigation into the ethical purposes of disease designation

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.