Journal of evaluation in clinical practice
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There are thousands of papers about stigma, for instance about stigma's impact on wellbeing, mental or physical health. But the definition of stigma has received only modest attention. In "Conceptualizing stigma" from 2001, Link and Phelan offer a thorough and detailed definition of stigma. They suggest that there are six necessary conditions for stigma, namely labelled differences, stereotypes, separation, status loss and discrimination, power, and emotional reaction. This definition is widely applied in the literature but is left mainly uncriticized. ⋯ We suggest that groups, not individuals, are the target of stigma, though it is individuals who may be the victims of it. We suggest a revised definition of stigma that is more simple, precise, and consistent with the empirical literature on stigma; there is stigma if and only if there is labelling, negative stereotyping, linguistic separation, and power asymmetry.
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This article examines the processes that contribute to the stigmatization of a group of people typically identified as "children in care" or "looked after children." In particular, we will look at the ways that we (adults, professionals, and carers) interact with these children, based on their status as both children and members of a socially marginalized and disadvantaged group, and how these modes of interaction can inhibit dialogue-a dialogue that is needed if we are to base our conceptions regarding the needs of these children on a more accurate understanding of their experiences and perspective. The problem is particularly challenging because the very terminology we use in the care community to identify this group is a product of the damaging preconceptions that have affected our interactions with its members and, we argue, it serves to reinforce those preconceptions. Using Fricker's work on epistemic injustice, in conjunction with evidence regarding how accusations of abuse and neglect of these children have been addressed in numerous cases, we illustrate the problems we have in hearing the voices of members of this group and the harmful effects this has on their own ability to understand and articulate their experiences. ⋯ Currently, dialogue between these children and those of us charged to "look after" them is too often characterized by a lack of trust: not only in terms of the children feeling that their word is not taken seriously, that their claims are not likely to be believed, but also in their feeling that they cannot trust those to whom they might disclose abuse or neglect. The goals of the paper are modest in that we aim simply to open up the debate on how to meet this epistemic challenge, noting that there are specific problems that extend beyond those already identified for hearing the voices of other victims of epistemic injustice. Explicitly recognizing the nature and extent of the problem still leaves us a long way from its solution, but it is a crucial start.
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A significant proportion of somatic symptoms remain, at present, medically unexplained. These symptoms are common, can affect any part of the body, and can result in a wide range of outcomes-from a minor, transient inconvenience to severe, chronic disability-but medical testing reveals no observable pathology. This paper explores two first-person accounts of so-called 'medically unexplained' illness: one that is published in a memoir, and the other produced during a semi-structured interview. ⋯ I claim that patients living with so-called 'medically unexplained' illnesses suffer a double burden. They endure both somatic and social suffering-not only their symptoms, but also disrespectful, traumatic and shame-inducing experiences of healthcare systems. I conclude with a reflection on the urgent need for changes in clinical training that could improve the quality of life for these patients, even in the absence of an explanation, treatment or cure for their symptoms.
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Exercise interventions and policies are widely prescribed in both sport and healthcare. Research investigating exercise interventions and policies is generally conducted using an Evidence-Based framework, placing an emphasis on evidence gathered from randomised controlled trials (RCTs). ⋯ The article argues that evidence from mechanistic studies ought to be considered alongside evidence from RCTs because: as RCTs investigating exercise interventions tend to be of low quality, mechanistic studies ought to be used to reinforce the evidence base; further, evidence from mechanistic studies is highly useful for both questions of extrapolation and implementation. This article argues for this on theoretical grounds, and also draws on a number of case studies.
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ICD-11's diagnostic definition possesses conceptual lacunae and normative implications calling for further attention. ⋯ At least with present day medical and scientific knowledge, a complete characterization of the AN phenotype cannot be achieved without reference to psychological states of motivation. And more research, not only clinical, genetic and neurobiological but also conceptual and ethical, will be required to resolve the challenges presented by AN.