Journal of evaluation in clinical practice
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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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Nowadays, a considerable number of women have a negative or outright traumatic birth experience. Literature shows that being involved in decision-making and exercising autonomy are important factors in having a positive birth experience. In this article, I explore the hypothesis that some views characteristic of the biomedical model of childbirth may hinder women's involvement in decision-making, leading them to what I have dubbed as a 'stigmatizing dilemma'; that is, to be perceived and treated as either irrational or selfish when trying to exercise their autonomy in the labour room. ⋯ Thus, not following expert directions might lead women to fall under the stigma of either irrationality or selfishness: they could be perceived and treated as either irrational, since they may not seem to seek the best means to accomplish their goal; or selfish, since they may seem to pursue goals other than the baby's health. I examine these stigmas in relation to two ideals: that of disembodied rationality and that of selfless motherhood. I also explore different ways in which the views and prejudices underlying this stigmatizing dilemma could be challenged.
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When we face an equation with an unknown variable, we 'solve for x', using methods that allow us to isolate and identify the unknown. Stigma is a known variable in health care equations, but remains impactful in a variety of ways that are not fully mapped or understood. In other words, stigma is a known unknown: it presents potential obstacles to the delivery of effective health care, but what kind of obstacles, of what size and significance, and for whom is often unclear. ⋯ The present paper begins by demonstrating that stigma in mental health care remains an obstacle worthy of sustained attention. It then discusses typical methods taken in efforts to destigmatize mental illness, and suggests that additional work is needed in the clinical context of mental health care. The pervasiveness and complexity of stigma requires diligence in clinical settings to integrate the experience of mental health care service users and work towards an adequate model of recovery.