Martha Nussbaum: Powerlessness and the Politics of Blame

“Powerlessness and the Politics of Blame”

Martha C. Nussbaum^₁

The Jefferson Lecture in the Humanities  

The John F. Kennedy Center for the Performing Arts  

Monday, May 1, 2017

"What’s the alternative? We can keep the spirit of determined protest against injustice while letting go of the empty fantasy of payback. This forward-looking strategy includes protesting wrongdoing when it occurs, but not imputing wrongdoing where there is, instead, the murky thicket of the global economy to manage, outsourcing and automation to reconcile with our citizens’ welfare. Never seizing hold of blame as a substitute for a feeling of powerlessness, but also not yielding to despair. Even when we are confident in imputing wrongdoing to an individual or a group, we can still firmly refuse payback, but look to the future with hope, choosing strategies designed to make things better rather than to inflict the maximum pain." 

"Policy makers distrust doctors' evidence in relation to mental illnesses."

Aust Health Rev. 2017 May 15. doi: 10.1071/AH16092. [Epub ahead of print]

Distrusting doctors.

McAllister A, Leeder SR.

Abstract

Objective The aim of the present study was to describe how policy makers (bureaucrats and politicians) in Australia and Ontario (Canada) perceive evidence provided by doctors to substantiate applications for disability income support (DIS) by their patients with mental illnesses. Because many mental illnesses (e.g. depression) lack diagnostic tests, their existence and effects are more difficult to demonstrate than most somatic illnesses.

Methods Semi-structured interviews were conducted with 45 informants, all influential in the design of the assessment of DIS programs. The informants were subcategorised into advocates, legal representatives, doctors (general practitioners (GPs) and specialists (e.g. psychiatrists)), policy insiders and researchers. Informants were found through snowball sampling. Following the principles of grounded theory, data collection and analysis occurred in tandem.

Results Informants expressed some scepticism about doctors' evidence. Informants perceived that doctors could, due to lack of diagnostic certainty, 'write these things [evidence] however [they] want to'. Psychiatrists, perceived as having more time and skills, were considered as providing more trustworthy evidence than GPs.

Conclusion Doctors, providing evidence to support applications, play an important role in determining disability. However, policy makers perceive doctors' evidence about mental illnesses as less trustworthy than evidence about somatic illnesses. This affects decisions by government adjudicators.

What is known about the topic? Doctors (GPs and psychiatrists) are often asked to provide evidence to substantiate a DIS application for those with mental illnesses. We know little about the perception of this evidence by the policy makers who consider these applications.

What does this paper add? Policy makers distrust doctors' evidence in relation to mental illnesses. This is partly because many mental illnesses lack diagnostic proof, in contrast with evidence for somatic conditions, where the disability is often visible and proven through diagnostic tests. Furthermore, GPs' evidence is considered less trustworthy than that of psychiatrists.

What are the implications for practitioners? Although doctors' evidence is often required, the utility of their evidence is limited by policy makers' perceptions.

Methods Mol Biol. 2017;1606:37-50. doi: 10.1007/978-1-4939-6990-6_3.

Personalized Medicine: Ethical Aspects.

Sharrer GT1.

Author information

1

Retired Surator of Health Sciences - Smithsonian Institution, Washington, DC, USA. sharrert@gmail.com.

Abstract

In our time of genome-based personalized medicine, clinical research and clinical medicine are accelerating at a quick pace. Faster and cheaper DNA sequencing and protein profiling, microfluidic devices for capturing blood biomarkers, nanoparticles for precise drug delivery and enhanced imaging, rapid computational analysis of massive data inputs, and other technological wonders coalesce to create a kind of Moore's Law for medicine. Needs are obvious, knowledge grows, capital becomes available, but these factors are not entirely sufficient to make health more achievable. Personalized medicine also requires social acceptability, not only for accuracy and efficacy but also because medicine is a moral domain. This chapter deals with medical ethics that determine the choices a society makes regarding healthcare; and it has not always been a steady, morally correct course of progress. Indeed, medical ethics has largely derived from socio-scientific calamities in the past. Personalized medicine, with its enhanced capacity to access the individuality of illness, must have a continuously evolving feedback mechanism-the most important element being the physician-patient relationship-which is its ethical footing.

Sparkling water could lead to obesity says new study

"A new study has discovered that drinking sparkling water can lead to obesity, researchers studied the effects on 20 human volunteers and found that those who drank sparkling water at breakfast had six times higher levels of the hunger hormone than those given still water. The first study was done on rats, the researchers from Birzeit University in the Palestinian West Bank tested sixteen rat siblings of the same weight."

Two good resources for physicians engaged in social media

Two good resources for physicians engaged in social media:

Blogs and Tweets, Texting and Friending 

Social Media and Online Professionalism in Health Care

Sandra DeJong

----AND---

Acad Psychiatry. 2011 May-Jun;35(3):168-74. doi: 10.1176/appi.ap.35.3.168.

Professional boundaries in the era of the Internet.

Gabbard GO1, Kassaw KA, Perez-Garcia G.

Author information

1

Department of Psychiatry, Baylor College of Medicine, Houston, TX 77401, USA. ggabbard12@aol.com

Abstract

OBJECTIVE:

The era of the Internet presents new dilemmas in educating psychiatrists about professional boundaries. The objective of this overview is to clarify those dilemmas and offer recommendations for dealing with them.

METHOD:

The characteristics of social networking sites, blogs, and search engines are reviewed with a specific focus on their potential to present problems of professional boundaries for psychiatrists.

RESULTS:

The professional boundary questions that have arisen in the expanded world of online communication can be subdivided into three areas: ethical concerns, professionalism issues, and clinical dilemmas. Only the first category involves true boundary problems as normally defined.

CONCLUSIONS:

The expansion of the Internet has redefined traditional areas of privacy and anonymity in the clinical setting. Guidelines are proposed to manage the alteration of professional boundaries, as well as issues of professionalism and clinical work, that have arisen from the complexities of cyberspace. The author discusses implications for residency training.

J Med Philos. 2017 Jun 1;42(3):278-303. doi: 10.1093/jmp/jhx008.

Antiquity's Missive to Transhumanism.

Levin SB1.

Author information

1

Smith College, Northampton, Massachusetts, USA.

Abstract

To reassure those concerned about wholesale discontinuity between human existence and posthumanity, transhumanists assert shared ground with antiquity on vital challenges and aspirations. Because their claims reflect key misconceptions, there is no shared vision for transhumanists to invoke. Having exposed their misuses of Prometheus, Plato, and Aristotle, I show that not only do transhumanists and antiquity crucially diverge on our relation to ideals, contrast-dependent aspiration, and worthy endeavors but that illumining this divide exposes central weaknesses in transhumanist argumentation. What is more, antiquity's handling of these topics suggests a way through the impasse in current enhancement debates about human "nature" and helps to resolve a tension within transhumanists' accounts of what our best moments signify about the ontological requirements for real flourishing

Future Generations and the Justifiability of Germline Engineering

Ioana Petre

J Med Philos (2017) 42 (3): 328-341.

 

DOI:

 

https://doi.org/10.1093/jmp/jhx003

Published:

 

17 April 2017

Abstract

The possibility of performing germline modifications on currently living individuals targets future generations’ health and well-being by reducing the diversity of the human gene pool. This can have two negative repercussions: (1) reduction of heterozygosity, the latter being associated with a health or performance advantage; (2) uniformization of the genes involved in reproductive recombination, which may lead to the health risks involved in asexual reproduction. I argue that germline interventions aimed at modifying the genomes of future people cannot be ethically justifiable if there is no possibility of controlling the intervention either by reversing or altering it, whenever need demands it. This argument is challenged on six different grounds: safety, population versus individual focus, spontaneous mutations, exceptionalism, the intentional pursuit of genetic diversity through germline interventions, and harm reduction potential.

"...it is unintelligible and too reassuring to simply predict that new technologies will enhance human beings."

J Med Philos. 2017 Jun 1;42(3):304-327. doi: 10.1093/jmp/jhx002.

The Posthuman as Hollow Idol: A Nietzschean Critique of Human Enhancement.

Aydin C1.

Author information

1

University of Twente, Enschede, The Netherlands.

Abstract

In this paper, the author aims to show that transhumanists are confused about their own conception of the posthuman: transhumanists anticipate radical transformation of the human through technology and at the same time assume that the criteria to determine what is "normal" and what is "enhanced" are univocal, both in our present time and in the future. Inspired by Nietzsche's notion of the Overhuman, the author argues that the slightest "historical and phenomenological sense" discloses copious variations of criteria, both diachronic and synchronic, for what can be considered "normal" and "enhanced." Radical transformation through technology does not simply enable us to become "stronger," "smarter," or "healthier," but it can and often will also change the very standard or yardstick with which we measure what counts as "stronger," "smarter," or "healthier." Put yet differently: new and emerging technologies are not neutral means but often bring about different and, from our current perspective, foreign standards for determining what are "normal" and "enhanced" capacities. Since the qualitative meanings of these terms are themselves not fixed, it is unintelligible and too reassuring to simply predict that new technologies will enhance human beings.

J Med Philos. 2017 Jun 1;42(3):237-260. doi: 10.1093/jmp/jhx001.

Bioethics and Transhumanism.

Porter A1.

Author information

1

Rice University, Houston, Texas, USA.

Abstract

Transhumanism is a "technoprogressive" socio-political and intellectual movement that advocates for the use of technology in order to transform the human organism radically, with the ultimate goal of becoming "posthuman." To this end, transhumanists focus on and encourage the use of new and emerging technologies, such as genetic engineering and brain-machine interfaces. In support of their vision for humanity, and as a way of reassuring those "bioconservatives" who may balk at the radical nature of that vision, transhumanists claim common ground with a number of esteemed thinkers and traditions, from the ancient philosophy of Plato and Aristotle to the postmodern philosophy of Nietzsche. It is crucially important to give proper scholarly attention to transhumanism now, not only because of its recent and ongoing rise as a cultural and political force (and the concomitant potential ramifications for bioethical discourse and public policy), but because of the imminence of major breakthroughs in the kinds of technologies that transhumanism focuses on. Thus, the articles in this issue of The Journal of Medicine and Philosophy are either explicitly about transhumanism or are on topics, such as the ethics of germline engineering and criteria for personhood, that are directly relevant to the debate between transhumanists (and technoprogressives more broadly) and bioconservatives.

Massachusetts weighing new tax on sodas

Massachusetts weighing new tax on sodas, sugary drinks

"A 12-ounce can of Mountain Dew, for example, contains 46 grams of sugar and would cost an extra 24 cents under the bill."

"In France, political correctness is more than a ridiculous set of opinions; it’s also – and primarily – a tool of government coercion."

The French fracture

A social thinker illuminates his country's populist divides.

"In France, political correctness is more than a ridiculous set of opinions; it’s also – and primarily – a tool of government coercion. Not only does it tilt any political discussion in favour of one set of arguments; it also gives the ruling class a doubt-expelling myth that provides a constant boost to morale and esprit de corps, much as class systems did in the days before democracy. People tend to snicker when the question of political correctness is raised: its practitioners because no one wants to be thought politically correct; and its targets because no one wants to admit to being coerced. But it determines the current polarity in French politics. Where you stand depends largely on whether you believe that anti-racism is a sincere response to a genuine upsurge of public hatred or an ­opportunistic posture for elites seeking to justify their rule."

Dairy got the all-clear this week - but was it justified?

Dairy got the all-clear this week - but was it justified?


"A new study, published recently in the European Journal of Epidemiology, appeared to give dairy products a clean bill of health. The researchers found no evidence for an increased risk of cardiovascular disease or death from consuming dairy products – even full-fat dairy products."

People Who Were "Fat Shamed" as Kids Are More Likely to Be Obese as Adults

The effect is especially pronounced for women.

TOM PHILPOTTMAY 10, 2017 6:00 AM

"Interestingly, just as girls in the original group reported much more teasing at home than boys did, the impact of fat shaming from family members seemed to hit them harder. Boys who were teased at home but not by peers carried no negative effects into adulthood, but for girls, having been teased at home was strongly associated with bad outcomes as adults, including negative body image."

"The best way to promote integrity in data-intensive science is to maintain a firm commitment to epistemological and ethical values..."

Account Res. 2017 May 8. doi: 10.1080/08989621.2017.1327813. [Epub ahead of print]

Data-Intensive Science and Research Integrity.

Resnik DB1, Elliott KC2, Soranno PA3, Smith EM4.

Author information

1

a National Institute for Environmental Health Ethics, National Institutes of Health , 111 Alexander Drive, Research Triangle Park , NC , 27709 , USA.

2

b Lyman Briggs College, Department of Fisheries and Wildlife, and Department of Philosophy , Michigan State University.

3

c Department of Fisheries and Wildlife , Michigan State University.

4

d National Institute for Environmental Health Ethics, National Institutes of Health.

Abstract

In this commentary, we consider questions related to research integrity in data-intensive science and argue that there is no need to create a distinct category of misconduct that applies to deception related to processing, analyzing, or interpreting data. The best way to promote integrity in data-intensive science is to maintain a firm commitment to epistemological and ethical values, such as honesty, openness, transparency, and objectivity, which apply to all types of research, and to promote education, policy development, and scholarly debate concerning appropriate uses of statistics.

From Aliya Husain and colleagues: Interstitial Pneumonia With Autoimmune Features: Value of Histopathology

Ayodeji Adegunsoye, Justin M. Oldham, Eleanor Valenzi, Cathryn Lee, Leah J. Witt, Lena Chen, Steven Montner, Jonathan H. Chung, Imre Noth, Rekha Vij, Mary E. Strek, and Aliya N. Husain (2017) Interstitial Pneumonia With Autoimmune Features: Value of Histopathology. Archives of Pathology & Laboratory Medicine In-Press.

Early Online Release

Interstitial Pneumonia With Autoimmune Features: Value of Histopathology

Ayodeji Adegunsoye, MD, MS; Justin M. Oldham, MD, MS; Eleanor Valenzi, MD; Cathryn Lee, MD; Leah J. Witt, MD; Lena Chen, BS; Steven Montner, MD; Jonathan H. Chung, MD; Imre Noth, MD; Rekha Vij, MD; Mary E. Strek, MD; Aliya N. Husain, MD

From the Section of Pulmonary and Critical Care Medicine, Department of Medicine (Drs Adegunsoye, Witt, Noth, Vij, and Strek and Ms Chen) and the Departments of Medicine (Drs Valenzi and Lee), Radiology (Drs Montner and Chung), and Pathology (Dr Husain), University of Chicago, Chicago, Illinois; and the Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California, Davis (Dr Oldham). Drs Adegunsoye and Oldham contributed equally to this article.

Reprints: Ayodeji Adegunsoye, MD, Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, 5841 S Maryland Ave, MC6076, Chicago, IL 60637 (email: deji@uchicago.edu).

Context.— Patients with idiopathic interstitial pneumonia may display evidence of autoimmunity, without meeting criteria for a defined connective tissue disease. A recent European Respiratory Society/American Thoracic Society statement proposed research criteria for interstitial pneumonia with autoimmune features (IPAF), which includes findings from the clinical, serologic, and morphologic domains.

Objectives.— To investigate the importance of histopathologic criteria within the morphologic domain and to report our methodology for identifying these features.

Design.— Patients with idiopathic interstitial pneumonia at the University of Chicago, who underwent surgical lung biopsy or lung transplantation were assessed for IPAF histopathologic features, using the initial pathology interpretation in the electronic records. A focused rereview of available slides by a pulmonary pathologist was then performed for patients who failed to meet IPAF criteria on initial pathology assessment.

Results.— Of 422 patients with idiopathic interstitial pneumonia, 176 (41.7%) underwent surgical lung biopsy or lung transplant. Forty-six of those 176 patients (26.1%) met IPAF criteria by initial pathology interpretation and a positive clinical or serologic feature. Of the remaining 130 patients, 73 (56.2%) met either the clinical or serologic domains without meeting the morphologic domain, whereas 36 (27.7%) had slides available for pathology rereview. This rereview demonstrated nonspecific interstitial pneumonia in 8 of 36 patients (22.2%) and lymphoplasmacytic infiltrates in 6 of 36 patients (16.7%), resulting in an additional 7 of 36 patients (19.4%) with idiopathic interstitial pneumonia that met the IPAF criteria. In IPAF, pulmonary vasculopathy was the most prevalent finding (45 of 84; 53.6%) and predicted increased mortality (hazard ratio, 2.5; P = .04).

Conclusions.— Using a methodological approach to identifying IPAF pathology, we demonstrate a significant increase in the number of patients meeting IPAF criteria because of focused pathologic review and highlight the prognostic value of the IPAF pathologic findings.

Michelle Mello and colleagues; Relationship Between State Malpractice Environment and Quality of Health Care in the United States

Jt Comm J Qual Patient Saf. 2017 May;43(5):241-250. doi: 10.1016/j.jcjq.2017.02.004. Epub 2017 Mar 27.

Relationship Between State Malpractice Environment and Quality of Health Care in the United States.

Bilimoria KY, Chung JW, Minami CA, Sohn MW, Pavey ES, Holl JL, Mello MM.

Abstract

BACKGROUND:

One major intent of the medical malpractice system in the United States is to deter negligent care and to create incentives for delivering high-quality health care. A study was conducted to assess whether state-level measures of malpractice risk were associated with hospital quality and patient safety.

METHODS:

In an observational study of short-term, acute-care general hospitals in the United States that publicly reported in the Centers for Medicaid & Medicare Services Hospital Compare in 2011, hierarchical regression models were used to estimate associations between state-specific malpractice environment measures (rates of paid claims, average Medicare Malpractice Geographic Practice Cost Index [MGPCI], absence of tort reform laws, and a composite measure) and measures of hospital quality (processes of care, imaging utilization, 30-day mortality and readmission, Agency for Healthcare Research and Quality Patient Safety Indicators, and patient experience from the Hospital Consumer Assessment of Healthcare Providers and Systems [HCAHPS]).

RESULTS:

No consistent association between malpractice environment and hospital process-of-care measures was found. Hospitals in areas with a higher MGPCI were associated with lower adjusted odds of magnetic resonance imaging overutilization for lower back pain but greater adjusted odds of overutilization of cardiac stress testing and brain/sinus computed tomography (CT) scans. The MGPCI was negatively associated with 30-day mortality measures but positively associated with 30-day readmission measures. Measures of malpractice risk were also negatively associated with HCAHPS measures of patient experience.

CONCLUSIONS:

Overall, little evidence was found that greater malpractice risk improves adherence to recommended clinical standards of care, but some evidence was found that malpractice risk may encourage defensive medicine.

Ending ObamaCare, Part One

House Republicans take a giant step toward better health care.

"The bill doesn’t repeal all of ObamaCare because it can’t without Democratic help under the Senate’s budget rules. But the bill marks a giant step away from the Democratic march to government-run health care, which is why the political and cultural left have been so vitriolic in their denunciations."

"But these nostalgic images are a shoddy replacement for any sophisticated understanding of history..."

Look back with danger

SIMON GOLDHILL

"Today’s constant talk of nostalgia – for old passport covers, old manners, old food, and above all that fantasy of a Britain before multiculturalism – is in part a response to rapid social change and feelings of insecurity. In part, it is what anyone who is growing older might feel, as their childhood becomes vividly distant. But these nostalgic images are a shoddy replacement for any sophisticated understanding of history – the complex story of the past, and the intricate forces that link the past and the present – and that is why we should be worried when politicians play the nostalgia card. When we forget that the questions “where have we come from?” and “where we going?” are integrally linked, we drastically reduce our chances of self-understanding or effective action. If we oversimplify history, we will live – as both Cicero and Kant predicted – with the shallow mindfulness of children."

Subst Abuse. 2017 Mar 23;11:1178221816685087. doi: 10.1177/1178221816685087. eCollection 2017.

"Don't Judge a Book Its Cover": A Qualitative Study of Methadone Patients' Experiences of Stigma.

Woo J1, Bhalerao A1, Bawor M2, Bhatt M3, Dennis B2, Mouravska N4, Zielinski L5, Samaan Z2,3,4,6.

Author information

1

Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.

2

Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.

3

Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada.

4

Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.

5

MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada.

6

Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON, Canada.

Abstract

INTRODUCTION:

Despite its efficacy and widespread use, methadone maintenance treatment (MMT) continues to be widely stigmatized. Reducing the stigma surrounding MMT will help improve the accessibility, retention, and treatment outcomes in MMT.

METHODS:

Semi-structured interviews were conducted with 18 adults undergoing MMT. Thematic content analysis was used to identify overarching themes.

RESULTS:

In total, 78% of participants reported having experienced stigma surrounding MMT. Common stereotypes associated with MMT patients included the following: methadone as a way to get high, incompetence, untrustworthiness, lack of willpower, and heroin junkies. Participants reported that stigma resulted in lower self-esteem; relationship conflicts; reluctance to initiate, access, or continue MMT; and distrust toward the health care system. Public awareness campaigns, education of health care workers, family therapy, and community meetings were cited as potential stigma-reduction strategies.

DISCUSSION AND CONCLUSION:

Stigma is a widespread and serious issue that adversely affects MMT patients' quality of life and treatment. More efforts are needed to combat MMT-related stigma.

Epidemiol Infect. 2017 May 2:1-10. doi: 10.1017/S0950268817000760. [Epub ahead of print]

Constructing Ebola transmission chains from West Africa and estimating model parameters using internet sources.

Pettey WBP1, Carter ME1, Toth DJA1, Samore MH1, Gundlapalli AV1.

Author information

1

University of Utah School of Medicine,Salt Lake City, Utah,USA.

Abstract

During the recent Ebola crisis in West Africa, individual person-level details of disease onset, transmissions, and outcomes such as survival or death were reported in online news media. We set out to document disease transmission chains for Ebola, with the goal of generating a timely account that could be used for surveillance, mathematical modeling, and public health decision-making. By accessing public web pages only, such as locally produced newspapers and blogs, we created a transmission chain involving two Ebola clusters in West Africa that compared favorably with other published transmission chains, and derived parameters for a mathematical model of Ebola disease transmission that were not statistically different from those derived from published sources. We present a protocol for responsibly gleaning epidemiological facts, transmission model parameters, and useful details from affected communities using mostly indigenously produced sources. After comparing our transmission parameters to published parameters, we discuss additional benefits of our method, such as gaining practical information about the affected community, its infrastructure, politics, and culture. We also briefly compare our method to similar efforts that used mostly non-indigenous online sources to generate epidemiological information.

Doctors urge more exercise for pregnant women

"About 45 percent of current mothers-to-be begin their pregnancy in an overweight or obese state, vs. 24 percent in 1983. In addition, nearly half of pregnant women now gain more weight in nine months than the amounts recommended by the Institute of Medicine. Those guidelines are ordered by body mass index of the woman -- normal, overweight or obese -- and stand at 25 to 35 pounds, 15 to 25 pounds, and 11 to 20 pounds."

From Tim Mackey and Bryan Liang: After Amarin v FDA: What Will the Future Hold for Off-label Promotion Regulation?

Mayo Clin Proc. 2016 Jun;91(6):701-6. doi: 10.1016/j.mayocp.2016.02.024. Epub 2016 Apr 12.

After Amarin v FDA: What Will the Future Hold for Off-label Promotion Regulation?

Mackey TK1, Liang BA2.

Author information

1

Department of Anesthesiology, Division of Global Public Health, Department of Medicine, University of California, San Diego School of Medicine, San Diego, CA; Joint Masters Program in Health Policy and Law, University of California, San Diego School of Medicine and California Western School of Law, San Diego, CA; Global Health Policy Institute, La Jolla, CA. Electronic address: tmackey@ucsd.edu.

2

Global Health Policy Institute, La Jolla, CA.

"When manufacturers engage in promotion for any indication, dosage, or administration outside the FDA approval, they engage in illegal off-label promotion.4 However, the lines between illegal and permitted off-label promotion are now being blurred in the wake of the Amarin decision, which is likely to have a lasting impact on future drug promotion practices, regulatory and enforcement activities, and the role of the physician in patient care."

J Bioeth Inq. 2017 May 3. doi: 10.1007/s11673-017-9784-y. [Epub ahead of print]

Stigma and Self-Stigma in Addiction.

Matthews S1, Dwyer R2,3, Snoek A4.

Author information

1

Plunkett Centre for Ethics, Centre for Moral Philosophy and Applied Ethics, Australian Catholic University (ACU), Institute for Religion and Critical Inquiry (IRCI), 7 Ice Street, Darlinghurst, Sydney, NSW, 2010, Australia. stephen.matthews@acu.edu.au.

2

Social Studies of Addiction Concepts (SSAC) Research Program, National Drug Research Institute (Melbourne Office), Faculty of Health Sciences, Curtin University, Bentley, Australia.

3

Centre for Cultural Diversity and Wellbeing, College of Arts, Victoria University, Melbourne, Australia.

4

Faculty of Health, Medicine and Life Sciences, Maastricht University, Peter Debyeplein 1, 6229 HA, Maastricht, The Netherlands.

Abstract

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.