Melissa Ceuterick

To explore the relationships between pain medication use and quality of life in individuals with chronic non-cancer pain (CNCP), with a focus on three domains: pain severity, well-being and psychosocial functioning, and stigma experiences. A secondary analysis was conducted using cross-sectional data from an online Belgian survey. The sample consisted of 332 participants with CNCP (M_age = 54 years; 82% women; 18% men). Participants were categorized into four groups: individuals taking (1) no medication, (2) non-opioids, (3) mild/weak opioids, or (4) strong opioids. Pain grades were assigned using the Graded Chronic Pain Scale. Distribution of frequencies and Spearman's correlation were calculated for pain severity, while (multivariate) analysis of variance was used for all psychosocial outcomes. Participants classified in higher pain grades were more likely to use stronger opioids. Significant differences emerged between medication groups in well-being and functioning, as well as stigma experiences. Specifically, individuals in the strongest opioid group reported the highest levels of pain interference, social isolation, enacted and internalized stigma, alongside the lowest levels of physical functioning and social participation. After controlling for pain severity, only differences between medication groups in pain interference and physical functioning remained significant. In contrast, pain severity showed significant main effects across all outcomes: pain interference, physical functioning, social participation, social isolation, depressive symptoms, anxiety, and overall stigma. This study emphasizes the need for a multidisciplinary treatment approach, given that both pain severity and opioid use were associated with poorer quality of life among individuals with CNCP.

Disparities in the quality of mental healthcare services for majoritized versus minoritized clients are pronounced, while therapists draw on intuition and wider societal ideologies rather than professional training to confront the question of how to address clients’ cultural identities and backgrounds in psychotherapy. This signals a gap between theoretical calls for cultural sensitivity and the practical implementation of culturally responsive care. The current study explores how psychotherapists deal with the dilemma of how to conceptualize, address, and discuss ‘culture’ in their practice. Drawing on a critical social–psychological framework for discourse analysis, we analyzed 31 semi-structured interviews with psychotherapists in Flanders, Belgium, and present the discursive patterns they articulated on culture and therapeutic conversations interpreted as related to culture. Therapists construct the importance of these conversations and position themselves while perpetuating wider societal discourse on cultural diversity in their clinical practice, drawing from five different repertoires: an action hesitancy repertoire, an experience as expertise repertoire, a paternalistic repertoire, a self-evidence repertoire, and a de-culturalization repertoire. Each repertoire has specific strengths and pitfalls for effective therapy with minoritized clients. As therapists are primary authorities in diagnosis and treatment, their practices greatly impact care quality and have the potential to either uphold or challenge existing disparities in mental healthcare.

Motherhood is socially obligatory in rural Punjabi, Pakistan, leaving no room for voluntary childlessness. Women facing conception challenges strive to attain motherhood, combating the stigma of being labelled childless. Using Butler’s performativity theory, this study delves into the experiences of childless women striving to become mothers in the pronatalist society of Pakistan. In-depth interviews with childless women and focus group discussions with community members were conducted. The data were analysed using a thematic analysis. Results revealed that women must demonstrate mothering qualities alongside seeking treatment to validate their desire for motherhood. The study concludes that societal discourses shape childless women’s lives, influencing their conscious and unconscious adherence to gendered social norms of motherhood.

Chronic pain, defined as pain persisting for more than three months, affects one in four Belgian adults. Treating chronic pain comprises challenges for patients and clinicians as the term encompasses diverse conditions such as fibromyalgia, migraine, and long-term pain without a known biomedical cause. Additionally, growing evidence highlights the limited efficacy of opioids in managing chronic non-cancer pain. This has prompted critical policy changes in pain management, including shifts away from opioid use. This study explores how Belgian policy documents depict patients, healthcare providers, and therapeutic relationships within the context of opioid use in the treatment of chronic non-cancer pain. A critical discourse analysis of 32 Belgian Dutch-language policy documents was performed using Fairclough’s framework. This approach examines how language in texts reflects and shapes social power dynamics and ideologies, and allows us to gain insight into the policy discourses surrounding opioid use for chronic pain. Based on our analysis, we suggest that written policy texts about the use of opioids to manage chronic pain are constructed through the deployment of three discourses: a medical authority discourse, a patient empowerment discourse, and a high-risk medication discourse. While all discourses are rooted in the biopsychosocial pain model, they prioritize different aspects of chronic pain management. Whereas the medical authority discourse emphasizes the decision-making role of physicians, the patient empowerment discourse shifts attention to patients’ experiences and preferences. Lastly, the high-risk medication discourse underscores opioids’ addictive potential. These discourses reflect varying perspectives on chronic pain management and have different implications for clinical practice. The findings offer valuable insights into how Belgian policy documents discursively construct or challenge therapeutic relationships and stigma.

Mental health issues, such as depression, are prevalent in Belgium, particularly among individuals with a migration background. General practitioners (GPs) may inadvertently contribute to these disparities through unconscious biases and stereotypes. This study investigates how Belgian GPs’ accounts reflect, perpetuate, or resist stigmatization toward patients with a migration background experiencing mental health issues and how these accounts are influenced by broader professional discourses. Theoretically, this paper is inspired by Imogen Tyler’s reconceptualization of stigma and her further development of “stigma power.” We conducted a critical discourse analysis guided by the principles of Norman Fairclough, analyzing 19 interviews with Dutch-speaking GPs in Belgium. Our findings reveal two main discourses in GPs’ accounts: (a) the health literacy discourse, resonating with the biomedical and biopsychosocial models, and (b) the person-centered discourse, resonating with the person-centered model. The discourses, embedded in institutional guidelines and policy regulations, function as “stigma machines,” perpetuating stigmatization of patients with a migration background in GPs’ accounts. However, the person-centered discourse also shows potential to counteract and resist stigmatization. This study underscores the importance of addressing both GPs’ professional accounts and broader professional discourses and power dynamics within the therapeutic relationship to effectively tackle ethnic disparities in mental health care. By examining how these power relations shape GPs’ professional accounts, we highlight the need for critical reflection on the role of institutional discourses in either perpetuating or challenging stigmatizing practices. This approach aims to contribute to more equitable mental health care for patients with a migration background.

Despite the high level of scientific support for the effectiveness of opioid substitution treatments (OSTs), individuals who rely on this treatment are a highly stigmatized population within healthcare settings. Previous studies mainly focused on the experiences of OST clients, while the perspective of medical professionals regarding OST remains largely unexplored. This study aims to investigate the discourse of pharmacists and general practitioners about OST through the lens of positioning theory. To explore their stance toward OST, semi-structured interviews were conducted with 30 pharmacists and general practitioners working in pharmacies, community health centers, private medical practices, prisons, and drug treatment services in Flanders, Belgium. The participants of this study discursively constructed four storylines to position themselves and OST clients, namely, a biomedical, psychodynamic, biopsychosocial, and moralizing storyline. These storylines are based on historical explanatory addiction models, and their use varies according to the participant’s work setting. While the moralizing storyline was characterized by othering, stereotyping, and labeling, participants who applied the biopsychosocial storyline approached clients in a destigmatizing manner. To conclude, participants used the identified storylines to define the position of clients in OST, along with their related rights and duties. The dominant storyline thus shapes the view on and treatment of OST clients in a medical setting.