This piece has been written by Micah Ingle and was first published by Mad in America on November 15, 2019, and can be accessed here.

A recent study published in the Review of General Psychology surveys existing research on the nature and effect of dehumanization in healthcare contexts. This includes both self-dehumanization, or self-objectification, and other-dehumanization. The review analyzes both participant examples of dehumanization, such as students and healthcare professionals, as well as document examples, such as newspaper and magazine articles. The majority of studies explored self-dehumanization, which was linked to higher anxiety and depressive symptoms, disordered eating, and other negative symptoms.

“Although such health-related dehumanization processes may occur both in everyday informal situations and in formal medical contexts where health care is a central activity, this topic has gained much attention in the latter. In medical contexts, where it has been described as endemic and multidetermined, dehumanization violates patients’ rights to autonomy and informed decision-making and is seen as one of the key drivers of inequitable health treatments and poorer clinical outcomes,” explain authors Eva Diniz, Sónia F. Bernandes, and Paula Castro.

The concern with dehumanization in mental healthcare dates back to humanistic psychologists’ criticisms of behaviorist psychology in the mid-twentieth century when humanists argued that behaviorism saw the individual as a machine rather than an experiencing, “whole” person.

The debate continues, with many criticizing the DSM and psychiatry for their use for “dehumanizing labels,” and others arguing that the medical model reduces empathy. Research suggests that empathy is a predictive factor in positive mental health outcomes.

The current study is a broad review of dehumanization in healthcare. This ranges from self-dehumanization and self-objectification to other-dehumanization, as well as from metaphors used in dehumanization processes to the different effects that dehumanization can have on individuals.

A total of 59 relevant articles were included in the review, from an original number of 3,229. The majority of the studies were connected in Anglo-Saxon countries, with most focusing on self-objectification among young adult women. Much of the following research relies on Fredrickson and Roberts’s “Self-objectification theory,” accounting for how women internalize oppressive social understandings and behaviors.

Fifteen of the studies analyzed dehumanizing metaphors in healthcare settings. Some individuals used metaphors to describe their bodies as, for example, a “time bomb” in reference to chronic illness and a “suspicious machine” in reference to their ability to achieve a successful pregnancy. Women viewing their bodies as “sexual objects” was also common. These metaphors seemed to be associated with a distancing from the individuals’ own experiences and emotions.

People with infectious diseases such as HIV often viewed themselves as “dirty” or “contaminated,” reducing themselves to stigmatizing characteristics of the conditions. Overweight individuals felt like they had “a second-class body” and reflected social stigmas around things like laziness and lack of agency, i.e., being a “couch potato.”

Nine studies explored metaphors related to other-dehumanization. Healthcare professionals referred to pregnant women’s bodies as “faulty machines,” which needed constant supervision. “Transsexual” individuals’ bodies were objectified as being either “operative” or “preoperative.” Magazines often framed women’s bodies as sexual objects as well, encouraging them toward being white, young, and thin, while emphasizing passivity and an instrumental understanding of their bodies.

Several studies (n=49) explored the predictors, mediators, moderators, and outcomes of dehumanization. Students with lower “perspective-taking” skills and “empathic concern” failed more often to view individuals as uniquely human. Psychiatrists and psychologists, who believed in a genetic as opposed to a psycho-environmental basis for mental illness, perceived less uniquely human emotions in patients, such as comfort or disappointment.

When patients were understood to have their own unique thoughts and to be able to plan and make choices, they were viewed as more human than when their “mental illness” was the overarching frame for how they were perceived. Lower socioeconomic-status patients were especially likely to be dehumanized in this way.

Nurses with a high emotional commitment to their organization and patients showed a stronger denial of uniquely human qualities, which was also associated with lower rates of burnout and distress. The same was true of healthcare professionals with high rates of direct contact with patients, suggesting that dehumanization may be a coping mechanism for some individuals. Non-healthcare individuals, however, were more likely to seek psychological help treatment if they viewed themselves as uniquely human.

“In sum, this set of studies showed that patients’ dehumanization seems to be protective of professionals’ mental health, decreasing stress, and burnout, whereas being a victim of dehumanization leads patients to poorer medical adherence and mental health.”

The authors report several situational factors affecting self-objectification. When young adolescent and young adult women were enrolled in yoga and mindfulness meditation classes, there was a decrease in self-objectification after eight weeks. On the other hand, when young adult women joined an exercise class that emphasized physical appearance as the primary goal, the participants showed an increase in self-objectification.

The same study showed that when a different exercise class emphasized health reasons, self-objectification decreased. Women who worked in sexually objectifying job environments reported higher self-objectification as well as higher rates of depression and lower job satisfaction.

Self-objectification was found by the authors to be associated with more anxiety and depressive symptoms, lower self-esteem, fewer social involvements, lower well-being overall, and more self-harm behaviors. Negative body evaluation was another consequence. Eating disorders, as well, were more common among those who engaged in self-objectification. This association was buffered by self-compassion, but not spirituality/religiousness.

In terms of physical health, self-objectification was associated with lower rates of exercise in public places, to avoid further sexual objectification by the “male gaze.” On the other hand, self-objectifying women more often engaged in extreme exercise activities and extreme dieting, to the point of unhealthiness. This was true for pregnant women, as well. Furthermore, women high in self-objectification engaged in riskier sexual and reproductive health behaviors, such as not attending medical appointments and not using contraception as much. Attitudes toward menstruation and breastfeeding were also negatively affected.

The authors note that much of the data was focused on students and laypeople, rather than extensively studying dehumanization among healthcare professionals. Additionally, much of the research did not take into account broader social factors such as SES, focusing instead of decontextualized individuals. These individuals were frequently young adult white females, which makes generalization difficult. The research literature would also have been improved by including the perspectives of both the victims and actors involved in dehumanization, rather than a more passive analysis, according to the authors.

They argue that more research is needed on other-dehumanization, different forms of self-dehumanization such as the effects of different bodily metaphors, and mediating social and economic factors.

Limitations to the review article itself were also identified. Keyword searches used were broad and may have missed more specific topics such as “bodyweight” and “eating disorder.” The authors also focused on “everyday” dehumanization and meaning-making, as opposed to pathological/clinical issues such as burnout and compassion fatigue.

The authors conclude:

“Overall, current research depicts a whole range of psychosocial processes of dehumanization and their interconnectivity not only in formal health contexts but also in everyday interactions, bridging some of the gaps left by health service research. Being an emerging field of research, there is a call for a broad and more contextualized understanding of self- and other-dehumanization on formal health-related contexts and beyond, as an important stepping stone to tackle current inequalities in health.”

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Diniz, E., Bernardes, S. F., & Castro, P. (2019). Self- and other-dehumanization processes in health-related contexts: A critical review of the literature. Review of General Psychology, 23(4), 475-495. (Link)

MIA Research News Team: Micah Ingle is a doctoral student in Psychology: Consciousness and Society at the University of West Georgia. He has published on therapeutic approaches centering the person-in-context, as opposed to the individualizing medical model, and on the characteristics of people high in empathy. His current interests include the intersection of sociopolitical/economic structures and mental health, individualism in psychology, gender, liberation psychology, and mythopoetic perspectives inspired by Jungian thought.