Stigma and Power Hierarchies in College Medical Care


For many college students, they are away from home for an extended period for the first time in their lives. Used to having their medical problems taken care of by their parents, this complicates seeking care for sicknesses at school. Many schools offer some form of a clinic on-campus, but these are commonly reported to be insufficient to take proper care of what students need. For many female students, especially those seeking reproductive care, it is difficult to seek care for an issue commonly characterized as taboo. As reported in class, women are more likely to see medical care, especially regarding to reproductive issues. At Notre Dame, issues like these become even more complicated as certain medical procedures are restricted due to the dominant Catholic views of the school. Seeking medical care alone as a young woman exposes patients to stigma and shame, allows women to feel ignored in their own experiences with their bodies, and reveals the impact that illness can have on overall lifestyle.

A typical college lecture hall filled with students. Sourced from Unsplash.

Personal Encounter with UHS

Note: I have changed the name of my friend who agreed to let me use this story for class to preserve her privacy.

My friend, Janie, experienced chronic urinary tract infections (UTIs) while at school at Notre Dame from an unknown cause. When she visited University Health Services (UHS) and her gynecologist at home, she experienced extreme judgement and stigma. The first thing her gynecologist asked her was whether she had a boyfriend (not her number of sexual partners, but whether she had a boyfriend) and when she said yes, they noted that in her chart as a piece of medical information. At her follow up appointments, her gynecologist asked about her boyfriend specifically, inquiring whether he was from home or school, how long they had been together, and other personal pieces of information.

Her gynecologist and UHS were ultimately unable to identify the root causes of what they diagnosed as chronic UTIs. Janie suffered four UTIs in four months as doctors from her hometown and Notre Dame refused to acknowledge that a bigger issue might be at play. They accused her of sleeping around and STDs contributing to her pain while refusing to give her antibiotics that would alleviate her pain or evaluate her for a more serious, long-lasting condition.

They made me feel as though my pain was not worthy of serious consideration, that I must be making it up for attention.

Janie on her experiences with medical professionals at University Health Services in Notre Dame

The condition became drawn out over four months, and it greatly impacted Janie’s quality of life. She was in extreme pain and often had to leave class during lecture due to pain. It eventually got to the point that she was unable to walk back from a class building to her dorm (a 15 minute walk). When she called UHS desperately requesting an appointment and reporting symptoms of kidney stones, the nurse told her that there was nothing she could do to get her an appointment in the next week and remarked, “if you were my daughter and in this much pain, I would send you to the ER.” With no car and nobody to take her to the ER, Janie took 3 Advils and tried to take a nap. She woke up to find herself in some relief (after months of agony) and her gynecologist from home later confirmed that she must have passed the kidney stones unaided by medicine.

Stock photo of a patient holding unmarked pills. Sourced from Pexels.

Reading Janie’s story alongside the texts from the course reveals three themes from this module. She experiences stigma and judgement about her character from her medical condition, encounters the power dynamics which dictate access to medicine for a college-aged girl by herself, and is confronted with the reality of illness and how it affects life outside of the medical realm.

Stigma in the Medical Sphere

Janie experienced stigma and shame from medical professionals because she was a college-aged woman seeking healthcare by herself for a UTI. There is a medical link between UTIs and sex, as anything that allows bacteria to enter the urinary tract can increase the risk of UTIs. Janie faced extreme judgement for her condition because medical professionals who were supposed to be caring for her often assumed that it was her fault that she was experiencing pain, and she deserved it because of her promiscuity. As discussed in Chapter 10 of Kleinman’s Illness Narratives, stigma often has religious ties, and “the afflicted person is viewed as sinful or evil…or [can be associated with] a moral connotation of weakness and dishonor” (Kleinman, 2020). It’s very likely that Notre Dame’s status as a Catholic University influenced the training that UHS employees get and affects the way that they interact with patients for conditions that may be related to premarital sex. When Janie experienced the medical professionals’ reaction to her health condition, she felt silenced and judged, just as patients in Kleinman’s book reported feeling.

Power Hierarchies Affecting Care

When Janie called and requested an appointment after reporting severe symptoms, UHS repeatedly told her that they were unable to fit her in. One nurse even told her that she would tell her own daughter to “just go to the ER.” And when Janie reported to the UHS nurse on the phone that she was experiencing extreme pain (7-8 out of 10), the nurse seemed skeptical, asking “really? There’s no way.” When she told the professionals that she thought she may have a kidney stone, reporting typical symptoms like proteinuria and radiating pain from her back down her hip, she was shut down and told that it was probably just another UTI. Similarly, Nelson writes that the communities served by the Black Panthers’ free clinics often described experiences where when “the resident…comes in to check up on [you, he]…talks to you as though you weren’t there” (Nelson, 2013). Because the medical professionals at the top of the power hierarchy did not view those communities as worthy of knowledge, the medical information was weaponized as it was withheld. Janie was also not treated as capable of understanding her own body, denied explanations of why doctors would not treat her for kidney stones and why her symptoms did not qualify. Just as the gay community protesting for AIDS treatments found themselves having to prove themselves credible in order to engage in healthcare discussions over their own care, Janie did not seem intelligent or credible enough as a young woman to be granted agency in her own care (Epstein 2020).

Stock photo showing a doctor explaining something to a patient. Sourced from Pexels.

Impact of Illness on Lifestyle

When Janie was chronically ill for four months, her illness affected more than just her physical health. It impacted her academics, mental health, and relationships with her friends and partner. In Chapter One of Illness Narratives, Kleinman acknowledges the far-reaching impacts of “illness,” defining it as “how the sick person and the members of the…social network perceive, live with, and respond to symptoms and disability” (Kleinman, 2020). Because she was in such severe pain and was denied medication, she had to leave class during lecture for long periods of time and fell behind on schoolwork. She was also unable to exercise, affecting her mental health. Kleinman details the effect of chronic illness on Alice Alcott, who experiences emotional reactions to her medical condition that affect the rest of her life. He explains that the work of the healer is also to deal with emotional consequences that may come from conditions and treatments (Kleinman, 2020). When Janie’s doctor refused to address her feelings of pain or her concern that it may be a more serious cause, she neglected this duty.


Epstein, S. (1995). The construction of lay expertise: AIDS activism and the forging of credibility in the reform of clinical trials. Science, Technology, & Human Values, 20(4), 408–437.

Kleinman, A. (2020). The meaning of symptoms and disorders. In The illness narratives: Suffering, healing, and the human condition (pp. 3–30). essay, Basic Books.

Kleinman, A. (2020). The personal and social meanings of illness. In The illness narratives: Suffering, healing, and the human condition (pp. 31–56). essay, Basic Books.

Kleinman, A. (2020). The Stigma and Shame of Illness. In The illness narratives: Suffering, healing, and the human condition (pp. 169–180). essay, Basic Books.

Nelson, A. (2013). The People’s Free Medical Clinic. In Body and soul: The black panther party and the fight against medical discrimination (pp. 75–114). essay, University of Minnesota Press.

Medicalization in Female Reproductive Care

Female reproductive care is both familiar and extremely foreign to many women. Talking about menstruation and other biologically female processes that concern the female reproductive system is often considered taboo. While this stigma may seem harmless, it can greatly restrict patient comfort and autonomy by allowing increased medicalization of the female body when women seek treatment for reproductive issues. In many instances, medicalization causes dismissal of female pain and exclusion of the woman from her own treatment plan. Under-medicalization refuses recognition of her pain and thus denies medical remedies, placing the blame on the woman. However, over-medicalization can also reject a woman’s autonomy over her own body, giving doctors jurisdiction because of the taboo subject area (Zola, 2012). Medical control over a woman’s reproductive organs normalizes the dismissal of female-reported pain and a lack of patient-doctor communication due to the taboo nature of the subject.

Image from Pexels.

A Personal Story

(Note: I changed the name of the woman here because the story is personal and I wanted to preserve her privacy.)

Last year, Stacy experienced the impacts of medicalization when she sought care here in South Bend. At midnight, Stacy went to the ER experiencing extreme pain in her lower abdomen. The ER was empty, and she was the only person in the waiting room. Her pain was so extreme that she could not walk. However, Stacy waited over an hour before a healthcare professional was able to see her. Once she was able to be seen by the doctor on call, she was shamed for her potential promiscuity.

“Doctors asked me over and over again if I was pregnant. When I said no, they would ask, ‘Are you sure?'”

Stacy on her experiences seeking treatment for lower abdominal pain at Beacon Memorial Hospital in South Bend

She rated her pain an 8 on a scale of 1 to 10 and yet doctors continually dismissed her pain. As a college-age woman of color, her self-reported pain was not deemed significant enough to warrant urgency. She was left alone in her hospital room for six hours, and doctors ran no tests besides bloodwork, despite her intense physical pain. When they ran urine tests, Stacy asked for water and was denied with no explanation. She eventually was given two ultrasounds and sent back to the room to wait.

At roughly 6:30 AM, several doctors and healthcare professionals came rushing into the hospital room to give her an IV with morphine. They told Stacy that her pain was coming from ovarian torsion and that she might lose an ovary. They said that she may need surgery, and that the doctor would be in at around 4 PM to perform it. When the doctor finally arrived, she told Stacy that surgery was not needed, and doctors discharged her.  The medical situation was never explained to Stacy, who went back to campus; she was simply sent home with 8 oxycodone pills and a bill for $6400 in hospital fees, although she never received care.

Image from Pexels.

Reading Stacy’s story in conjunction with texts from this module of the course reveals three major themes for women as they experience healthcare: the dismissal of female pain, moral judgements surrounding healthcare, and the refusal of female agency. These themes represent an over-stepping of the medical field and provide concrete examples of medicalization in the real world.

Dismissal of Female Pain

When Stacy first arrived at the hospital, her pain was dismissed by doctors, possibly due to her age, race, or gender. This is not an uncommon experience for women, especially women of color like Stacy.

One in five women say they have felt that a health care provider has ignored or dismissed their symptoms.

Emily Paulsen, Duke University Healthcare

The refusal to accept and treat female pain can be viewed as an under-medicalization. One of the four ways that Zola reports medicalization occurring is “through the retention of absolute control over certain technical spheres” (Zola, 2012). Through this logic, isn’t the refusal to take control by treating pain an example of under-medicalization? When doctors deny that a woman’s pain exists, they are not only denying her treatment—they also characterize her as an unreliable narrator, stripping her of the psychological agency to report her own pain.

Moral Blame

Because doctors and medical professionals deny women the psychological credibility to be perceived as rational actors over their own bodies, women are often refused agency in their treatment plans. As seen in Stacy’s story, the doctors who treated her assumed that the pain she reported reflected some sort of mistake on her part. Had she practiced unprotected sex? Was she having sex? This moral judgement relates to the discussion in Zola where our society’s perception of illness inherently places blame on the patient (Zola, 2012).

Denial of Agency

Ranging from period taboo to difficulties with fertility, many women are shamed for talking about reproductive health. This relegates female reproductive health to the medical sphere, placing it solely within the doctors’ jurisdiction. When female bodies become the property of the physician rather than the woman herself, an inevitable loss of autonomy occurs. In Stacy’s story, her own pain was not explained to her. Doctors abandoned her to suffer in confusion rather than walk her through treatment options. Even when her diagnosis was finally made, it was not explained. There was never any option for an active involvement in her own treatment. As a young woman of color, Stacy was not given the option to communicate with the doctor as she devised Stacy’s treatment plan. Depersonalization transformed Stacy from an agent to a body in the eyes of the medical field. Dehumanization does not just work in the medical field—systematic racism impacts everything from housing to food access through policies like segregation and redlined (Bailey et al 2021). Women of color lose agency in the medical field because of power hierarchies that have been in place for hundreds of years and still function today.

Image from Pexels.

Cost of Care

In Stacy’s story, she was charged $6400 and ended up paying approximately $1800 out of pocket, although she ultimately received no treatment but pain medicine (which was not regulated). In fact, she was denied water when she asked for it. How can doctors justify that charge? Profit-driven hospitals use medicalization to decrease quality of care and increase margins of profit (Rosenthal 2013). Stacy experienced how medicalization can create high charges and worse care firsthand.


Bailey, Z. D., Feldman, J. M., & Bassett, M. T. (2021). How structural racism works — racist policies as a root cause of U.S. racial health inequities. New England Journal of Medicine, 384(8), 768–773.

Paulsen, E., & Paulsen, E. (n.d.). Recognizing, addressing unintended gender bias in patient care. Duke Health Referring Physicians. Retrieved February 24, 2023, from

Rosenthal, E. (2014, April 18). Paying till it hurts. The New York Times. Retrieved February 24, 2023, from

Zola, I. K. (1972). Medicine as an institution of Social Control. The Sociological Review, 20(4), 487–504.