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© 2024 The Authors. Journal compilation © 2024 Egalitarian Publishing Ltd.
Journal of Critical Psychology, Counselling and Psychotherapy, Vol. 24, No. 1, 6-15
‘Energy limiting conditions’ (ELC) is a grassroots term, emerging from the work of
disabled researchers in co-production with disabled respondents, delineating health
conditions that share signicant energy limitations (often reduced to ‘fatigue’) as a form
of impairment and substrate of disability discrimination and denial (Hale et al., 2020; Evans
et al., 2023). ELC encompass but extend beyond ‘medically unexplained symptoms’ (see
Hunt 2022a), including ‘rare’ conditions such as Ehlers Danlos syndromes and stigmatised
or medically ‘contested’ diagnoses such as myalgic encephalomyelitis / chronic fatigue
syndrome (ME/CFS) and long Covid. Such conditions are subject to medical contestation
and to clinical and social manifestations of disability denial, including gaslighting, victim
ABSTRACT: A group of debilitating health conditions disproportionately
impacting women, increasingly known as ‘energy limiting conditions’, is
associated with a long history of medical and societal disability denial. This
article offers reections on socio-cultural, bio-political and intrapsychic
contributors to this denial, employing thinking consistent with critical
psychology.
KEY WORDS: COVID, medicalisation, patriarchy
Joanne Hunt is a disabled researcher with a background in psy therapies. Her research interests
centre on the (bio)politics of stigmatised health conditions, sited at the intersection of disability
studies, gender studies, critical psychology, and ethics, with particular focus upon disability-
afrmative healthcare. Email: joanne.hunt@uu.se
Joanne Hunt
Reections on gendered
disability denial: The
case of energy limiting
conditions
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© 2024 The Authors. Journal compilation © 2024 Egalitarian Publishing Ltd.
Journal of Critical Psychology, Counselling and Psychotherapy, Vol. 24, No. 1, 6-15
blaming and epistemic injustice (Hale et al., 2020; Evans et al., 2023; see also Blease et
al., 2017; Hunt, 2023a; Lian & Robson, 2017; Merone et al., 2022). Importantly, these
manifestations of denial can be considered gendered: many conditions that fall under
the ELC umbrella, including ME/CFS and long Covid, disproportionately impact women,
where this term is used inclusively of cis and transgender women (see Evans et al.,
2023). Moreover, this diagnostic cluster bears a long-standing association with the
psy disciplines that, it will be contended, is inextricably linked with the persistence of
gendered disability denial.
Since what follows positions disability denial as a central construct, this term
requires some unpacking. Disability is understood by the author through a theoretically
pluralistic lens: as a form of social oppression imposed upon people with ‘impairments’
(body/minds deemed to diverge from social norms), the interaction of body/minds with
an oppressive, exclusionary society, a source of diversity, a political position and historical
community (see Goodley, 2017). Disability is further understood as a biopolitical
phenomenon, the subject and object of endeavours “to rationalize the problems that
the phenomena characteristic of a group of living human beings, when constituted as a
population, pose to governmental practice” (Tremain, 2001, p.618). As will be discussed,
an important facet of ‘governmental practice’ relevant to ELC and disability denial
relates to welfare reform politics. Broadly drawing from psychoanalytical thinking,
‘denial’ is understood as defensive practices that seek to manage psychological conict
by disavowing (refusing to acknowledge responsibility for, or denying the existence
of) a given phenomenon. It follows that disability denial refers to the devaluation,
stigmatisation, epistemic and ontological invalidation of body/minds positioned as ‘Other’
in the mainstream psychosocial imaginary, combined with a disavowal of how society
may further disable (oppress, invalidate, exclude) the disabled Other. From a biomedical
and mainstream (hegemonic) psychology perspective, manifestations of disability denial
in the ELC arena are most widely documented and contested in the case of ME/CFS and
long Covid. Before moving to critically-informed reections upon disability denial, this
mainstream and dominant perspective is briey re-visited.
The dominant account of disability denial in the ELC arena, most notable in
the case of ME/CFS and long Covid, is tightly tied to that of a ‘paradigm war’ that
persists between biomedical and (bio)psychosocial conceptualisations of these health
conditions, and associated healthcare practice and policy. Whilst well documented
elsewhere (see Hughes et al., 2023), it should be reiterated that biomedical proponents
have long criticised biopsychosocial framing of ME/CFS on grounds of downplaying
biological inuences whilst over-exaggerating the role of psychosocial inuences,
in particular through promoting theories of psychosocial causation. More precisely,
psychosocial theories posit that people can recover from long Covid, ME/CFS, and many
other ELC through foregrounding psychosocial factors such as positive mindset, ‘hard
work’ and motivation (see Lian & Robson, 2017; Shakespeare et al., 2017). Biomedical
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Journal of Critical Psychology, Counselling and Psychotherapy, Vol. 24, No. 1, 6-15
proponents reasonably contend that this leads to clinical minimisation, dismissal and
disbelief (manifestations of disability denial), and seek to counter this through application
of mainstream scientic methods to reveal the lack of evidence base beneath (bio)
psychosocial theorising (see Geraghty & Esmail, 2020; Hughes et al., 2023; Putrino, 2023).
On the other hand, some psychosocial proponents have suggested that the downplaying
of psychosocial inuences among academics and patient-advocates who espouse the
biomedical model risks another type of disability denial, that of mental health stigma
(see Smith & Wessely, 2014).
Whilst the position of biomedical and (bio)psychosocial adherents appears
to be diametrically opposed, common to both sides of the debate is an allegiance to
mainstream (experimental, hypothetico-deductive) science (see White et al., 2011;
Hughes et al,. 2023; Putrino, 2023). This methodological approach is highly suited to
addressing some questions; however, the general endorsement within biomedicine and
mainstream psychology of a decontextualised model of health and hierarchy of evidence
(Fox et al., 2009) overlooks much of the socio-cultural, historical and (bio)political
context that favours one paradigm over another in the ELC arena (Clifford, 2020;
Stewart, 2019; Hunt 2022a, 2022b). This point is important since this context provides
a fuller account of disability denial. Critical social sciences, including critical psychology,
are well-equipped to scrutinise the very context that biomedicine and hegemonic
psychology typically overlook (see Fox et al., 2009). The remainder of this article thus
adopts thinking from critical psychology, chiey at its intersection with disability studies,
in considering how ‘macro-structural’ factors (cultural representations, societal and
institutional norms, systems of power, politics) contribute to disability denial in the ELC
arena.
Macro-structural inuences: The gendered ‘government of disability’
Structural (‘macro-level’) drivers of gendered disability denial can be primarily
conceptualised as coalescing around invalidating cultural representations pertaining to
gender and disability, further entwined with a logic of ‘neoliberal-ableism’ (see Goodley,
2017), a concept that requires explication. Ableism has been dened as “a system of
beliefs that privileges normate notions of the body/mind and ability that are culturally
constructed and views disabled people as inferior and lacking” (Bê, 2020, p.421). Ableism
can thus be understood as a macro-phenomenon, a system of power that denies or
devalues disabled subjectivities in much the same way as patriarchy others ‘feminine’
perspectives. Neoliberalism or neoliberal-capitalism may be variously dened as a bio-
political logic, a psychology, and an economic policy model (Adams et al., 2019; Goodley,
2017), all of which will be demonstrated as pertinent to disability denial. Equally
pertinent, the role of neoliberalism in shaping subjectivities that conform to culturally
abled (able-bodied, able-minded) and ‘masculine’ ideals has attracted scrutiny within
critical (feminist) psychology and disability studies (Riley et al., 2019; Tremain, 2017;
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Journal of Critical Psychology, Counselling and Psychotherapy, Vol. 24, No. 1, 6-15
Goodley, 2017). Such thinking, which will be applied to ELC in what follows, exemplies
how neoliberalism and ableism (‘neoliberal-ableism’) are co-constitutive, additionally
demonstrating the interlinking of androcentric norms and patriarchal power systems.
As an economic policy model and biopolitical logic, neoliberalism further
entwines with ableism through a privileging of the ‘market’ and nancial interests of
private corporations over and above respect for human rights. Of great relevance to
ELC, increasing privatisation and reductions in state spending within health and welfare
fora are clearly evidenced in successive UK welfare reforms, which have been justied
through the construction of the ‘not really disabled’ subject (Soldatic, 2020). In other
words, a group of disabled people have been stripped of their disability status in an
attempt to justify the removal of state support and ensuing rights infringements (Stewart,
2019; Clifford, 2020). This project has been explicitly associated with a neoliberal
logic that seeks to push those stripped of social protections into the labour market,
increasing competition and driving down wages (Soldatic, 2020). In the case of ELC, this
re-constitution as ‘not really disabled’ and ensuing disability denial (see Hunt, 2023b) has
been facilitated by the fact that these conditions typically defy prevalent stereotypes of
impairment and disability, owing to their uctuating and often ‘invisible’ (not immediately
apparent) nature (Hale et al., 2020).
Importantly, this neoliberal logic carries gendered dynamics and consequences.
As critical scholars have highlighted, research indicates that more than half of disabled
people are women, with disabled women being less likely to be employed, paid less
when employed, more likely to live in poverty and require state support relative to
disabled men; further intersected disadvantage (e.g. on grounds of race) is generally
associated with greater social marginalisation (Fine & Asch, 1988; Wendell, 1989). As
previously intimated, research also indicates that women are generally subject to
greater marginalisation within healthcare relative to men, notably through clinical over-
attribution of health issues to psychogenic phenomena deemed recoverable via the
’right’ mindset (see Fine & Asch, 1988; Evans et al., 2023). Such ndings inevitably reect
intersecting patriarchal-abled power structures, including a well-documented legacy
of medical and societal misogyny and ableism, where constructions of the allegedly
‘not really disabled’ subject further entwine with representations of ‘hysterical’ or
‘neurasthenic’ women (see Wendell 1989; Richman et al., 2000; Evans et al., 2023).
As a psychology, neoliberalism promotes an ‘affective politics’ (Soldatic, 2020)
that reinforces disability denial. Neoliberal logic positions the ideal citizen-subject as
‘hard-working’, highly motivated, self-sufcient, rational, entrepreneurial and competitive,
holding that these traits lead to ‘success’ and that people therefore get what they deserve.
This position (effectively combining the myth of meritocracy with just world fallacies)
leads to the inevitable conclusion that people who do not ‘succeed’ as per neoliberal
exigencies are lazy, self-indulgent, lacking motivation and ‘undeserving’ of support. Such
narratives fuel invalidating affect such as resentment and disgust, engendering shame
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Journal of Critical Psychology, Counselling and Psychotherapy, Vol. 24, No. 1, 6-15
among those positioned as undeserving Other (Soldatic, 2020). Importantly, the Other
is both disabled and gendered, designated as failing to conform to culturally constructed
masculine and abled ideals, including self-sufciency, (self)-control, rationality and
physical strength (see Riley et al., 2019; Goodley, 2017). These ‘ideals’ can be discerned
in individualist, hegemonic psychology inspired healthcare interventions developed
to promote recovery among people with ELC (see Hunt, 2022a). Before turning to
examine these interventions and how they perpetuate disability denial, the role of psy
in perpetuating gendered disability denial deserves further scrutiny.
Psy’s complicity with patriarchy and neoliberal-ableism, alongside psy’s
invalidation of disabled, feminine and gender non-conforming subjectivities, has been
widely documented. On one hand, literature consistent with critical feminist thinking has
demonstrated how the ‘psy complex’, the interspace of knowledge regimes produced
by psy and subjects governed by these regimes (Rose 1998), constitutes gendered
subjectivities that risk marginalising those who do not conform to hegemonic masculine
ideals (Riley et al., 2019; see also Goodley, 2017; 2020). On the other hand, disability
studies scholars and activists have criticised the role of psy in producing neoliberal-
ableist knowledge regimes that further marginalise disabled people (e.g. Goodley, 2017;
2020). Thinking from within feminist disability studies bridges these schools of thought,
recognising that “the oppression of disabled people is closely linked to the cultural
oppression of the body” (Wendell, 1989, p.104), a form of oppression and desire to
control that is common to both patriarchy and neoliberal capitalism (see also Goodley,
2017). Such dynamics are discernible in psy discourse and clinical practice in the ELC
arena and beyond (Riley et al., 2019; Hunt, 2023a). Equally evident in these contexts
is a “relentless focus on the internal and individual at the expense of the social and
political’’ (Wilkinson, 1997, p.258), a dynamic facilitative of victim blaming and reected
in hegemonic psychology’s adherence to (neo)liberal individualism (Adams et al., 2019;
Goodley, 2020; Fox et al., 2009). In the case of ELC, such victim blaming dynamics are
particularly evident in the following example drawn from UK social policy.
It has been argued that disability denial vis-à-vis diagnoses that fall within the
ELC umbrella, within the UK and beyond, forms part of a larger, neoliberal-ableist
‘psy-corporate-state complex’ (Hunt, 2023b). This complex is contended to comprise
academics (chiey within psy), state ofcials and actors within the disability rehabilitation
and insurance industries, bound together by common interests pertaining to healthcare
and welfare reforms (Hunt, 2022a; 2022b; see also Stewart, 2019). In the UK policy
arena, and with particular relevance to the above-mentioned constitution of ‘not really
disabled’ people (Soldatic, 2020), it has been suggested that this complex has constituted
a group of purported undeserving disabled people through a particular variant of (bio)
psychosocial theorising and the construct of ‘common health problems’ (see Hunt,
2023b). Whilst this construct has been fully explicated elsewhere (e.g. Shakespeare et
al., 2017), it is noteworthy that common health problems (including musculo-skeletal
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and cardio-respiratory diagnoses) bear some diagnostic overlap with ELC. Importantly,
common health problems are said to disproportionally impact women (Waddell &
Burton, 2004), to represent a level of impairment found among most working-age
people, and to be amenable to recovery via positive mindset, motivation and hard work
(see Shakespeare et al., 2017; Hunt, 2023b). Accordingly, much of the disability-denying
rhetoric that emerged from this psy-corporate-state complex vis-à-vis common health
problems is clearly discernible in clinical and wider social contexts involving ELC (see
Blease at al., 2017; Merone et al., 2022; Lian & Robson, 2017; Evans et al., 2023).
Before moving to an examination of how these structural (macro) inuences
manifest at a meso-level and micro-level in healthcare practice and policy, it is
noteworthy that the above discussion can be further sited within what has been
termed the ‘government of disability’ (Tremain, 2015). Inspired by Foucault’s thinking
on biopolitics, ‘government’ arises from a vast apparatus (dispositif) of “discourses,
institutions, architectural forms, regulatory decisions, laws, administrative measures,
scientic statements[…]” (Foucault, 1980, p.194) that correct or normalise (‘discipline’)
individual conduct and shape subjectivities according to socio-cultural norms and for
(bio)political purposes. ‘Governmentality’ can then be further dened as a process of
subjectication that occurs as individuals are invited to adopt an array of ‘disciplinary’
(normalising, corrective) technologies (Tremain, 2001; 2015). In the case of disability, a
form of distinctly neoliberal-ableist governmentality has led to a variety of dominant
representations of disabled people as archetypal Other emerging into discourse and
the social imaginary (Tremain, 2015). More specically in the case of ELC, hegemonic
representations include the undeserving welfare scrounger, the hysteric or neurasthenic
(Soldatic, 2020; Richman et al., 2000), whilst the most clearly evidenced disciplinary
technologies comprise the healthcare interventions of cognitive behavioural therapy
and graded exercise therapy (Hunt, 2023b). The article thus turns to a discussion of how
gendered neoliberal-ableist governmentality manifests in healthcare practice and policy.
Internalising governmentality: Healthcare practice and policy
From the intersection of critical psychology and disability studies, scholars and activists
have explored how both disabled and non-disabled people (problematic disabled/non-
disabled binary acknowledged) internalise macro-structural facets of (dis)ableism and
re-produce them, through social practices, on ‘meso’ and ‘micro’ levels (e.g. Goodley,
2017; Marks, 1999). In the case of ELC and disability denial, such reproduction can be
clearly evidenced in healthcare practice and policy. Most notably, a particular variant
of (bio)psychosocial theorising, widely applied to many ELC, has been charged with
perpetuating various manifestations of disability denial (see Blease et al., 2017). Yet,
whilst a common point of critique is how these theories amplify ‘psychosocial’ and
downplay ‘biological’ considerations (e.g. Geraghty & Esmail, 2020), far less discussed
is that the ‘psychosocial’ is grounded in a (neo)liberal individualism (thus aligned to
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hegemonic psychology) that ignores the socio-cultural and political context of ill-health
and disability (see Hunt, 2022a; 2023a). This is important since, as previously stated,
this approach encourages victim blaming and other manifestations of disability denial.
Indeed, (bio)psychosocial practice and policy vis-à-vis many ELC can be understood as
an internalisation and reproduction of neoliberal-ableist, disability-denying norms and
assumptions (Hunt, 2023a).
Relatedly to the above, psychologically-inspired ‘treatments’ (disciplinary
technologies) advocated by (bio)psychosocial proponents can be conceptualised as an
internalisation and reproduction of a form of neoliberal-ableist governmentality that
is also gendered. That is to say, cognitive behavioural and graded exercise therapy are
informed through androcentric and neoliberal-abled ‘values’ such as emotional stoicism,
rationality, self-control and physical achievement (see Hunt, 2022a). Disabled people are
then invited or coerced into these therapies to work on themselves in pursuit of the
idealised (hegemonic masculine, neoliberal-ableist) citizen-subject (Rose, 1998; Tremain,
2015). In a similar vein, the manner in which post-exertional malaise (common in ELC
such as long Covid and ME/CFS) is reduced to ‘fatigue’, in turn positioned as recoverable
via the ‘right’ mindset and behaviour, is consistent with androcentric, neoliberal-ableist
assumptions (see Lian & Robson, 2017). Whilst these therapies offer a clear example
of governmentality (thus disability denial) in the ELC arena and beyond, other facets of
healthcare practice and policy may be argued to reect a collective need to disavow
disability. In the shadow of the pandemic, the now widely recognised ‘expectation of
recovery’ placed upon those who survive infection with SARS-Cov-2, alongside the
unpreparedness of health and social systems to address long Covid, might be understood
as the inevitable legacy of long-standing ableism and androcentrism within medicine, psy
and wider knowledge-producing fora. The development and persistence of this legacy
can be further explicated through delving into the ‘micro’ sphere, and applying critical
psychology thinking vis-à-vis unconscious processes (Fox et al., 2009).
A growing body of literature at the intersection of critical psychology and
disability studies probes disability-related implicit bias, most pertinently working to reveal
“non-disabled people’s unresolved, unconscious conicts around their own bodies and
personhoods” (Goodley, 2020, p.362). Accordingly, much has been written on defensive
behaviours deployed to manage how disability thwarts fundamental psychical needs or
desires, including the need to control the self and one’s environment, and the desire to
avoid confronting dependency, deterioration and death (e.g. Marks, 1999; Goodley, 2017;
Wendell, 1989). Such thinking has been applied within the ELC arena, where it has been
suggested that disability denial is bolstered by defences against psychological conict
engendered through body/minds that threaten psychic and social investments in a ‘just’
(controllable, predictable, neoliberal-ableist) world (Hunt, 2022a; 2023a). Such micro-
level dynamics, collectively woven into the fabric of clinical and wider social practices,
then reproduce the overarching structures that feeds them. In other words, and highly
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Journal of Critical Psychology, Counselling and Psychotherapy, Vol. 24, No. 1, 6-15
consonant with thinking at the intersection of critical psychology and disability studies,
socio-structural and psychical (‘macro’ and ‘micro’) phenomena are co-constitutive.
Conclusion: Toward positive social change?
This article has espoused theory consonant with critical psychology, chiey at its
intersection with disability studies, as a lens to shine light on various contributors to
gendered disability denial. These contributors might be summarised as the clinical and
social internalisation and reproduction of neoliberal-ableist, androcentric norms and
ideals. Hegemonic social mores then constrain and enable particular types of practices
and subjectivities that position disabled people (notably women and gender non-
conforming people) as archetypal Other: body/minds to be devalued, misrepresented, and
denied. Importantly, the contributors to disability denial as postulated in this article tend
to be overlooked in mainstream academic disciplines and other knowledge producing
spheres, most clearly in the case of ME/CFS and long Covid. If society continues to
look past these issues, it seems reasonable to suggest that gendered disability denial
and the marginalisation it produces will persist, leaving the inequitable status quo intact.
Critical psychology and other marginal academic disciplines offer a wealth of resources
to promote emancipatory praxis and positive social change.
Nevertheless, and related to critical psychology’s position as a marginally-
situated discipline, similar oppressive dynamics to those discussed here operate within
and across academic disciplines, leading to a hierarchy of knowledge producers and
related epistemologies (Wilkinson, 1988). The author’s experience as a disabled woman
on the margins of the academy suggests that the persistence of gendered disability
denial is a partial artefact of dominantly-situated knowledge producers misrepresenting
or denigrating – sometimes whilst co-opting and erasing – the lived experience and
epistemic labours of disabled women. It is likely not coincidental that these subjugated
or co-opted knowledges are often highly consistent with, or explicitly theorised through,
a critical social lens (e.g. Clifford, 2020; Evans et al., 2023; Hale et al., 2020; Hunt, 2022a;
2022b; Stewart, 2019; Wendell, 1989). Thus, until there is greater respect for epistemic
and epistemological diversity within knowledge producing spheres, it is unlikely that
social injustices will be fully addressed.
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