The Looping Effect

First coined by the Canadian Philosopher Ian Hacking. Hacking (2006) talks about how we view people as "objects of inquiry". We use classifications as a way to control, to help, to keep ourselves safe, for the good of the public and for individuals themselves, and sometime simply to observe and have others mirror similar behaviors (Hacking 2006).

He considers people with classifications as "moving targets" because of the interactions and inquiries with them allow them change. Theoretically, the person following the influence of classification has changed and is no longer the same as they were before classification. Our sciences and interactions with these classifications create new people. Hacking (2006) calls this "making up people".

What is important in order to "maintain" a loop? Why is it a good thing?

Chrisophe Gaulde, Boris Nicolle, Axel Constant and Anne-Marie Gagné-Julien (2025) all sought to argue the beneficial nature of the looping effect. Through the revision of disease classification (nosology) and the looping effect. As opposed to treating it as a negative and destabilizing concept.

We must resolve epistemic injustice to create balance; justice occurs when we incorporate patient testimony within clinical practice in someway.

Clinicians have two roles that contribute to the maintenance of the loop (Gaulde et al. 2025).

Patients explaining individual experiences to clinicians, establishing a looping effect (Clinical/Individual level).

Clinicians then reporting those experiences to begin experimentation that generate looping effects (Nosological/Population level).

Is it good a good thing?

Cristophe Gauld et al., argue that looping can be beneficial under certain circumstances.

Example: When patients with Major Depression Disorder (MDD) discover that their symptoms are all a part of a certain diagnosis, a reduction of self-blame and stigma is observed. This can then lead to change in behaviors and psychology of patient, which then manifest into new symptoms of MDD.

Epistemic injustice is the dismissal and minimization of someone’s knowledge and production capabilities (Gaulde et al. 2025). A type of moral harm that comes in the form of unfair judgement of a person's ability and knowledge of something that afflicts them.

If epistemic injustice occurs, so does classification instability. Which in turn leads to trouble accurately treating patients.

Testimonial Injustice

Is the existing prejudice and discrimination as an addition to the already possible existence of epistemic injustice after receiving diagnosis. Ethnic minorities, women, working class and other marginalized groups are further affected. Their experiences and credibility are diminished because of these existing discriminatory attitudes.

Hermeneutic Injustice

Is the undermining of a patients' attempt to interpret an experience relative to their diagnosis due to their lack of experience with it.

Occurs when there are barriers preventing the modification of a diagnosis "due to an unfair denial or minimization of patients’ credibility based on" previously existing prejudice and discriminatory attitudes Gourd et al., 2025).

Care is taken into insuring that there is no distortion going on within patients that would normally break the loop. Patient feedback is privy to scrutiny, by encouraging a collaborative relationship between the patient and the clinician. This is done by questioning, examining, discussing and interpreting their experiences together. The loop can be disrupted when epistemic, testimonial and/or hermeneutic injustices occur.

Example: Someone diagnosed with bipolar disorder can attempt to explain their experience with early symptoms of a manic episode. If these symptoms are ignored by the clinician then a looping break occurs, and the possibility for an adjustment to treatment to prevent its worsening is lost.

The Medicalization of Grief?

People struggling with bereavement and symptoms of depression do not respond to typical treatments of depression as opposed to those not experiencing the bereavement. Treatment focusing on grief were seen to be far more effective for those individuals experiencing bereavement with symptoms of MDD (Kelley 2024).

Detrimental Looping Effects in the Medicalization of Grief

Can alter the view of an individuals grief as being a victim of a disorder that discourages engagement with their emotions

Grief as an identity may arise. Much how drug addicts consider themselves addicts. This can also unnecessarily prolong the duration of the their grief as they are simply "grievers" and impede resolution.

Allows for individuals to use clinical language regarding their diagnosis. Which can hinder adaptability through use of their own language and understanding of their grief.

Diagnosing grievers with a mental disorder “insult[s] the dignity of loving relationships”. (Cacciatore and Frances 2022)

Alice Kelley's Rebuttal

If PGD diagnosis does not exist, individuals will simply be diagnosed with a broader disorder or not diagnosed at all.

An ambiguous diagnosis of PTSD, attachment disorder or depression has more potential of harm due to its increasingly broad nature.

Karla Hoff and Priyanka Pandey set out to showcase Ian Hacking's concept of "Making up People" (2014). Looking at lingering social hierarchal attitudes in India based on economic status and bloodline to see how the recruited students perform in the presence of each others' social status. Assessing intellectual performance by separating what are called the "high caste" (hereditary higher social class) and the "low caste" (the marginalized under class) and placing them in different group settings with one another.

Important to note: The students that are the low caste were once called "dalits" who were the underclass of india that were not allowed to own land, use public wells, or sit inside schools. Even today, children born from low caste parents face segregation, verbal and even physical abuse from some teachers that elicit feelings of inferiority.

Operating under a school setting where the caste status of students is usually made public, Hoff and Pandey created six separate groups. All of which were middle school male students. The group contained a variation of the castes, dependent on their scenario. They were then placed in a variety of different scenarios that would have them solve a few mazes after some practice and feedback (students were also incentivized).

Scenarios:

3 low caste and 3 high caste, Caste was not made known

3 low caste and 3 high caste, Caste was made known

Caste was made known, but participants were segregated

Results:

High caste students performed better when their caste was public

Low caste students performed worse when their caste was public

Low caste performed significantly better if their caste was not public

Muhammad Ali Khalidi makes an argument that interactive kinds do not have necessarily have to be human like Ian Hacking had asserted (2010).

Khalidi gives the example of classifying marijuana as illegal, which in turn alters the public's perception of the plant as something dangerous as well as altering the way that we cultivate and distribute it etc... Ultimately transforming this crop into an illegal and "dangerous" substance in both public perception and law.

Sofia Kvist Lindholm and Anette Wickström looked into the ways young adults interact with their own mental health classifications and change them by way of language (2020). Through use of an ethnographic study, 41 Swedish students (31 girls, 10 boys), who were 15 years old were interviewed from two different schools with a variation of SES. They were asked questions to elicit responses that would showcase their utilization of them describing psychiatric concepts when pertaining to their wellbeing.

The appropriation of medical terminology and diagnosis by teenagers serves as a way to describe their everyday "ups and downs" of life. By stripping medical diagnosis off of words such as "anxiety", "depressed" or "depression", they serve to become normalized in everyday use.

Modifiers:

The students would apply modifiers when talking about anxiety and depression to communicate the severity and context of the situation it applied to.

"So much anxiety" or "a little anxiety"

"anxiety anxiety"

"a little depressed"

Combinations such as, "a little anxiety" would be used to detract from the severity of the word and implication. They were all interchangeable with feeling "low". Anxiety was often used to describe pressure to do well in school, or just the pressure to perform well.

Although some students would make use of the word for more intense social situations. An example was given of a student that was forced to meet with her father despite her not wanting to. Lindholm and Wickström noted that a common theme in the problems these students expressed were things out of their control that would negatively impact their wellbeing.

Amanda: According to the social welfare office, my dad still has the rights to see me, so I must meet with him . . . I mean I get so much anxiety due to this.

Oscar: Being depressed is not such a heavy word anymore because it is used so much. Philip: yes, I think ‘to be a little depressed’ is the same thing as being a bit low. Oscar: yes today, that’s what it means.

The students talk about their being a difference between "anxiety" and "real anxiety".

The looping effect operates in many facets of society, medicine, our personal lives and even the language we use. From the maintenance of the established loops utilized for updating existing diagnosis with new information from patient and clinician testimony and experience. These looping effects can be seen good or bad and each have their reasons. Such as possibly modifying how we view ourselves regarding our diagnosis and how we can attach ourselves to it. Stifling growth beyond our struggles and allowing us to abuse labels as something to fall back on when times get hard. Regardless, it gives us new avenues of research into the possible improvements in people’s lives and to the further understanding of our complex relationships with constantly evolving diagnosis and how we express them.

Even while we become moving targets and symptom expressions change, the way our clinicians treat and explain them to us should shift as well. Marginalizing titles such as “poor”, “stupid” or other synonymous words do in fact effect our performance. Especially in the presence of who society perceives as superior, or more capable. Finally, the language we use is constantly changing and evolving. The fact that we normalize and “appropriate” words like “depressed” and “anxious” in our daily lives speaks to the looping effective at work. Changing the contextual meaning and adding nuance and dynamic use to medical terminology, evolving it beyond its initial binary use and definition.

Gauld, Christophe, Boris Nicolle, Axel Constant, and Anne-Marie Gagné-Julien. 2025. “The Role of Clinicians in the Looping Effect: Epistemic Injustices and Looping Breaks.” Medicine, Health Care, and Philosophy 28(3):561–76. doi:10.1007/s11019-025-10279-2.

Hacking, Ian. 2006. "Making up people." London Review of Books, 28(16). https://www.lrb.co.uk/the-paper/v28/n16/ian-hacking/making-up-people

Hacking, Ian. 2007. "Kinds of people: Moving targets." In Proceedings-British Academy (Vol. 151, p. 285). Oxford University Press Inc.. https://www.joelvelasco.net/teaching/5330(spring2021)/hacking-kinds_of_people.pdf

Hoff, Karla, and Priyanka Pandey. 2014. “Making up People—The Effect of Identity on Performance in a Modernizing Society.” Journal of Development Economics 106:118–31. doi:10.1016/j.jdeveco.2013.08.009.

Kelley, Alice Elizabeth. 2024. “THE LOOPING EFFECTS OF MEDICALIZING GRIEF.” Crítica; Revista Hispanoamericana de Filosofía 56(167):101–26. doi:10.22201/iifs.18704905e.2024.1536.

Khalidi, Muhammad Ali. 2010. “Interactive Kinds.” The British Journal for the Philosophy of Science 61(2):335–60. doi:10.1093/bjps/axp042.

Lindholm, Sofia Kvist, and Anette Wickström. 2020. “‘Looping Effects’ Related to Young People’s Mental Health: How Young People Transform the Meaning of Psychiatric Concepts.” Global Studies of Childhood 10(1):26–38. doi:10.1177/2043610619890058.

London School of Economics and Political Science. 2025. “Looping Effects in Psychology: Turning Anomalies into Opportunities.” LSE News. November 6. https://www.lse.ac.uk/pbs/news/articles/looping-effects-in-psychology