Stigma

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Definition
Stigma refers to negative associations with certain afflictions, illnesses, disabilities, and/or deviations from accepted social understandings of health and normalcy. Stigmatized perceptions of people with certain health conditions, real or perceived, can result in unfair judgments by health professionals and laypersons which may affect treatment or treatment-seeking behaviors. In some instances, stigma-related discrimination can lead to social alienation and even societal exclusion. Stigma often compounds illness and disease leading to further deleterious health effects.

The word stigma means "sign" or "mark" and some diseases and illnesses quite literally "mark" people, advertising their health status and making them potential targets for stigmatization and subsequent discrimination and/or alienation. A well-known historical example of health-related stigma and social exclusion is leprosy. Lepers in many societies, marked by the telltale skin lesions of leprosy, were thought to be cursed or punished by the gods. Many people suffering from leprosy were forced to live excluded from society, sometimes in total isolation or permitted contact with other lepers only. “Stigma is a broad and multidimensional concept whose essence centers on the issue of deviance … When individuals fail to meet normative expectations because of attributes that are different and/or undesirable, they are reduced from accepted people to discounted ones” (Alonzo and Reynolds 1995:303-304).

Stigma is a social construction, meaning that it is culturally determined. Similar to sick role, stigmas are understood differently in different contexts. Therefore, biomedical paradigms are not sufficient in addressing the affects of stigma on disease. “Stigma is not a singular concept expressed and experienced in a common way. Rather, it is a complex phenomenon expressed both subtly and overtly” (Fife and Wright 2003:51). Ethnography can be employed in order to address the phenomenological experiences of stigmatized persons (see ethnographic examples below).

History
Sociologist Erving Goffman is one of the seminal authors who highlighted stigma in a sociocultural context. His book, //Stigma: Notes on the Management of Spoiled Identity// (1974) is frequently cited in literature on stigma. He is credited with bringing academic attention to the compounding effects of stigma on disability and disease; his conceptualization brings awareness to the isolation and exclusion stigmatized persons might experience. Goffman established three categories of stigma. The first is an aversion to the physical body, the second a tarnishing of individual character, and the last is association with a feared, loathed, or otherwise marginalized social group.

Goffman's work continues to influence contemporary anthropological and sociological research. Medical sociologists and anthropologists have examined stigma surrounding a number of diseases including mental illnesses, tuberculosis, leprosy, cancer, and HIV/AIDS among others (Fife and Wright, 2003). Das and Addlakha’s ethnographic work in Delhi (2001) is an example of how stigma is explored in contemporary medical anthropology.

Anthropologists Das and Addlakha highlight the influence of what they call the domestic sphere as an influential social power on bodily perceptions in India. Two life histories, told in rich detail, illustrate the regulating effects of the family on societal rules regarding a woman's marriageability and assertiveness. Ethnographic data was collected on two stigmatized women: Mandira, considered “disfigured” and “defective” because of a birthmark covering nearly half her face, and Pushpa, whose “schizoaffective disorder” might be understood as little more than outspokenness in another cultural context. Das and Addlakha’s analysis suggests that the family is a powerful social force influencing how stigma surrounding disability and mental illness are created, reinforced, and regulated. Das and Addlakha (2001) suggest that stigma is not located “in” individual bodies, but also within social relationships, particularly kin networks.

Case Studies/Examples
“Illness is a socially constructed phenomenon based on the value of life and health, and it represents a deviation from what we hope for and expect. However, some illnesses are imbued with additional cultural meanings that result in a "spoiled identity" and the stigmatization of afflicted individual” (Fife and Wright 2003:52). HIV/AIDS and its early associations with homosexuality and intravenous drug use contribute to the stigmatization of HIV infection. Patients, family members, and medical professionals are acutely aware of the stigma associated with HIV/AIDS and social science researchers, including medical anthropologists, have taken up research on the effect of stigma and disease. Researchers indicate a resurgence in interest in stigma associated with HIV/AIDS infection, particularly as negative associations and stigma remain high even in disproportionately affected communities (Parker, 2003).
 * //HIV/AIDS and Stigma[[image:stigma.jpg width="228" height="178" align="right"]]//**

An example illustrates how Goffman's categories might work together in the life of an HIV-positive young woman. This individual might be met with aversion if she is extraordinarily thin, weak, or has obvious skin lesions. This person might also be associated with intravenous drug users, a socially marginalized and often negatively-judged social group. Her illness may increasingly represent her deviation from societal norms, and she may be harshly judged by what is seen as a violation and a defamation of her character. The young woman may experience an identity and status change as her HIV-status becomes her master status. She may be identified or described first by her disease rather than her academic accomplishments, athletic talents, or personality traits. She may lose her job or become ostracized from friends, family, or peer groups as a result of her stigmatized state of health. “In stigmatization, deviance, rather than being an attribute of the deviant, becomes a label attached to a person by others. By stigmatization we mean the rejection and disgrace that are connected with what is viewed as physical deformity and behavioral aberration. Normal expectations, which we may have of one another, are thus contaminated and deflected from their course” (Cahnman 1968:293).

Recently, stigma has become a buzzword in the global debate surrounding AIDS research and international funding for HIV and AIDS interventions. However, some scholars would argue that cross-cultural understandings of stigma are often misrepresented and their affect on intervention over-inflated. Castro and Farmer assert that “rather than stigma, logistic and economic barriers determine who will access [treatment and testing] services” (Castro and Farmer 2005:53). Research by Castro and Farmer in rural Haiti suggests that that stigma can be reduced and HIV-testing successfully encouraged when quality HIV care is introduced and made accessible in affected communities (Castro and Farmer 2005).

Research reminds us that while it is important for health professionals and community members to be aware of the powerful affects of stigma, policy decisions should be based in evidence-based research. “Stigmatized persons lose social status” (Fife and Wright 2003:51) and people suffering from an illness or affliction, particularly a potentially debilitating disease like AIDS, endure compounding effects when stigma impedes their willingness to become tested and/or their access to treatment. Researchers such as Parker (2003) look at stigma with attention to discrimination and the conceptual accuracy of extant ideas surrounding stigma. Applied work should continue to employ these lessons from the field in order to design more effective intervention programs (Parker 2003).


 * //Weight Bias at Home and at School//**

Stigma, like all cultural constructions, changes throughout time and space. An example that illustrates this fluidity is the globalizing effect of slim-body ideals (Brewis et al., 2011). Increasing stigma attached to overweight and obesity has been documented worldwide, even in geographic areas where larger-bodies had previously been valued (Brewis et al. 2011). This film clip describes the difficulties some youth face when certain body types are stigmatized.

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Related Terms/Pages
See sick role for discussion surrounding cultural understandings of sickness.

See __Disabilities Studies__ for discussion surrounding stigma and body norms.

See __Deafness__ for cultural comparisons of Deaf communities and the fluidity of stigma.

See Ethnography for more information on this qualitative research method.

2001 National Institute of Health's Stigma and Global Health Conference []

//Stigma, Contagion, Defect: Issues in the Anthropology of Public Health// Veena Das, Ph.D. John Hopkins University Paper for the 2001 National Institute of Health's Stigma and Global Health Conference []

HIV/AIDS Anti-Stigma Campaign []

Obesity Action Coalition on Obesity Stigma []

//**Leper: Life Beyond Stigma**// This film clip provides insight into the cultural associations in India of leprosy as a punishment from God. media type="youtube" key="qdEnimS_Ju4" height="209" width="253" align="center"

//**Lepers Stigmatized and Abused**// This film clip provides a contemporary example of an ostracized leper colony.

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