The Calling - Stigmatized !EXCLUSIVE!

"We're calling on Congress to say if they're going to be putting forward a national labeling standard it needs to be one that gives people labels that humans can read and is at least as strong as Vermont's law," Schilling said.

The Calling - Stigmatized

Thanks for posting the poem. It speaks eloquently of what people with all kinds of stigmatized conditions face. It's hard for me to understand that in this day of unlimited information, there are still those who attach stigma to epilepsy. I remember how horrified and angry I was when I heard a group of women trying to cast the demon of epilepsy out of a friend of mine. I was so embarrassed for her, but she took it gracefully. I hate to think how many times she's had to endure that kind of ignorance and indignity.

Stigmas are a significant barrier to health (Hatzenbuehler, Phelan, & Link, 2013; Smith, 2011) and risk management (Flynn, Slovic, & Kunreuther, 2001). Stigmas damage material, social, and psychological well-being (e.g., Barron & Hebl, 2010; Goffman, 1963; Hatzenbuehler et al., 2013; Markowitz, 1998; Miller & Major, 2000). Stigmas also have been shown to influence risk perceptions. For example, stronger perceptions of an infectious disease as stigmatized has predicted less personal susceptibility and greater optimistic bias (Smith & Morrison, 2006).

Scholars presuming a cultural deterministic perspective often focus on the variation and emphasize the social construction of stigmas. Stigmas have been created about many different kinds of health conditions and social arenas (see review in Pescosolido, 2015). Over time, the social value of health conditions change. For example, obesity was a desired marker of social status and wealth historically, but it is stigmatized in some contemporary Western societies (e.g., Newman, 2014). The same condition may be stigmatized by one society, but not another. The stigma may appear in distinct forms within a community (Becker & Arnold, 1986), and sometimes the same condition receives stigmatization in one social context but not another (Crocker, Major, & Steele, 1998). In this perspective, stigmas are considered as embedded in moral judgments within cultural communities (Kleinman, 1988; Yang, Kleinman, Link, Phelan, Lee, & Good, 2007), creating and preserving social order (Foucault, 1977) and symbolic power (Bourdieu, 1987), and putting their stained character on public display (Johnson, 2010).

Etiology describes the cause(s) of a stigmatizing condition. To be most effective at inducing stigma-related outcomes, etiology content must suggest that a person voluntarily and actively decided to violate social responsibilities and engaged in taboo activities (Smith, 2007, 2011). Even without explicit etiology content, people make assumptions about why people do what they do and tend to make character-based assumptions about why people engage in negative actions or experience negative outcomes (e.g., Jones & Nisbett, 1971). Studies show that this attribution bias does not extend to all negative behaviors, but only to those that violate accepted norms of social morality (Trafimow, Bromgard, Finlay, & Ketelaar, 2005). These attributions, from explicit descriptions or inferences, may affect future interactions. Attribution theory (Jones & Davis, 1965) suggests that people assume that the choices of others remain consistent over time. If stigmatized people choose to hurt the group once, they are likely to do so again. Etiology content, then, assists with developing stereotypes about stigmatized people as morally flawed (Goffman, 1963; Jones et al., 1984) and undeserving of normal rights as a group member because they intentionally put others at risk. Etiology content evokes anger, which evokes a behavioral tendency to aggressively destroy or remove the target of their anger (Mackie & Smith, 2002).

Peril content highlights the danger that a stigmatized group poses to the rest of the community (Deaux et al., 1995; Frable, 1993; Jones et al., 1984). Peril content describes the danger the stigmatized group poses to the rest of the community (Smith, 2007). Drawing upon research in product hazards (DeTurck, 2002), peril content may include the source of the danger, recommendations to avoid dangerous people, and the consequences if one fails to avoid dangerous people (Smith, 2007). Peril, then, induces perceived dangerousness, which is the belief that the stigmatized group and its members are able and likely to harm the rest of the community by their presence and actions (Smith, 2007). Together, peril and etiology content locate the community threat in people (i.e., dangerousness of people), as a fundamental aspect of their character or action.

Social interactions between stigmatized and non-stigmatized persons are effortful, difficult situations (e.g., Goffman, 1963; Smith & Hipper, 2010; Thompson & Seibold, 1978), characterized by negative emotions, stress, and intense impression-management activities (Goffman, 1963). For example, participants interacting with confederates bearing facial marks, versus non-stigmatized confederates, produced fewer words, had less eye-contact, and showed stronger cardiovascular reactivity (Blascovich, Mendes, Hunter, Lickel, & Kowai-Bell, 2001). Goffman (1963) argued that these tensions and efforts, in part, lead stigmatized and non-stigmatized persons to avoid each other. Avoidance is often imperfect, and stigmatization may occur.

Stigmatization is defined as verbal or nonverbal communication that expresses the devaluation of the target based on their membership in a stigmatized group (Quesnell, 2015). As the definition suggests, stigmatization is viewed as a social, dynamic, and interactive process that shapes and is shaped by the behavioral interplay between stigmatizers and targets (Archer, 1985). Stigmatization behaviors fall into two broad categories: depreciation and distancing. Depreciation refers to intentional verbal and nonverbal communication expressing devaluation of someone based on a social identity, delivered by stigmatizers to their targets. Communication acts in this category include name calling, verbal and physical aggression (Puhl, Luedicke, & Heuer, 2011), and more subtle acts, such as some forms of teasing and advice (Quesnell, 2015). For example, in a qualitative study, an obese interviewee reported being advised to lose weight by her doctor despite the fact that she was seeking treatment for an unrelated uterine concern (Cossrow, Jeffery, & McGuire, 2001). Distancing, in contrast, are nonverbal acts to create physical or social space between stigmatizers and their targets. Communication acts in this category include ignoring, avoiding (Mehrabian, 1967), and ostracizing (Williams, 2007). At the societal level, stigmatization may appear as segregation (Williams & Gerber, 2005) or genocide (Woolf & Hulsizer, 2005). The ways people enact stigmatization and the effects of different forms of stigmatization have received the little consideration, and they deserve future attention.

It is not clear which mechanisms are at play with courtesy stigma, but four possibilities have been discussed in the literature: betrayal, balance, contagion, and presumed similarity. People choosing to be friends with stigmatized persons, by providing some level of sympathy or support, can be seen as betraying their community. The balance theory perspective (Heider, 1958) suggests that liking someone who likes a stigmatized person, but not liking the stigmatized person, may create an undesirable state of unbalanced cognitions. One way to restore the balance is to stigmatize associates of the marked person (see Neuberg et al., 1994 for empirical evidence). Association can also invite judgments as to whether friends have the potential to acquire the stigmatized health condition, as if stigmas were a social contagion. For example, people in the proximity of a stigmatized person may become targets: in one study, an average-weight male job applicant who sat next to an overweight female applicant experienced devaluation in a job interview (Hebl & Mannix, 2003). Association can also invite assumptions that the associate shares the same character flaws or immorality as the stigmatized group. For example, social workers who provided services for sex workers have been assumed to bear a history of sex work simply because of their job (Phillips, Benoit, Hallgrimsdottir, & Vallance, 2012). Courtesy stigma can extend to people who live with, work with, are related to (Peterson, Cohen, & Smith, 2013; Smith, Wienke, & Coffman, 2014), or have occasional interaction with stigmatized persons (Pryor, Reeder, & Monroe, 2012). Supporters targeted by courtesy stigma experience many of the same negative consequences as the stigmatized people they support, such as lower self-esteem and higher stress (Mak & Kwok, 2010; Struening, Perlick, Link, Hellman, Herman, & Sirey, 2001). In addition, courtesy stigma can create turnover in health and service professions associated with stigmatized groups (Pryor et al., 2012).

People want to avoid being targets of stigmatization (Herek, 2007). People who have conditions that label them as members of a stigmatized group anticipate judgments of responsibility, being labeled, and potential devaluation and discrimination. Consequently, potential targets engage in coping strategies aimed at preventing negative reactions and influence (Barreto, 2014; Herek, 1996; Link, Phelan, & Hatzenbuehler, 2014; Miller & Major, 2000; Smith, 2007; see involuntary responses to stigma in Miller & Kaiser, 2001). In this section, we briefly summarize theoretical models focused on coping with stigmas.

There are concerns about stigma research, such as tensions over who should study stigmas. Scholars who do not belong to stigmatized groups may fail to understand the lived experiences of those who do belong to stigmatized groups, and may favor their a priori concepts and fail to adjust their scholarship to those insights (see Link & Phelan, 2001 for a review). While studies vary in their focus on stigma at the level of a person, social entity, or society (e.g., Link & Phelan, 2001; Pescosolido, 2015), the published work on stigma often has an individualistic focus (Link & Phelan, 2001): there is more work on persons than relationships or structural issues, even though these were central parts of the original scholarship (e.g., Fiske, 1998; Goffman, 1963). This person-centered research has also focused more on personal attributes that identify people as part of a stigmatized group (Link & Phelan, 2001) than on marks others affix to stigmatized targets (Fine & Asch, 1988). 041b061a72