This essay is going to discuss the sociological idea of stigma and its effect on an individual, furthermore this essay will also define other concepts in relation to stigma such as the ‘Hidden Distress Model’. We will also discuss examples of this health illness in order to demonstrate the impact of stigmatization and their ‘Coping Strategies’. Moreover this essay will study how different individuals within society react to people with mental disabilities and other health illness for instance HIV and AIDS and how some individual in society find stigma more fearful than the condition they have been diagnosed in, for example a person who has been in a socially stigmatizing condition may feel discriminated and isolation and pain due to their illness.
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To address the issue of stigmatization, firstly it’s important to clarify whether or not there is a link between social integration and health. A study carried out by Berkman and Syme (1979) states the extent of individual’s integration within society has a significant effect on their health. In their research they identified two forms of ‘network scores’. They established that those with ‘low network scores’ had a higher mortality rate compared to those that had high ‘network scores’ (Nettleton 2006).
Stigma refers to a negatively well-defined condition, attribute, trait or behaviour conferring a deviant status which is socially, culturally or historically not the same. (Gabe et al, 2004). The word stigma was defined by the Greeks, they used the term to refer to the bodily signs a person had this could be cuts or burns. They intended the term to those whom they believed to be socially outsiders such as slaves or criminals, mainly those who were unhygienic or diseased would be avoided by people. (Gabe et al, 2004)
Goffman (1963) refers stigma as the difference between the virtual social identity, which is the stereotyped made in everyday life and the real social identity and stigma is the relationship between characteristics and stereotype. This two concepts – ‘Virtual Social Identity’ which is the stereotypes attributes we think we attain and ‘Actual Social Identity’ relates to the attributes an individual actually has.
We will pay particular attention to Actual Social Identity, this concept is when a person actually possess the signs of a stigma. Goffman says that ‘stigma is a special kind of relationship between attribute and stereotype’, and therefore people get stigmatized for the reason that their illness is obvious, for instance if a patient is deaf, blind or unable to walk therefore in a wheelchair or uses a hearing aid, in society they are seen as being abnormal because they don’t have the abilities of a normal person and for that reason they are socially undesirable or inferior also Goffman (1963) states ‘people with such ‘abnormalities’ are said to be stigmatized’ (Armstrong, 2003, p.42) . Although some illnesses can be obvious others can be relatively concealed, however they can still feel and ‘experience ‘felt stigma’ because they still see’ themselves to be inferior and they feel they are hiding a discreditable part of their personality from the outside world’ (Scamber and Hopkins, 1986, cited in Armstrong, 2003, p.42).
In today’s society the term stigma is used to refer to an individual who is culturally unacceptable with any condition, characteristic or behaviour (Gabe et al, 2004). According to Goffman (1968) his ideas added felt and enacted stigma, the former is the feeling that we are being discriminated against and the latter is actually being stigmatised through discrimination.
Goffman recognised three types of stigma that he explained as:
- Stigma of the body, which relates to blemishes or physical deformities;
- Stigma of character which relates to the mentally ill or criminals, and finally
- Stigma associated with social factors which can be either racial or tribal throughout different cultures. Goffman goes on to say that his types of stigma can vary differently between social, cultural or historical environments (Goffman 1963, cited in Gabe et al., 2004, p.69).
While Goffman mentioned three types of stigma, Scambler mentioned two types of stigma. He combined his ideas in what he calls the ‘Hidden Distress Model’ which had been developed to explain the way in which an individual overcomes felt stigma in order to prevent experiences that play part of stigma. This, Scambler described it to be carried out by ‘Non-Disclosure’ which focuses attention on the fact that individuals would want to keep their condition from others in a hope to hide any information about their health condition and only will ever reveal their condition if it is necessary to do so. (Scambler, 2008).
The approach of the ‘Hidden Distress Model’ explains the reasons of the concealment of a condition, it is that because of the fear of associated stigma, moreover felt stigma is very easily seen so that one can avoid the occurrence of enacted stigma. Experiencing strong felt stigma could lead to higher stress which then leads to putting the patient harder circumstances in order to control their illness, which later on makes their illness worse over time due to the energy released through the concealment of their condition.
Moreover in relation to this Scambler (2008) states “Paradoxically, felt stigma is more disruptive of people’s lives and well-being than enacted stigma… ” he also says that felt stigma tends to increase the anxiety levels of an individual more so that enacted stigma.
To apply these concepts in real life circumstances, we will present how the avoidance of enacted stigma through felt stigma can worsen risks of various health issues ultimately deteriorating their health condition. Research study carried out on HIV and AIDS, has shown that people with such stigma are only known to their doctors and many chose not to kept it a secret and to disclose this information because of the way society thinks of AIDS and HIV. Patient might decide to avoid routine checks or treatment in the hope that they will not experience enacted stigma from others, for instance when they are entering or exiting the sexual health clinic or attending local HIV screening tests because of the stigmatising assumptions that are related to HIV /AIDS such as being gay or heavy drug user (Lubkin and Larson, 2012). Additional example can be seen with women who is avoiding screening for the sexually transmitted disease called HIV and AIDS for the fear of other people acting unreasonably towards them because they feel that they will be judged against behaviour associated with a lot of sexual partners. (Lubkin and Larson, 2012). And because this is associated with the person fearful of being treated different or labelled. People may not always seek medical help for their stigma conditions because of their fears of being faced with enacted stigma, however Zola (1973 has looked in to the timing of when individuals may decide to seek medical help, and in he discovered that majority of the people wait and put up with their symptoms for a while before they actually choose to seek medical assistance. Research study carried out on HIV and AIDS, has shown that people with such stigma are only known to their doctors and many chose not to kept it a secret and to disclose this information because of the way society thinks of AIDS and HIV.
As mentioned above avoidance of sexual health screening can lead to worsening health problems, a person with the health illnesses mentioned above could have life threatening diseases for the individual if he or she continue to express the ideas of the hidden distress model.
There are many studies that prove that is stigma is based on social concept. This study suggests that stigma is more about social concept rather than a characteristic of an individual. Parker and Aggleton (2003) ‘point out, processes of stigmatization remain part and parcel of processes of power, domination and discrimination; what becomes stigmatized is bound up with usual norms and values. Therefore it is socialized, not an individual, concepts (Nettleton, 2006, p.96). Therefore this study says felt stigma is more powerful than any accrual episodes of enacted stigma and for that reason it makes people more stigmatized.
Moving on to the concept of ‘Coping Strategies’ has been formed to explain the ways in which an individual copes with the effects of an illness. The term ‘coping’ refers to the “Cognitive processes whereby an individual learns to tolerate illness” and strategy relates to the actions people take in the face of illness (Bury 1991 cited in Nettleton 2006).
The term coping is used to maintain the feeling of self-worth and a sense of belief during an illness (Gerhardt 1989 cited in Bury 1991). The thought of normalisation can be used in ‘coping’ with an illness; this can be expressed in two with in the ‘Coping Strategies’. The first is to supress any negativity related to the illness so that the person can maintain their own personal identity which they held prior to their diagnosis; the second is to look at normalisation in terms of treatment where the treatment routine should not be remote place so that the individual can integrate with other people and not be isolated (Kellecher 1988, cited in Bury 1991). Bury (1991)
This further explains that it is the values of the individual that can determine how others respond to them in regards to their illness.
The model of ‘strategy’ is the actions that are taken in order to ‘maximise favourable outcomes’. (Bury, 1991). Moreover how a person responds to health illness experience regarding their condition does determine the extent to which they perform their strategies, the more negative experience they have can develop greater awareness in their everyday lives so as to escape or reduce the experience of enacted stigma. The controlling of illness through the use of strategies can differ from the influence of social settings to the forms that are developed in order to deter any focus to the condition as well as achieving set goals so that they can maintain their own sense of value and their belief of what their everyday life requires.
Goffman (1963) states that the way in which an individual copes with a stigmatising condition differs depending on the actual type of condition, he has specified two terms in relation to this – ‘discredited’ and ‘discreditable’; the first one is regarding an individual whose condition is widely known and the second refers to those whose condition is concealed. It’s described that those who have a discredited condition will find it harder to manage their stigma.
There are three different ways in which an individual can cope their own stigmatising condition the first is ‘Passing’ this is where one would try to fit in to the society as ‘normal’ usually the stigmatised individuals would constantly try to conceal their condition because they do not want anyone else to know if their illness; and for those with felt stigma are more likely to choose the passing approach for instance an individual with hard of hearing condition may decide to not use the hearing aid so that they can ‘fit in’ more with the society (Lubkin and Larson, 2012; Armstrong, 2003).
The second one is ‘Covering’ this refers to an individual with a discrediting attribute where they will try their utmost to conceal the significance of their stigmatising condition. (Goffman, 1963; Armstrong, 2003), in this situation the individual would try and take off the focus from his or her condition in order to avoid the experience of enacted stigma, the process could be amusing towards the situation which would reassure a less tense atmosphere making it to be more easy to manage (Lubkin and Larson, 2012).
Stigma is the result of a reaction expressed through the society that ultimately spoils identity of unacceptable norms that affect the stigmatised individual in a negative way. (Gabe et al, 2004). Nettleton (2006) states “Stigma is not an attribute of individuals, but is rather a thoroughly social concept which is generated, sustained and reproduced in the context of social inequalities.”
Some people are stigmatised because the part of the individual that is different is considered to be self-inflicted and in the ‘normal’ people’s eyes they are less worthy of help (Lubkin and Larson, 2012)
Parsons (1951) describes illness as a deviance form the norm and he also perceives illness as capable of cracking the social structure as the sick are unable to accomplish their social role within society. It can be expected that when an individual is sick they respond on the reaction of others, while society responds depending on the nature of the illness. (Lemert, 1967) suggests that there is three stages of deviance and he identifies these as primary deviance, which is related to an actual defined of a state or behaviour, and he claims that inside the law an action that was seen to be normal can become illegal or deviant, moreover secondary deviance refers to ‘the changes in behaviour that occur as a consequence of labelling’, for instance the stress of being discriminated and stereotyped can make an individual’s behaviour change over time. And the last stage is Tertiary deviance, which is the stigmatised individual’s reaction to the stigma from others leads to master status, for example categorising and stereotyping dominate individuals behaviours.
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Scambler (2008) mentions that social factors is a major factor, which has impact people’s behaviour when they faced with what they recognize and recognise to be danger to their health and well-being. Freidson (1970) draws ‘societal reaction’ (Nettleton, 2006, p.73) furthermore he argues that there is three types of legitimacy. The first legitimacy is the ‘cases where it is achievable for a person to recover from illness, so they can get treatment for their condition, in addition their access to the sick role is conditional, the second is the incurable condition and their access to the sick role must be unconditionally, due to the fact that person might not get well and the last one is the illness being stigmatized by others and access to the sick role is to be treated as illegitimate (Nettleton, 2006, p.73).
According to Reidpath (2005) ‘ the fear of being stigmatized and subjected to discrimination many case some people to avoid or delay seeking medical help’ and this is because of fear, that people with stigmatized conditions feel socially isolated and often rejected moreover they are alienated in the society. For several stigmatized individuals, in order to to feel normal or socially accepted in the society they might join a talk group to form their own communities in order to meet people with similar issues (Armstrong, 2003). Many stigmatized people use copying mechanism in order to cope with their conditions and according to Goffman (1963) ‘a person with a stigmatizing condition could pursue several copying strategies that were largely based on the salience of the stigma he or her carried.
Scamber and Hopkins (1986), cited in Scamber, 2008, p.210, they described individuals ‘fearing discrimination, tend to conceal their epilepsy each time possible Certain ways they appear as normal included covering up their illness, a person with discrediting behaviour has no opportunity to go about it as normal but can still try to reduce the signs of his or her stigma and alternative way of passing as normal is managing expectations. This will l will lead the person to withdrawing from society and their social life, in order to avoid embarrassment and shame. An example people with conditions such as epilepsy, or HIV/Aids are able to hide away their condition when out in community, from partners, family and friends but they still do end up feel some kind of felt stigma due to them hiding some parts of their characters, nevertheless the individual way of avoiding social response to their illness and this is an case of passing as normal, concealing and managing expectations. People with stigma also get labelled unpleasant names such as handicap because they are being judged on their appearance and the abnormality they lack.
To conclude this essay, we agree with the idea of that felt stigma being more powerful than enacted stigma because individuals are more fearful of being stigmatized then the actually illness itself. This statement showed to be true by research studies that have been carried out this these areas. In this essay we have seen that before individuals are diagnosed with illness they prefer to hide from their illness and ignore their symptoms and refuse to seek medical attention they require also individuals develop fear of their community and the society because of their health condition, likewise they fear their family, friends look and treating them differently.
We have also looked into in to some research on stigma, we recognise why people are more fearful about the health condition than the illness because in society we tend to judge and isolate individuals on how they appear to look, before we even personally know them, for instance people in a with wheelchair we label them disabled. As Scrambler and Hopkins 1989, says that people with stigmatized illnesses are essentially outcasts and this is because they are socially rejected from society, due to their signs or symptoms and we see them as inferior. Nettleton (2006) suggests that illness reminds us that the normal functioning of our minds and is important to social action and relations with others, and this an significant fact and part of the reason proves why people are more fearful about their condition because they believe that people will be looking at them differently, judging and discriminating against them before it even happens. In addition to that we think people with serious health condition sexually transmitted diseases for instance HIV and AIDS should not tell their condition to others, for their own protection because some people have strong views and opinion on these conditions and these condition are associated with having many sexual partners and unhygienic. Scheff (1966) suggests that mental illness is a product of society’s opinions and reaction to the individual’s illness, we do believe that society’s has developed ways of just labelling people with all sort of illnesses especially people who are mentally ill and they are labelled as crazy and therefore they are treated different to others and stigmatized.
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