Week 5

Question 1

What is stigma dictionary definition

Answer 1

A mark or spot on skin
A mark of disgrace or infamy (e.g. branding or marking of a slave or criminal)
Visible sign/ characteristic of a disease

Question 2

What is stigma Goffman 1963

Answer 2

An attribute that is ‘deeply discrediting’
Reduces the bearer ‘from a whole and usual person to a tainted, discounted one’

Question 3

Stigma, stereotype and prejudice

Answer 3

Stigma- social interaction (sociology), focus on individual and society, visible or known difference, negative
Prejudice- social cognition (psychology), focus on group or individual, attitudes and emotions, negative
Stereotype- social cognition (psychology), focus on group, social expectations, positive, negative or neutral

Question 4

Development of stigma as a sociological concept

Answer 4

Impact of what is happening in whole society rather than particular ‘groups’ e.g. values, fears
Social interaction between the stigmatising and the stigmatised
Social impact on the individual who is stigmatised

Question 5

Social causes/ effects of stigma

Answer 5

People distinguish and label human differences; some are seen as undesirable
What is undesirable is decided by society, differences between times/cultures
Impact of powerful people and institutions as effect of labelling will spread faster
People can experience emotional reactions to labelled people- fear, repulsion, disgust
Labelled persons may feel shame, humiliation
Labelled persons experience status loss and discrimination as consequence

Question 6

Why is this important for health/care

Answer 6

Important element in the experience of illness
Special care needs for people with a visible health condition
Potentially delay in help seeking
Stigma and prejudice can influence health practitioners and policies

Question 7

Stigmatised health conditions

Answer 7

Visible differences
Mental health
Infectious diseases
Feared conditions e.g.cancer

Question 8

Stigma of cancer

Answer 8

‘Incurable’ disease can lead people to avoid even saying word
Unclear causes makes its more frightening
Can lead to visible difference
Potentially embarrassing outcomes (impotence/colostomy bag)
Blaming patients might make others feel safer
However positive impact of better prognosis for many, awareness raising, charity activities

Question 9

Three types of stigma (Goffman)

Answer 9

‘Abominations of the body’- physical disfigurement/ deviations from a social norm
‘Blemishes of character’- a known record e.g. alcoholism, long term unemployment, seen as character flaw
‘Tribal identities’- negative evaluation of people due to association with a particular group most often via family e.g. class, ethnicity, religion

Question 10

Physical stigma

Answer 10

Long history of identifying and classifying physical deformities
-fear and disgust but also fascination
-living/ dead bodies were displayed
Appearance a common focus of teasing in childhood
Visible differences can lead to others staring, avoidance, inappropriate questions

Question 11

Impact of physical stigma

Answer 11

Heightened social anxiety
Embarrassment
Depression
Low self esteem
Social withdrawal
Isolation

Question 12

Stigmatised activities/experiences

Answer 12

Drug/alcohol addiction
Time spent in prison
Long term unemployment
Prostitution
Mental illness
‘Alternative’ sexualities

Question 13

Tribal identities

Answer 13

A person visibly belongs to a particular group
-religious groups (clothing, symbols)
-‘racial’ groups (physique, skin colour)
-ethnic groups (all of above)
-chosen ‘tribes’ (clothing, symbols)
Stigma expresses wider social power structures
‘Courtesy stigma’- stigma rubs off on people close to stigmatised person

Question 14

Impact of stigma (Goffman)

Answer 14

Stigma changes the social identity of a person (both to themselves and others)
A person becomes ‘discredited’ when they have a sign of a stigmatising condition which cannot be disguised; they’re forced to deal with their stigma in almost all interactions
Also labelled as ‘discrediting’ stigma
A person becomes ‘discreditable’ when its possible for them to conceal a sign of a stigmatising condition

Question 15

Effects of being discreditable vs discredited

Answer 15

Where an individual is discredited: enacted stigma (people stare, avoid, express disgust), effects on employment and earning potential, isolation (people may avoid contact in anticipation of a negative response)-felt stigma
Where a individual is discreditable: concealment strategies which may not work, passing as ‘normal’, evaluating whether or not to reveal condition
People can move between the two (e.g. with relapsing-remitting conditions)

Question 16

Managing a ‘spoiled’ identity

Answer 16

A ‘spoiled identity’ implies that an individuals social identity is dominated by the stigmatised illness/attribute
People may respond to this by: passing as normal, information control (deciding who to trust), avoiding all social contact, trying to avoid blame, refusing to be ashamed

Question 17

How is stigma different from stereotype

Answer 17

Stereotype focuses on group identity
Stigma focuses on the stigmatised individual and the effect on them
Stigma also includes wider society, power dynamics

Question 18

How is stigma different from prejudice

Answer 18

Prejudice is similar to stereotype but more about attitude/negative emotions towards particular groups and individuals
Focuses more on the person holding the prejudice who may never be in contact with the person they’re prejudiced against
Can lead to discrimination/scapegoating
It may explain why HCP may treat people differently personally (being rude) and medically (not offering treatment)

Question 19

Impact on outcomes/ health inequalities?

Answer 19

Ongoing debate on whether prejudice in healthcare contributes to inequality in outcomes
Disadvantaged groups have worse outcomes
Reasons for this are complex: environment, behaviour, experiencing discrimination
Negative attitudes discourage people from seeking help

Question 20

What is medicalisation

Answer 20

Process by which human conditions and problems come to be defined and treated as medical conditions and thus become subject of medical study, diagnosis, prevention and treatment
Examples are childbirth, menopause, alcoholism
This can be as a basis of encroachment by the medical profession or could be sought by groups in society
Conrad states ‘describes a process by which non-medical problems become defined and treated as medical problems, usually in terms of illness and disorders’

Question 21

What are the three levels of medicalisation according to Conrad and Schneider

Answer 21

The conceptual- medical vocabulary used to describe an issue that could be described through other means, not necessarily within a medical encounter or leading to treatment, e.g. bad/antisocial behaviour
The institutional - organisations use a medical approach to manage problems in which organisation specialises (reduce people to their medical conditions).e.g. absenteeism; physicians being managers of hospitals
The interactional- patient actively seeks involvement of HCP, face to face contact, a social problem is defined as medical, diagnosis . E.g. prescribing anti-depressant medication for an unhappy family life